Вы находитесь на странице: 1из 215

Contents

Preface to the Seventh Edition vii


Preface to the First Edition (excerpts) viii
Glossary xv

1. Introduction 3 Cauda Equina 29


External Features of Spinal Cord 30
Divisions of Nervous System 3
Internal Structure 30
Cellular Architecture 3
Clinical Anatomy 30
Synapse 6
Neuroglial Cells 6 Spinal Nerves 32
Reflex arc 7 Nuclei of Spinal Cord 32
Components of Central Nervous System 7 Nuclei in Anterior Grey Column or Horn 32
Parts of the Nervous System 9 Nuclei in Lateral Horn 33
Development of Brain I I Nuclei in Posterior Grey Column 34
Neural Tube 11 Laminar Organisation in Spinal Cord 34
Spinal Cord I 7 Sensory Receptors 35
Gross Study of Brain 16 Tracts of the Spinal Cord 35
78 Descending Tracts 35
Clinicoanatomical Problems 78 Pyramidal or Corticospinal Tracts 35
Frequently Asked Question 78 Extrapyramidal Tracts 37
Multiple Choice Questions 18 Ascending Tracts 37
lntersegmental Tracts 42
2. Meninges of the Brain and Cerebrospinal
Clinical Anatomy 44
Fluid 19
46
The Meninges 19 Clinicoanatomical Problems 46
,.. 19 Frequently Asked Questions 46
Dura Mater 19 Multiple Choice Questions 47
Arachnoid Mater 19
Pia Mater 21 4. Cranial Nerves 48
Cisterns 22 Introduction 48
Clinical Anatomy 24 Embryology 48
Cerebrospinal Fluid 24 Nuclei 49
Clinical Anatomy 25 General Somatic Efferent Nuclei 49
Mnemonics 25
Special Visceral Efferents Nuclei 49
26 General Visceral Efferent Nuclei 50
Clinicoanatomical Problem 26 General Visceral Afferent and
Frequently Asked Questions 26 Special Visceral Afferent Nuclei 5 7
Multiple Choice Questions 26
General Somatic Afferent Nuclei 53
Special Somatic Afferent Nuclei 53
3. Spinal Cord 28
First Cranial Nerve 53
Introduction 28 Olfactory (Smell) Pathways 53
D 28 Clinical Anatomy 55
Meningeal Coverings 28 Second Cranial Nerve 56
xii BRAIN-NEUROANATOMY

Optic Pathways 56 Nuclei 81


Reflexes 57 Course and Relations in Head and Nec k 81
Clinical Anatomy 60 Branches in Head and Neck 82
Third Cranial Nerve 61 Clinical Anatomy 83
Oculomotor Nerve 61 Eleventh Cranial Nerve 84
Functional Components 61 Accessory Nerve 84
Nucleus 61 Functional Components 84
Course and Distribution 61 Nuclei 84
Clinical Anatomy 63 Course and Distribution of the Cranial
Fourth Cranial Nerve 63 Root 84
Trochlear Nerve 63 Course and Distribution of the Spinal Root 84
Functional Components 63 Clinical Anatomy 85
Nucleus 63 Twelfth Cranial Nerve 86
Course and Distribution 64 Hypoglossal Nerve 86
Clinical Anatomy 65 Functional Components 86
Sixth Cranial Nerve 65 Nucleus 86
Abducent Nerve 65 Course and Relations 86
Functional Components 65 Extracranial Course 86
Nucleus 65 Branches and Distribution 87
Course and Distribution 65 Clinical Anatomy 87
Clinical Anatomy 65 Mnemonics 88
Fifth Cranial Nerve 66 F-, tc; .o Pe 1E'11 ~ 88
Trigeminal Nerve 66 Clinicoanatomical Problem 88
Nuclear Columns 66 Frequently Asked Questions 88
Sensory Components of V Nerve 66 Multiple Choice Questions 89
Motor Components for Muscles 67
Trigeminal Nerve/Cranial Nerve V 67 5. Brain Stem 90
Ophthalmic Nerve Division 68
Maxillary Nerve Division 68 Introduction 90
Mandibular Nerve Division 69 Medulla Oblongata 90
Clinical Anatomy 69 External Features 90
Seventh Cranial Nerve 70 Internal Structure 92
Facial Nerve 70 Transverse Section through Pyramidal
Functional Components 70 Decussation 92
Nuclei 70 Transverse Section through Sensory
Course and Relations 70 Decussation 94
Branches and Distribution 71 Transverse Section through Floor of Fourth
Ganglia 73 Ventricle 95
Clinical Anatomy 73 Clinical Anatomy 96
Eighth Cranial Nerve 74
Pons 96
Vestibulocochlear Nerve 74
External Features 96
Pathway of Hearing 74
Internal Structure of Pons 97
Vestibular Pathway 77
Tegmentum in the Lower Part of Po ns 97
Clinical Anatomy 77
Ninth Cranial Nerve 77 Tegmentum in the Upper Part of Pons 98
Glossopharyngeal Nerve 77 Clinical Anatomy 99
Functional Components 78 Midbrain 99
Nuclei 79 Subdivision I 00
Course and Relations 79 Internal Structure of Midbraln 100
Branches and Distribution 80 Transverse Section of Midbrain at the
Clinical Anatomy 81 Level of Inferior Colliculi I 00
Tenth Cranial Nerve 81 Transverse Section of Midbraln at the
Vogus Nerve 81 Level of Superior Collic uli IO 1
Functional Components 81 Medial Longitudinal Bundle I 02
CONTENTS xiii

Clinical Anatomy 103 Clinical Anatomy 132


Mnemonics 103 Human Speech 133
r 1 '> ,... f cm I r 103 Diencephalon 134
Clinicoanatomical Problem I03 Thalamus 134
Frequently Asked Questions I04 Metathalamus 137
Multiple Choice Questions 704 Clinical Anatomy 137
Epithalamus 138
6. Cerebellum 705 Pineal Body 138
Location 705 Hypothalamus 138
External Features 705 Functions of Hypothalamus 139
Parts of Cerebellum 105 Clinical Anatomy 140
Morphologic al and Functional Divisions Subthalamus 140
of Cerebellum 106 Clinical Anatomy 140
Connections of Cerebellum 709 Basal Nuclei 141
Grey Matter of Cerebellum 709 D,s ect on 14 1
Histological Structure 11 O Corpus Striatum 141
Functio ns of Cerebellum 112 Connections of Corpus Striatum 142
Clinical Anatomy 143
Development 112
White Matter of Cerebrum 144
Clinical Anatomy 112
)I S l .)n /44
Summary 113
Association Fibres 144
113
Commissural Fibres 145
Clinicoanatomical Problem 113
Corpus Callosum 145
Frequently Asked Questions 114
Projection Fibres 145
Multiple Choice Questions 114
Internal Capsule 146
7. Fourth Ventricle 115 Gross Anatomy 146
Fibres of Internal Capsule 146
Lateral Boundaries 115 Blood Supply 148
Floor 115 Clinical Anatomy 149
Roof 116 Development 149
Recesses of Fourth Ventricle 118 ct t R,.. E'rrb\;1 149
Clinical Anatomy 118
Clinicoanatomical Problems 149
118 Frequently Asked Questions 150
Clinicoanatomical Problem 118
Multiple Choice Questions 150
Frequently Asked Questions 119
Multiple Choice Questions 119 9. Third Ventricle, Lateral Ventricle and Limbic
System 757
8. Cerebrum 120
Third Ventricle 151
Introductio n 120
,e ion 151
120
Clinical Anatomy 152
Cerebral Hemisphere 121
Lateral Ventricle 152
Lobes of Cerebral Hemisphere 124
"'c;s 110n 152
lnsula 124
Sulci and Gyrl on Superolateral Surface 124 Central Part 153
Functio nal or Cortical Areas Anterior Horn 154
of Cerebral Cortex 126 Posterior Horn 155
Moto r Areas 127 Inferior Horn 155
Clinical Anatomy 130 Limbic System 156
Sensory Areas 130 Clinical Anatomy 159
Clinical Anatomy 131 arts -, P nt.;rib , 160
Areas of Special Sensations 131 Clinicoanatomical Problem 160
Clinical Anatomy 132 Frequently Asked Questions 160
Functions of Cerebral Cortex 132 Multiple Choice Questions 760
xiv BRAIN-NEUROANATOMY

10. Some Neural Pathways and Reticular 12. Investigations of a Neurological Case,
Formation 161 Surface and Radiological Anatomy and
Pyramidal Tract 161
Evolution of Head 180
Clinical Anatomy 162 Investigations Required in a Neurologic al
Pathway of Pain and Temperature 162 Cose 180
Taste Pathway 163 Surface Anatomy 181
Reticular Formation 164
Radiological Anatomy of the Brain 182
Action of Drugs 165
Evolution of Head 182
~ e 165
Frequently Asked Questions 165 Frequently Asked Questions 184
Multiple Choice Questions 166
13. Autonomic Nervous System 185
11 . Blood Supply of Spinal Cord and Brain 167
Sympathetic Nervous System:
Blood Supply of Spinal Cord 167 Thoracolumbar Outflow 185
Clinical Anatomy 168 Parasympathetic Nervous System 188
Arteries of Brain 168 Comparison of Parasympathetic and
Vertebral Arteries 168 Sympathetic Nervous Systems 191
Basilar Arteries 168 Nerve Supply of the Viscera 189
Clinical Anatomy I 70 Afferent Atonomic Fibres 192
Internal Carotid Artery 170 Clinical Anatomy 193
Circulus Arteriosus o r Circle of Willis 171
Clinical Anatomy 175 Appendix 194
Arterial Sup ply of Different Areas 174
Blood- Brain Barrier I74 Summary of the Ventricles of the Brain 194
Perivasc ular Spaces 175 Nuclear Components of Cranial Nerves 195
Clinical Anatomy 176 Arteries of Brain 196
Veins of the Cerebrum 176
C/lnicol Terms 197
Clinical Anatomy 178
Multiple Choice Questions 199
Mnemonics 178
F 1c s to I ememb r I 78 Further Reading 200
Cllnicoanatomical Problems 178 Spots 201
Frequently Asked Questions 179
Multiple Choice Questions I 79
Index 203
Glossary

L: Latin w ord, Gr: Greek word


Allocortex L. other bark Old cortex, i.e. paleocortex and archicortex
Alveus L. trough White ma tter on the ventricular surface of hippo-
campus
Amygdala L. almond Nucleus in roof of inferior horn of la teral ventricle
Arachnoid Gr. like spider's web. Middle meningeal layer
Archicerebell um Gr. old cerebellum Phylogenetic cerebellum area in caudal region
Astereognosis Gr. loss of knowledge Inability to recognise solid objects
Astrocyte Gr. star cells A type of neuroglial cell
Ataxia Gr. negative order Loss of muscular coordination
Athetosis Gr. without place Bizzare movements
Autonomic Gr. self law Autonomic NS
Axolemma Gr. axis back Covering of axon
Basis pedw1culi Ventral part of midbrain
Brachium L. arm Fibres connecting 2 parts
Brainstem Midbrain + pons + medulla oblongata
Bulb Medulla oblongata
Calamus scriptorum L. reed pen Area in caudal part of N ventricle
Calcar L. spur e.g. calcarine sulcus, cakar avis
Cauda equina L. horse's tail Lower lumbar and sacral nerve roots
Ca uda te nucleus L. comma-shaped Part of corpus striatum
Cerebellum L. little brain Part of brain
Cerebrum L. brain Cerebral cortex + d iencephalon
Chorea L. dance Involuntary movement of limbs
Cinerium L. ash coloured e.g. tubercinerium
Cingulum L. girdle Na me of association fibres
Claustrum L. barrier Grey matter between insula and lentiform nucleus
Colliculus L. small swelling e.g. dorsal part of mid brain and facial colliculus
Commissure L. joined together Type of white fibres joining identical parts of 2 cerebral
hemispheres,
Corona L. crown like e.g. corona radiata
Corpus callosum L. body hard Main commissural fibre bundle
Corpus striatum L. body striped Grey matter at base of cerebral hemisphere
Cortex L. bark Outer layer (i.e. grey matter) in cerebellum and
cerebrum.
xvi BRAIN-NEUROANATOMY

Crus L. leg. e.g. crus cerebri or basis pedw1euli


Cuneus L. wedge e.g. nucleus and fascicu lus cuneatus and cuneus gyrus
in cerebral cortex
Decussation L. like X Crossing over
Dentate L. toothed e.g. dentate gyrus of temporal lobe, dentate nucleus
of cerebellum
Diencephalon Gr. thro' brain Thalam us + hypothalamus + ep ithalam us +
subthalamus + metathalamus.
Dura mater L. hard mother Outer covering of brain
Emboliformis Gr. plug like One of the nuclei of cerebellum
Endoneurium
Entorhinal
. Gr. within nerve
Gr. within nose
Connective tissue sheath around each nerve fibre
Anterior part of parahippocampal gyrus adjacent to
uncus
Ependyma Gr. upon garment The lining epithelium of ventricles of brain and the
central canal of spinal cord
Epithalamus Gr. upon nerve Sheath surround the nerve
Exteroceptor L. external + receiver Receiver for external environm ent
Falx L. sickle e.g. fa lx cerebri, falx cerebelli
Fasciculus L. bundle Bundle of white fibres
Fimbria L. fringe e.g. bundle of fibres alongmedialedgeofhippocampus
Forceps L. pair of tongs e.g. forceps minor, forceps major
Fornix L. arch Part of limbic system
Ganglion Gr. swelling e.g. dorsal root ganglia, basal ganglia
Genu L. knee (bend) e.g. facial nerve, corpus callosum
Glia Gr. glue Neu roglia
Globus pallidus L. ball +plate e.g. medial part of lentiform nucleus
Glomerulus L. ball of thread e.g. glomeruli of olfactory bulb
Gracilis L. slender Nucleus and fasciculus gracilis
Habenula L. rein Swelling in epithalamus
Hemiballism us Gr. half jumping Violent movement of one side of body due to disease
of subthalamic nucleus
Hemiplegia Gr. half stroke Paralysis of one side of the body
Hydrocephalus Gr. water in head Excessive CSP
Indusium L. garment Grey matter on dorsal surface of corpus callosum
Infundibulum L. funnel Stem of neurohypophysis
Insula L. island Part of cortex lying at the depth of lateral sulcus
lsocortex Gr. same bark Regions of cerebral cortex with 6 layers
Lemniscus Gr. ribbon Medial lemniscus
Lentiform L. lens-like Lentiform nucleus
Limbus L. border, C-shaped Limbic lobe, limbic system
Limen L. threshold Ventral part of insula
Locus ceruleus L. place dark blue e.g in floor of IV ventricle
Macula L. spot e.g. macula lutea
Mamrnillary body L. nipple-shaped mammillary bodies
Medulla L. middle medulla oblongata
Mesencephalon Gr. middle brain midbrain
Meta thalamus Cr. after+ inner chamber Medial and lateral geniculate bodies
Metencephalon Gr. after+ brain e.g. pons + cerebellum
Microglia Gr. small + glue Type of neuroglial cells
GLOSSARY xvii

Molecular L. mass Tissue with large number of nerve fibres


Myelcncephalon G. marrow +brain Medulla oblongata
Neostriatum ew + striped region Caudate nucleus and putamen
Neurite G. of nerve Axons and dendrites of the neurons
reurobiotaxis G. nerve+ living attraction erve cells moving towards sources of stimuli
euroglia G. nerve + glue Cellular, non-nervous cells glueing the neurons
Neurolemma or G. nerve - husk Sheath around the peripheral nerve fibre
neurilemrna
Neuropil G. nerve + felt Nerve cell process between the bodies of neurons.
Nociccptivc L. to injure + to take Response to painful stimuli
Obex L. barrier In fourth ventricle
Oligodendrocyte G. few+ processes Type of neuroglia
Olive L. oval Olivary nuclei
Operculum L. lid Various opercula around the lateral sulcus to hide the
insula
Paleocerebellum G. ancient+ small cerebellum Old part of cerebellum
Palcos tria tum G. ancient+ striped area Old part of corpus striatum, i.e. g lobus pallidus.
Paraplegia G. beside + stroke Paralysis of lower part of trunk and both lower limbs
Perikaryon C. around+ nut Neuron
Pes L. foot Pes hippocampi
Pineal L. pine Pineal gland
Plexus L. palit Interwoven fibres
Pneumoencephalogram Air+ brain+ to write Visualisation of ventricles and subarachnoid space by
replacing of CSF by air
Pons L. bridge Part between midbrain and medLilla oblongata
Proprioceptive L. one's own+ receptor Afferents from joints, tendons, etc.
Prosencephalon C. before+ brain Forebrain part
Ptosis C. falling Drooping of upper eyelid
Pulvinar L. cushioned seat Posterior projection of thalamus
Putamen L. shell Lateral part of corpus striaturn
Pyriform L. pear + form Olfactory cortex is pear-shaped in lower animals
Quadri p lcgia L. four + stroke Paralysis of all four limbs
Raphe G. seam Midline structure
Reticular L. net Net formation
Rhinal G. nose Related to nose
Rhinencepha Ion C. nose + brain Components of olfactory system
Rhombencephalon G. lozenge-shaped+ brain Refers to hindbrain vesicle
Rostrum L. beak Beak-shaped portion of corpus callosum
Rubro L. red Red nucleus
Satellite L. attendant Cells around neurons of dorsal root ganglion and
autonomic ganglia
Septum pcllucidum L. partition transparent Septum pellucid um of lateral ventricles
Somatic G. bodily Skeletal muscles (in neurology)
Somesthetic G. body + perception Sensation of pain, touch and temperature
Splenium C. bandage Posterior thick end of corpus callosum
Stria tum L. furrowed Caudate nucleus and putamen
Subiculum L. decreased layer Transitional cortex between hippocampus and para-
hippocampal gyrus
Substantia gelatinosa Substance + soft Collection of small neurons at the apex of posterior
horn of spinal cord
xviii BRAIN- NEUROANATOMY

Substantia nigra Substance + dark Present in midbrain


Subthalamus L. under + inner chamber Region beneath thalamus
Synapse G. to join Site of contact between neurons
Syringomyelia G. pipe+ marrow Cavities in grey m atter around central canal
Tapetum L. carpet Fibres of body of corpus callosum
Tectum L. roof Roof of midbrain comprised of 4, colliculi
Tegmentum L. to cover Do rsal portion of pons and midbrain
Telachoroidea L. web + membrane Vascula r connective tissue core of choroid plexus.
Telencephalon G. end + brain Cerebral hemisphere
Telodendria G. end + tree Terminal branches of the axon
Thalamus G. inner chamber Part of diencephalon
Tomography G. cutting+ w rite Sectional radiography
Transducer L. to change Mechanism w hich changes one form of energy into
another
Trapezoid body Trapezium like Transverse fibres at the juction ,of dorsal and ventral
parts of pons for auditory pathway
Uncinate L. hood-shaped Uncinate fasciculus
Uncus L. hood Hook-shaped anterior end of parahippocam pal gyrus
Uvula L. little grape Part of inferor vermis of cerebelllun
Vallecula L. valley Depressed area on the inferio r medullary vela
Ventricle L. diminutive of belly Ventricles of brain
Vermis L. worm Middle region of cerebellum
Zona incerta Grey matter in subthalamus
Brain-Neuroanatomy
1. Introduction 3
2. Meninges of the Brain and 19
Cerebrospinal Fluid
3. Spinal Cord 28
4. Cranial Nerves 48
5. Brain Stem 90
6. Cerebellum 105
7. Fourth Ventricle 115
8. Ce rebrum 120
9. Third Ventricle, Lateral Ventricle and 151
Limbic System
10. Some Neural Pathways and 161
Reticular Formation
11 . Blood Supply of Spinal Cord and Brain 167
12. Investigations of a Neurological Case, 180
Surface and Radiological Anatomy
and Evolution of Head
13. Autonomic Nervous System 185
Appendix 194
I Anato1ny Made Easy ·.

Ichchak dana, beechak dana, dane upar dana


Hands naache, feet naache, brain. hai khushnarna
lchchak dana
Seventh ka nucleus glwom kar aaye fifth ke pass,
nucleus ambiguus laterally jaye
Spinal accessory neeche ko aaye,
motor sensory pass ho jayen,
kaisa aashikana- ichchak dana
Bolo kya- Neurobiotaxis, bolo kya- Neurobiotaxis
CHAPTER

1
Introduction
.'/7,,- mf,neily r/ /I,, ,,,;,,,I~,,., 9ual 11.> /1,,,1,fJju,,.,.
-Wei Lang

Nervous sys tem is the chief controlling and co- 2 Efferent com ponent ca rries motor information to
ordinating system of the bod y. muscles, glands, blood vessels and heart via:
It is responsible for judgement, intelligence and a. Somatic ner vous system for the control of skeletal
memory. Nervous system is highly evolved at the cost muscles.
of regeneration. b. Au tonomic nervous system for control of heart,
1t is the most complex system of the body. smooth muscle of the organs, glands and blood
It adjusts the body to the surroundings and regulates vessels. It is subdivided into sympathetic and
all bodily activities both voluntary and involw,tary. The p arasympathetic parts.
sensory part of the nervous system collects informa tion
from the surroundings and helps in gaining know ledge
and experience, w hereas the motor part is resp onsible
CELLULAR ARCHITECTURE
for respon ses of the body. The nervous tissue is made up of:
Average weight of adult brain in air is 1500 grams. 1 Nerve cells or nemons (Fig. 1.1).
Since brain floats in cerebrospinal fluid, it only weighs 2 Neuroglial cells (neuroglia), forming the supporting
50 grams w hich is comfortable. (connective) tissue of the CNS. In peripheral nervous
There are about 180-200 billion neurons in an a dult system, these are replaced by Schwann's cells.
brain (very rich). Both types of cells are supplied by abundant blood
vessels.
DIVISIONS OF NERVOUS SYSTEM
NEURON
ANATOMICAL
Each neuron is made up of the following.
It is d ivided into: 1 A cell body: Collectively they form grey m atter and
1 Central nervous system (CNS) which comprises the nuclei in the CNS, and gan glia in the peripheral
brain and spinal cord. It is responsible for integrating, nervous system.
coordinating the sensory informa tion and ordering 2 Cell processes of two varieties:
appropriate motor a c tions. CNS is the seat of a. Dend rites (Greek bmncli ofa tree) a re many, short,
learning, memory, intelligence and emotions. richly branched and often varicose (Fig. 1.1).
2 Peripheral nervous system (PNS) includes 12 pairs b. The axon is a single elongated process. Collec-
of cranial n erves and 31 pairs of spinal nerves. These tively the axons form tracts (white matter) in the
provide afferent impulses to C S and carries CNS, and nerves in the peripheral nervous system.
e ffe re nt impulses to muscles, glands and blood The branches of axons often a rise at r ight angles
vessels (Flowchart 1.1 ). and are called the collaterals.
Functionally, each neuron is specialized for sensi-
FUNCTIONAL tivity and con ductiv ity. The impulses can flow in them
Pe riphera l n e rvous sys tem fun ctionally has two with great rapidity, in some cases abou t 125 meters p er
components: second. A neUion shows dynamic polnrihJ in its processes.
1 Afferent component provides sensory information to The impulse flows towards the cell body in the dendrites,
CNS. and away from the cell body in the axon (Fig. 1.1).
3
BRAIN-NEUROANATOMY

Flowchart 1.1: D ivision s of nervous sy stem

Nervous system

Central nervous system Peripheral nervous system

Brain Spinal cord I Somatic nervous


system
Autonomic nervous
system

Cranial nerves Spinal nerves Sympathetic Parasympathetic


(12 pairs) (31 pairs) nervous system nervous system

Bipolar
,J...,\)\)

r Pseudounip olar
Dendrite
Soma

1---lfi.~~.._-Soma
Soma
(perikaryon)

Axon

(a) (b)

1 a-- - - -- --Schwann cell


( neurolemmocyte) ~~~~=a
Dendrite
(c) Collateral branch

Figs 1.2a to c: Types of neuro n s

Fig. 1.1: Multipolar neu ron


4 Unipolar neurons are present in the mesencephalic
nucleus of trigeminal nerve and also occur during
Classification of Neurons foetal life. These cells are more common in lower
vertebrates (Fig. 1.2c).
According fo he Number of their Processes
1 Multipolar neurons. Most of the neurons in man are According to Length of AKon
multipolar, e.g. all motor and internuncial neurons 1 Golgi Type I: These neurons have long axons and
(Fig. 1.1). numerous short d endrites. These are seen in pyra-
2 Bipolar neurons are confined to the first neuron of the midal cells of cerebral cortex (Fig. 1.3a), Purkinje cells
re tina, g angli a of eighth cran ial ner ve, and the of cerebellum and anterior horn cells of spinal cord
olfactory mucosa (Fig. 1.2a). (Fig. 1.3b).
3 Pseudounipolar neurons are actually unipolar to begin 2 Golgi Type Tl: These are ne urons with short axons,
with but become bipolar functionally and a re found and establish synapses with neighbouring ne urons.
in dorsal nerve root ganglia and sensory ganglia of These are also seen in cerebral cortex and cerebella r
the cranial nerves (Fig. 1.2b ). cortex.
INTRODUCTION

- - - -- - Polymorphous layer
,,,,-~- - - Capillary

Fig. 1.3a: Pyramidal cells of cerebral cortex

Fig. 1.3b: Purkinje cell of cerebellum

3 Amacrine neurons without axon, only with dendrite. 3 Tertiary or 3rd order sensory JZeuro11s a re seen in
They are seen in retina of eyeball. thalamus (see Fig. 3.14).
Mature neuron is inca pable of dividing. Recently
some neurons in olfactory region and h ippocampus Motor neurons
have been seen to divide. Brain tumours arise chiefly These carry impulses from CNS to distal part of the
from the neuroglial cells. body. These somatic motor neurons are of two types:
1 Up per motor neurons are situated in motor area of
Functional Clas:;ificotion
brain. These synapse w ith cranfal nerve nuclei and
Neurons are classified into sensory neurons, autonomic anterior horn of spinal cord (see Fig. 10.1).
neurons, i.e. parasympathetic, sympathetic neurons and 2 Lower motor neu rons are located in cranial nerve
motor neurons.
nuclei and anterior horn of s.pinal cord. erves
Sensory neuro11s emerging from these nuclei s upply the various
These are of three types: skeletal muscles (see Fig. 3.10).
1 Primary or 1st order sensory 11e11ro11s are present as
spinal or sensory neurons in the dorsal root ganglion Parasympathetic neurons (autonomic)
of spinal nerves (Fig. 1.2b). 1 Preganglionic neurons are located in cranial nerve
2 Seco11dary or 211d order sensory 11e11ro11s are pre ent in TTI, VII, IX and X, also in sacral 2-4 segments of the
the grey matter of spinal cord and in brain stem. spinaJ cord.
BRAIN-NEUROANATOMY

2 Postganglionic neuro ns are located close to the wall


or within the wall of the viscera.
3 The parasympathetic outflow is called "craniosacral
outflow" . Mitochondria - -~
Axon
Sympathetic 11euro11s (autonomic) terminal
1 Preganglionic neu rons are located in the lateral horn Presynaptic
bouton Synaptic
of thoracic one to lumbar two segments of the spinal vesicle
cord.
2 Postganglionic neurons are situated in the ganglia Presynaptic dense-I---"~~
projection
of the sympathetic trunk away from the v iscera.
3 The sympathetic outflow is called " thoracolumbar
outflow."

According to Shape (Fig. 1.4)


Stellate
Basket Fig. 1.5: Structure of a synapse
Fusiform
not by continuity ('neurnn theory' of Waldeyer, 1891).
Pyramidal
The impulse is transmitted across a synapse through
biochemical neurotransmitters (acetylcholine).
Accord·ng fo Size
Macroneuron: More than 7 µm size, e.g. Betz cells. NEUROGLIAL CELLS
Microneuron: Less than 7 µm size, e.g. granular cells. Various types of neuroglial (Greek nerve glue) cells are
as follows:
SYNAPSE 1 Astrocytes are concerned with nutTition of the nervous
The neurons are connected to one another by their tissue a re s tar-shaped cells. These form blood- brain
processes, forming long chains along which the barrier. These are of two types, protoplasmic (Fig. l.6a)
impulses are conducted. The site of contact (contiguity and fibrous (Fig. 1.6b). Astrocytes are absent in pineal
without continuity) between the nerve cells in known gland and posterior pituitary.
as 'synapse' (Greek together) (Fig. 1.5). One cell may 2 Oligodendlrocytes (Greek few processes) are counter-
establish such contacts through its dendrites with as parts of the Schwann cells. Schwarm cells myelinate
many as 1000 axonal terminals. However, it must be the peripheral nerves. Oligodendrocytes myelinate the
remembered that each neuron is an independent wut tracts (Fig.. 1.6c).
and the contact between neurons is by contiguity and 3 Microglia (Greek small glue) behave like macrophages
of the C S. They develop from mesoderm (Fig. 1.6d).
Stellate cell Fusiform cell
4 Ependymal cells are columnar cells lining the cavities
of the CNS (Fig. l.6e).
. ~-·
l, ✓r ·
.( ~ 5 Schwarm cells.
~{:i;:·---
,.~..,.._~rdt':-- Various features of these cells are shown in Table 1.1.
Proliferation of glialcells is called the 'gliosis'. AC S
i, ·: ....._,. --
._ lesion heals by gliosis. A spontaneous gliosis is an
indica tion of a degenerative change in the nervous
tissue. Since the g lial cells are capable of dividing, they
can form the CNS tumours.

GREY MATTEIR AND WHITE MATTER


Unit of nervous tissue is the neuron, comprising of cell
body, dendriites and axon. Neurons are supported by
neuroglia and blood vessels.
Grey matter is the part of nervous tissue containing
the cell body (soma), neuroglial cells and abundance
of blood vessels. It covers the outer aspect of brain and
is known as 1the cortex. Grey matter present within the
Fig. 1.4: Types of neurons depth of white matter is called ganglia / nuclei.
IMTRODUCTION

'

Cilium
(motile)

)U~U~- Microvilli
fr;J~:----iJ-- Indented,
heterochromatic
nucleus

(e)

Figs 1.6a to e: Types of neuroglial cells

Table 1.1: Types of neuroglial cells


Protoplasmic astrocyte Fibrous astrocyte Oligodendrocyte Microglia
Cell size Large Large Medium Small, elongated
Shape of nucleus Oval, light stained Oval, light stained Small, spherical dark stained Small, elongated dark stained
Cytoplasmic Many, short and thick Many long slender Few short, beaded Short, thin spinous
processes
Cytoplasm Granular Fibrillar
Situation Grey matter White matter White matter Grey and white matters
Function Blood- brain barrier BBB Myelination Phagocytosis
(BBB)
Embryological origin Neural crest Neural crest Neural crest Mesoderm

W hite matter comprises only the fibres, i.e. axons, sensory and motor neurons. An involuntary motor
d endrites, neuroglial cells a nd fewer blood vessels. ln response to a sensory stimulus is known as the reflex
brain white matter lies deep to cortex of brain. In the nction. Only cortical responses are voluntary in nature.
spinal cord white matter lies superficial to the deeply All subcortical responses are involuntary and therefore
placed "H-shaped" grey matter. are the reflex activities. Reflex ac6on is chief fmlction
of spina l cord. Knee jerk and ankle jerk are mono-
REFLEX ARC synaptic reflex arcs (Fig. 1.8). Some common reflex arcs
A reflex arc is the functiona l unit of the nervous system. are shown in Table 1.2.
In its simplest form (monosynaptic reflex arc), it consists
of: COMPONENTS OF CENTRAL NERVOUS SYSTEM
1 A receptor, e.g. the skin/ m uscle. l The spinal cord: lt extends from the base of the skull
to the lowe r border of first lmnbar vertebra in an
2 The sensory ne uron.
adult. The spinal cord receives sensory information
3 The motor neuron. from the skin, joints, and muscles of the trunk and
4 The effector, e.g. the muscle. limbs and contains the motor neurons responsible
In complex forms of the reflex arc, the internuncial for both voluntary and reflex movements. It also
neurons (interneurons) are inte rposed be tween the receives sensory information from the internal
BRAIN-NEUROANATOMY

Table 1.2: Some common reflexes


Name of reflex Way of eliciting Result Comment
Biceps jerk Striking biceps brachii Flexion of the elbow joint CS, C6 segments intact
tendon Tendon jerks may be exaqgerated in upper motor
neuron lesion or lost in lower motor neuron lesion
Triceps jerk Striking triceps brachii Extension of the elbow joint C7, CS, segments intact
tendon
Knee jerk Striking the ligamentum Extension of the knee joint L3, L4 segments of spinal cord intact
(Fig. 1.7) patellae
Ankle jerk Striking tendo calcaneus Plantar flexion of the ankle S1 , S2 segments intact
joint
Abdominal Striking a quadrant of Contraction of abdominal Positive reflex indicates normal pyramidal tract
reflex abdomen muscles with T7- T12 nerves intact
Plantar reflex Scratching the sole of Plantar flexion of the great A normal plantar response indicates intact
foot from lateral side toe and other toes pyramidal tract
towards big toe
Babinski's sign Same as in plantar reflex Dorsiflexion of the great toe Babinski's sign indicates pyramidal tract
(Fig. 1.8) and fanning of other toes injury, except in infants

Dorsal root ganglion


(pseudounipolar)

Muscle spindle (receptor) - - ~

Quadriceps - - -----.
femoris

Ventral horn
of grey matter
Motor end plate in
Patellar hamme r ~ skeletal muscle (effector)

'lj Fig. 1.7: Components of the knee jerk

organs and control many visceral functions. Within 2 Brain stem: It includes
the spinal cord there is an orderly arrangement of a. The medulla: This is the direct rostral extension of
sen so ry cell groups that receive input from the the spinal cord . It participa tes in regulating blood
periphery and motor cell groups that control specific pressure and res pira tion control . It resembles the
muscle groups. In addition, the spinal cord contains spinal cord in both organization and function.
ascend ing pathway through whi ch sensor y b. The pons: lt lies rostral to the medulla and contains
information rea ches the brain and descending a large number of neurons lthat relay information
pathways that relay motor command from the bra in from the cerebral hemisphe res to the cerebellum.
to motor neurons. The grey matter is in the centre c. The midbrain : This is the smallest brain s tem
and white matter is a t th e periphery. CSF containing component which lies ros tral to the pons. The
central canal lies in the grey matter. midbrain contains essential relay n uclei of the
INITRODUCTION

thick band of fibres, the corpus callosum. The


hemisphere shows in.foldings in the form of su lei and
gyri, giving more space for the neurons.
6 Ventricles of brai11: Ventricles are continuous cavities
in various parts of brain. Lateral ventricle is cavity
of each cerebral hemisphere .. Third ventricle is
present be tween the two thalami. It continues as
aqueduct of midbrain. IV ventricle is cavity of hind
brain, i.e. pons, medulla and cerebellum and continues
downwards as central canal of spinal cord . CSF
circulation in the ventricles and subarachnoid space
provides nourishment to the components of brain.
7 Protective coverings: Brain and spinal cord are covered
by 3 meninges with intervening spaces. The outer-
most is the d ura mater, middle layer is delicate
cobweb-like arachnoid mater and the inner one is
Fig. 1.8: Babinski's sign the pia ma ter. The subdural space is very narrow
w hile the subarachnoid space is big containing very
auditory and visual system. Several regions of this important cerebrospinal fluid.
structure play an important role in the direct Lastly brain and spinal cord with their meninges are
control of eye movement, whereas others are securely kept in the bony skull and vertebral canal
involved in motor control of skeletal muscles. respectively. C Sis the most protected part of the body.
3 Ccrebe/111111: The cerebellum lies dorsal to the pons
and medulla. It has a cormgated surface. The cere-
PARTS OF THE NERVO S SYSTEM
bellum receives soma tosensory input from the spinal
cord, mo tor information from the cerebral cortex a nd CENTRAL NERVOUS SYSTEM (CNSJ1
balance in.formation from the vestibular organs of
the inne r ear. The cerebel lum integrates this l Brain: Occupies cranial cavity.
information and coordinates the planning, timing 2 Spinal cord: Occupies upper two-thirds of the verte-
and patterning of skeletal muscle contractions during bral canal.
movement. The cerebellum plays a major role in the PERIPHERAL NERVOUS SYSTEM
control of tone, equilibrium and posture, including
head and eye movements. 1 Somatic (cerebrospinal) nervous system . Tt is made
4 The die11ccplrnlon: It includes the thalamus a nd up of 12 pairs of cranial nerves and 31 pairs of spinal
hypothalamus It is present between the cerebral nerves. Its efferent fibres reach the effectors without
hemi spheres and the midbrain. T he thalamus interruption (Fig. 1.9a).
receives almost all sensory and motor information
going to the cerebral cortex except smell. It regulates Soma in Soma in
levels of awareness and some emotional aspects of anterior lateral horn
sensory experiences. The hypothalamus lies ventral horn of of grey matter
grey
to the thalamus and regulates a utonomic activity and matter Soma in nuclei
the hormonal secretion b y the pituitary gland. of CN (Ill, VII,

~
Sympathetic IX, X) and lateral
5 The cerebml hemisplwres: This is the largest region of ganglion near horns of S2-4
the brain. it consists of the cerebral cortex/ grey ma ter CNS
and the fibres which form white matter with deeply
located nuclei: the basal ganglia, the hippocampal
formation and the amygd ala. The cerebral hemis-
pheres are divided by the hemispheric fissure and
are tho ught to be concerned w ith perception, cogni-
tion, emotion, memory and high motor functions.
,,_)l
Pa•;;:;:1~:;1,,
Each hemisphere comprises 4 lobes, e.g. frontal,
parietal, temporal and occipital lobes. Effector Effector Effector
Each hemisphere has a flat med ial surface which lie (a) {bl (c)
adjacent to each other sepa rated by a longitudinal Figs 1.9a to c: Types of peripheral nervous system: (a) Somatic,
fissure. ln the lower part of the fissure is present a (b) sympathetic, and (c) parasympathetic
BRAIN-NEUROANATOMY

2 Autonomic (splanchnic) nervous system. It consists of


sympathetic and parasympathetic systems. Its efferent Lateral ventricle
fibres first relay in a ganglion, and then the post- Cerebrum
lnterventricular -.--+- --,,......
ganglionic fibres pass to the effectors (Figs 1.9b and c). forannen

CLINICAL ANATOMY

Tumours of the nervous tissue arise mostly from the + - --+--Pons


neuroglia, as developed neuro ns have lost the power Cerebellum
of m u]ti plication except in a few areas. Tumours from
neuroglial cells are called gliomas. These are hjghly
malignant and rapidly growing tumours.
Fig. 1.1 Oa: Parts of the brain
Parts of Brain
Hindbrain includes pons, medulla and cerebellum.
The main parts and their subdivisions are shown in The dilated part of the central canal of spinal cord
Table 1.3, Figs U Oa and b. within the conus medullaris is known as the terminal
The brain stem includes the midbra in, pons and ventricle. Similarly, the cavity of septum pcllucidum
med ulla. is sometimes called the fifth ventricle.

Table 1.3: Parts of brain


Parts Subdivisions Cavity
1. Forebrain A. Telencephalon (cerebrum), made up of two cerebral hemispheres and Lateral ventricle
(prosencephalon) the median part in front of the interventricular foramem
8 . Diencephalon (thalamencephalon), hidden by the cerebrum, consists of: Third ventricle
a. Thalamus
b. Hypothalamus
c. Metathalamus, including the medial and lateral gemiculate bodies, and
d. Epithalamus, including the pineal body, habenular trigone and posterior
commissure
e. Subthalamus
2. Midbrain Crus cerebri, substantia nigra, tegmentum, and tectum, from before Cerebral aque-
(mesencephalon) backwards duct
3. Hindbrain A. Metencephalon, made up of pons and cerebellum Fourth ventricle
(rhombencephalon) B. Myelencephalon or medulla oblongata

Cerebral hemisphere _ _ __ _...._.


(forebrain)

Diencephalon - -c==----c:~ - -- - = --.,-f---


(thalamencephalon)

Midbrain
\ i Pon:J Metencephalon g--~
\ 1~,.:
' 1\.____ Ger g :§
J~-
Q) C


L
Brainstem Pons _ _ _ _ _..., ' - - -- - - Medu~ Myelencephalon
Medulla - - -- - -- ~ c:::

Fig. 1.10b: Parts of the brain (dissection)


INTRODUCTION

DEVELOPMENT OF BRAIN a. Anterior neural ridge ➔ fibroblast growth factor 8


(FGF8) ➔ cranial end of forebrain expresses BFl ➔
NEURAL TUBE controls development of telencephalon.
The whole of nervous system develops from ectoderm b. Rhombencephalic isthmus -➔ FGF8 ➔ isthmus
except the blood vessels and the microglia (neuroglial expresses ➔ engrailed genes -➔ controls develop-
tissue). ment of midbrain and cerebellum.
At the beginning of 3rd week of development, the
ectodermal germ layer has the shape of a flat disc that Further Development of the Brain
is broader in cephalic region than i_n the caudal region. Prosencephalon, mesencephalon and rhombencephalon
With the appearance of the notochord and its inductive are first arranged cephalocaudally. Soon it develops 4
influence, ectoderm overlying the notochord thickens flexures. These are:
to form a slipper-shaped plate, called neural p late. Cells a. Cervical flexure: It appea rs at the j unction of
of the plate make up neuroectoderm and with induc- rhombencephalon and spinal cord.
tion, the process of neurulation starts. The plate is b. Cephalic or mesencephalic flexure: This flexure is
located in the mid-dorsal region in front of the primitive
located in the region of mjdbrain.
pit. Its lateral edges get raised to form the ne ural folds.
With further development, the neural groove c. The mesencephalon is separa ted from rhomben-
between the two folds on either side becomes deeper. cephalon by a furrow called rhombencephalic flexme
Eventually, the neural folds approach each other in (Fig. 1.11).
midline and finally fuse, thus forming the neural tube. d. When the embryo is 5 weeks old, the prosencephalon
Fusion beg.i ns in the cervical region and proceed s in consists of 2 lateral outpocketings, the primitive
cephalocaudal direction. At the most cranial and caudal cerebral hemispheres. At this stage, a deep furrow
ends of the embryo, fusion is delayed and the cranial appears at the middle of rhombencephalon. This is
and caudal neuropores temporarily form open called pontine fl exure, and it divides rhomben-
connections between the base of neural tube and the cephalon into metencephalon and myelencephalon.
amniotic cavity. The flexures change orientation of various parts of
Final clostue of cranial neuropore occurs on 25th day brain.
and caudal neuropore two days later of the embryonic The lumen o f the spinal cord, the central canal is
Ufe, and eventually neuropores disa ppear leading to a continuous with that of primitive brain vesicles.
closed h1be. The cavity of rhombencephalon is known as fourth
Before the neural tube is completely closed, it is ventricle, those of cerebral hemisphere are lateral
divisible into an enlarged cranial part with three ventricles and cavity of diencephalon is third ven tricle.
divisions which forms brain and a caudal tubular part
Cavity of lateral ventricles communicates with that
which forms spinal cord.
of third ventricle through interventricular foramen of
The cephalic end of the neural tube shows three
divisions (Table 1.3): Monro. Cavity of third and fourth ventricles is
1. Prosencephalon or forebrain connected through narrow cerebra I aqueduct of Sylvius
2. Mesencephalon or midbrain (Fig. 1.12).
3. Rhombencephalon or hindbrain.
Neural Crest Cells and their Derivatives
MOLECULAR BASIS OF DEVELOPMENT During folding of the neural tube, a group of cells are
OF SPINAL CORD AND BRAIN formed along each side of neural groove and after the
Spinal Cord formation of neural tube, lie between the surface
Spinal cord comprises basal/motor plate and alar/ ectoderm and neural tube. These cells (ectoderma l in
sensory plate. Sonic hedgehog (SHH) is expressed in o rigin) migrate laterally, and are called neural crest
notochord. SHH ventralises neural tube and forms cells. They extend from prosencephalon at the cranial
basal/motor plate. end of the tube to the level of caudal somites (Fig. 1.13).
Bone morphogenetic protein, BMP4 and BMP7 Derivatives are:
expressed from non-neural ectoderm at border of neural 1. Primitive cranial ganglia
tube dorsalises the neural tube. 2. Primitive spinal ganglia.
Brain 1 Primitive cranial ganglia
Hindbrain is regulated by HOX genes. Forebrain and mid- • Sensory ganglia of V, VII, Vil.I, lX, X cran ial nerves
brain regulated by UM! and OTX2. Also governed by: • Parasympathetic ganglia
BRAIN- NEUROANATOMY

Rhombencephalic flexure - - - =~
Mesencephalon----t- -

Cervical flexure
Spinal cord

_ _..,._ _ _ Mesencephalon

.f-- Metencephalon

ci::_~ Pontine flexure

·/ Myelencephalon

Cephalic flexure · / / -
Cervical flexure- - - -- - - ~/ / Spinal cord
(b)

Figs 1.11 a and b : Development of the various flexures of the brain

• Pigment cells (melanoblasts)


- -+-+--- Lateral ventricle • Schwarm ceJls
- ----+--i-- lnterventricular foraman • Satellite cells
• Odonto,blasts
_ _ . . . .,_. . . _,="'~ - - Ill ventricle • Mesenchyme of head region
A ~=--- - - Optic cup
Diencephalc:>n
The median part of prosencephalon forms diencephalon.
It comprises a roof plate and two alar plates. The choroid
plexus of third ventricle is formed from ependymal cells
of roof plate and the vascular mesenchyme.
After the formation of the telencephalon, the lateral
wall of diencephalon becomes thickened and gets
divided into 3 regions, by appearance of two sulci.
These are called epithalam.ic and hyothalam.ic sulci, and
the central pa1rt between the two sulci is called thalamus.
The part above the epithalamic groove is a small region
represented by habenular nuclei and pineal body. The
part below the h ypothala mic groove forms h ypo-
thalamus.
Fig. 1.12: Further development of the brain vesicles including
the ventricles
Pineal body or epiphysis develops from the most
caudal part of roof plate. The pineal body initially
• Ciliary, otic, submandibular and pterygopalatine appears as an epithelial lining in the midl ine, but by
• Pia mater and arachnoid mater (leptomerunges) the 7th week of intrau terine life, it begins to evaginate.
Eventually, it becomes a solid organ located on the roof
2 Primitive spinal ga11glia of the mesencephalon. It serves as a channel through
• Dorsal root ganglia of spinal nerves w hi ch lig ht and d a rkness affect endocrine and
• Sympathetic ganglia behavioral rhythms, i.e. circadian rhythm. In the adult,
• Adrenal medulla calcium is frequently deposited in the epiphysis and it
even serves as a landmark on an X-ray skull.
3 From both 1 and 2 As a result of proliferative activity; the various nuclei
• Pharyngeal cartilage cells of thalamus are formed by multiplication of cells in the
• Chromaffin cells mantle layer of the wall of diencephalon.
INITRODUCTION

Neural crest cell

Pial cell

ganglion cell Melanophore

Fig. 1.13: Development of neural crest cells

Hypothalamus forming lower portion of the alar growth of vario us part of hemisphere, the choroid
plate differentia tes into a number o f nuclear areas p lexus protrudes into la teral ven tricle along a line
which serves as regulation centre of the visceral func- known as choroid fissure.
tions, i.e. s leep, d igesti on, bod y tempe rature and Above the choroid fissure, the wall of hemisphere is
emotional behaviour. thi cken ed, thus forming the hippocampus w hich
The prominent group of these nuclei are mamrnillary ma inly has an olfactory function and this part bulges
body, which forms distinct p rotuberance on the ventral into lateral ventricle.
surface of the hypothalamus on each sid e of the mid- With further growth and expansion, the hemispheres
line. cover the lateral aspect of diencephalon, mcsencephalon
and cranial portion of metencephalon.
Telencephalon
The telencephalon, consists of two lateral outpocketings, Corpus Striatum
the cerebral; (right and left) hemispheres and a median Some of the cells of the mantle layer in thick basal part
portion, the lamina terminalis. The cavities of hemi- of la te ral wall of hemisphere form corpus striatum. It
spheres, the lateral ventricles commu nicate with the expands posteriorly and gets divided into 2 parts:
lumen of diencephalon, through the interventricular a. A dorsomedial portion, the caudate nucleus
foramen of Monro. b. A ventrola teral portion, the lentiform nucleus.
This division ocnus by axons passing to and from
Cerebral Hemispheres the cortex of the hemisphere. Th e fibre bundle thus
Cerebral hemisphe res arise as bilateral (right and left) formed is known as internal capsule (Fig. 1.14).
evaginations at the beginning of 5th week of develop-
ment from the late ral wall of prosencephalon. By the Lobes of Brain
middle of 2nd month of development, the basal part of Continuous growth of cerebral hemispheres in anterior,
hemisphere, i.e. the pa rt which is initially formed by dorsal, posterior a nd inferior directions result in
the forward extension of thalamus, begins to increase formation of frontal, parieta l, occipital and temporal
in size. As a result, this area bulges into the lumen of lobes. As the growth in the region of corpus striatum
the lateral ventricle as well as into the fora men of Monro. slows down, the area between temporal and frontal
ln the region w here the wall of hemisphere is lobes becomes depressed and forms the insula. The area
attached to the roof of diencephalon, the ne uroblasts is la ter overgrown by adjacen t lobes and at the time of
fail to d evelop and it remains very thin. Here the birth is almost completely covered. In later part of fetal
hemispheric wall consists of a single layer of ependymal life due to growth in a limited area, the suJci and gyri
cells covered b y vascular mesenchyme and together make their appearance. This is to accommodate more
they form choroid p lexus. Due to disproportionate ne urons in a limited a rea (Fig. 1.15).
BRAIN-NEUROANATOMY

Superior sagittal sinus - - - -- - -- - ----, ~ -- - -- - Faix cerebri


Cerebral hemisphere - -- - -.,,,...- --....

- - ~-..-_.,__ _ Lateral ventricle


1----+-- Ependyma
.r--=----~- t-- Hippocampus
r~..-.,...",,s-----,,,___-+- - Choroid plexus of lateral ventncle

Internal capsule - - - -',--


Caudate nucleus _ _ _ ___,,__...,__, / .,,,.--,,~ -- - Globus pallidus
- .,~ - - -- Putamen

~ -- -- - Choroid plexus of lllrd ventricle


lnterthalamic connection - - - - - - - 7i"---::j:7'':::::h.._J__-1-~-
lllrd ventricle
Thalamus-- - - - - l!t7L""-- - Hypothalamic nuclei

Fig. 1.14: Development of caudate and lentiform nuclei. Between these two nuclei, the fibres of internal capsu le are seen

28 weeks

Cerebellum

36 weeks

'/ l t---+-----F"---- -- Central sulcus


Frontal lobe
/ ( \ ) ) ~ ~ Parietal lobe
1 / _j Parietal-occipital sulcus

Lateral sulcus---=--=----
\/"'l ~
Temporal lobe- - - ~

11- - \ 1 - -- -- - Medulla oblongata

Fig. 1.15: Developmental stages of cerebral cortex

Cerebral Cortex neocor tex in the s uperolateral region . Earlier formed


From development point o f view, the cerebral cortex cells are neuroblas ts. Motor areas o f the cortex are rich
consists of: in pyramidal cells, while the sensor y areas have
abund ance of granular cells.
a . The hippocarnpal cortex
b. Pyriform cortex Cerebral Commissures
c. The n eocortex In the adult, the rig ht and left halves of the cerebral
The developing telencephalon h as a medial wall, hemispheres are connected by a number of fibre
apposed to the counterpart of the opposite sid e, a bundles called commissures, w hich cross midline.
superolateral waU and a basal wall. The hippocampal • The most important is lamina terminalis. lt is part of
cortex develops in m edial wall, pyriforrn cortex in the the wall of the neural tube that closes the cranial end
marginal layer, superficial to corpus s tria tum, and of the prosencephalon. After the appearance of
telencephalic vesicles, lamina tcrminalis lies in the
INTRODUCTION

TI1e periphe ral processes of the dorsal nerve root


1
.J
anterior wall of IITrd ventricle. Neurons growing ganglia grow upwards to form sensory component of
from one hemisphere pass to the other through, the the spinal nerve. Axons of neurons in the dorsal grey
lamina terminalis. So, it becomes thickened to form column enter marginal layer to form ascending tracts
commissured pla te. o f the spinal cord, and the axons of cells of neurons
• Anterior commissure: The first of the crossing bundles d eveloping in various parts of brain ente r the marginal
to appear is anterior commissure. It consists of fibres layer to form descending tracts.
connecting the olfactory bulb and related brain areas As the mantle layer forms the dorsal and ventral
of one hemisphere to those of opposite side. columns, the white matter becomes subd.ivided into
• Hippocampal or forn.ix comrnissure is the second to dorsal, ventral and lateral white columns.
appear.
• Corpus cal/0s11111: It is the most important commissure. Positional Changes of Spinal Cord
rt appears in the 10th week of development and During the 3rd month of intra uterine life, the spinal
connects non-olfactory areas of the right and left cord extends the entire length of e mbryo. Due to rapid
side. growth of dura mater and vertebral column as rela tive
• Optic chiasma: lt appears in the anterior wa ll of to the ne ural tube, the terminal end of spinal cord is
diencephalon and contains fibres from medial halves located, a t birth, at the level of 3rd lumbar vertebra.
of two retinas. This process of recession continues after birth, as a result
of which, in the ad ult, spinal cordl usually ends at the
Development of Spinal Nerve Roots uppe r border of 2nd lumbar or at lower border of 1st
Motor nerve begins to appear during the 4th week o f lumbar vertebra.
development, arising from nerve cells located in the Below this level, a thread-like extension of pia mater
basal lamina (ventral horn) o f spinal cord. Dorsal nerve forms filum terminale and is a ttached to the periosteum
roots form the collection of fibres arising from the cells of coccyx. Nerve fibres below the level of cord are called
of the d orsal root ganglia (spinal ganglion ). Central cauda equina (horse's tail).
processes from these ganglia form bund les that grow Beca use o f this recess ion of spinal cord , the
into spinal cord opposite the d orsal horns. Almost intervertebral fora men no longer lie at the level at which
immedia tely spinal ner ve divides into dorsa l and correspond.ing nerves emerge from the spinal cord. The
ventral ra mi. Dorsal primary rami supply dorsal axia l nerves run obliquely to reach their respective foramen.
musculature and skin of back. Ventral primary rami The obliquity is least in lower cervical region, gradually
supply limbs, ventral body wall and form major nerve increases a nd is more in lumbar, sacral and coccygeal
plexuses, i.e. cervical, brachia! and lurnbosacral plexuses. regions (Fig. 1.16).

L1 □~
L20J - -- Spinal cord

~ - - - - Lengthened root
of fourth sacral nerve
Dura mater
//i:.f--- - Arachnoid mater > - - - - - Filum te1rminale

(a)

Fig. 1.16: Ascent of the spinal cord: (a) in intrauterine life; (b) in adult
BRAIN- NEUROANATOMY

One advantage of this recession of spinal cord is Brain can be cut in the following planes:
when cerebrospinal fluid is tapped for diagnostic l Coro11al plrme: When brain is cut through dorsal and
purposes. During a lumbar puncture, the needle is ventral surfaces in the coronal plane (Fig. 1.18A to C).
inserted at the lower lumbar level, avoiding the lower
2 Horizontal pla11e: When it is cut from side to side
end of the cord.
(Fig. 1.18D).
Development of medulla oblongata, pons and mid-
brain is given in Chapter 5. Development of cerebellum 3 Sagittal plane: When brain is cut in relation to longi-
is incorporated in Chapter 6. tudinal axis, i.e. from anterior to posterior aspect
(Fig. 1.18E and F).
GROSS STUDY OF BRAIN 4 Oblique plane: When brain is cut at an angle from
Brain can be studied by viewing it from following sites cerebra l cortex down th rough the brain s tem
(Figs 1.17a to f). (Fig. 1.18G).

(c)

Anterior Anterior Dorsal

Left lateral + Right lateral Right lateral + Left lateral Anterior + Posterior

Posterior Posterior Ventral

(f)

Dorsal Dorsal Dorsal

Posterior + Anterior Right lateral + Left lateral Left lateral+ Right lateral

Ventral Ventral Ventral

Figs 1.17a to f : Various views of the brain: (a) Superior view, (b) ventral view, (c) medial view, (d) superolateral surface, (e) anterior
view, and (f) posterior view
INTRODUCTION

C B A

Coronal sections


Horizontal section

E F

Sagittal sections

-{

Oblique section

Fig. 1.18: Sections of brain in different planes: (A to C-coronal sections; D-horizontal section, E and F-sagittal sections;
G-oblique section
BRAIN- NEUROANATOMY

CLINICOANATOMICAL PROBLEM
• Neurons in human brain are about 180- 200 billion A m an aged 60 and his son aged 12 had injuries to
• Matu re neu rons do not div ide after birth except their a rm regjon and wris t regjon respectively in an
in olfactory regjon a nd in hippocampus. automobile acciden t.
• lf neurons di vid e one w ill have fleating memo ry. • Who will have better retu rn of functions?
• M ore e ffective regeneration w ill be in the father
• imp ulse travels from dendrite to cell bod y and then or son and w hy?
into axon
Ans. All repair occur faster in younger lhan older
• Contact be tween neurons is by contiguity (like
pe rsons. So the son's injury will heal earlier.
hand shake) an d n ot by continuity
More effective regeneration will be again in the
• Human has the largest cerebrum so far son as the injury is in a distal area. In a distal area, a
• Epen dymal cells are responsible for the forma tion few structures are left to be supplied; so there are
of cerebrospinal fluid. Astrocytes form the blood- less chances of innervating the wrong structures
brain barrier. during the reparative process.

FREQUENTLY ASKED QUESTION

1. Write short notes on: c. Pa rts of nervous system


a. Synapse d . Reflex arc
b. euroglia l cells e. Babinski's sign

MULTIPLE CHOICE QUESTIONS

1. Wha t nerve fibre convey impu lses toward s cell 6. N am e the type of neuroglial ce lls that aid regenera-
bod y of a neuron? tion by forming a regenera tion tube to help estab lish
a. Axon b. Dend rites firm connection.
c. Axon co lla terals d . Axon terminals a. Schwann cells b. Astrocytes
2. Myelin sheath on p eripher al nerves is contributed c. M icroglial d . Ependym al
by: 7. Wha t cells conduct m essage towards brain?
a. Axon itself b. Secre tory vesicles a. Motor neuron b. Sensory neu ron
c. Schwann cells d. Cell bodies o f neuron c. lnterneuron d. Ne uroglia
3. A neuron with many d endrites arising from cell 8. Myelin sheath is produced by:
body and ca rry ing impulses away from the neu ron a. euron
v ia the axon is: b. Axon
a. Multipola r c. Dendrite
b. Bipolar d . Schwann's cells/oligod endrocyte
c. Unipolar and sensory 9. The three regjons of brain s tem are:
d . Bipola r and m otor a. Cerebrum, dienceph alon , midbrain
4. The grey appearance of spinal grey m atter is due b. Pons, cerebellum, midbra in
to: c. Diencephalon, midbrain cerebrum
a. euronal body b. Neuroglia d. Midbrain, pons, medulla oblongata
c. Neurites d . Blood vessels 10. Three parts of hindbrain are:
5. Which type of cells helps regulate composition o f a. Cerebru m, pons, cerebe llum
CSF? b. Pons, med ulla oblongata, cerebellu m
a. Astrocyte b. Oligodendeocyte c. Pons, midbrain, cerebellum
c. Microglia d . Ependym al cells d . Thalamus, pons, cerebellum

ANSWERS
1. b 2. c 3. a 4. a 5. d 6. a 7. b 8. d 9.d 10. b
CHAPTER

2
Meninges of the Brain
and Cerebrospinal Fluid
,17,(' l,u,11a11 I 1ai11 rnn/a;,,., ,1n<>1r //,(111 /,',,'{/ A,lliou J l < tnt:,11.J .

~ll/r 11rfl .,,,,,., t'nr inlr,r,~111,rrlf'rl //, u 11:;I, flll r,1111171117 11rl1ro,I. 6/ /()()(){)()1J1i/;,, oj'11r1t·f' /fi1f',
-Anthony Robbins

INTRODUCTION Pull it on a horizontal plane. Thus, the fused endosteum


The brain is a very important delica te organ. It is and dura mater get separated from the underlying
protected by the fo llowing coverings. subarachnoid mater, pia mater and the brain.
1 Bony covering of the cran ium. Identify various venous sinuses between the
2 Three membranous coverings (meninges): endosteum and folds of dura mater. Underneath the
a. The outer dura mater (pachymeninx). dura mater and separated by a flimsy subdural space
b. The middle arachnoid mater. is the cobweb-like arachnoid mater. It is separated from
c. The inner pia mater. The arachnoid and pia are the underlying pia mater by the subarachnoid space,
together known as the leptomeninges. containing cerebrospinal fluid and blood vessels of the
3 The cerebrospinal fluid fills the space between the brain. Cranial nerves also pass through this space. Near
arachnoid and the pia maters (subarachnoid space) the superior sagittal sinus, arachnoid mater forms
and acts as a water cushion. arachnoid villi. The subarachnoid space is dilated
The brain a lmost floats in the cerebrospinal fluid around the brain stem and at the base of the brain
without putting "its weight" on the neck. The outermost forming the subarachnoid cisterns.
meninx, the dura ma ter not only separates the right a nd Cerebrospinal fluid formed by choroid plexuses flows
left cerebral hemis phere, but a lso partiti o ns the through the ventricles of the brain into the subarachnoid
cerebrum from cerebellum a nd hypophysis cerebri. In space to be absorbed via subarachnoid villi into the
addition, it e ncloses various venous sinuses. The CSF superior sagittal sinus.
forms watery cushions around the blood vessels to give
the m shock-free env ironment. DURA MATER
The cerebral dura (Latin hnrd mother) mater has been
THE MENINGES studied in detail with the head and neck in Chapter 12,
Volume 3. However, it may be recapitulated that it is
DISSECTION made up of two layers, an outer endosteal layer and an
Cut through the fused endosteum and dura mater on inner rn.eningeal layer, enclosing the cranial venous
the ventral aspect of brain from the inferolateral borders sinuses between the two. The menjngeal layer forms
extending along the superolateral margin. Pull upwards four fo ld s wh ich di v id e t h e cran ia l cavity into
the endosteum along with the fold of dura mater present intercommunicating compartments for different parts
between the adjacent medial surfaces of cerebral of the brain (Figs 2.1 and 2.2 and Table 2.1).
hem ispheres , extending from the frontal lobe till the
ARACHNOID MATER
occipital lobe. This is falx cerebri. Pull backwards a
similar but much smaller fold between two adjacent The a rachno id (La ti n cobweb like) mater is a thin
lobes of cerebellum-the falx cerebelli. transparent membran e that loosely surrounds the brain
Separating the ce rebrum and the cerebellum is without dipping into many of its sulci. Thus, it bridges
another fold of dura mater called the tentorium cerebelli. all irregula rities of the brain. It enters following sulcus /
fissure.
19
BRAIN-NEUROANATOMY

.. ' .
Superior border of falx cerebri _ _ _ __,,,, •• •• .,,-.• • :•.~•!•: :.f ,!, ,• I
: ••• 4 ... _.
••, • . ,. •• r
~. \

- Tentorial notch

Anterior end of falx cerebri - Posterior end of


falx cerebn

Tentorium cerebelli - - - - - - - - - - - - - -

Foramen magnum - - - - - - - - - - - - - - ~

Fig. 2.1: Various folds of meningeal layer of dura mater

Table 2.1: The meningeal layer sends inwards following folds of dura mater
Folds Shape Attachments Venous sinuses enclosed
Faix cerebri Sickle-shaped, separates the Superior, convex margins are attached to Superior sagittal sinus
(Fig. 2.1) right from left cerebral sides of the groove lodging the superior
hemisphere sagittal sinus
Inferior concave margin is free lnfmior sagittal sinus
Anterior attachment is to crista galli and Straight sinus
frontal crest
Posterior attachment is to upper surface
of cerebelli tentorium
Tentorium cerebelli Tent-shaped, separates the Has a free anterior margin. Its ends are Transverse sinuses,
cerebral hemispheres from attached to anterior clinoid processes superior petrosal sinuses
hindbrain and lower part of Rest is free and concave
midbrain Posterior margin is attached to the lips of
Lifts off the weight of occipital groove containing transverse sinuses,
lobes from the cerebellum superior petrosal sinuses and to posterior
clinoid processes
Faix cerebelli Small sickle-shaped fold partly Base is attached to posterior part of inferior Occipital sinus
separating two cerebellar surface of tentorium cerebelli
hemispheres Apex reaches till foramen magnum
Diaphragma sellae Small horizontal fold Anterior attachment is to tuberculum sellae Anterior and posterior
Posterior attachment is to dorsum sellae; inteircavernous sinuses
laterally continuous with dura mater of
middle cranial fossa

1 The stem of lateral sulcus where it is pushed by lesser Prolongations


w ing of sphenoid. 1 It p rovides sheaths for the cranial n erves as far as
2 The longitudinal cerebral fissure where it is carried their exit from the skull.
in by falx cerebri. 2 Arachnoid villi are small, finger-like p rocesses of
3 It cannot be id entified in the hypophyseal fossa. arachnoid tissue, projecting into the cranial venou s
sinuses. They absorb CSF. With ad vancing age, the
Relations arachnoid villi enlarge in size to form pedu nculated
It is se parated from the dura by the subdural space, tufts, called arachnoid granula tions. These granula-
and from the pia by the suba rachnoid space containing tions may produce d epressions in bone (Figs 2.3
cerebrospinal fluid (CSF) and blood vessels. and 2.4).
MENINGES OF THE BRAIN AND CEREBROSPINAL FLUID

Superior

Posterior + Anterior
Inferior
- -- - - - -- - Outer endosteal
layer of dura mater

-= ~ - - ~ .:----,--- Branches of middle


meningeal artery

Fig. 2.2: Endosteal layer of dura mater

Superior

Posterior + Anterior
Inferior

l.".:'.C"-c=:-""-:=- -__,,_--;------.-:-- - - Blood vessels in


subarachnoid space
Arachnoid mater- --
covenng brain

- - - Skull

Dura mater

Fig. 2.3: Arachnoid mater

PIA MATER 3 Folds of pia mater enclosing tufts of capillaries form


The pia (La tin loving mother) ma ter is a thin vascula r the telnchoroidea. Such pia mater lined by secretory
membra ne which closely invests the brain, dipping into ependyma form the choroid plexus.
various sulci and o ther irregularities of its smface. It
comprises epi-pia a nd pia-glia. On the cerebellum pia EXTRADURAL (EPIDURAL) AND SUBDURAL SPACES
mater dips and forms folds in relation to larger fissures The extradural or epidural space is a potentia l space
of cerebellum . It is pierced by blood vessels to nourish between the inner aspect of skull bone a nd the end osteal
the b rain and spinal cord (Figs 2.4 and 2.5). layer of du ra mater. Vertebral epid ura I space is present
between vertebral column and spinal duramatar. The
Prolongations subdural space is also a potential space between the
1 It provides sheaths for the cranial nerves merging dura and arachnoid ma ters. These become actual spaces
with the epincu rium around them . in pathological conditions. The s ubdura l space is
2 lt also provides perivascular sheaths for the minute traversed by cerebral veins on their path for draining
vessels entering and leaving the brain substance. into dural venous sinuses.
BRAIN-NEUROANATOMY

Emissary vein

r - -- - Dura mater

Arachnoid granulation - -- - - - - - ~
Cerebral
hemisphere

Fig. 2.4: Arachnoid granulation

Blood vessels in- - ---..::- .,,...~:r"'""'.


subarachnoid space

Superior

Posterior + Anterior
Inferior

Fig. 2.5: Pia mater

SUBARACHNOID SPACE perivascular spaces are separated by laye r o f pia matter.


This is the space between the arachnoid an d the pia Sp ace be tween the nervous tissu e a nd fo ld of p ia
maters. It is traversed by a network of a rachnoid trabe- mater with ar terioles is known as Virch ow-Robin's
per ivascula r space.
culae which give it a sponge-like appearance (Fig. 2.5).
lt surrounds the b rain and spinal cord, and ends
Cisterns
below a t the lower bo rder of the second sacral vertebra.
At the base of the brain and around the brainstem, the
TI1e subarachnoid space contains CSF, and large vessels s u barach noid s p ace fo rm s inte rcommunica ting
of the brain. Cranial nerves pass through the space. pools, called cisterns (Latin reservoir). These reinforce
La rger arteries lie in s ubar achnoid sp ace. Smaller the protective effect of CSF on the vita l centres situa ted
on es carry sh eaths of pia. Subarachnoid sp ace a nd in the med ulla. The subarachn oid cisterns are as follows.
l Crrel1rl/0111ed11/lnry cistern or cistema 111ag11a: ft is the
MENINGES OF THE BRAIN AND CEREBROSPINAL FLUID

lobes. The cistern is continuous with the sub-


1
...J
largest cistern lying in the angle between medulla arachnoid spaces a round anterior, middle and
oblongata, cerebellum and occipital bone. It is posterior cerebral a rtery. It contains:
triangular in section. rt bridges the interval between 1. The optic ch.iasma
inferior surface of cerebellum and medulla oblongata 2. The bifurcation of the basilar artery.
(Figs 2.6a and b). It receives CSF from the fourth 3. Peduncular segments of the PICA.
venh·icle via the median foramen of Magendie and 4. Peduncular segments of the superior cerebellar
the paired la teral foramina of Luschka. The cerebello- arteries.
medullary cistern contains: 5. Perforating branches of the PICA.
1. The vertebral artery and the origin of the postero- 6. The posterior communicating arteries (PCoA).
inferior cerebellar artery (PICA). 7. The basal vein of Rosenthal.
2. The ninth (IX), tenth (X), eleventh (XI) and twelfth 8. The third (111 ) cranial nerve, which passes
(XII) cranial nerves. between the posterior cerebral and superior
3. The choroid plexus. cerebellar arteries.
2 Cisterna po11tis: It is present on the ventral aspect of 4 Cistern of lateral s11lcus: Tt lies in front of each temporal
pons. lt is continuous with interpeduncular cistern pole and is formed due to bridging of arachnoid
cranially, with cerebcllomedullary cistern behind and mater over the lateral sulcus. Th.is cistern contains
with spinal subarachnoid space caudally. It contains: middle cerebral artery.
1. The basilar artery and the origin of the a ntero- 5 Cistern of great cerebral vein (cisten,a a111/1iens): Th.is
inferior cerebellar artery {AICA). cistern lies in the space between splenium of corpus
2. The origin of the superior cerebellar arteries. ca llosum and superior surface of cerebellum. lt
3. The sixth (VI) cranial nerve. contains pineal gland and great cerebral vein of Galen.
3 l11terped11nc11/nr cistem: This is a large cistern as the 6 Lumbar cistem: This is a large subarachnoid space in
arachnoid mater passes across the two temporal the lumbar region of the vertebral column distal to

,./""""-- - - - - Arachnoid granulation

Choroid plexus of - -~
third ventricle
~h ~ - +--~----. .. - - - - - - - Superior sagittal sinus
...,,~.....~~-'-t\.:..._,_....
----- _ __Arachnoid mater
A ~ ~ - - - Subarachnoid space
Choroid plexus of - -f+fH' - - - - - i~ -- - ,
lateral ventricle
.......~ - - Pia mater
Foramen of Monro-~ t\--t--;;:..:_~ ~~~~c.,:::-~,._., ,---;c,..-:..,.-- .....- .,~ - Great cerebral vein
(interventncular)
- - Cistern of great cerebral
vein (cisterna amb1ens)
lnterpeduncular - - - - -= =H--\t--J'I-/ ,,,
cistern

Lateral aperture - - - '-':c;~ ~ - -- - Cerebellomedullary cistern


(foramen of Luschka) (c1sterna magna)
' - - - - - - -- Median aperture
C1sterna pontis - -~
(foramen of Magend1e)

Choroid plexus o f - - - -~
fourth ventricle

Fig. 2.6a : Various cisterns of the brain including formation , circulation and absorption of cerebrospinal fluid
BRAIN-NEUROANATOMY

- lnterpendicular Lumbar puncture is the easiest method and is


cistern commonly used.
- Cistern of great
It is done by passing a need le in the interspace
cerebral vein between the third and fourth lumbar spines.
• Biochemical analysis of CSF is of diagnostic value
in various diseases.
Cisterna pontis • Papilloedema: The subarachnoid space sends
extensions along the optic nerves till the back of
eyeball. Increased CSP pressure compresses the
IV ventricle wall of retinal vein leading to forward bulging of
optic disc with oedema of the disc. Oedema of the
Cisterna magna optic disc is known as pnpilloedema. It can be
viewed by an ophthalmoscope.
• Lumbar epidural space: The epidural space is the
space between vertebral cana l and dura mater.
The procedure is same as lumbar puncture, the
needle should reach onJ yin the epidural space and
Fig. 2.6b: MRI depicting the cisterns
not deep to it in the dura mater. Epidural space is
the termination of the spinal cord. In the space utilized for giving anaesthesia or analgesia.
between L3 and L4 (which is part of the lumbar • Inflammation of pia mater and arachnoid mater
cistern), lumbar puncture is done to obtain a sample is known as meningitis. This is common ly
ofCSF. tubercular or pyogenic. It is characterised by fever,
The arterial pulsations within the cisterns help to marked headache, neck rigidity, and a changed
force the CSF from the cisterns onto the superolateraJ biochemistry of CSF.
surface of the hemispheres. The cisterns themselves
form cushions around the medulla.
CEREBROSPINAL FLUID (CSF)
Communications
The s ubarachnoid space communicates with the The cerebrospinal fluid is a modified tissue fluid. lt is
ventricular system of the brain at: contained in the ventricular system of the brain and in
1 A median fora men of Magendie. the subarachnoid space around the brain and spinal
2 Two lateral foramina ofLuschka, situated in the roof cord. CSF replaces lymph in the CNS (Fig. 2.6a).
of the fourth ventricle. The CSF passes th.rough these
foramina from the fourth ventricle to the sub- FORMATION
arachnoid space. 1 The bulk of the CSF is formed by the choroid plexuses
of the lateral ventricles and lesser amounts by the
Prolongations choroid plexuses of the third and fourth ventricles.
1 The space is prolonged into the arachnoid sheaths 2 Possibly, it is also formed by the capillaries on the
around nerves where it communicates with the surface of the brain and spinal cord.
neural lymphatics, particularly around the first, The total quantity of CSF is about 150 ml. it is formed
second and eighth cranial nerves. at the rate of about 200 ml per hour or 5000 ml per day.
2 The space al o extends into the pial sheaths around The normal pressure of CSF is 60 to 100 mm of water.
the vessels entering the brain substance (perivascular
space). Thus, CSF comes into direct contact with CIRCULATION
nerve cells.
CSF passes from each lateral ventricle to the third
ventricle through the interventricular foramen of Monro.
CLINICAL ANATOMY From the third ventricle, it passes to the fourth ventricle
• CSF can be obtained by: through the cerebral aqueduct. From the fourth ventricle,
a. Lumbar punctu re the CSF passes to the subarachnoid spaces of the cere-
b. Cisternal pw,cture brum and the vertebral canal through the median and
c. Ventricular puncture. lateral a pertures of the fourth ventricle (Flowchart 2.1).
Some of it passes down the cenh·al canal of spinal cord.
MENINGES OF THE BRAIN AND CEREBROSPINAL FLUID

Flowchart 2.1: Circulation of cerebrospinal fluid (CSF) 5 A major function of CSF is to cushion the brain with.in
Forms in lateral ventricles
its solid vault. The brain and CSF have approximately
the same specific gravity, so that the brain simply
floats in the flu id.
lnterventncular foramen
6 There is no CSF brain barrier, so drugs can reach the
Ill ventricle
neurons throug h CSF.
7 There is blood CSF barrier. Therie are no antibodies in
Aqueduct of midbrain
C S, making infections of brain very serious entity.

IV ventricle
CLINICAL ANAT


Central
canal of

3 apertures in roof-one median and two lateral
• Drainage of CSF at reg ular intervals is of thera-
peutic value in meningitis. Certain intractable
headaches of unknown aetiology are also known
spinal cord
Open in to have been cured by a mere lumbar pun cture


Subarachnoid
space around

Cerebellomedullary cistern
and pontine cistern,
with d rainage of CSF.
• Obstruction in the vertebral canal produces Froin's
syndrome or locu/ation syndrome. This is charac-
spinal cord and i.e. subarachnoid spaces in cranial cavity terised by yellowish d isco loura tio n o f CSF
cauda equ1na (xanthochromia) below the level of obstruction,
Tentorial notch and its spontaneous coagulation after w ithdrawal
d ue to a high p rotein content. Hiochemical examin-
Veins of spinal cord j Inferior surface of cerebrum ation of such fl uid reveals that the protein content
is raised, b ut the cell content: is normal. This is
Superolateral surface of cerebrum known as albuminocytologic dissociation.
• Hydrocephalus: It is the d ilatation of the ventricular
Arachnoid granulations system and occurs d ue to obstruction of CSF
circulation. It may be of the following types:
Absorption j a. Comm1111icating: If the obstruction is ou tside the
+
Superior sagittal sinus l
ventricular system, usually in the subarachnoid
space or arachnoid granulations, it is termed
as communicating. This occurs d ue to fi brosis
ABSORPTION following meningitis. It is also called external
hydrocephalus.
1 CSF is absorbed ch iefly thro ugh the arachnoid vil li
Clinical fea tures are:
and granulations, and is thus drained in to the cranial
- Head size is rather large.
venous sinuses.
- Tense anterior fontanelle
2 It is also absorbed partly by the perineural lymphatics - Dilated veins over thin scalp.
around the first, second and eighth cranial nerves. b. Non-comm1111icnting: lf the obstruction is within
3 It is also absorbed by veins related to spinal nerves. the ventricular system . It is called n on-
communicating or internal h ydrocephalus. This
FUNCTIONS OF CSF is usually caused by a tumour or inflammation
1 CSF decreases the sudden pressure or forces o n (Figs 2.7a and c). A shunt pmced ure is employed
delicate nervous tissue. to divert the CSF from the ventricular system
2 CSF nourishes nervous tissue. Only CSF comes in
into the peritoneal cavity.
contact with n e u rons. Even blood cannot directly com e
in contact with ne urons. lt provides nourishment and
returns products of metabolism to the venous sinuses. Mnemonics
3 Neurons cannot live without glucose and oxygen for PAD
m o re t ha n 3-5 min utes . These arc cons ta ntly P - Pia mater
provided by CSF.
A - Arachnoid mater
4 Pineal gland secretions reach pitu itary gland via
D - Dura mater
CSF.
BRAIN- NEUROANATOMY

Figs 2.7a to c: (a) Hydrocephalic child, (b) normal ventricles, and (c) dilated ventricles in hydrocephalic child

CLINICOANATOMICAL PROBLEM
• Ci s te rns conta in inc reased am ount of CSF to An infant of 3 m onths was b rought to a neurologist
protect the big veins, circle of Willis, e tc. for abn ormal large size of her head with differently
• CSF is present outs ide the brain in the s ub- looking eyes. On examination, she showed large and
arachnoid s pace; within the brain in its ventricles . tense fontanelles.
Thus, the brain is floating in CSF and its weight is • What are the various types of this condition?
not felt by the person. Ans: The condition is called hydrocephalus. It is due
• Ce rebrospina l fluid is present in the central cana l to blockage of flow of CSF. If excessive CSF collects
of s pinaJ cord and in subarachno id sp ace around within, ventricular system, it is called internal hydro-
the spinal cor d. cephalus.
• Incre ased formation or d ecreased a bsorption If excessive fluid collects in the subarachnoid
or any obs truction in its flow lead s to hydro- space, it is called external hydrocephalus.
cephalus. The treatment is surgery.

FREQUENTLY ASKED QUESTIONS

1. Describe the folds of meningeal layer of dtua mater 3. Write sh ort notes on:
under the following headings: ame, shape, a. Formation and circulation of CSF
attachments, and venous sinuses enclosed. b. Arachnoid granulations
2. Describe the various cisterns of the brain. c. Lumbar puncture

MULTIPLE CHOICE QUESTIONS

1. Which sequence lists cranial meninges in order 3. Largest of cranial dural partition is:
from superficial to deep? a. Sella turcica
a. Pia, arachnoid, dura b. Falx cerebri
b . Dura, pia, arachnoid c. Tentorium cerebelli
c. Dura, arachnoid, pia
d. Falx cerebelli
d . Arachnoid, dura, pia
4. Dura and arachnoid extend up to the lower border
2. In region where two layers of dura mater separate,
of which vertebra?
the gap between them contains:
a. Dural venous sinus a. 2nd lumbar
b. Epidural veins b. 3rd lumbar
c. Subdural fluid c. 2nd sacral
d. Subarachnoid fluid d. 5th sacral
MENINGES OF THE BRAIN AND CEREBROSPINAL FLUID

5. CSF perform which of the following functions? a. Lateral apertures


a. Provide buoyancy for brain b. Median aperture
b. Cushion neural structure from s udden jerks c. Araclrnoid vi lli
c. Deliver nutrition and ch emical messengers d. Arachnoid trabeculae
8. Blood-brain barrier of CNS is missing or markedly
d. All of the above
reduced in which of the following locations?
6. Which structure produces CSF in each ventricle? a. Spinal cord and cerebellum
a. Choroid plexus b. Pituitary gland and thalamus
b. Arachnoid villus c. Choroid plexus, pons and medulla oblongata
c. Arachnoid granulation d. Choroid plexus, hypothalamus and pineal g land
d. Diaphragma sellae 9. How much is the total volunw of CSF in ml?
7. From sub arclrnoid space, CSF fl ows into dural a. 50 b. 100
venous sinus through: c. 150 d. 275

ANSWERS
1. c 2.a 3.b 4. c 5. d 6. a 7. c 8.d 9. c
CHAPTER

3
Spinal Cord
/J'ofl,r~11e r<111 n e,H:.:J/ ,~ftlo~e [l-tt?y ,ca,r
- Anonymous

INTRODUCTION
The spinal cord is the longcylindricallower part of central
nervous system. It is the main pathway for information
Subarachnoid - ---'~ ,
connecting the brain and peripheral nervous system. It space
occupies upper two-thirds of vertebral canal and is
enclosed in the three meninges. It gives rise to 31 pairs
of spinal nerves and retains the basic structural pattern.

DISSECTION Subdural · --+---=-~


space

u
Study the spinal cord after it was removed from vertebral
canal (see Chapter 11 , Volume 3) and separated from
the dura mater and arachnoid mater. Identify the dorsal
root by the presence of dorsal root ganglion or spinal
ganglion. Note the position of cervical enlargement in Arachnoid ·
the upper part and lumbosacral enlargement in the lower mater Pia mater
part. See the numerous nerve roots surrounding the filum enclosing the
spinal cord
terminale forming the cauda equina (Figs 3.2 and 3.3).
Cut transverse sections of spinal cord at cervical, Fig . 3.1 : Spinal cord with its meninges
thoracic, lumbar, and sacral regions to note the shape
a nd size of the horns in rel ation to white matter position of a spinal segment in relation to the surface
(Table 3.2) . o f the body, it is important to remember tha t a vertebral
spine is always lower than the corresponding spinal
segmen t. The level of spinal segment w ith their
Features vertebral lev1el is shown in Table 3.1.
The spinal cord is 18 inches or 45 cm in an adult male
and 42 cm in adult female. The weigh t of spinal cord MENINGEAL COVERINGS
is 30 g . It is surrounded b y the three meninges The spinal cord is surrounded by th ree m eninges. The
(Fig. 3.1). outermost is t:he dura mater, the middle one is arach noid
It extends from upper border of atlas vertebra to the
lower border of first lumbar vertebra in an adult. ln Table 3.1 : LE?vel of vertebral levels and spinal segments
children, it extends up to L3 vertebra. Superiorly, it is Vertebral levi~ls Spinal segments
continuous with the medulla oblongata, inferiorly it C1-C7 C1- C8
terminates as conus mcdullaris (Fig. 3.2 and Table 3.1). T1- T6 T1-T8
As the spinal cord is much sho rter than the length of TT-T9 T9-T12
the vertebral column, the spinal segments do not lie T10- T11 L1- L5
T12- L1 S1-S5 and Co1
opposite the corresponding vertebrae. In estimating the
28
:SPINAL CORD

mater and the innermost is the pia mater. The space at appropriate levels form enlargements to be able to
between dura mater and arachnoid mater is called supply increased musculature. It presents
subdural space. The arachnoid and pia maters are a. Cervical enla rgement for supply of upper limb
separated by subarachnoid space which contains muscles. This extends from C4 to Tl spinal
cerebrospinal fluid (Fig. 3.1 ). The medical procedure segments with maximum diameter of 38 mm a t
known as a lumbar puncture or spinal tap involves use level of C6 segment (Fig. 3.2).
of a needle to withdraw cerebrospinal fluid from the b. Lumbar enlargement for supply of muscles of lower
subarachnoid space, usually from the lumbar region limb. It extends from level of L2 to S3 segments. Its
of the spine. maximum diameter is35 mmat level of Sl segment.
The spinal cord extends in the lower part of 1st
lumbar vertebra as con11s medullaris. Below the level of CAUDA EQUINA
conus medullaris only pia mater is continued as a thin Dorsal and ventral nerve roots of right and left sides of
fibrous cord, the filum terminate. L2 to LS, 51 to S5 and Col nerves lie almost vertically
The spinal cord is enclosed only by the meningeal around filum terminale (Fig. 3.3). These are called cauda
layer of dura mater. The space between the meningeal
layer and endosteum of the vertebral canal is called
epidural space, where epidural anaesthesia ca n be
given. The epidural space is filled with adipose tissue,
•---~
lntervertebral foramina

and it contains a network of blood vessels. Cervical


The spinal pia mater undergoes modification as roots 1-8
Cervical - - - - .-=;1-f
follows to keep the spinal cord in position during the enlargement
movements of the vertebral col umn. (C4-T1 )
a. Ligamenta denticula ta are 21 pairs of teeth-like
projections. They fu e laterally with the arach-
noid and dura mater midway between the exits
of the roots of adjacent spinal nerves. The highest
process attaches immediately superior to foramen
magnum. The Ligamentum denticulatum keeps the
spinal cord in position. Thoracic
b. Linea splendens is a thickening seen at the antero- roots 1- 12
median sulcus in the lower part of the spinal cord.
c. The filwn terminale is 20 cm long and after leaving
through sacral hiatus ends by getting attached to
the periosteum of dorsal surface of first segment
of coccyx. It consists of two parts: Lumbar - ~-
• Filum termina te internum, the upper part enlargement
(L2-S3)
which is 15 ems long which extends up to lower
border of second sacral vertebra.
• Filum termina le extcrnum, the lower part
which is outside the dura mater and is attached Lumbar
roots 1-5
to the fi rst segment of the coccyx. Between the
lower border of L1 and 52 vertebrae, the Cauda equina - -...,C.=7-/JUfj
(L2 to Co1)
subarachnoid space contains spinal nerve roots
which constitute the ca uda equina. lt is due to
this feature tha t lumbar puncture is done below
Sacrum
L2 vertebra without any danger to spinal cord.
The dura and arachnoid along with s ubarachnoid Sacral
roots 1-5
space containing CSF extend up to 2nd sacra l vertebra.

ENLARGEMENTS
- Coccygeal root
Lin1bs form the appendages of the trunk. Their muscles
have to be supplied by neurons of spinal cord. Neurons Fig. 3.2: The spinal cord with 31 pairs of spinal nerves
BRAIN-NEUROANATOMY

- - - - - Posterior The dorsal horn is fow1d at all spinal cord levels and
median sulcus
is comprised of sensory neuron that receive and process
Posterolateral -A- I----__,,.---- - Posterior incom ing soma tosensory information. From there,
sulcus median septum
ascending projections emerge to transmit the sensory
Posterior - ...,,::....->.,-., _ ,4..---=::,.~- Posterior
horn funiculus information to the d iencepha lon. The ventral ho rn
Lateral horn~- - Lateral
comprises motor neurons that innervate skele tal
funiculus muscle. Nerve cells in the grey substance are multi polar,
Anterior horn G-- --,~ - - - J L - Central varying much in their morphology. Many of them are
canal Golgi type I and Golgi type II nerve cells. The axons of
Anterolateral Golgi type 1 are long and pass ou t of the grey matter
sulcus into the ventral spinal roots or the fibre tracts of the
White white matter. The axons and dendrites of the Golgi type
median fissure
commissure II cells are largely confined to the neighboring neurons
Fig. 3.3: Transverse section of thoracic segment of spinal cord
in the grey matter.
Shape and size of the horns differ in different seg-
eguina as these resemble a horse's tail. Dorsal and ventral ments due to fun ctional reasons (Figs 3.4a to e) and
nerve roots of one segment join together at respective shown in Table 3.2.
intervertcbral foramen to exit as the spinal nerve. There
are 40 nerve roots at the beginning of ca uda eq uina . CLINICAL ANATOMY
These are dorsal and ventral nerve roots of right and left
sides fo r each segment. So each segment has 4 nerve • Con us med11/laris syndrome: Due to injury to S2, S3,
roots. Thus, there are 4 x 4 = 16 lumbar nerve roots; 4 x 5 S4 segments of spinal cord. Features are:
= 20 sacral nerve roots and 4 x 1 =4 coccygea l nerve roots, a. Anaesthesia in the perineu m. The region is
makin g it to 40 nerve roots. One dorsal root and one su pplied by these three segm ents.
ventral root joins to form o ne spinal nerve and b. Involvement of bladder and bowel is early S2,
(Fig. 3.3) leaves through the foramen on one side. So at S3, S4 segm ents carry sacral componen t of the
every inten ,ertebral foramen 4 nerve roots exit the cauda parasympathetic system which supplies the
equina; leaving it thinner. In the end only filum tenninale bladder and lower bowel.
remains to be attached to the coccyx. c. Sexual functions are affected as same nerves
EXTERNAL FEATURES OF SPINAL CORD carry o ut sexual functions as weU.
Anteriorly, the spinal cord reveals a deep an terior • Cn11da equina syndrome: Damage to cauda equina
median fissure lodging the anterior spinal artery. results in:
Posterior median sulcus is a thin longitudinal g roove a. Lower m oto r neuron type of paralysis in the
from which a septum runs in the depth of spinal cord lower limbs d ue to compression of ventraJ nerve
(Fig. 3.3). roots.
Each half is subdivided into anterior, lateral and b. Root pain is a n important symptom d ue to
posterior regions by anterolateral and pos terolateral involvement of d orsal nerve roots.
sulci. Ventra l or motor nerve roots emerge from the c. Bladder and bowel involvem en t is late.
anterolateral sulcus. Dorsal or sensory nerve roots enter • Poliomyelitis: It is a viral d isease which involves
spinal cord from posterolateral suJcus. anterior horn cells leading to flaccid paralysis of
the affected segments. It is a lower motor neuron
INTERNAL STRUCTURE paralysis (Figs 3.5 and 3.6).
White m a tter, i.e. nerve fibres lie outside and grey If poliomyelitis affects the upper cervical segments
matter lies inside. In the centre of grey matter is the of spinal cord, it m ay be fatal becau se of the
centra I canal containing CSF (Fig. 3.3). The canal is lined involvement of C4 segment which s upplies the
by single layer of ependymal cells. diaphragm through phrenic nerve.
The grey matter is in the form of " H" w ith a grey • Tabes dorsa/is (Fig. 3.6): It occurs during tertiary
commis ure joining the grey matter of right and left stage of syphilis. There is degenerative lesions
sides. of dor al nerve roots and of posteri or whi te
Grey matter comprises one posterior horn and one columns. Its fea ture is severe pain in lower limbs,
anterior horn on each side in the entire extent of the as the disease occur s in lower thoracic and
cord. Only in T1-L2 and S2-S4 segments, there is an lu mbosacr al segm ents . T he lower limbs a re
additional lateral horn for the supply of the viscera. mainly affected.
This horn is a part of autonomic nervous system.
SPINAL CORD

Grey commissure - - -~
,--- - - Substantia gelat1nosa
Posterior grey column - --

Third cervical
segment
Accessory nucleus for innervation of
sternocle1domastoid and trapezius muscles

(a)

~ -.,,..- -- Substantia gelatinosa


/•)I---- " ' , - - - Nucleus proprius
Lateral white column
Sixth cervical r-.....-r-+-- Lateral group for innervation
segment of upper limb muscles

Medial group for innervation


of neck muscles

1111'-----',--- - - Nucleus proprius


Sixth thoracic
segment Nucleus dorsal1s
I I ! ' - - - - - ! -- - -

-......___,.'----- Preganglionic sympathetic outflow

Antenor grey column - - -~ -......__ _ _ _ Medial group for innervation


(c) of trunk muscles

Second lumbar a+--- ' , . - -- Nucleus proprius


segment • ----'.::-----+-- - Nucleus dorsalis
Medial group for -->.-+ - --++f--'IA - 1---- Lateral group for innervation
innervation of of lower limb muscles
trunk muscles

(d)
- - - - Substantia gelatinosa

--.'-----'\ - - ---Nucleus propnus


Third sacral
segment Preganglionic parasympathetic outflow
Medial group for - ----'f-+--+l+-'ll!III
innervation of S''-1---- - Lateral group for innervation
trunk muscles of lower limb muscles

Figs 3.4a to e: Features of spinal c ord at various levels

Table 3.2: Shape of horns in different segments of spinal cord


Segments of spinal cord Posterior horn Lateral horn Anterior horn
Cervic al , oval shape Slender Absent Narrow in 1- 3 s egments
(Fig. 3.4) Broad in C4 to CB segments for supply
o f upper limbs
Thoracic, circular shape Slender Present for th oracolumbar outflow Slender in T2- T12 segments, broad in
T1 segment
Lumbar, circular shape Bulbous Present only in lumbar 1 and 2 segments Bulbous for supply of lower limbs
Sac ral , circular but s maller Thick Present in sacral 2-4 segments for Bulbous for supply of lower limbs
sacral outflow
BRAIN- NEUROANATOMY

Branches of a Typical Nerve


Dorsal Ramus
It supplies the dorsal one-third of the body wall. Dorsal
rami do not supply the limbs (Fig. 3.7).

Ventral Ramus
rt supplies the ventral two-thirds of the body wall
including the limbs (Fig. 3.7).

SPINAL SEGMENT
Segment or part of spinal cord to which a pair of dorsal
nerve roots (right and left) and a pair of ventral nerve
roots is attached is called a spinal segment.
Since length of spinal cord (45 cm) is smaller than
the length of vertebra l column (65 cm), the spinal
segments do not correspond to the vertebral levels.
Spinal segm ents being shorter li e above the
corresponding vertebrae (Table 3.1).
Fig. 3.5: Poliomyelitis of right lower limb
During the third month of embryonic development,
the spinal cord extends the entire length of the vertebral
Degenerative lesions of dorsal nerve can a l and both grow at about the same rate. As
root and posterior column (tabes dorsalis) development continues, the body and the vertebral
colunm continue to grow at a much greater rate than
the spinal cord proper. The outcome of this uneven
growth is that the adult spinal cord extends to the level
of the first or second lumbar vertebrae, and the nerves
grow to exit through the same intervertebral forarnina
as they did during embryonic d evelopment. This
growth of the nerve roots occurring w ith in the vertebra 1
canal, resu lts in the lumbar, sacral, and coccygeal roots
extending to their approp riate vertebral levels. All
spinal nerves, except the first, exit below their
corresponding vertebrae.

NUCLEI OF SPINAL CORD


Poliovirus infects anterior
horn cells poliomyelitis The grey matter of spinal cord is arranged in three
horns. Anterior is motor, lateral being visceral efferent
Fig. 3.6: Tabes dorsalis and poliomyelitis
and afferent in function, and posterior is sensory in
function.
SPINAL NERVES
Nuclei in Anterior Grey Column or Horn
Spinal nerves arise in pairs. There are 31 pairs of spinal
nerves as 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and The anterior horn is divided into a ventral part, the head
1 coccygea l (Fig. 3.7). and a dorsal part, the base. The nuclei in anterior horn
Each spinal nerve arises by a series of six to eight innervate the skeletal muscles. Most prominent neurons
dorsal and ventral nerve rootlets. These rootlets unite are alpha neurons. Their axons leave the spinal cord
in or near the intervertebral foramen to form the spinal through ventral ner ve roots to innerva te skele tal
nerve. muscles. Smaller neurons are gamma neurons. These
supply intrafusal fibres of muscle spindles. The cells in
Dorsal Root Ganglion the anterior horn are arranged in the following three
As the dorsal rootlets converge, there is a swelling, main groups.
the d orsal or posterior root ganglion (Fig. 3.7), which 1 Medial group: It is present throughout the entire
houses the cell bodies of all the sensory neurons in that extent of spinal cord and innervates the axial muscles
particular nerve. The neurons are pseudowupolar type. of the body (Fig. 3.8).
:SPINAL CORD

Lateral branch - -- - - - = -- -- ->.,


Dorsal ramus - ------,.-- -- - ~
-+_.,,.,_-----1-- - Transverse section
of spinaI cord

~ - - - -- - ¼ n~l ramw

Grey ramus comrnunicans

' - - - - - - - - - - Sympathetic ganglion


Lateral cutaneous branch
White ramus
communicans

Fig. 3.7: Typical spinal nerve

Fig. 3.8: Cell groups in spinal cord

2 l.Jrteml group: Present only in the cervical and lumba r 3 Central group: Only in upper cervical segments as
enlargements and supplies musculature of limbs. Tt p hrenic nerve n ucleus and nucle us of spinal root of
is subdivided into three subgroups. accessory nerve.
a. Anterola te ral su pplying proximal mu scles of
Nuclei in Lateral Horn
limbs (sh o ulde r an d a rm / gluteal region a nd
thigh) (Fig. 3.4). N uclei in lateral horn a re as follows:
1 lntermediolateral 11uclc11s: This acts as bo th efferent and
b. Posterolateral supplying intermediate muscles of afferent nuclear columns. This nucleus is seen at two
limbs (forearm / leg). levels.
c. Post-posterolateral innervating the distal segmen t a. From Tl to L2 segments, giving rise to p rega.nglionic
(ha nd / foot). sympathetic fibres (thoracolumba r outflow).
BRAIN- NEUROANATOMY

b. From S2 to S4 segments, giving rise to pre- whereas laminae V and VI are concerned primarily with
ganglionic parasympathetic fibres chiefly for the proprioceptive sensations. Lamina VII is equivalent to
pelvic viscera (Fig. 3.4). the intermediate zone and acts as a relay between
At these two levels, the interm.ediolateral cell column muscle spind le to midbra in and cerebellum, and
receives visceral afferent fibres. laminae VTIT-IX comprise the ventral horn and contain
2 Intermediomedial nucleus: This is mostly internuncial mainly motor neurons. The axons of these neurons
neuronal column. innervate mainly skeletal muscle. Lamina X surrounds
the central canal and contains ne uroglia.
Nuclei in Posterior Grey Column Lamina T: Corresponds to posteromarginal nucleus.
Afferent Nuclear Group Column Lamina Tl: Corresponds to substantia gelatinosa.
The four main afferent nuclei a re seen in this are: Lnminae III and IV: Correspond tco nucleus proprius.
1 Postero111argi1wl nucleus: Thin layer of neurons caps The neurons of laminae I-IV are related to extero-
the posterior horn. It receives some of incoming ceptive sensations, i.e. crude touch, crude pressure pain
dorsal root fibres. and temperature. Their axons give rise to ventral and
2 Substantia gelatinosn: This is found at the tip of poste- lateral spinothalamic tract.
rior horn through the entire extent of spinal cord. Lnminne V and VI: Correspond to lbase of d orsal column.
3 Nucleus proprius: It lies subjacent to the substantia Neurons of laminae V and VI are meant for reflex
gelatinosa throughout the entire extent of cord (Fig. 3.4). proproceptive impulses. Their axons give rise to dorsal
1-3 groups of nuclei are present in laminae I- IV. and ventral spinocerebellar tract.
4 Nucleus dorsalis of Clarke also known as thoracic Laminae VJ/: Occupies the territory between dorsal and
nucleus at the medial part of base of posterio r horn ventral horns . This lamina contains many cells that
extending from C8 to L3 segments. These are situated function as interneurons. Tluee clear cell columns are
in laminae V and VI. recognised w ithin th is lamina . These a re inter-
mediolateral, intermedlomedial and nucleus dorsalis
LAMINAR ORGANISATION IN SPINAL CORD (nucleus thoracis or Clarke's column). Nucleus dorsal is
In thick sections, spinal cord neurons appear to have a is present on the medial aspect of dorsal horn from C8
laminar (layered) arrangement. Ten layers of neurons to L3 segments and its axons g ive rise to d o rsal
are recognised, known also as laminae of Rexed. These spinocerebellar tract. The sacral autonomic nucleus is
are numbered consecutively by Roman nume rals, an inconspicuous colu mn of cellls in the la teral part of
s tarting at the tip of the dorsal horn and moving lamina Vil in segments S2, S3 and 54.
ventrally into ventral horn (Fig. 3.9). Lamina Vlll: Corresponds to ventral horn in thoracic
Lam inae I to IV, in genera l, are concerned w ith segments but at the level of limb ,mlargements of spinal
exteroceptive sensation and comprise the dorsal horn, cord, it lies on the medial aspect: of ventral horn.

Dorsal horn of Lamina I


grey mater Lamina II
Lamina Ill
Lamina IV
Lamina V
Lateral horn of Lamina VI
grey mater
Lamina VII

Lamina VIII

Ventral horn of Lamina IX


grey mater

Lamina X

Fig. 3.9: Various laminae in spinal cord


SPINAL CORD

Lamina IX: Includes the lateral group of nuclei of the TRACTS OF THE SPINAL CORD
ventral horn. The axons of these neurons leave the spinal
cord to supply the striated or skeletal muscles of limbs. A collection of nerve fibres that com1ects two masses of
Lamina X: Surr0tmds the central canal. It is composed grey matter within the central nervous system is called
of decussating axons, neuroglia and some neurons in a tract. Tracts may be ascending or descending. They are
the grey matter surrounding central canal that have usually named after the masses of grey matter connected
properties of interne urons. by them. Some tracts are called fasciculi or lemnisci.
The following tracts are seen in a transverse section
SENSORY RECEPTORS through the spinal cord. Their location should be identified.
The peripheral endings of afferent fibres which receive
impulses are known as receptors. DESCENDING TRACTS
The descending tracts are of two types-pyramidal and
Functional class~(icntion
extrapyramidal (Table 3.3).
1 Exteroceptors: These respond to stimuli from external
environment, that is pain, temperature, touch and Pyramidal or Corticospinal Tracts
pressure.
The pyramidal or corticospinal tract consists of two parts:
2 Proprioceptors: These respond to stimuli in deeper
1 Lateral corticospinal tract, which lies in the lateral
tissues that is contraction of muscles, movements, posi- fu.niculus.
tion and pressure related to joints. These are responsible
2 Anterior corticospinal tract, which lies in U1e anterior
for coordination of muscles, maintenance of body
funiculus.
posture and equilibrium. These actions are perceived
both at unconscious level and at conscious level. The pyramidal o r corticospinal tract (Fig. 3.10) is for-
med by the axons of pyra midal cells predominantly
3 lnteroceptors/e11teroceptors: These include receptor lying in the motor area of cerebral cortex. There is some
end-organs in the walls of viscera, gland, blood contribution to it from axon of cells in premotor and
vessels and specialised structures in the carotid sinus, sensory areas. From here, the fibres course through the
carotid bodies and osmoreceptors. Also ca rr y pos terior limb of internal capsule, midbrain, pons and
sensations of hunger, nausea and pain. medull a oblo nga ta. At the lower level of m edulla
4 Special se11se receptors: These are concerned w ith oblongata, 80% of fibres cross to the opposite side. This
vision, hearing, smell, balance and taste. is known as pyramidal decussntion. The fibres that have

Table 3.3: The descending tracts


Name Function Crossed and Beginning Termination
uncrossed
Pyramidal tracts
1. Lateral corticospinal I
Main moto, t,act to, skJllf, I
voluntary movements
Crosses in
medulla
Motor area of cortex
(areas 4, 6)
Anterior grey column cells
(alpha motor neurons)
2. Anterior corticospinal Facilitates flexors Crosses in Motor area of cortex Anterior grey column cells
corresponding (areas 4, 6) (alpha motor neurons)
spinal segment
Extrapyramidal tracts
1. Rubrospinal Efferent pathway for cere- Crossed Red nucleus of Anterior grey
bellum and corpus striatum midbrain column cells
2. Medial reticulospinal Extrapyramidal tract Uncrossed Reticular formation Anterior grey column cells
Facilitates extensors of grey matter of pons (interneurons)
3 . Lateral reticulospinal Extrapyramidal tract Uncrossed Reticular formation of Anterior grey
Facilitates flexors and crossed grey matter of medulla column cells
oblong a ta (interneurons)
4 . Olivospinal Extrapyramidal tract Uncrossed Inferior olivary nucleus Anterior grey column cells
5. Lateral Efferent pathway for Uncrossed Lateral vestibular Anterior grey column cells
vestibulospinal equilibratory control nucleus
6. Tectospinal Efferent pathway for Crossed Superior colliculus Anterior grey column cells
vis ual reflexes
BRAIN-NEUROANATOMY

Motor cortex - - - ---+l


(areas 4,6.3, 1.2)

,------- - -- Lentiform nucleus


Thalamus - - -- ----;

Midbrain

Pons

t--- - -- - - - Upper motor neuron


.,.-._,,,--..

Medulla oblongata
0

Crossing of 80% pyramidal _ _ __ _ __,


fibres to opposite site

Lateral corticospinal tract - - ~ /

Lower motor neuron of ~ - - Lower motor neuron of


lateral corticospinal tract anterior corticospinal tract
(uncrossed)

Fig. 3.10: PyramidaVcorticospinal tracts course of corticospinal fibres

crossed enter lateral column of w hite matte r of spinal Thus, the cerebral cortex thro ugh la teral and ante rior
cord and descend as lateral corticospinal tract. Most of corticosp inal tracts controls anterior h o rn cells of
these fibres terminate by synapsing th rough the inter- opposite half of spinal cord (Table 3.3).
nuncial neurons at the anterior horn cells (Fig. 3.11). Functional Significance
The 15% of fibres that do not cross enter anterior w hite 1 The cerebral cortex controls gross and fine skilled
column of spinal cord to form anterior corticospinal volunta ry m ovements of opposite half of bod y
tract. The fibres of this tract also cross a t appropriate thro ugh anterior horn cells.
levels to reach grey matter of the opposite half of spinal 2 Influence of this tract is supposed to be facilitatory
cord and synapse with intemuncial neurons similar to for flexors and inhibitory for extensors.
those of la teral corticospinal tract (Fig. 3.11). Only 5% 3 Anterior corticospinal tract controls volun tary gross
corticospinal fibres s u pp ly muscles of the same side, movement like walking and running.
chiefly the neck muscles. Thus, neck mu scles have 4 Corticospinal tract facilitates superficial reflexes and
bilateral controls. muslee tone.
SPINAL CORD

--4- -+-- - Lateral corticospinal tract


(crosse,d pyramidal)

Fig. 3.11 : Location of descending tracts in spinal cord

5 Actions of basal ganglia and cerebellum are mediated 4 O/ivospi11al tract: Its fibres originate from the inferior
by corticospinal tracts. olivary nucleus in medulla oblongata, descend to
spinal cord, lie in the anterolatieral column of white
Extrapyramidal Tracts
matter and synapse with the anterior horn cells.
These are: 5 Ves tibulospinal tracl: The fibres arise from lateral
1 Rubrospinal tract.
vestibular nucleus lying at pontomedullary junction.
2 Medial reticulospinal tract.
The fibres descend uncrossed to spinal cord. This
3 Lateral reticulospinal tract.
tract is situated in the anterior white column of spinal
4 Olivospinal tract.
cord. These fibres synapse with anterior horn cells.
5 Vestibulospinal tract.
It has 2 types:
6 Tectospinal tract.
1 Rubrospinal tract: This tract is formed by the axons of a. Lateral-controls extensors muscle tone
red nucleus, situated in the mid brain. The fibres cross b. Medial-for movement of head.
with the fibres of the opposite side in the tegmentum 6 Tectospiual tract: The tract is formed by the axons of
of midbrain; thus constituting the ventral tegmental neurons lying in the superio r colliculus of the mid-
dernssation (see Fig. 5.14). The tract descends through brain (see Fig. 5.14). The fibres cross to the opposite
the pons and medulla oblongata and enters the side thus forming dorsal tegmenlal decussation in mid-
lateral white column of spinal cord. The fibres termi- brain. The tract descends through pons, medulla and
nate by synapsing through internuncial neurons with anterior white column of spinal cord. The fibres ter-
anterior horn cells (Fig. 3.11). It controls the tone of minate on the cells of anterior horn through inter-
limb flexor muscles b y being exci tatory to motor nuncial neurons. It mediates reflex movements of
neurons of these muscles. head and neck in response to visual stimulus.
2 Medial retirnlospinal tract: The medial reticulospinal All these descending tracts control the voluntary
tract is formed by the fibres from reticular formation movements of skeletal muscles of the body through
in pons and descends to the cervical segments only. anterior horn cells directly or through internuncial
lt lies in the anterior white column of spinal cord. It
neurons. The influence is on both alpha and gamma
has uncrossed fibres (Fig. 3.11 ). Tt influences voluntary
neurons. Gamma neurons also a ffect alpha neurons
movement, reflex activity and muscle tone by controlling
through muscle spindles. So, all influences finally reach
the activity of both alpha and gamma neurons.
3 Lateral reticulospina/ tract: The lateral reticulospinal alpha neurons. Pyramidal and e:•<trapy ramidal tracts
tract originates from reticular formation in brainstem have been compared and shown in Table 3.7.
(midbrain, pons and medulla oblongata) and
descends up to thoracic segments of spinal cord. It ASCENDING TRACTS
has both crossed and uncrossed fibres. It lies in the 1 Lateral spinothalamic tract (Fig. 3.12).
anterolateral white column of spinal cord. Both the 2 Anterior spinothalarnic tract.
tracts terminate b y synapsing with the neurons in 3 Fasciculus gracilis (medially) (Fig. 3.13).
lamina VII of the spinal cord. 4 Fasciculus cuneatus (laterally).
-I
5
6
BRAIN-NEUROANATOMY

Dorsal or posterio r spinocerebellar tract.


Ventral or anterior spinocerebellar tract
The cerebell um finally receives second neurons
fibres, whereas from the thalamus relayed third neuron
7 Spino-olivary tract. fibres are projected to the sensory areas in the cerebral
8 Spinotectal tract. cortex (Table 3.4).
For the sensory pathways, the first neuron fibres
always start in the dorsal root ganglia w hich has Exteroceptive Sensations
pseudounipolar cells. The peripheral process of these
1 Lateral spi11othnlamic tract: This tract carries the
cells form the sensory fibres of peripheral nerves. The
central process of the neurons in the dorsal root ganglia sensation of pain and temperature. The first neuron
enter the spinal cord through dorsal nerve root and fibres start in the dorsal root ganglia. These relay by
terminate either by synapsing with cells in posterior synapsing w ith neurons lying in the grey matter of
grey column of spinal cord or at higher level in the laminae II and III. Pain fibres relay in lamina II
medulla oblongata with the cells of nucleus gracilis and (substantia gelatinosa). The second neuron fibres
nucleus cuneatus. cross immediately to opp osite side close to the central
After relay in the nuclei, second neuron fibres start canal and ascend as tract in the lateral white column
and ascend to either thalamus or cerebellum. of spinal cord (Figs 3.12 and 3.13).

Table 3.4: Neurons of sensory tracts


Tracts 1st 2nd 3rd Clinical tests
Lateral spinothalamic Dorsal root Substantia gelatinosa Posterolateral ventral
1 Pain wilth pinprick
ganglion nucleus of thalamus 2 Temperature with hot and cold
water in the test tubes
Anterior spinothalamic Dorsal root Nucleus proprius 1 Joint SE!nse
ganglion 2 Vibration sense
Fasciculus gracilis Dorsal root Nucleus gracilis in medulla Posterolateral ventral 3 Tactile localisation
ganglion oblongata nucleus of thalamus 4 Tactile discrimination
5 Rhomb,9rg's test
Fasciculus cuneatus Dorsal root Nucleus cuneatus in medulla Posterolateral ventral 6 Stereo£1nosis
ganglion oblongata nucleus of thalamus 7 Crude touch
8 Crude pressure

J
Dorsal spinocerebellar Dorsal root Clarke's column Nil All cerebelllar tests, like the finger-
ganglion nose and heel-knee tests for
Ventral spinocerebellar Dorsal root Nucleus proprius Nil intention tremors
ganglion

Fasciculus cuneatus- -- ---~ ~ -- - - - - -- - - Fasciculus gracilis


(tract of Burdach) (tract of Goll)

Posterolateral tract of Lissauer _ ___.,,-,........


(intersegmental tract)

Dorsal (posterior)
spinocerebellar tract

- Ventral (anterior)
spinocerebellar tract
Lateral spinothalamic tract
(crossed)
(crossed)

~ - - - Spino-olivary tract

Ventral (anterior) - - - - - - = --T-


spinothalamic tract (crossed)

Fig. 3.12: Location of ascending tracts in spinal cord. Three tracts marked 'X' are crossed and remaining tracts are uncrossed
SPINAL CORD

Somatic - - - - - +
sensory cortex

Thalamus
Third order neuron
(in internal capsule)

Midbrain

(lJ)..__ _ ___ Spinal lemniscus (anterior a1nd


lateral spinothalamic tracts)

Pons

....,__ _ __ _ Anterior spinothalamic tract


~- -~ joins medial lemniscus

Medulla oblongata

First order neuron from limbs :::::l::l,g;:..


(pain , temperature,
coarse touch. pressure)

Spinal cord

Fig. 3.13: Spinothalamic pathways

2 Anterior spinotlwlamic tract: This tract ca rries the fibres These lie in contin uity with each other in the antero-
for crude touch and pressure, tickle and itch. First la teral white column of spinal cord showing somato-
neuron fibres a re in the dorsal root ganglia. These top ic la mination. The sensa tions of pressure, tou ch,
relay in the grey matte r o f posterior horn or nu cleus tem perature a nd pain are lying; med ial to la te ra l.
pro prius (laminae TTI and IV). The secon d n euron Pressure sensa tions are m ed ial most near the an terior
fib res ascend for 1-2 segments and cross to opposite median fissure. Cervical segmen ts are facing medially
side in the white commissu re and ascend as a tract and sacral segments face la terally.
in the anterior white column of spinal cord (Fig. 3.13). Proprioceptive Sensations
The an te rior and lateral s pinoth alamic tracts carry Th e sensations like deep to uch , p ressu re, tacti le
cxteroceptive sensations from the opposite half of bod y localisa tion (the a bility to loca te exactly the pro-
(Fig. 3.1 2). prioceptive pa rt touched ), tacti le discri mination (the
BRAIN-NEUROANATOMY

ability to localise two separate points on the skin that of spina l cord. As the tract ascends, it receives
is touched), stereognosis (ability to recognise shape accession from each dorsal root. The fibres which
of object held in hand) and sense of vibration are enter in the coccygeal and lower sacral region are
carried by fasciculus gracilis and fasciculus cuneatus. thrust medially by fibres which enter at higher levels.
1 Fnscicu/11s grncilis (tract of Goll): It commences at the
Fasciculus gracilis w hich contains fibres derived
caudal limit of spinal cord and is composed mainly
of the long a cending branches of the medial division from lower thoracic, lumbar, sacral and coccygeal
of fibres of dorsal nerve roots. These are the first segments of spinal cord occupies the med ial part of
order neuron fibres from dorsal root ganglia. These posterior column of upper part of spinal cord and is
run directly upwa rds (without relaying in the spinal separated from fasciculus cuneatus by p ostero-
grey matter) in the posterior column of white matter intermediate septum (Figs 3.14 and 3.15).

Somatic - - ---+l
sensory cortex

Thalamus
(ventral posterolateral nucleus)
Third order neuron
(in internal capsule)

Midbrain

Pons

Medulla oblongata

First order neuron from limbs :±::i::;:z;~T11r-:


proprioceptive (position sense and
kinaesthesia). exteroceptive
(touch, pressure)

Spinal cord

Fig. 3.14: Tracts of dorsal columns


SPINAL CORD

~ -- - -- -- - Fasciculus cuneatus
(tract of Burdach)

---,I-',--- - ', - -- Lateral corticospinal tract


(crossed pyramidal)

~ /£-~- - -- --Ventral (anterior)


spinothalamic tract

Fig. 3.15: Somatopic lamination of tracts in spinal cord

2 Fnscirnlus w11entus (tract of B11rdacl1): It commences 2 Ve11tral or anterior spinocerebellar tract: The first neuron
in mid-thoracic reg ion. It d erives its fibres from fibres are the central processes of dorsal root ganglia.
upper thoracic and cervical segments.
Both fasciculi contain first neuron fibres from central
process of dorsal root ganglia and end by synapsing
with the neurons in nucleus gracilis and nucleus
cuneatus, situated in the medulla oblongata from
where second neuron fibres take origin.
[,.:,.~---(tt;.;:--- - Inferior
cerebellar
Reflex Proprioceptive Sensations peduncle
The reflex proprioceptive sensations are carried by
1--- - - Posterior
dorsal and ventral spinocerebellar tracts. They convey spinocerebella r tract
to the cerebellum both exterocepbve (touch) and Cerebellum
unconscious proprioceptive impulses arising in Golgi
tendon organ and muscle spindle and are essential for
the control of posture (Table 3.5).
1 Dorsal or posterior spinocerebe/lar tract: It begins at the Medulla
level of 3rd lumbar segment of spinal cord. The first oblongata
0
neuron fibres are the central processes of dorsal root
ganglia. These relay in the dorsal nucleus (thoracic
or Clarke's column) which lies on the medial side of
the base of posterior grey column in these segments.
This relay gives rise to second neuron fibres which
form dorsal spinocerebcllar tract. This uncrossed First order neuron from llmbs---1~K'
tract ascends in the lateral column of white matter (unconscious muscle and
of spinal cord. Here it is situated as a flattened band joint sense)
at the posterior region of lateral column, medially in
contact with lateral corticospinal tract. lt ascends to
Spinal cord
the level of medulla oblongata where its fibres pass
through inferior cerebellar peduncle to reach the
cerebellum (Fig. 3.16). Fig. 3.16: Pathway of dorsal spinocerebellar tract
BRAIN- NEUROANATOMY

Table 3.5: The ascending tracts of the spinal cord


Name Function Crossed and Beginning Termination
uncrossed
1. Lateral spinothalamic Pain and temperature Crosses to Laminae I-IV Forms spinal lemniscus in medulla,
(axons of 2nd order from opposite half of opposite side of posterior reaches posterolateral ventral
neurons) body in the same grey column nucleus of thalamus for another
spinal segment relay and ends in areas 3, 1, 2
2. Anterior spinothalamic Touch (crude) and Ascends to 2-3 Laminae I-IV Joins medial lemniscus in brainstem
(axons of 2nd order pressure from opposite spinal segments of posterior reaches posterolateral ventral
neurons) half of body to cross to grey column nucleus of thalamus for another
opposite side relay and ends in areas 3, 1, 2
3. Fasciculus gracilis Conscious proprioception Uncrossed Dorsal root Relays in nucleus gracilis, 2nd order
(axons of 1st order Discriminatory touch ganglion cells fibres form medial lemniscus which
sensory neurons) Vibratory sense reaches posterolateral ventral
(lower limb} Stereognosis nucleus of thalamus for another
relay and ends in areas 3, 1, 2
4. Fasciculus cuneatus Same as above Same as above Same as above Relays in nucleus cuneatus, rest is
(axons of 1st order same as above
sensory neurons)
(upper limb)
5. Posterior spino- Unconscious proprio- Uncrossed Laminae V, VI of Vermis of cerebellum
cerebellar (axons of ception from individual posterior grey (via inferior cerebellar
2nd order neurons) muscles of lower limb column peduncle}
6. Anterior spinocere- Unconscious proprio- Crosses twice, Laminae V, VI of Vermis of cerebellum (via superior
bellar (axons of 2nd ception from lower limb once in spinal posterior grey cerebellar peduncle) via recrossing
order neurons) as a whole cord and recros- column
ses in midbrain
7. Spino-olivary (axons Proprioceptive sense Uncrossed Laminae I-IV Dorsal and medial accessory
of 2nd order neurons) column olivary nuclei
8. Spinotectal (axons of Afferent limb of reflex Crossed Laminae I-IV Tectum or superior colliculus of
2nd order neurons) movements of eyes column midbrain
and head towards

The second neuron fibres are derived from the large INTERSEGMENTAL TRACTS
cells of posterior grey column (laminae V, VI) in the These are formed of fibres connecting various segments
lumbar and sacral segments. The second ne uron of spinal cord. These are p resent in anterior, posterior
fibres cross to opposite side. These asce nd in the and lateral columns of white ma tter adjacent to the grey
lateral wh ite column of spinal cord anterior to the matter of spinal cord. Tract of Lissaue r is also a n inter-
fibres of dorsal spinocerebella r tract to pass through segmental tract.
the medulla oblongata and pons. These fibres finally
curve along lateral aspect of superior cerebellar ped- BLOOD SUPPLY OF THE SPINAL CORD
uncle, and recross with superior cerebellar peduncle The sp.inal cord receives its blood supply from three
to regain their original side of origin (Fig. 3.17). longitudinal arterial channels that extend along the
Functionally, both spinocerebellar tracts control the length of the cord. The anterior spinnl artery is present
coordination and movements of muscles controlljng in relation to the anterio r median fissure. At the level
posture of the body. The ventral tract conveys muscle of medulla, the paired anterior spinal arteries join to
form a single artery tha t lies in the a nterior median
a nd joint information from the entire lower limb,
fissure of the spinal cord. Two posterior spinal arteries
while the do rsal tract receives informa tion from
(one on each side) run along the posterola teral sulcus
individual muscles of lower limb (Table 3.5).
(i.e. along the line of attachment of the d orsal ne rve
3 The other ascending tracts, the spi110-olivnry and roots) . In addition to these channels, the pia ma te r
spinotectal, a re responsible for proprioceptive and covering the spinal cord has an arterial plexus (called
visual reflexes. the arterin vasocorona) which also sends b ranches in to
SPINAL CORD

Midbrain
Superior cerebellar -------.
peduncle

Middle --+----,f------------+-1
cerebellar
peduncle

1----- -Anterior spinocerebellar tract

Medulla
oblongata 0

Inferior cerebellar
peduncle First order
neuron 1----- - Second order neuron
from limbs (crossed)
(unconscious
muscle and
joint sense)

Fig. 3.17: Pathway of ventral spinocerebellar tract

the substance of the cord (see Fig. 11.2). The main source that open into a venous plexus lying between the dura
of blood to the spinal arteries is from the vertebral and the vertebral canal (epidural or internal vertebral
arteries (from which the anterior and posterior spinal plexus) and through it into various segmental veins.
arteries take origin). However, the blood from the
vertebral arteries reach es only up to the cervical
segments of the cord. The spinal arteries also receive SUMMARY
blood through radicular arteries that reach the cord
Sensations enter the spinal cord via dorsal roots and
a long the roots of spinal nerves. These radicular arteries
arise from spinal branches of the vertebral, ascending ascend in the dorsal column as medial lemniscal system
cervical, deep cervical, intercostal, lumbar and sacral and in the anterolateral column as spinothalamic path-
arteries. Ma ny of these radicular branches are small and ways. Both sensory systems decussate, but at different
end by supplying the nerve roots. A few of them, which levels (Figs 3.13 and 3.14). Medial leminiscus dicussates
are larger, con tribute blood to the spinal arteries . in medulla oblongata, while spinothalamic d ecussate
Frequently, one of the anterior radicular branches is in spinal cord .
very large and is called the arteria radirnlaris magna. Its Cerebellum gets information abou t the tru nk and
position is variable. This artery may be responsible for legs through dorsal and ventral spinocerebellar tracts
supplying blood to as much as the lower two-thirds of and from arm and neck via cuneocere bellar tracts.
the spinal cord.
Sensations from the face and mouth get carried via
The veins draining the spinal cord are arranged in
the form of six longitudinal channels. These are antero- trigeminal nerve.
median and posteromedian channels that lie in the Motor fibres start from motor areas of brain, pass
midline; also anterolateral and posterolateral charm.els through corona radiata, posterior limb of internal
that are paired. These channels are interconnected by a capsule and brainstem. In the lowest part of the medulla
plexus of veins that form a venous vasocorona. The oblongata, most of fibres cross to opposite side and
blood from these veins is drained by radicula r veins terminate on anterior horn cells (Fig. 3.10).
BRAIN-NEUROANATOMY

Fibres arising from motor cortex till they reach anterior b. lpsilateral loss of conscious proprioceptive
horn cells are called upper motor neuron fibres. Anterior sensations caused due to damage to posterior
horn cells and fibres arising from the cells till they reach white column (Fig. 3.18).
the muscle are called lower motor neuron fibres. c. Contralateral loss of pain and temperature and
touch caused due to damage to lateral spino-
CLINICAL ANATOMY
thalamic and anterior spinothalamic tracts.
At the level of lesion:
Amyotrophic lateral sclerosis: It is a degenerative a. Ipsilateral lower motor neuron paralysis caused
disease which is caused due to damage of the cells due to damage to ven tral nerve roots.
in the ventral horn. The clinical features involve b. Ipsilateral anaesthesia over the skin of the
weakness, atrophy of muscles of hands and arms and segment due to injury to the ventral nerve roots.
later extending to the lower limb. Above the level: Ipsilateral hyperaesthesia above the
Subnwte combined degeneration: The posterior and level of lesion due to irritation of dorsal nerve roots.
lateral funiculi are degenerated bilaterally and it is • Syringomyelia (Central spinal cord syndrome): There
caused due to deficiency of intrinsic factor w hich is formation of cavities around the central canal
helps in absorption of vitamin B12 . The symptoms usually in the lower cervical region. Its features are:
include upper motor neuron lesion features, loss of a. Bilateral loss of pain and temperature occurs
position and vibratory sensation of lower limbs. due to injury to the decussating fibres of lateral
• In lower motor neuron lesion there is flaccidity, spinothalamic fibres (Fig. 3.19).
hyporeflexia, wasting and it is ipsilatera I. b. Bilateral loss of touch occurs due to injury to
If all motor neurons reaching a muscle get affected, anterior spinothalamic tract.
muscle will be fully paralysed. It will feel flaccid. As the decussa tion of lateral and anterio r
Since no impulses reach muscle, it will not respond spinothalamic tracts occurs at different levels,
to reflexes. there is dissociated sensory loss.
As a result of denervation, it will atrophy soon. As this disease occurs in lower cervical and upper
thoracic regions there is problem in both the upper
The paralysis is ipsilateral. limbs and front of chest.
• In upper motor neuron lesion there is spasticity, Syringomyelia disrupts the crossing fibres of
h y pe rreflexia, usually no wasting, and it is anterolateral system. The medial lemniscal system
contralateral. is spared .
a. If upper motor neurons to a muscle get affec- • Partial cord lesion (unilateral): In high cervical
ted, initiation of movement may get lost. Since lesions, there is weakness of finger movements
lower motor neurons are intact, basal ganglia accompanied by dragging of the leg.
may cause increase in muscle tone, leading to a. Upper motor neuron paralysis on the side oflesion.
spasticity.
b . Sensory loss: N umbness on the side of lesion.
b. Also reflexes get disinhibited, leading to h yper- Joint position sense and two-point discrimi-
reflexia. nation impaired on the side of lesion.
c. Muscles do not show wasting except by disuse. c. Burning pain, pinprick and temperature sensa-
d. Mostly upper motor neuron lesions are in tion impaired on the opposite side.
internal capsule and since these fibres have not Pyramidal fibres synapse with anterior horn cells.
yet decussated, the functional loss will be on These control fine movements of hand and fingers.
the contralateral side. Extrapyramid al fibres have multiple synapses.
Table 3.6 shows comparison between lower motor These are concerned with large muscle groups
neuron (LMN) and upper motor neuron (UMN) used in posture and locomotion.
paralysis. Thrombosis of anterior spinal artery leads to loss
Table 3.7 shows the comparison between pyramidal of tracts and loss of motor neurons in anterior
and extrapyramidal tracts. two-thirds spinal cord. This results in motor loss
• Brown-Sequard's syndrome: This is caused due to due to involvement of the motor neurons in
hemisection of the spinal cord (Fig. 3.18). Various ventraI horn of spin a 1cord, including corticospinal
features are: tracts and spinothalamic tracts. It is also known
Below the level of lesion as anterior spinal artery syndrome. Fasciculus
a. Ipsilateral upper motor neuron paralysis caused gracilis and fasciculus cw1eatus remain normal as
by pyramidal tract damage. these are supplied by postrior spinal artery.
SPINAL CORD

Initially this is a stage of "spinal shock". There is


flaccid paralysis of all the muscles including loss of
all superficial and deep reflexes below the label of
injury. There is retention of urine and feces. This stage
usually lasts for 3 weeks.
After 3 weeks smooth muscles a nd skeletal
lpsilateral rooU muscles activity reappears but both types of reflexes
segment signs
are exaggerated. There is spastic paralysis.
If transaction occurs above CS, there is paralysis
of all 4 limbs (quadriplegia). If injury occurs between
Tl and L1 segment, then there is paralysis of both
lower limbs (paraplegia).
Treatment of nerve cell injury is at experimental
level only by stern cell transplantation. "Prevention
is the only cure". Aggression while driving may cost
Contralateral - ---+--
impairment of a life or lifelong disability/ dependence.
pain and
--1-- ~ lpsilateralpyramidal
Pain is the most imp ortant sen sation . The
temperature
sensation weakness and receptors of pain (free nerve endings) are called
impaired joint position nociceptors. These get stimulated by bum, chemicals,
sense and accurate
touch localisation
physical injury, prostaglandins, histamine, etc.
Pain can be treated by giving salicylates, which
decreases theprostaglandinformation. Local anaesthetic
can also be used to decrease pa.in temporarily. Even
Fig. 3.18: Brown-Sequard's syndrome
dorsal nerve roots can be cut, but with this, all
afferents are abolished. Lastly cordotomy can be
done as pa.in fibers lie superficial in the spinal cord.

Table 3.6: Comparison between lower motor neuron


Sensory
(LMN) paralysis and upper motor neuron (UMN) paralysis
deficit LMN paralysis UMN paralysis
Muscle tone abolished Muscle tone increased
Leads to flaccid paralysis Leads to spastic paralysis
Muscles atrophy later No atrophy of muscles
Reaction of degeneration Reaction of degeneration not
seen seen
Tendon reflexes absent Tendon reflexes exaggerated
Limited damage Extensive damage
lpsilateral Mostly contralateral
Babinski sign negative Babinski sign positive
All superficial and deep Superficial reflexes like
Crossing of right and left lateral reflexes lost due to damage abdominal, cremasteric, plantar
spinothalamic tracts
to motor pathways are lost due to damage to
corticospinal tracts
Fig. 3.19: Syringomyelia (Central spinal cord syndrome)
May affect single muscle Affects many groups of muscles
group as in poliomyelitis as in hemiplegia. Damage to
and Bell's palsy corticospinal tract removes the
Complete Transaction of Spinal Cord inhibitory effect on the super-
ficia I reflexes, resulting in
Severe trauma usually results in complete cutting Babinski positive sign
(transaction) of spinal cord. The result is loss of There is loss of control on lower
sensation and paralysis of muscles on both the sides motor neurons, which become
at the level of section and below the level of section hyperactive, leading to spastic
of spinal cord. paralysis
BRAIN- NEUROANATOMY

Table 3.7: Comparison of pyramidal and extrapyramidal • Polio virus affects the neurons of anterior horn cells
tracts of the spinal cord. Polio drops as a vaccine has
Pyramidal tracts Extrapyramidal tracts eradicated the dreadful disease.
Recent in evolution Older in evolution
These comprise only cortico- These comprise olivospinal,
spinal and corticonuclear vestibulospinal, tectospinal, CLINlCOANATOMlCAL PROBLEMS
tracts reticulospinal, rubrospinal tracts
Origin from motor cortex Thes arise from olivary vesti- Case 1
bular, tectum (collicular) reticular A 7-year-old boy has been having rugh grade fever
and red nuclei for 5 days. One evening he complained of weakness
The impulse passes directly Impulse passes by polysynaptic in rus right lower limb. Soon he could not support
to anterior horn cells route via cortex, basal ganglia,
the weight.
cerebellum and brainstem
• What is the probable diagnosis?
Function is to perform Control tone and equilibrium.
voluntary skilled movement These facilitate/inhibit flexor/ • Which part of the nervous system is affected?
extensor reflexes • What type of paralysis is it and what are its
Injury leads to increased Injury leads to increased features?
muscle tone and loss of muscle tone with clasp knife Ans: The likely diagnosis is the viral infection of
motor activity rigidity
poliomyelitis. The part of the nervous sys tem
affected is the anterior horn cells of the spinal cord
from lumbar 2 to sacral 5 segments of spinal cord.
The type of paralysis is the lower motor neuron
• Spinal cord shows cervical enlargement for the supply paralysis. Muscles feel flaccid, tendon reflexes get
of upper limb muscles. It also sh ows lumbar absent, reaction of degeneration is seen. Later there
enlargement for the supply of lower limb muscles. is muscular atrophy. The limb becomes thinner and
• Spinal cord in adult is much shorter than the shorter than the opposite limb.
vertebral canal. The cord ends at the lower border
Case 2
of lumbar one (Ll) vertebra. A young person is involved in an automobile
• Lateral horn is only present in T1- L2 and S2- S4 accident with injury at cervical 5 and ce rvical 6
segments of spinal cord. vertebrae. He develops paralysis of all four limbs
• Sympathetic fibres (white ramus communicans) • What type of paralysis is the person suffering
start from lateral horn ➔ ventral root ➔ trunk of from?
s pina l nerve ➔ ventral primary ramus ➔ • What are the differences between upper motor
sympathetic ganglion (Fig. 3.7). neuron and lower motor neuron paralysis?
• The sympathetic ganglion gives g rey ramus
communicans (grc), after receiving and relaying An s : The young person has developed upper
the w hite ramus commwucans (wrc). motor neuron paralysis in rus limbs. His symptoms
• Corticospinal fibres cross to the opposite side; 80% are:
cross in pyramidal decussation, 15% cross in the • Loss of power of voluntary movements
spinal cord and 5% do not cross. • Tendon reflexes are exaggerated
• Out of 6 main ascending tracts; Two going to the • Babinski sign is positive (see Fig. 1.7)
cerebellum and reach the ipsilateral side sooner/ • Reaction of degeneration is absent
later. Two relay in nuclei of spinal cord to reach The differences between upper motor neuron and
opposite side. Two relay in the nuclei present in lower motor neuron types of paralysis are mentioned
the medulla oblongata to reach the opposite side. in clinical anatomy of this chapter.

FREQUENTLY ASKED QUESTIONS

1. Describe the ascending tracts of spinal cord. b. Nuclei in posterior grey column
2. Describe the descending h·acts of spinal cord. c. Syri.ngomyelia
3. Write short notes on: d. Differences between upper motor neuron and
a. Sensory receptors lower mo tor neuron paralysis
SPINAL CORD

MULTIPLE CHOICE QUESTIONS


1. 1n spinal cord, myelin sheath is formed by: 6. Following tracts are present in lateral whi te column
a. Schwann cells b. Oligodendrocytes except:
c. Astrocytes d. Microglia a. La teral spinothalamic
2. Medial lemniscus carries: b. Rubrospinal
a. Pain and temperature sensation from trunk and c. Ventral spinocercbellar
limbs
d . Fasciculus gracilis
b. Proprioceptive sensations from trunk and limbs
c. Proprioceptive sen sation from head 7. Regarding spinal cord, all are true except:
d. Auditory sensation a. It ends in adults at lower border of L1
3. Regarding spinal cord, the following are true except: b. The cord is covered by 3 meninges
a. It has cervical and lumbar enlargements c. It shows thoracic and lumbar enlargements
b. Tt ends in adults at lower border of 3 rd lumbar d. Grey matter occupy its central pa rt
vertebra
8. Lateral corticospinal tract terminates at:
c. It is traversed by the central canal
a. Clarke's column
d . Tt begins a t le vel of foramen magnum as a
continuation of medulla oblongata b . Substantia gelatinosa
4. Regarding corticospinal tract all of the following c. Anterior horn cells of spinal cord
are trne except: d. Vcntroposterolateral nucleus of thalamus
a. Most of fibres decussate at lower end of medulla 9. Pyramidal fibres mostly a rise from Brodmann's
oblongata cortical area:
b. It arises from motor area of cerebral cortex a. 3, 1, 2 b. 8
c. lt ends in anterior horn cells
c. 4 d. 18
d. Its lesion at level of pons produces para lysis of
ipsilateral side 10. Which of the following tracts contains primary
afferent neuron fibres?
5. Injury of lateral sp inothalamic tract results in:
a. lpsilateral loss of pain and temperature a. Fasciculus graci lis and fascicuJus cuneatus
b. Contralateral loss of touch and pressu re b. Anterior spinothalamic tract
c. Contra latera l loss of pa in and temperature c. Lateral s pinothalamic
d. None of the above d. Do rsal spinocerebellar

ANSWERS
1. b 2. b 3.b 4. d S. c 6.d 7.c 8. c 9. c 10. a
CHAPTER

4
Cranial Nerves
,'j/,./e11 /d..u>• ,ne ,,/,ro/r' II,~ , ,rulf',I
- Leigh Hunt

INTRODUCTION YID - Vestibulocochlear (statoacoustic) victory


IX - Glossopharyngeal give
The 12 pairs of cranial nerves supply muscles of eyeball,
X - Vagus value
face, palate, pharynx, larynx, tongue and two large
muscles of neck, lungs, heart and most of the part of XI - Accessory and
Xll - H ypoglossal happiness
gastrointestinal tract. Besides these, they are afferent to
special senses like smell, sight, hearing, taste and touch. Attachment of the nerves to brain:
Some nerves form the afferent loop and others form I, 11 to the forebrain.
the efferent loop of the reflex arc. Olfactory takes the III, TV to midbrain.
sense of smell and stimulates dorsal nucleus of vagus V, Vl, VII Vlll to the pons.
for enhanced secretion if the smell is good. Optic nerve IX, X, XT, XTT to the medulla oblongata (Fig. 4.1).
is afferent from eye while lil, IV and VI are efferent to
the eye muscles. CN V, the largest cranial nerve, is EMBRYOLOGY
mainly sensory to the face. The motor nerve of face is During early stages of development, the wall of the
VII nerve. To come close to V nerve nucleus, VII nucleus neural tube is made up of three layers:
winds around VI nucleus so that a reflex arc can be a. The inner ependymal layer.
mediated between the afferent and efferent loops of the b. The middle mantle layer.
arc. It is termed as "neurobiotaxis". Statoacoustic nerve c. The outer marginal layer.
is afferent for hearing and balance while spinal root The mantle layer represents grey matter and the
accessory acts as its efferent component for turning the marginal layer, the white matter.
face to the side from where sound is heard. VII, IX and Soon the mantle layer differentiates into a dorsal alar
X are carrying sensation of taste from tongue and lamina (sensory) and a ventral basal lamina (motor),
efferent component is XII nerve for movements of the two are partially sepa rated internally by the sulcus
tongue and nucleu s ambiguus gives fibres to IX, X, and limitans.
cranial root of XI for the muscles of palate, pharynx
Functional components of cranial nerves:
and larynx.
In the spinal cord, though grey matter forms a
compact fluted column in the centre, it shows differen-
FEATURES
tiation into two somatic and two visceral fw1etional
There are 12 pairs of cranial nerves. Each cranial nerve columns. The somatic columns are the general somatic
has a number and a name as follows: efferent (motor o r anterior horn) and the general
Mnemonic somatic afferent (sensory or posterior horn).
I - Olfactory oh, These supply structures derived from somites. The
II - Optic oh, visceral columns arc the general visceral efferent
ffl - Oculomotor oh, (motor) and the general visceral afferent (sensory).
IV - Trochlear try, These are autonomic columns and supply the viscera,
V - Trigeminal try, vessels and glands (Fig. 4.2a).
VI - Abducent again In the brain stem, particularly hindbrain, the alar and
VII - Facial failure, basal laminae come to lie in the same ventral plane
48
CRANIAL NERVES

Olfactory bulb - - - ~ ~ - -- - - - Olfactory nerves (I)

~ - - Motor root - ]
Trigeminal nerve (V)
Sensory root

Abducent nerve (VI)

Motor root -]
Facial neNe (VII )
_,....-:'.;..-------"\---+--- Sensory root

,:,..:;;,::;,,':-'?;~-+ --+-vestibulococl11ear nerve (VIII)


0D'='\\::--:..:__.J-_ Glossopharyngeal neNe (IX)

Vagus neNe (X)

Accessory nE?Ne (XI )

Hypoglossal neNe (XI I)

Fig. 4.1: Attachment of cranial nerves to the base of brain

because of stretching of the roof plate (dorsal wall) of the oculomotor nerve and supply five extrinsic
neural tube by pontine flexure. Further, the grey matter muscles of the eyeball except the lateral rectus and
forms separate longitudinal functional columns, where the superior oblique.
the motor columns (from basal lamina) are medial and 2 The trochlear nucle11s is situated iJn the midbrain at the
the sensory colunu1s (from alar lamina) lateral in level of the inferior colliculus. Tt supplies only
position. the superior oblique muscle th.rough the trochlear
In addition to the four functional columns differen- nerve.
tiated in the spinal cord, there appear two more
3 The nbducent nucleus is situated in the lower part of
columns (a motor and a sensory) for the branchial the pons. It supplies onJy the lateral rectus muscle
apparatus of the head region, namely the special through the abducent nerve.
visceral (branchial) efferent and the special visceral
4 The hypoglossal nucleus lies in the medulla. It is
afferent; and one column more for the special sense,
namely the special somatic afferent. Thus a total of elongated and extends into both the open and closed
parts of the medulla. It supplies seven out of eight
seven columns (3 motor and 4 sensory) are formed.
Each column, in its turn, breaks up into smaller frag- muscles of the tongue through the h ypoglossaJ
ments to form nuclei of the cranial nerves (Fig. 4.2b). nerve.

NUCLEI Special Visceral Efferent/Branchit::11 Efferent Nuclei


These nuclei supply striated muscle derived from the
The details of the nuclei of cranial nerves are
summarized in Table 4.1. branchial arches.
1 The motor nucleus of the trigeminal nerve lies in the
General Somatic Efferent (GSE) Nuclei upper part of the pons. It supplies the muscles of
These nuclei supply skeletal muscle of somatic origin mastication through the mandibular nerve.
(Figs 4.3 and 4.4a). 2 The nucleus of the facial nerve lies in the lower part of
1 The owlomotor nucle11s is situated in the midbrain at the pons. It supplies the various muscles innervated
the level of the superior colliculus. Its fibres enter by the facial nerve.
BRAIN- NEUROANATOMY

M t - -- - ; - - GSA
- -->t-----::;,,k--- GVA

---+---GVE

00--+ - - - - f - - GSE

GSA . General somatic afferent


GVA : General visceral afferent
GVE General visceral efferent
GSE General somatic efferent

(a) (b)
Figs 4.2a and b: Transverse section of an embryo showing the arrangement of functional/nuclear columns of cranial nerve nuclei.
(a) Spinal cord, and (b) in brain stem

General visceral efferent (Ill, VII, IX, X)

Special visceral efferent (V, VII, IX, X, XI)

_ __ _. General somatic efferent (111, IV, VI, XII)

Fig. 4.3: Transverse section of medulla oblongata showing the position of cranial nerve nuclear columns

3 The n11cle11s a111bigu11s lies in the medulla. It forms an ganglion to supply the sphincter pupillae and the
elongated column lying in both the open and closed ciliaris muscles.
parts of the medulla. It supplies: 2 The lncrirnnfon; nucleus lies near the salivatory nuclei
a. The stylopharyngeus muscle through the glosso- (in the lower pons). It gives off fibres that pass
pharyngeal nerve; and through the facial nerve and its b ranch, the greater
b. The muscles of the soft palate, the pharynx and petrosa l nerve to rel ay in the pterygopa latine
the larynx through the vagus and the cranial part gang lion and supply the lacrimal, nasal, palatal and
of the accessory nerve (Fig. 4.3). pharyngeal glands.
3 The superior salivatory nucleus lies in the lower part of
General Visceral Efferent Nuclei the pons. It sends fibres through the facial nerve and
These nuclei give origin to preganglionic neurons that its chorda tympani branch to the submandibular
relay in a peripheral autonomic ganglion. Postganglionic ganglion for supply of the submandibular, sublingual
fibres arising in the ganglion supply smooth muscles salivary glands and glands in the oral cavity.
or glands (Fig. 4.4a). 4 The inferior salivatory nucleus lies in the lower part of
1 The Edi11ger-Westphal 11ucle11s lies in the midbrain in the pons just below the superior nucleus. It sends
close relation to the oculomotor nucleus. Its fibres fibres through the glossopharyngeal nerve to the otic
pass through the oculomotor nerve to the ciliary ganglion for supply of the parotid gland (Fig. 4.4b).
CRANIAL NERVES

Afferent Efferent 5 The dorsal 1111cle11s of the z,ag11s is a long co lu mn


extending into the open and closed par ts of the
Midbrain med ulla. It gives off fibres that pass through thevagus
nerve to be distributed to thoracic and abd ominal
viscera (the ganglia concerned a represent in the w alls
of the viscera supplied).
Pons

General Visceral Afferent Nucleus and


Special Visceral Afferent Nucleus (Table 4.1 )
The only nucleus in this category is the 1111cleus ofsolitan;
Med ulla tract or tractus solitarius. It lies in the medulla and
extends in to both its closed and open parts.
Its lower part receives ge11ernl visceral sensations as
Spinal cord 'I
I
I
I
follows:

! / a. Through the glossopha ryngeal nerve from the

Special somatic
General somatic
Jm
~
L General visceral
Special visceral
tonsil, pharynx, posterior part of the tongue, caro tid
body and carotid sinus.
b. Through the vagus nerve from the pharynx, larynx,
General and special visceral General somatic trachea, oesophagus and other thoracic and abdo-
Fig. 4.4a: Position of cranial nerve nuclear columns in brain stem minal viscera.

__
---- Mid brain

------------~✓r,, _________
,
____....-----
Oculomotor
nucleus Superior colliculus 1
I
I
I
- - - - + - - - -- - - Mesencephallc nucleus
of trigeminal

Motor nucleus of - - - --1-------;-~ Main sensory nucleus


trigemlnal of trigeminal (upper pons)

Lacrimatory----,1 - -- - + - ------..
nucleus

SSA
column

Salivatory nuclei- ---"""'<""-~,;-----~-+-' 1


',,,,
Dorsal nucleus - -----+--------------+--+-« Spinal nucleus of
ml @
ofvagus tngeminal (GSA) ,@ lsvA
(upper part)
Nucleus ambiguus- - - - - --+----.....,...--+-ti--i4 • "'~ ~ ' - - Nucleus of
Hypoglossal-----
nucleus
-
',,
----\-- -- - - +-111
I
solitary tract
(GVA and SVA)
0 J
I GVE column
Spinal I SVE column ]"VA
(lower part)
cord i - ---+---+-- - - GSE column
(c)

Figs 4.4b and c: (b) Scheme to show the cranial nerve nuclei as projected on to the posterior surface of the brain stem with four vestibular
nuclei, and (c) parts of nucleus of tractus solitarius: VII- facial; IX-glossopharyngeal and X-vagus
Table 4.1: Nuclei of the cranial nerves
Nerves Nuclei Location Functions Function of the nerve component
SVA Smell 01,1
II - - SSA Sight
,0
~
Ill Oculomotor nucleus Midbrain, level of GSE Movements of eyeball zI
superior colliculus GVE Contraction of pupil, accommodation z
m
GSA• Proprioceptive C:
,0

IV Trochlear nucleus Midbrain, level of GSE Movement of eyeball (superior oblique) ~


z
inferior colliculus GSA• Proprioceptive
V 1 Motor nucleus Upper pons BE/SVE Movement of mandible
....
)>
0
2 Mesencephalic nucleus Midbrain GSA Proprioceptive, muscles of mastication, face and eye ~
3 Superior sensory nucleus Upper pons GSA Touch and pressure from skin and mucous membrane of facial region
<
4 Spinal nucleus From upper pons to C2 GSA Pain and temperature of face
segment of spinal cord
VI Abducent nucleus Lower pons GSE Lateral movement of eyeball
GSA• Proprioceptive
VII 1 Motor nucleus Lower pons BE/SVE Facial expressions, elevation of hyoid
2 Nucleus of tractus solitarius Lower pons SVA Taste, anterior two-thirds of tongue
3 Superior salivatory nucleus Lower pons GVE Secretomotor to submandibular and sublingual salivary glands
4 Lacrimatory nucleus Lower pons GVE Secretomotor to lacrimal gland, nasal and palatal glands, etc.
GSA Proprioceptive
VIII cochlear Two cochlear nuclei, dorsal and Junction of medulla SSA Hearing
ventral and pons
Vestibular Four vestibular nuclei, superior, Junction of medulla SSA Equilibrium of head
spinal, medial and lateral and pons
IX 1 Nucleus ambiguus Medulla BE/SVE Elevation of larynx
2 Inferior salivatory nucleus Medulla GVE Secretomotor to parotid gland
3 Nucleus of tractus solitarius Medulla SVA Taste from posterior one-third of tongue
GVA* Sensations from mucous membrane of pharynx and posterior one-third
of tongue go to dorsal nucleus of vagus and spinal nucleus of V nerve
GSA* Proprioceptive
X and cranial 1 Nucleus ambiguus Medulla BE/SVE Movements of palate, pharynx and larynx distributed through to X
part of XI 2 Dorsal nucleus of vagus Medulla GVE Motor and secretomotor to bronchial tree and gut; inhibitory to heart
GVA Sensations from viscera
3 Nucleus of tractus solitarius Medulla SVA Taste from posterior most part of tongue and epiglottis
GSA* Sensations from the skin of external ear go to the spinal nucleus of V nerve
Spinal part of XI Spinal nucleus of accessory Spinal cord, Cl-5 BE/SVE Sternocleidomastoid and trapezius
nerve segments
XII Hypoglossal nucleus Medulla GSE Movements of tongue
GSA Proprioceptive

GSE: general somatic efferent; BE: branchial efferent; GVE: general visceral efferent; GVA: general visceral afferent; SVA: special visceral afferent;
GSA: general somatic afferent; SSA: special somatic afferent.
• These components do not have corresponding nuclei and terminate in the nuclei of different nerves.
CRANIAL NERVES

Its upper part also receives se11sal ions of taste (special through the lrigemi.nal nerve. The nucleus is also
visceral afferent) as foUows: believed to receive proprioceptive fibres from the
a. From the anterior two-thirds of the tongue, and the ocular, facial and lingual muscles, teeth and
palate except circumvallate papillae through the temporomandibular joint.
facial (VII) nerve in its superior part (Fig. 4.-k). Special Somatic Afferent Nuclei
b. From the posterior one-third of the tong u e
through the glossopharyngeal nerve (IX) includ- 1 The coc/1lear 1111clci (dorsal and ventral) that receive
ing the circumvallate papillae in its middle part. impulses of hearing through the cochlear nerve.
c. From the posteriormost part of the tongue and 2 The vestibular nuclei (superior, spinal, medial and
from the epiglottis through the vagus (X) nerve in lateral) that receive fibres from the semicirc ular
ca na ls, the utricle and the saccule thro ugh the
its inferior part.
vestibular nerves (Table 4.1 ).
General Somatic Afferent Nuclei Special Features
These are all related to the trigeminal nerve. Muscles of facic1l expression of lower face are supplied
1 The main or superior sensory 1111c/c11s of the trigeminal only from contralateral motor cortex.
nerve lies in the upper part of the pons (Fig. -U). The muscles of upper face are supplied both from
2 The spinal nucleus of the trigeminal nerve descends ipsilateral and contralateral motor cortex (Fig. 4.5a).
from the main nucleus into the medulla. It reaches Cranial part of nucleus ambiguus gives fibres to IX, X
the upper two segments of the spinal cord (Fig. 4.-lb). and cranial root of XI nerve. The caudal part of this
Its parts are: nucleus gives fibres to spinal root o f Xl nerve (Fig. 4.Sb).
a. Pars caudalis which receives impulses of pain, The gen ioglossus muscle of the tongue receives fibres
temeprature from forehead from contrala tera l motor cortex only. Rest o f the
b. Pa rs interpolaris receives impulses from cheek muscles of the tongue receive from both ipsila tera l
c. Pars oraris receive impulses from around mouth. cortex and contra lateral motor cortex (Fig. 4.Sc).
Highlights of the cranial nerves are shown in
3 The mesencephalic nucleus ofthe trigemi11al nerve extends Fig. 4.6.
upwards from the main sensory nucleus into the
midbrai.n. lt is the only example of primary sensory
neuron whose cell bodies arc within CNS. FIRST CRANIAL ERVE
These nuclei receive the follow ing fibres: OLFACTORY (SMELL) PATHWAY
a. Exteroceptive sensations (touch, pain, tempera- It belongs to special visceral afferent column.
ture) from the skin of the face, through the trige-
minal nerve; and from a part of the skin of the Receptors and the First Neuron
auricle through the vagus (auricular branch ) and 1 The olfactory cells (16-20 million in man) are bipolar
through the facial nerve. neurons. They lie i.n the olfactory part of the nasal
b. Proprioceptive se nsa tions from mu sc les o f mucosa, and serve both as receptors as well as the first
mastication reach the mesencephalic nucleus neurons i.n the olfactory pathway.
Rostral

Nucleus
ambiguus
From contralateral _.:....,..,....'-'- To muscles
motor cortex only, of lower face
nil from ipsilateral

From ips1lateral To muscles


From contralateral
motor cortex only ➔t
=
• Genioglossus

and contralateral of upper face From ,psilateral and ":i, ... Other muscles
motor cortex contralateral sides of of tongue
motor cortex
(a) (c)
Accessory Accessory nerve
nucleus (spinal root) Joins
the cranial root to
split again
Caudal
(b)
Figs 4.Sa to c: (a) Nucleus of facial nerve, (b) nucleus ambiguus, and (c) nucleus of hypoglossal nerve
BRAIN-NEUROANATOMY

Olfactory
Nasal cavity (smell)

Optic
Eye (vision)

Oculomotor
Ciliary muscle, sphincter
pupillae and all extraocular
muscles except SO and LR
Trochlear
SO muscle
Abducent
LR muscle

Trigeminal
Sensory-face
Motor- muscles of mastication

Fac ial
Muscles of face, posterior
belly of digastric, stylohyoid,
auricularis muscles and
stapedius

Vestibulocochlear
Cochlear (hearing)
Vestibular (balance)

Glossopharyngeal
Taste-posterior 1/3 of tongue
Sensory-tonsil. pharynx,
middle ear
Motor-stylopharyngeus.
parotid gland

Vagus + Cranial root of XI


Motor-heart, lungs, palate,
pharynx, larynx, trachea,
bronchi and GI tract
Sensory-heart, lungs,
thrachea , bronchi, larynx,
pharynx, GI tract and
extenral ear

Spinal root of accessory


'ixu Sternocleidomastoid and
trapezius muscles

Hypoglossal
Tongue muscles
Strap muscles
(C1 , 2, 3 fibres)

Fig. 4 .6 : Highlights of the cranial nerves


CRANIAL NERVES

2 The olfactory nerves, about 20 in number, represent Some impulses from uncus travel via medial fore-
central processes of the olfactory cells. They pass brain bundle and reticular formation to dorsal nucleus
through the cribriform plate of ethmoid and make of vagus and salivatory nuclei in medulla oblongata,
synaptic glomeruli with cells of olfactory bulb. where these may increase or decrease gastric secretion
according to type of smell (Fig. 4.7b).
Second Neuron Olfactory afferent pathway comprises only two
neurons. The fibres reach the cerebral cortex w ithout
The mitral and tufted cells in the olfactory bulb give
synapsing in an y of the tha lamic nuclei.
off fibres that form the olfactory tract and reach the
primary olfactory areas (Fig. 4.7a). These are located in
the primary olfactory cortex which includes the anterior CLINICAL ANATOMY
perforated substance, periamygdaloid and prepiriform
area. • A11osmia: Loss of olfactory fibres with ageing.
• Sense of smell is tested separately in each nostril.
Third Neuron • Allergic rhinitis causes temporary olfactory
impairment.
Third neuron located in the primary olfactory cortex
• Head injury: Olfactory bulbs may be torn away
which includes the anterior perforated substance, and from olfactory nerves as these pass through
several small masses of grey matter around it like fractured ,cribriform plate of ethmoid leading to
periamygdaloid area and prepiriform area. anosmia. Such a fracture may also cause CSF
rhinorrhoea, i.e. CSF leakage through the nose.
Fourth Neuron • Abscess of frontal lobe of brain or meningioma in
Fibres arising in the primary olfactory cortex go to the the anterior cranial fossa may press on the
secondary olfactory cortex (entorhinal area) located in olfactory bulb or olfactory tract resulting in
the uncus and anterior part of the parahippoca mpal anosmia.
gyrus, tertiary olfactory cortex in posterior part of orbi to- • Uncinate fits: Lesion of lateral olfactory area may
frontal cortex. ca use temporal lobe epilepsy or uncinate fits.
These fits are of imaginary disagreeable odors
Smell is perceived in both the primary and secondary with involvement of tongue and lips.
olfactory areas (Fig. 4.7a).

,-.t---+_ _,,_____.,_,,__ __ _ Olfactory bulb

+----'i-,.,<'----+--+--- - Olfactory tract


- - - Cingulate gyrus
-lti'--r------>.---+--- - Area subcallosal
r-lll--'---,,:.;___ _ __.,.._-+-- - - Medial olfactory stria
~ ~::....::s....------.-----\,----- Lateral olfactory stria _ _,___ _ Medial forebrain
bundle
r"<::..-.,--..---4-_.,..__ _ Anterior perforated substance
,-4-_ __,.;;_ _ Medial olfactory
(septa!) area

-lnterpeduncular nucleus

· Raphe nuclei of midbrain (reticular formation)

.....__ _, Salivatory nuclei of medulla oblongata

Fig. 4.7a: Inferior view of brain showing olfactory areas Fig. 4.7b: Some connections of olfactory cortical areas
BRAIN-NEUROANATOMY

part of binocular field. Left halves of field of vision, i.e.


SECOND CRANIAL NERVE larger temporal half and smaller nasal half of left field
HUMAN VISION of vision form left half of binocular field.
Most importantly there is a macular vision which is
Human vision is binocular, though one sees with both the most acute or sharp and coloured vision.
the eyes, the inverted images formed are seen as one Retina: Re tina is also divided into temporal a nd nasal
and straight only (Fig. 4.8). parts and each is further subdivided into upper and
Human vision is stereoscopic, i.e. one sees height, lower parts. Temporal field is seen by nasal hemiretina
width and thickness of the object. and vice versa. Fibres from the nasal parts of the two
Human vision is coloured, one sees different colours retinae decussate to form the optic chiasma and travel
put up by nature. to the contrala teral side in the optic tract. Fibres from
When one looks a t an object, both eyes a re focused the temporal hemiretinae continue ipsilaterally in the
on it. Right eye sees a li ttle additional of right sid e optic tract.
whereas left eye sees a little additional of left side of Rig ht optic tract carries the fibres of the right
the object. These visions are monocula r vis ions. Main temporal hemiretina and the left nasal hemiretina and
part is the binocular vision. vice versa. Macular fibres lie in the central part of optic
OPTIC PATHWAYS tract, upper retinal fibres project downwards and lower
retinal fibres project upwards.
Field of Vision
It includes four fields as upper tem po ral, lower Retina
temporal, upper nasal and lower nasal. Nasal fields are It is d escribed in Chapter 19 of Volume 3. First order
smaller than the temporal fields. Larger right temporal neurons a re represented by the bipolar cells of retina.
and smaller right nasal fields of vision fuse to fo rm right They receive impulses from the rods and cones present
in the retina.
- - - Visual field - - - +
Optic Nerve
-Binocular-
zone Optic nerve is made up of axons of ganglion cells of
the retina which form the second order neurons. In a
strict sense, the optic nerve is not a peripheral nerve
because its fibres have no neurilcmmal shea ths. It is a
tract. Its fibres have no p ower of regeneration. The
nerve is described in Chapter 13 of Volume 3.
Optic Chiasma
In the chiasma, the nasal fibres (i.e. fibres of the optic
nerve arising in the nasal, or medial half of the retina)
including those from the nasal half of the macula, cross
the midline and enter the opposite optic tract. The
temporal (lateral) fibres pass through the chiasma to
enter the optic tract of the same side (Fig. 4.8).
Optic Tract
"w.---- Optic tract Each optic tract w inds round the cerebral peduncle of
the midbrain. Near the lateral gcniculate body, it
~ - - Lateral geniculate
nucleus divides into lateral and medial roots. The lateral root is
thick and terminates in the lateral geniculate body. A
Meyer's loop few of its fibres pass to the superior colliculus, the pre-
tectal nucleus and the hypothalamus. The medial root
is believed to contain the supraoptic commissural fibres.
Each optic tract contains temporal fibres of retina of
the same side and nasal fibres of the opposite side.
Lateral Geniculate Body
A"x.r,c:....-,:'---- Occ1p1tal lobe Lateral geniculate body receives the lateral root of the
(cortex)
optic tract. Medially, it is connected to the s uperior
Fig. 4.8: Visual pathways colliculus, and laterally, it gives rise to the optic radiation.
CRANIAL NERVES

The cells in this body are arranged in six layers which Flowchart 4.1: Pupillary light reflex
form the third ord er neurons.
Layers 2, 3, 5 receive ipsilateral fibres, and layers 1, Shining of torch light 1n left eye

4, 6 receive contralateral fibres.


Optic nerve
Optic Radiation (Geniculocalcarine Tract)
Optic radiation begins from the lateral geniculate body, Optic ch1asma
passes through the retrolen tiform part of internal
capsule, and ends in the visual cortex (Fig. 4.8). Optic tract

Visual Cortex
Few fibres go to pretectal nucleus of same and even opposite side
The optic radiation terminate in the striate area where
the colour, size, shape, motion, illumina tion and trans-
parency are appreciated separately. Objects arc identified Edinger-Westphal nuclei of both sides I
by integration of these perceptions w ith past experience
stored in the parastriate a nd peristriate areas 18 and 19. Ill nerve nuclei of both sides
The area of the visual cortex that receives impulses
from the macula is relatively much larger than the part
Branch to inferior oblique; relay in c,hary ganglion
related to the rest of the retina.

REFLEXES Short ciliary nerves of both sides


These are: (1) pupillary light reflex (Fig. 4.9 and
Flowchart4.1}, (2) accommodation reflex (Fig. 4.10 and Sphincter pupillae muscle of boll, eyes constrict I
Flowchart 4.2), (3) dilation of pupil (Flowchart 4.3),
(4) corneal/ conjunctiva I reflex (Fig. 4.11 and Flowchart
4.4), (5) visual body reflex (Fig. 4.12 and Flowchart 4.5).
Both pupils constrict I

~ -- - - To constrictor pupillae and ciliaris


muscles

Impulses pass along optic - --II-- - - - ',.,_~


nerve. chiasma and optic tract

n+-~ - - > t ---trt,-- - - Edinger-Westphal nuc:leus


and Ill nerve nucleus of both eyes

Fig. 4.9 : Pupillary light and consensual light reflex


BRAIN- NEUROANATOMY

~ - -- - - - -- Constrictor pupillae muscle of


iris and cilians muscles

Supenor longitudinal fasciculus

Fig. 4.10: Accommodation reflex

Superior sensory
nucleus of trigeminal nerve

Trigeminal
ganglion

t.-- - - 1 - -- Medial longitudinal


bundle

Main motor nucleus


Facial nerve - Orb1culans
Lateral
geniculate
body
t.llJ- - - - + - - - - Motor nuclei of
cranial nerves

oculi muscle A t- - - - - - --Motor nuclei of


of facial nerve anterior horn cells
Fig. 4.11 : Corneal/conjunctiva! reflex Fig. 4.12: Visual body reflex
CRANIAL NERVES

Flowchart 4.2: Accommodation reflex Flowchart 4.3: Dilation of pupil

Read a film magazine Hypothalamus

Optic nerve j
Brain stem

Optic chiasma
Spinal cord with lateral horn (thoracic segments)
Optic tract

Lateral geniculate body T1-T4 roots

Optic rad1at1on Superior cervical ganglion

Occipital cortex

Superior longitudinal fasciculus


l Relay

Fibres pass along internal carotid artery

Medial frontal gyrus (frontal eye field)

Ophthalmic artery
Ill nerve nuclei

Ill nerve and Edinger-Westphal nuclei of both sides Long ciliary artery

Branch to ciliary ganglion


Some fibres go to Nerve to inferior oblique
medial reel! which result
No relay
in medial convergence
of the eyes Branch to ciliary ganglia
Dilator puptllae

! Relay

Short ciliary nerves Flowchart 4.5: Visual body reflex

Constrictor pupillae and cilians j


R
TI
Flowchart 4.4: Corneal/conjunctival reflex Optic nerve

Touching of cornea or conjunctiva

Optic chiasma

Ophthalmic nerve

Superior sensory nucleus of V Optic tract

Medial longitudinal bundle


Superior colliculus

Motor nucleus of VII

Motor nuclei of cranial nerves for Antenor horn cells of spinal


Orblculans oculi constricts j movements of head and neck cord for movements of body
~ I BRAIN-NEUROANATOMY

CLINICAL ANATOMY • A lesion on the right optic tract leads to left


homonymous hemianopia (left half of field of
• Lesion in retina leads to scotoma, that is certain
vision).
points may become blind spots.
• Loss of vision in one half (left or right) of visual • Papilloedema: Results due to increased intracranial
field is called hemianopia. pressure. It leads to swelling of optic disc due to
If the defect is in same halves of both eyes, it is blockage of tributaries of the retinal veins.
called homonymous. If defect is in different • Optic neuritis: Lesion of optic nerve that results in
halves, it is called heteronymous. decrease of visual acuity. Optic disc appears pale
• Optic nerve damage results in complete blindness and smaller. Methyl alcohol is a usual toxic
of that eye (Fig. 4.13). chemical leading to blindness.
• Optic chiasma lesion if central will lead to
bitemporal hemianopia, but if peripheral on both • Argyll Robertson pupil: In this condition. The
sides will lead to binasal hemianopia (Fig. 4.13). accommodation reflex is present but the
• Complete destruction of optic tract, lateral light reflex is absent. The pretectal area is affected
geniculate body, optic radiation or visual cortex (see Fig. 5.14).
of one side results in loss of the opposite half of • Foster Kennedy syndrome-tumour at the base
field of vision. of frontal lobe resulting in compression of nerve .

Left eye Right eye


Temporal Nasal Nasal Temporal

,0
2 2

~ - - - Lateral geniculate
nucleus
4 4

5 5

6 6

Fig. 4.13: Field defects associated with lesion of visual pathway. (1) Blindness of left eye, (2) bitemporal hemianopia, (3) left
nasal hemianopia, (4) right homonymous hemianopia with macular involvement. (5) right homonymous hemianopia, and (6) right
homonymous hemianopia with macular sparing
CRANIAL NERVES

Superior colliculus
THIRD CRANIAL NERVE
OCULOMOTOR NERVE
, - - - - - - - Ill nerve nuclear
This is the third cranial nerve. It is distributed to the complex
extraocular as well as the intraocular muscles. Since it ,...-f--P....-- Red nucleus
is a somatic motor nerve, it is in series with the IV, Vl
and XII cranial nerves, and also with the ventral root Substantia nigra
of spinal nerves.
Functional Components
1 General somatic efferent, for muscles of eyeball
which help in its movements (Fig. 4.14).
2 General visceral efferent o r parasympathetic, for Fig. 4.14: Third cranial nerve and its nucleus
contraction of pupil and accommodation.
3 General somatic afferent column carries proprio- • Yentro-medial-to medial rectus
ceptive fibres from the extraocular muscles to
• Caudal central-to le,·ator palpabrae superioris
mesencephalic nucleus of V.
• Median raphe-to superior rectus
Nucleus • Ed inger-Wes tph al-to ciliaris and sphincte r
The oculomotor nucleus is situated in the ventromedial papillae muscles.
part of central grey matter of midbrain at the level of
superior colliculus. Ventrolaterally, it is closely related Course and Distribution
to the medial longih1dinal bundle.
1 ln their intraneurnl course, the fibres arise from the
The nucleus is connected:
nucleus and pass ventrally through the tegmenh1m,
a. To the pyramidal tracts of both sides which form
red nucleus and substantia nigra.
the supranuclear pathway of the nerve.
b. To the pretectal nuclei of both sides for the light reflex. 2 At the base of the brnin, the nerve is attached to the
c. To the fourth, sixth and eighth nerve nuclei by oculomotor sulcus on the medial side of the crus
medial longitudinal bundle for coordination of the cerebri (Fig. 4.1 ).
eye movements. 3 The nerve passes between the superior cerebellar and
d. To the tectobulbar tract for visuoprotective reflexes. posterior cerebral arteries, and runs forwards in the
The nuclear complex includes lhe following parts: interpeduncular cistern, on the lateral side of post-
• Dorsolateral- to supply inferior rectus muscle erior communicating artery to reach the cavernous
• Intermediate-to inferior oblique sinus (Fig. 4.15).

Oculomotor nerve

Trochlear nerve

Pia mater

Fig. 4.15: Scheme to show the precavernous courses of the third, fourth and sixth cranial nerves
BRAIN-NEUROANATOMY

4 The nerve enters the cavernous si1111s (Fig. 4.16) by 6 In the orbit, the smaller uppe:r division ascends on
piercing the posterior part of its roof on the lateral the lateral side of optic nerve, and s upplies the
side of the posterior clinoid process. rt d escends to superior r ectus and part of t:he levator palpebrae
the lateral wall of the sinus where it lies above the superioris.
trochlear nerve. In the anterior part of the sinus, the The larger, lower, div is ion divides into three
nerve divides into upper and lower div isions. branches for the medial rectus, the inferior rectus and
5 The two divisions of the nerve enter the orbit through the the inferior oblique. The nerve to the inferior oblique
middle part of the superior orbital fissure. In the fissure, is the longest of these. It gives off the parasy m-
the nasociliary nerve Iies in between the two di visions pathetic root to the ciliary ganglion and then supplies
while the abducent nerve lies inferolatera l to them. the inferior oblique muscle (Fig. 4.17).

Internal carotid- - - - -- - - - - - ~
artery ,-:;:::::.:::::~~=:::::=?J
Oculomotor nerve---- - - - -

Endo:steal layer of dura matter

Sphe1no1dal air sinus

Mandibular ,...__ _ _ _ _ _ Internal carotid artery


nerve
~ - - - - -- - Abducent nerve
Fig. 4.16: Course of Ill, IV, V and VI nerves in the cavernous sinus

Superior oblique - ---,r;--,.


,Q;:":il,--~ --- Superior rectus
Lateral rectus - - --
111-1t--- - Medial rectus
Ciliary ganglion- __..,__.._.

,,,...-- - Sphenoid ridge

!:.. -- --, ,~~___,, ,---~--- Petrous rid!Je


~7,?.~~-=-=;~~~---- Basilar artery

Superior cerebellar artery-- - ~

"-"- - ~- - - - - Red nucleus


•L--- ""'7"' - - - - - - - 111 nucleus
Aqueduct - - - - - ~- - - +)
, . . . _ - - - - - - - Superior colliculus
Fig. 4.17: The origin, course and the distribution of oculomotor nerve. Superior oblique and lateral rectus also seen
CRANIAL NERVES

Inferior Superior Superior Inferior


oblique
• Pupil dila tes and becomes fixed to light.
rectus rectus oblique
• A midbrain lesion causing contra la te ral hemi-
plegia and ipsila teral para lysis of the third ner ve
is known as Weber's syndrome.
Medial
• Supranuclear paralysis of the third nerve causes
rectus loss of conjugate movement of the eyes.
• Compression of fl/ nerve: Compression of m nerve
due to extradural haema to ma causes dilatation of
Superior Inferior Inferior Superior p upil. Parasympa thetic fibres lying superficial get
oblique rectus rectus oblique affected first. Pupil dilates on a ffected side and
there is little response to light.
Fig. 4.18: Action of individual extraocular muscle. Arrows indicate
direction of movement • Aneurysm of posterior cerebral or superior cerebellar
artery: Aneurysm of any of these two arteries may
comp ress 111 nerve as it passes between them.

Wrinkled forehead

Drooping lid

All b ra nches e n te r the mu scles on their ocul ar


surfaces except that for the inferior oblique which enters ....___,<-+--- - Dilated pupil
its poste rior border. ' - - 1 - - - -- Downward abducted
Figures 4.18 and 4.19 show the actions of extraocular eye
muscles.

CLINICAL ANATOMY

• Complete and total paralysis of the third nerve Fig. 4.20: Paralysis of left third nerve
results in:
a. Ptosis, i.e. drooping of the upper eyelid.
b. Latera l squint FOURTH CRANIAL NERVE
c. Dilatation of the pupil (Fig. 4.20)
d. Loss of accommoda tion TROCHLEAR NERVE
e. Slight proptosis, i.e. forward projection of the
It supplies only the superior oblique muscle of the
eye.
f. Diplopia or d ouble vision. eyeball (Fig. 4.23). It is the o nly cranial nerve which
emerges on the dorsal aspect of the brain stem.
• Ptosis or drooping of up per eyelid due to para Iysis
of voluntary part of levator palpebrae superioris Functional Components
muscle.
1 Genera 1soma tic efferent, for lateral movement of the
• Pupillary light reflex in affected eye is a bsent.
eyeball.
• Dil a tatio n of pup il du e to p ar alys is of p ar a-
2 The general soma tic afferent, for proprioceptive
sympa thetic fibres to sphincter pupillae muscle.
im p ulses fro m the m uscle to the m esencephalic
• Eyeball gets turned downward s a nd la terally due nucleus of V nerve.
to unopposed action of lateral rectus and superior
oblique muscles. Nucleus
• Loss of accommoda tion d ue to paralysis of ciliary
muscles. The trochlear nucleus is situa ted in the ventromcdial
part of the central grey ma tter of midbrain at the level
BRAIN-NEUROANATOMY

of inferior colliculus. Ventrally, it is closely related to ' - - -- - - Emerging IV


the med ial lon gitudina l bundle. nerve
The connections of the nucleus are similar to those of
the oculomotor nucleu s, except for the pretectal nuclei.

Course and Distribution


1 1n its intraneural course, the nerve runs dorsally round
the central grey matter to reach the upper pa rt of the
superior or an terior medu llary velum where it '--...,....." ' - - - ---,'-- Decussation of
decussates with the opposite nerve to emerge on the superior cerebellar
peduncles
opposite sid e (Fig. 4.21 ).
2 Surface attachmen t: Troch.lear nerve is attached to the Corticobulbar and
superior medullary velum on e on each side of the corticospinal tracts
frenulum veli just below the inferior colliculus. It is Fig. 4.21: Emerging fibres of trochlear nerves with their nuclei
the onl y cranial nerve which emerges on the dorsal
aspect of the brain stem (Fig. 4.1). oculomotor and ophthalmic nerves. In the anterior
3 The ne r ve winds ro und the s uperio r cerebellar part of sinus, it crosses over the oculomotor n erve
peduncle and the cerebral peduncle just above the (Fig. 4.16).
p ons. It passes between the posterior cerebra l a nd 5 TrochJea r nerve enters the orbit through the lateral
superior cerebe ll ar arteries to appear ventrally par t of the superior orbital fissu re.
between the temporal lobe and upper border of pons. 6 ln tlze orbit, it passes medially, above the origin of
4 The nerve enters the cavernous sinus by p iercing the levator palpebrae s uperioris and ends by supplying
posterior corner of its roof. Next it runs forwards in the superior obliqu e muscle on its orbital surface
the la teral wall of cavernous sinus between the (Fig. 4.22).

Superior oblique- - - -

Superior orbital fissure

Sphenoid ridge----

Cavernous sinus - - - --.ill

~ - - - - Superior cerebellar artery

- - -- - - Trochlear nerve

Fig. 4.22: The origin, cou rse and the distribution of the trochlear nerve
CRANIAL NERVES

CLINICAL ANATOMY 2 The nerve is attached to the lower border of the pons,
opposite the upper end of the pyramid of the meduJJa
• When trochlear nerve is damaged, diplopia occurs (Fig. 4.1).
on looking downwa rds; vision is single so long as 3 The nerve runs upwards, forwards and laterally
the eyes look above the horizonta l plane. through the cisterna pontis and usua lly dorsal to the
• Paralysis of the trochlear nerve results in: a nterior inferior cerebellar .artery to reach the
a. Defective depression of the adducted eye. cavernous sinus.
b. Diplopia. 4 The abducent nerve enters the cavernous sinus by
piercing its posterior wall at a point lateral to the
d orsum sellae and superior to the apex of the petrous
SIXTH CRANIAL NERVE temporal bone. As the nerve crosses the superior
bo rder of the petrous temporal bone, it passes
ABDUCENT NERVE beneath the petrosphenoidal ligament, and bends
sharply forwards. In the cavernous sinus, at first it
lt supplies the lateral rectus muscle of the eyeball
lies lateral to the internal carotid artery and then
(Fig. 4.23). It has a long intracranial course.
inferolateral to it (Fig. 4.16).
Functional Components 5 The abducent nerve enters the orbit thro ugh the
middle part of the superior orbital fissure. H ere it
1 General somatic efferent, for lateral movement of the lies inferolateral to the oculom otor and nasociliary
eyeball. nerves.
2 The general somatic afferent, for proprioceptive 6 In the orbit, the nerve ends by supplying only the
impul es from the muscle to the mesencephalic lateral rectus muscle. It enters the ocular surface of
nucleus of V nerve. the muscle (Fig. 4.24).
Nucleus
Abducent nucleus is situated in the upper part of the CLINICAL ANAT
floor of fourth ventricle in the lower pons, beneath the
• In increased intracrania l pressure it gets com-
facia l collicuJus. Ventromedially, it is closely related to
pressed resulting in medial s91uint and diplopia.
the medial longitudinal bundle.
• Sixth nerve paralysis is one of the commonest false
Connections of the nucleus are similar to those of
localizing signs in cases with raised intracranial
the third nerve, except for the pretectal nuclei.
pressure. Its susceptibility to such damage is due
Course and Distribution to its long course in the cisterna pontis, to its sharp
bend over the superior border of petrous temporal
1 In their intrrmeural course, the fibres of the VI nerve
bone and the downward shi ft of the brain stem
nm ventrally and downwards through the trapezoid towards the foramen magnum resulting in medial
body, medial lemniscus and basilar part of pons to squint and diplopia.
reach the lower border of the pons.

Fig. 4.23: VI nerve with its nucleus. It includes unusual course of VII nerve
BRAIN-NEUROANATOMY

sensory and third, the largest biranch is mixed nerve.


Trigeminal nerve is the nerve of first brachia I arch.
Branches of this nerve provid,e sen sory fibres to the
Lateral rectus
four parasympathetic ganglia associated with cranial
ou tflow of parasympathe tic nervous system. These are
ciliary, pterygopalatine, otic and submandibular.
---- - Superior orbital Ophthal mic, the first division carries sensory fibres
fissure
from the structures derived from frontonasal process.
Maxillary, the second division conveys afferent fibres
from stru ctu res derived from m axi ll a ry p rocess.
~ - - Cavernous Mandibular, the third mixed division carries sensory
sinus fibres derives from mandibular process.
~ -- - Abducent
nerve
Nuclear Columns
1 General somatic afferent column: Thjs colwnn has three
nuclei. These are:
U-- --=- 1------- - Nucleus of VI
a. Spi11al 11ucleus of V nerve: Fibres conveying pain
nerve and temperatu re sen sations from most of the face
area relay here (Fig. 4.26).
Fig. 4.24: The origin, course and distribution of the abducent b. Principle senson; n11cleus of\/ 11erve: Fibres carrying
nerve toucl1 and pressure relay in this nucleus.
c. Mese11cephalic nucleus: This n ucleus extends in the
• Sixth nerve paralysis causes fa ilure of abduction midbrain. It receives projprioceptive impulses
of the affected eye (Fig. 4.25). from muscles of mastication , temporomandibular
joint and teeth.
• Diplopia occurs due to p aralysis of right lateral
rectus muscle. 2 Branchial effere11t colw1111: The nucleus of V nerve is
situated at the level of upper pons. The fibres of the
R L motor nucleus s upply eight muscles derived from
first branchia I arch.

Sensory Components of V Nerve


Sensations of pain, temperature, touch and pressure
from skin of face, mucous mem b rane of nose, most of
Conjugate position of eyes
the tongue, paranasal a ir sinuses travel along axons.
in primary position Their cell bodies lie in the V ganglion (Fig. 4.27) or
se milunar ganglion o r Gasserian gan gli o n. This
ganglion is equivalent to the spinal ganglia of other
nerves. It lies at the apex of petrous temporal bone in a
dural cave, the Meckel's cave. Peripheral processes form
the three nerves.
The central processes of V ganglion form sensory
No abduction of right eye on root. Some fibres ascend and oth e r descend. Ascend ing
looking to the right paralysed side
fibres end in superior sensory nucleus. Descendmg
Fig. 4.25: Paralysis of right sixth nerve fibres end in the spinal nucleus of V nerve.
Pain and temperature reach spinal nucleus. Touch
and pressure sensations go to su perior sensory nucleus
FIFTH CRANIAL NERVE (Fig. 4.28).
Ophthal mic nerve fibres end. in the inferior p art,
TRIGEMINAL NERVE maxillary nerve fibres end in the middle part and
Fifth cranial nerve is the largest cranial nerv e. It mandibular nerve fibres terminate in the upper part of
comprises three bran ches, two of which are purely spinal nucleus.
CRANIAL NERVES

~ - - -- - - -- -Fourth ventricle

,---,....- - - -- - Superior sensory nucleus


of V nerve

Trigeminal ganglion

Cut longitudinal corticospinal - -- - - /


and corticonuclear fibres '--- -- - -- Nuclei pontis
Fig. 4.26: Nuclei of trigeminal nerve at level of upper pons

Superior sensory
nucleus of V ~ - -- - Trigeminal
ganglion
~ V1
Genu
of facial ~ Superior orbital
nerve fissure

4___ Foram~~
rotundum
,---- Foramen ovale
VII ·-====-- v3
Trigeminal nucleus Stylomastoid
ganglia foramen
Medulla
/1 ,1'. ---- Frontalis
f ;- Orb1cularis oculi ~
j 1V"~ Buccal ~
~
Fig. 4.27: Trigeminal ganglia and its three branches

Accordin g to another view, the ophthalmic fibres lie


in the median part, maxillary fibres in the medial part
Spinal cord

Spinal - -+-- •
l=~-- j1,,-- - Nasal
_-.;:f!--.- - Orbicularis oris
Platysma
-~
u.
nucleus
and the mandibular fibres in the lateral part of the ofV
nucleus.
Proprioceptive fibres from muscles of mastication, Fig. 4.28: Sensory input of trigeminal (yellow) and motor output
extra ocular muscles and facia l muscles bypass V ganglion of facial nerve (orange)
to reach unipolar cells of mesencephalic nucleus.
Axons of neurons of s pinal nucleus, supe rior sensory
nucleus and centra l processes of cells of mesencephalic mesencephalic nucleus. Fibres of motor root s upply
nucleus cross to the opposi te side and ascend as four muscles of masticatio n temporalis, masseter, lateral
trigeminal lemn.iscus. The lemni.scus ends in the ventral pterygoid and medial p terygoid and four other muscles
posteromed ia l nucleus of thalamus, where these fibres which are te nsor veli palatin.i, tensor ty mpani,
relay. The third neuron fibres end in areas 3, 1 and 2 of mylohyoid and anterior belly of dligastric.
cerebral cortex.
Branches of Trigeminal Nerve
Motor Component for the Muscles Cranial nerve V / trigeminal n erve comprise three
Th e motor nucleus receives impulses from the right branches, ophtha lmic Vl, maxillary V2 and mandibular
and left cerebral hemi s phe res, red nucle us and V3 (Fig. 4.29).
BRAIN- NEUROANATOMY

~ -- - --II-+-- - - - Nasociliary

~~-., .~-t=~=i;~
_;_.,~~- + - - ---Supratrochlear nerve

Otic ganglion- --~->,,....>...:,~c\H-+=-lii!

Tensor veli palatini-- - -:i..--~-o:::..4\-1-+-~

Facial nerve with--- -----\----'lt':;;;;:;:;:;;,ir::!..,.,


chorda tympani

Fig. 4.29: Distribution of three branches of trigeminal nerve

Ophthalmic Nerve Division (Sensory) Lacrimat


Ophthalmic nerve is sensory. Its branches are: Lateral pa rt of upper eyelid; conveys secretomotor
fibres from zygoma tic nerve to lacrimal gland.
Frontal
Maxillary Nerve Division (Sensory)
1 Supmtrochlear: Upper eyelid, conjunctiva and lower
It is sensory and gives branches as follows:
part of forehead.
2 Supraorbital: Frontal air sinus, upper eyelid, forehead In Middle Cranial Fossa
and scalp till vertex (Fig. 4.29). Meningeal branch
In Pferygopalatine Fossa
Nasociliary
1 Ganglionic branches
1 Lo11g cilinn;: Sensory to eyeball.
2 Zygomatic:
2 Branch to ciliary ganglion . a. Zygomaticotemporal ) Sensory
3 Posterior ethmoidnl: Sphenoidal air sinus, posterior b. Zygomaticofacial
ethmoidal air sinuses. 3 Posterior superior alveolar
4 Anterior ethmoidnl: In lnfraorbitat Canal
a. Middle and anterior ethmoidal sinuses 1 Middle superior alveolar
b. Medial internal nasal 2 Anterior superior alveolar
c. Lateral internal nasal On Face
d. External nasal: Skin of ala of vestibule and tip of
nose.
5 /11/ratrochlear: Both eyelids, side of nose, lacrimal
lnfraorbital
a. Palpebral
b. Labial
l Sensory
sac. c. asal
CRANIAL NERVES

Mandibular Nerve Division (Sensory and Motor)


Sensory examination:
It is a mixed nerve and it branches are:
• An ascending lesion spares the openings of nose
From Trunk and mouth (muzzle area) till last.
1 Meningeal • Test with pin prick, temperature and light touch
2 Nerve to medial pterygoid supplies: over each s ide of the w hole face.
a. Tensor veli pala tini • The sensations in three branch es of V nerve can
b. Tensor tympani
be tested clinically.
c. Medial pterygoid.
Motor examination:
From Anterior Division
• Look for wasting or th.inning of temporal is muscle.
1 Deep temporal
There may be ' hollowing out' of the tempo ra l
2 Lateral p terygoid
fossa.
3 Masseteric
• Ask the patient to press upper a nd lower teeth
4 Buccal- skin of cheek (Fig. 4.29).
together and feel fo r tempo1ralis and masseter
From Posterior Division muscles.
1 Auriculotemporal (Fig. 4.29): • Ask patient to open th e mouth. If pterygoid
a. Au ricular muscles are weak, the jaw would deviate to weak
b. Superficial temporal side as the normal muscles will push the jaw to
c. Articular to temporomandibular joint the weak s ide.
d. Secretomotor to parotid gland. In injury to:
2 Lingual- general sensation from anterior two-thirds • Ophthalmic nerve: There is lo:ss of corneal blink
of tongue. reflex. This reflex is mediate d by Vl which is
3 Infe rior alveolar-lower teeth, mental for skin of chin afferent pathway a nd VII nerve which subserves
and nerve to my lohyoid w hich a lso supplies: as efferent pathway (Figs 4.11 and 4.31).
a. Mylohyoid • Maxillan; nerve: There is loss oJf sneeze reflex. This
b. Anterior belly of digastric. bran ch is the affer ent p a th of sneeze reflex.
Efferent pathway of sneeze reflex is nucleus
amb iguus, respiratory centre in medulla oblon-
CLINICAL ANATOMY
gata, ph.renic nerve nucleus, motor cells of spinal
• Fifth crani a l nerve subserves sensation from face cord for intercostal muscles.
and n e ighbouring a reas. It also innervates the Mandibular nerve: There is loss of jaw jerk reflex
muscles of mastication . (Fig. 4.32).
• Proprioceptive fibres terminate in mesencephalic • Flaccid paralysis of muscles o f mastication in
nucleus . injury of mandibular nerve l,eading to decrease
• Light touch fibres end in the main sensory or streng th for biting.
superior sensory nucleus. • Hypoacusis, i.e. partial deafness to low pitched
• Pain and temperature fibres terminate in nucleus sounds due to p aralysis of te n so r tympani
of spinal tract of h·igeminal. muscle.
• Motor fibres begin from the motor nucleus of • Trigeminal neuralgia: Pain alon g the distribution
trigeminal. of the nerve w hich is ca used due to local les ion or
• The separate location of main sensory nucleus and unknown cause. The principal disease affecting
spinal nucleus account for dissociated sen sory sensory root of V n erve is characterized by attacks
loss, i.e. low pontine or medullary lesion wi ll o f severe pain in the area of distributi on of
result in loss of pain and temperature sensation maxillary or mandibu lar div isions. Maxillary
while light sensa tion is preserved. nerve is most frequently involved.
• low p ontine, medullary and cervical lesions • The trigeminal gan g lion h airbo urs the herpes
produce a characteristic 'onion skin' dis tribution simp lex virus ca usin g herpes (shingles) in the
of pin p rick and temperature loss (Fig. 4.30). dis tribution of the nerve.
BRAIN-NEUROANATOMY

SEVENTH CRANIAL NERVE

FACIAL NERVE
Facial nerve is the nerve of the second branchial arch.

Functional Components
1 Special visceral or brnnchial efferent (SVE), responsible
for muscles of facial expression and for elevation of
the hyoid bone (Table 4.1 and Fig. 4.36).
2 General visceral efferent (GVE) or parasympathetic
fibres. These fibres are secretomotor to the sub-
mandibular and s u blingual salivary glands, the
lacrimal gland, glands of the nose, palate and
pharynx (Figs 4.4a and b).
3 General visceral afferent (GVA) component carries
aiferent impulses from the above mentioned glands.
Fig. 4.30: Brain stem lesion of trigeminal nerve
4 Special visceral afferent (SV A) fib res carry tastes
sensations from the palate and from anterior two-
thirds of the tongue except from vallate papillae.
5 General somatic afferent (GSA) fibres probably
innervate a part of the skin of the ear. The nerve does
not give any direct b ranches to the ear, but some
fibres may reach it through communications with
the vagus nerve. Proprioceptive impulses from
muscles of the face travel through branches of the
trigeminal nerve to reach the mesencephalic nucleus
of the nerve.

Nuclei
The fib res of the nerve are connected to four nuclei
situated in the lower pons.
Fig. 4.31 : Testing the corneal blink reflex 1 Motor nucleus or branchio motor (Fig. 4.32).
2 Superior salivatory nucleus or parasympathetic.
3 Lacrimatory nucleus is also parasympathetic.
4 ucleus of the tractus solitarius which is gustatory.
It also receives a fferent fibres from the g lands
(Figs 4.4b and c).
The motor nucleus lies deep in the reticular formation
of the lower pons. The part of the nucleus that supplies
muscles of the upper part of the face receives cortico-
nuclear fibres from the motor cortex of both the right
and left sides.
ln contrast, the part of the nucleus that supp]jes muscles
of the lower part of the face receive corticonuclear fibres
only from the opposite cerebral hemisphere (Fig. 4.Sa).

Course and Relations


The facial nerve is attached to the brain stem by two
roots, motor and sen ory. The sensory root is also called
Fig. 4.32: Elicitation of jaw jerk reflex
the nervus intermedius (Fig. 4.33).
CRANIAL NERVES

Canal for - - - - ----,,1'-


facial nerve

,-----"<"~- -Facial nerve (motor root) First part runs - - - ~~ Second part runs
laterally backwards
-------- Vestibulocochlear nerve
Geniculate - --!---
Nervus intennedius (sensory root) ganglion
Dura mater
Arachnoid mater ~ ~ - - Nerve to
'-::::::- --::~ ~ - - Pia mater stapedius

Fig. 4.33: Structures in the left internal acoustic meatus


Third part runs
downwards
The two roots of the facial nerve are attached to the
la teral part of the lower border of the po ns just medial
to the eighth cranial nerve. The hvo roots run laterally
and forward s, w ith the eig hth ne rve to reach the Stylomastoid - -- - -- - -...r
internal acoustic mea tus. foramen

ill the mentus, the motor root lies in a groove on th e Fig. 4.35: Course of facial nerve
eigh th nerve, w ith the sensory root in terven ing
(Fig. 4.33). Here the seventh a nd eighth nerves are promontory, and is also called the genu. The geniculate
accompanied by the labyrinthine vessels. At th e bottom ganglion of the nerve is so called beca use it Lies on the
or fundus of the meatus, the two roots, sensory and genu. The second bend is gradual, and lies between the
motor, fuse to form a single trunk, which lies in the promontory and the aditus to the mastoid antrum.
petrous temporal bone (Fig. 4.34). The facial nerve leaves the skull by passing through
Within the ca na l, the course of the nerve can be the stylo mastoid fora men.
divided into three parts by two bends (Fig. 4.35). 1n its extracranial course, the facial nerve crosses the
The first part is directed laterally above the vestibule; lateral side of the base of the styloid process. It enters
the second part runs backwards in relation to the media l the posteromedial surface of the parotid gland, runs
wall of the middle car, above the promontory . The third forwards through the gland crossing the retromandi-
part is directed vertica lly downwards behind the bular vein and the external carotid artery. Behind the
promontory. neck of the mandible, it divides into its five terminal
branches which emerge along the anterior border of
The first bend a t the junction of the fi rst and second
the parotid gland.
parts is sharp. It lies over the anterosuperior part of the
Branches and Distribution
Inferior vesilbular Superior vestibular area
area for fibres from for fibres from cristae
1 Within the facial canal:
maculae of utricle of anterior and lateral a. Greater petrosal nerve
and saccule semicircular canals
b. The nerve to the staped ius
c. The chorda ty mpani (Fig. 4.36).
Canal for 2 At its exit from the stylomastoid foramen:
facial nerve
a. Posterior auricular
Transverse b. Digastric
crest
c. Stylohyoid.
3 Terminal branches within the parotid gland :
Cochlear a. Temporal
area
b. Zygomatic
c. Buccal
Foramen singulare for fibres d. Marginal mandibular
from crista of posterior semicircular canal e. Cervica l.
Fig. 4 .34: Some features seen on the fundus of the left internal 4 Communicating branches w ith adjacent cranial and
acoustic meatus spinal nerves.
BRAIN- NEUROANATOMY

Zygomatic nerve
communicates
Nucleus of tractus solitarius (SVA and GVA) with lacrimal nerve

Lacrimal
Internal auditory meatus gland
Lacrimal
Greater
petrosal

i----- Sphenopalatine
ganglion

Nasal, palatal
and pharyngeal
glands

Lingual nerve

Submandibular
ganglion
Stylomastoid
foramen
Posterior-- - -
auricular

Posterior belly - --~


of digastric

SVE - - SVA -
Submand ibular
gland GVE - - GSA -
GVA ----

Marginal mandibular
Fig. 4.36: Distribution of functional components of VII nerve

Greater petrosal nerve-course has been traced in ear by passing through the pe trotympanic fissure. It
Flowchart 4.6. then passes medial to the spine of the s phenoid and
The nerve to the stapedius arises opposite the pyr amid enters the infratempo ral fossa. Here it joins the lingual
of the middle ear, and supplies the stapedius muscle. nerve through which chorda tympani nerve is distri-
The muscle d ampens excessive vibrations of the stapes buted. It carries:
caused by high-pitched sounds. In p aralysis of the a. Preganglionic secretomotor fibres to the s ub-
muscle, even normal sounds appear too loud and is mandibular ganglion for s upply of the submandi-
known as hyperacusis (Fig. 4.36). bular and s ublingual salivary glands.
The chordn tt; mpani arises in the vertical part of the b. Taste fibres from the anterior two-thirds of the
facial cana l about 6 mm above the s ty lomastoid tongue except circumvalla te papillae.
foramen. It runs upwa rds and forwards in a bony canal. The posterior auricular nerve arises just be low the
It enters the middle ear a nd runs forwards in close stylomastoid foramen. It ascends between the mastoid
relation to the tympanic membrane. It leaves the middle process and the external acoustic meatus, and supplies:
CRANIAL NERVES

Flowchart 4.6: Tracing nerve supply of lacrimal gland nerve also communicates w ith the sen sor y n erves
Greater petrosal nerve distributed over its motor territory.

Ganglia
Deep petrosal nerve
The ganglia associa ted with the facial nerve are as
Nerve of pterygoid canal
follows.
1 The genicula te ganglion (Fig. 4.36) is located on the
first bend of the fa cial nerve, in relation to the medial
l Relay wall of the middle ear. It is a sensory ganglion. The
Postganglionic for lacrimal gland join zygomatic nerve taste fibres present in the nerve are p eriphera l
processes of pseudounipolar neurons present in the
Pass through communicating branch genicula te ganglion.
2 The submandibular ganglion is a parasympathetic
Lacrimal nerve ganglion for relay of secretomotor fibres to the sub-
ma ndibular and sub ling ual glands. The preganglionic
Lacrimal gland ! fibres come from the chorda tympani n erve (Table 4.2).
It is described in Chapter 7 of Volume 3.
3 The pterygopalatine ganglion is also a parasympathetic
a. Auricularis posterior
gang!io11. Secretomotor fibres meant for the lacrimal gland
b. Occipitalis relay in this ganglion. The fibres reach the ganglion
c. Intrinsic muscles on the back of auricle. from the ne rve to the pterygoid canal (Table 4.2). It
The digastric branch, arises close to the previous nerve. is described in Chapter 15 of Volume 3.
lt is short and supplies the posterior belly o f the
digastric. CLINICAL ANATOMY
The stylohyoid branch, arises with the digastric branch,
is long and supplies the stylohyoid muscle. • Bell's palsy: Sudden paralysis of facial nerve at the
stylomastoid forarnen, results in asymmetry of
The temporal branches cross the zygomatic arch and
supply: corner of mouth, inability to close the eye,
disap peara nce of n asolabial fold and loss of
a. Auricularis anterior
wrinkling of skin of forehead on the same side
b. Auricularis superior (see Fig. 2.20 of Volume 3).
c. Intrinsic muscles on the lateral side of the ear • Lesion above the origin of chorda tympani nerve
d . Frontalis will show symptom s of Bell's palsy plus loss of
e. Orbicularis oculi taste from anterior two-thirds of tongue except
f. Corrugator supercilii. valla te papillae (Fig. 4.37).
The zygomatic branches run across the zygomatic bone • Lesion above the origin of nerve to s tapedius will
and supply the orbicularis oculi. cause symptoms 1, 2 (Fig. 4.37). It also causes
The buccnl branches a re two in number. The upper hyperacusis.
buccal branch runs above the parotid duct a nd the • Lesions 1, 2 and 3 (Fig. 4.37) are lower motor
lower buccal branch below the duct. They supply neuron type. Upper m otor ne uron paralysis will
muscles in that vicinity especially the buccinator. not affect the upper part of face, i.e. orbicularis
The marginal mandibular branch runs below the angle oculi, only lower half of opposite side of face is
of the mandible deep to the platysma. It crosses the affected. The upper half of face has bilateral
body of the mandible and supplies muscles of the lower representation, whereas lower half has only
lip and chin. contralateral representation (Fig. 4.5a).
The cervical branch em erges from the apex of the • Facial nerve can be injured at any level during its
parotid gland, and runs downwards and forwa rds in course. Figure 4.37 shows symptoms according to
the neck to supply the platysma. level of injury of VII nerve.
Lower motor neuron paralysis ofVll nerve causes
Com11111nicati11g branches: For effective coordination
paralysis of ipsilateral half of face, i.e. both upper
betwee n the m ovements of the muscles of the firs t,
quadrant and lower quadrant of same side as the
second a nd third branchial arches, the m otor nerves of
injury.
the three arches communicate with each other. The facial
BRAIN-NEUROANATOMY

Upper motor neuron paralysis of Vil nerve results • ln case of damage to facial nerve proximal to
in paralysis of contralateral lower quadrant of face genicu late ganglia, regenerating fibres for
only. submandibula r salivary gland grow in endoneural
• For clinical testing of the facial nerve, and for sheaths of preganglionic secretomotor fibres
different types of facial paralysis-infranuclear supplying the lacrimal gland. That is why patient
(see Fig. 2.20 and for supranuclear see Fig. 2.21 of lacrima tes while eating food.
Volume 3). • Ramsay-Hunt syndrome: Involvement of geniculate
• Facial nerve palsy in newborn: The mastoid process ganglia by herpes zoster results in this syndrome.
is absent in newborn and stylomastoid foramen It shows following symptoms:
is superficial. Manipulation of baby's head during a. Hyperacusis.
delivery may damage the VII nerve. This leads to b. Loss of lacrimation.
paralysi s of facial mu scles esp ecially th e c. Loss of sensation of taste in anterior two-thirds
buccinator, required for sucking the milk. of tongue.
• Crocodile tears syndrome: Lacrimation during eating d. Bell's palsy and lack of saUvation.
occurs due to aberrant regeneration after trauma. e. Vesicles on the auricle.

1. Loss of lacnmation
2. Loss of stapedial reflex - -- - - - - Internal auditory meatus
3. Loss of taste from anterior 2/3rds of tongue
4. Lack of salivation ~ -- ---Geniculate ganglion
5. Paralysis of muscles of facial expression (Bell's palsy)

1,2,3,4,5 - - - - ~
2,3,4,5 - -- - - - -
3,4,5 - - -- - --;;

- - - -- Chorda tympani

- - - - - -----Stylomastoid foramen
Temporal

Zygomatic

Cervical - - - - - -..__

Fig. 4.37: Symptoms according to the level of injury to cranial nerve VII

nerve (Fig. 4.39). This nerve terminates in the dorsal


EIGHTH CRANIAL NERVE and ventral cochlear nuclei.
2 The second neurons lie in the dorsal and ventral
VESTIBULOCOCHLEAR NERVE cochlear nuclei. Most of the axons arising in these
This nerve comprises hearing and vestibular parts. It nuclei cross to the opposite side (in the trapezoid
belongs to special somatic afferent column (Table 4.2). body) and terminate in the superior olivary nucleus.
(many fibres end in the nucleus of trapezoid body
Pathway of Hearing or of the lateral lemniscus). Some fibres are uncrossed
1 The first neurons of the pathway are located in the (Fig. 4.40).
spiral ganglion. They are bipolar. Their peripheral 3 The third neurons lie in the superior olivary nucleus.
processes innervate th e spiral o rgan of Corti Their axons form the lateral lemniscus and reach the
(Fig. 4.38), whj]e central processes form the cochlear inferior collicu Ius.
CRANIAL NERVES

Table 4.2: Connections of parasympathetic ganglia


Ganglia Sensory root Sympathetic Secretomotor Motor root Distribution
root parasympathetic root
Ciliary From nasociliary Plexus along Edinger-Westphal Ciliaris muscles
(Fig. A.1 of nerve ophthalmic nucleus ➔ oculomotor Sphincter pupillae
Volume 3) artery nerve ➔ nerve to
inferior oblique
Otic Branch from Plexus along Inferior salivatory Branch Secretomotor to parotid gland
auriculotemporal middle nucleus ➔ glosso- from via auriculotemporal nerve
nerve meningeal pharyngeal nerve ➔ nerve to Tensor veli palatini and tensor
artery tympanic branch ➔ medial tympani via nerve to medial
tympanic plexus ➔ pterygoid pterygoid (unrelayed)
lesser petrosal nerve
Pterygopalatine Two branches Deep petrosal Lacrimatory nucleus ➔ nervus - Mucous glands of nose, paranasal
from maxillary from plexus intermedius ➔ facial nerve ➔ sinuses, palate, nasopharynx
nerve around internal geniculate ganglion ➔ greater Some fibres pass through
carotid artery petrosal nerve + deep petrosal zygomatic nerve ➔ zygomatico-
nerve = nerve of pterygoid temporal nerve ➔ communicating
canal branch to lacrimal nerve ➔
lacrimal gland
Submandibular Two branches Branch from Superior salivatory nucleus ➔ Submandibular, sublingual,
from lingual plexus around facial nerve ➔ chorda tympani and anterior lingual glands
nerve facial artery ➔ joins the lingual nerve

Tectorial membrane

Basilar Afferent and efferent


membrane nerve fibres
Fig. 4.38: Organ of Corti

Fundus of internal
Vestibular nuclei auditory meatus

Dorsal cochlear
nucleus '-4--l'-l - --'-+-+--4--,f--- - Semicircular
canals
Ampullae with
cristae

nucleus
Cochlear nerve

+-- - + -- - -- Cochlea with


organ of Corti

Fig. 4.39: Course of cochlear and vestibular nerves


BRAIN-NEUROANATOMY

Medial
geniculate
body

Mldbrain

Po ns

Medulla

Fig . 4.40: Auditory pathway

4 The fourth neurons lie in the inferior colliculus. Their 5 The fifth neurons lie in the medial geniculate body.
axons pass through the inferior brachium to reach Their axons form the auditory radiation, which
the medial geniculate body. (Some fibres of lateral passes through the sublentiform part of the internal
lemniscus reach the medial geniculate body w ithout capsule to reach the auditory area (Figs 4.41a and b)
relay in the inferior colliculus.) in the temporal lobe.

High frequency - -+:;1-l----.!.....---'>r-t--1--..


sound

Low frequency - --',-4-.J,...--+..1-..,__~ f<l...-// of cerebrum


sound

Primary auditory
Primary auditory (areas 4 1, 42 )
Area 4 1 - - -- - - _ J
Area 42 - - -- ----J
Association auditory _ _ __ _ ___, (b)
(area 22)

Figs 4.41a and b: Auditory cortex: (a) Posterior ramus of lateral sulcus, and (b) depth of lateral sulcus
Vestibular Pathway
CRANIAL NERVES

b. To the motor nuclei of the brain stem (ch iefly of


1
.J
The vestibular receptors are the maculae of the saccule the JJI, IV, VI and XI nerves) through the medial
and utricle (for static balance) (Fig. 4.42) and in the crista longitudinal bundle (Fig. 4.44).
of the ampullaris of semicircular ducts (for kinetic c. To the ante rior horn cells of the spinal cord
balance) (Fig. 4.43). Fibres from cristae of anterior and through the ves tibulospinal tract.
lateral semicircular canals and some fibres from the two d. Fibers also reach thalamus and premotor cortex
maculae lie in s uperior vestibu lar area of internal of frontal lobe.
acous tic mea tus. Throug h the vestibular p a th way, th e impulses
Fibres of crista of pos terior semicircu lar canal lie in arising in the labyrinth can influence the movements
fora.men singulare. of the eyes, the head, the neck and the trunk.
Most of the fibres from maculae of utricle a nd saccule
lie in inferior vestibular area (Fig. 4.34).
CLINICAL ANATOMY
These three ner ve divisions are peripheral processes
of bipolar n eurons of the vestibular ga ng lion. This Deafness: Three types of hearing loss are seen:
ganglion is s ituated in the internal acoustic meatus. The 1. Conductive deafness is the fai lure of sound waves
centra l p rocesses a ris ing from the neurons of the to reach to the cochlea.
ganglion form the vestibular nerve w hich ends in the 2. Sensorineural deafness is the failure of production
vestibular nuclei. or transmission of action potential due to cochlear
The second neurons in the pathway of balance lies in disease, cochlear nerve di sease or d efects in
the vestibular nuclei (Fig. 4.39). These nuclei send fibres: cochlear nerve central connections.
a. To the archicerebellum through the inferior 3. Cortical dea fness is a bilateral o r dominant
cerebellar peduncle (vestibulocerebellar tract). posterior temporal lobe lesion. It results in a failure
~ - -- --Gelatinous to unders tand spoken lang uage even tho ugh
mass hearing is preserved .
Vertigo: This is an illusion of rotato ry movement due
to disturbed orientation of the body in space. The
pa tient feels tha t the environment is moving. It is
due to disease of vestibular nerve.
/ --'l......,.L--- - Supporting Tinnitis: It is a sensation of buzzing, ringing, hissing
columnar o r singing quality. Tinnitus may be unila te ral or
cells bilateral; high or low pitch; continuous or inter-
mittent.
Meniere's syndrome: It is characterized by recurrent
Fig. 4.42: Structure of the macula attacks of tinnitis, vertigo and h earing loss
accompanied b y a sen sitiv ity to noises. It affects
middle aged or older p ersons. In this condition, there
is an increase in volume of endolymph.
Acoustic neuroma: It is a slow growing benign tumor
of neurolemmal cells. It causes an early loss of hearing.

NINTH CRANIAL NERVE

GLOSSOPHARYNGEAL NERVE
Glossopharyngeal is the ninth cranial nerve. 1t is the
ner ve of the third branchial a rch .
It is motor to the s tylopharyngeus. It is secretomotor
to the parotid gland and gusta tory to the posterior one-
third of the tongue including the ci rcumvallate p a pillae.
It is sensory to the pha rynx, the tonsil, soft palate,
the posterior one-third of the tongue, carotid body and
Fig. 4.43: Structure of crista ampullaris carotid sinus.
BRAIN- NEUROANATOMY

Midbrain

Nuclei of neurons - ----1---..


(CN Ill, IV, VI)
for eye muscles

Cerebellum

'I----+- - Medial longitudinal bundle

Vestibular nerve _ _ _ ...,

Upper medulla

Fig. 4.44: Vestibular pathway

Functional Components 2 General visceral efferent (GVE) fibres (preganglionic)


1 Special visceral eff erent (SVE) fibres arise in nucleus arise in inferior saliva tory n ucleus and travel to the
ambiguus and supply the stylopharyngeus muscle otic ganglion . Postganglionic fibres arising in the
(Fig. 4.45). ganglion to supply the parotid gland (Table 4.2).

Spinal nucleus of trigeminal Spinal nucleus of trigeminal

Vagus
Glassopharyngeal nerve (X)
nerve (IX)
Inferior ganglion

Inferior - - - GSA
- - - GVA
ganglion Superior ganglion---- ----' - - - GVE
- - - SVA - - - SVE

Fig. 4.45: Functional components and nuclei of IX and X cranial nerves


CRANIAL NERVES

3 Geneml visceral afferent (GVA) fibres are peripheral Course and Relations
processes of cells in inferior ganglion of the nerve. 1 1n their intra11e11ra/ course, the fibres of the nerve pass
These carry general sensations from the phary nx, forwa rds and laterally, between the olivary nucleus
pa late, posterior one-third of tongue, tonsil, carotid and the inferior cerebellar peduncle, through the
body and carotid sinus to the ganglion. The central reticular formation of the medulla.
processes convey these sensations to lower part of
the nucleus of the solitary tract. 2 At the base of the brain, the nerve is attached by 3 to
4 filaments to the upper part of the posterolateral
4 Special visceral afferent (SY A) fibres are also peripheral
sulcus of the medulla, just above the rootlets of the
processes of cells in the inferior ganglion. They carry
vagus nerve (see Fig. 5.1).
sensa tions of taste from the posterior one-third of
the tongue including circumvallate papillae to the 3 1n their intracra nial course, the filaments uni te to
inferior ganglion. The central processes convey these form a single trunk which passes forwards and
sensations to the nucleus of the solitary tract. laterally towa rds the jugular foramen, crossing and
5 General somatic afferent (GSA) fibres are the peripheral groovin g the jugular tubercle of the occipital bone.
processes of the cells in the inferior ga nglion of 4 The nerve leaves tlie skull by passing through the
the nerve. These carry general sensations from the middle part of the j11g11lar foramen, anterior to the
middle ear, proprioceptive fibres from stylo- vagus and accessory nerves. It has a separate sheath
pharyngeus. The central processes ca r ry these of dura mater (Fig. 4.46a).
sensations to nucleus of spinal tract of trigeminal
nerve. 5 In the jugular fora men, the nerve is lodged i.n a deep
groove leading to the cochlear canalicuJus, and is
Nuclei separated from the vagus and accessory nerves by
The three nuclei in the upper part of med ulla a re named the inferior petrosa l sinus.
below: In its extracraninl course, the nerve descends:
1 N ucleus ambiguus (branchiomotor). a. Between the internal jugular vein and the internal
2 lnferior salivatory nucleus (pa rasympathetic). carotid artery, deep to the styloid process and the
3 ucleus of tractus solitarius (gustatory). muscles attached to it.

Styloid process - - - - -H-- -11• ,9.¥/


l<'f---+- - - Spinal root of
Internal carotid - - - ---IH-7¥--rr•WI accessory nerve
Glossopharyngeal nerve - - - ---,.lN

Pharyngeal branch of vagus - -- --6'1'1

Facial artery----=. , ~
Posterior auricular _ _ _..,.
Hypoglossal nerve - - ~ ~-iilrl .41' - . l ~- - + ~- -.....f.,jf - - - - - Superior laryngeal
branch of vagus

Inferior
petrosal sinus
---f-~•, Lingual artery
Internal laryngeal nerve
, "IJ.l~~
... - SJ-~- - -
Ascending
pharyngeal artery

- -- CN IX External laryngeal nerve +--tiff-it -- - - Vagus nerve

::i-+- - CN x Superior thyroid Nll-4--- - - Inferior root of


-+--r-- - CN XI Superior root of-- - - - - ansa cervicalis
ansa cervicalis

(a) (b)

Figs 4.46a and b: (a) Structures passing through right jugular foramen (seen from above), and (b) relation of cran ial nerves IX, X,
XI, XII to carotid arteries and internal jugular vein
BRAIN-NEUROANATOMY

b. It then turns forwards winding round the la te ral branch of the p lexus is called the lesser petrosal nerve.
aspect of the stylopharyngeus, passes between the It contains preganglio nic secreto motor fibres for th e
external and internal carotid arteries, and reach es parotid gland and relays in the o tic ganglion. Post-
the side of the p harynx (Fig. 4.46b). Here it g ives gan glionic fibres join a uriculo te mporal nerve to
p haryngeal branches. reach the gland .
c. It en ters the su bma nd ibula r region by passing 2 The carotid branch descend s on the internal carotid
deep to the hyoglossus (see Fig. 7.2), wh ere i t arte ry and s upplies the carotid sinus and the carotid
b reaks up into tonsillar and lingu al branches. bod y (Fig. 4.47).
6 At the base of skull, ninth nerve presents a s uperior 3 The pharyngeal branches take part in the forma tion of
and an inferior ganglion . Super ior ganglion is a the p h aryn geal plexu s, a lon g wi th vagal and
detached pa rt of th e in fe rio r, and gives no branches. sympathe tic fibres. The glossopharyngeal fibres are
The inferior ganglion is la rger, occupies notch on th e distributed to the m ucous membrane of the ph arynx
lower border of p etrous temporal, and gives o ut a nd palate.
communicating and tympanic branches. 4 The muscular branch s upplies the stylopharyngeus
(Fig. 4.47).
Branches and Distribution 5 The tonsillar branches s u pply the to nsil and join the
1 The tympanic nerve is a branch of the inferior ganglion lesser palatine nerves to form a plexus from w hich
of the glossop h aryngeal n erve. It enters the middle fibres are distributed to the soft palate and to th e
ear through the tympanic canaliculus, takes part in palatoglossal arches.
the form ation of the tympanic p lexus in the middle 6 The lingunl branches carry taste and general sensations
ear and d istribu tes i ts fibres to th e middle ear, th e from the p osterior one-third of the tongue including
auditory tube, the mastoid antrum and air cells. One the circumvallate papillae.

Lesser superficial
petrosal nerve
~ - - Olic ganglion
GSA-----1-~
GVE----J...-
SVE- -+ir.11
SVA--,t....--,,::;~
GVA . L. ,.,.__~

Superior ganglion- - - --.i...

Inferior ganglion------,
& - -- - Tympanic nerve

---- - - ----l~- Circumvallate


papillae with
taste buds

Pharyngeal branches on - - - - -- -1---- '=-,___, - + - - - - - - - - H y o i d bone


middle constrictor
\.__ _:::r- - - - - - Thyrold cartilage

Fig. 4.47: Distribution of functional components of glossopharyngeal nerve


CRANIAL NERVES

CLINICAL ANATOMY 3 General visceral afferent fibres are peripheral processes


of cells located in the inferior ganglion of the nerve.
• Lesion of this nerve causes: They bring sensations from the pharynx, larynx,
a. Absence of secretions of parotid gland. trachea, oesophagus and from the abdominal and
b. Absence of taste from posterior one-third of thoracic viscera. These are con veyed by the central
tongue and the circumvallate papillae. processes of the ganglion cells to the lower part of
c. Loss of pain sensations from tongue, tonsil, nucleus of tractus solitarius. Some of these fibres
pharynx and soft palate. terminate in the dorsal nucleus of the vagus.
d. Gag reflex is absent. 4 Special visceral afferent fibres a re a lso periphera l
• Glossopharyngeal neuralgia: It is a short sharp severe processes of neurons in the inferior ganglion. They
attack of pain affecting posterior part of pharynx carry sensations of taste from the pos teriormost part
or tonsillar area. of the tongue and from the epiglottis. The central
• Jugular foramen syndrome is due to injury at the processes o f the cells concerned terminate in the
jugular foramen resulting in multiple cranial nerve upper part of the n ucleus of the tractus solitarius.
palsies. 5 General somatic afferent fibres are peripheral processes
• The glossopharyngeal nerve is tested clinically in of neurons in the superior ganglion and are distributed
the following way: to the skin of the external ear. The central processes
a. On tickling the posterior wall of the pharynx, of the ganglion cells terminate in relation to the spinal
the re is reflex contraction of the pharyngeal nucleus of the trigeminal nerve (Fig. 4.4b).
muscles. No s uch contraction occurs when the The upper part of the nucleus o f tractus solitarius
ninth nerve is paralysed. comprises s uperior, middle and inferior parts. These
b. Taste sensibility on the pos terior one-third of parts rece ive fibres from VII, IX and X nerves,
the tongue can also be tested. It is lost in ninth respectively (Fig. 4.4c).
nerve lesions.
• Isolated lesions of the ninth nerve are almos t Nuclei
unknown. They are usually accompanied b y 1 Nucleus ambiguus (branch.iomotor): Mostly a part
lesions of the vagus n erve. of the cranial root of accessory nerve; partly of vagus.
• Pharyngitis may cause referred pain in the ear as 2 Dorsal nucleus of vagus (parasympa thetic): It is a
both are supplied by TX nerve. However, in these mixed nucleus, being both m otor (visceromotor and
cases eus tachian catarrh sh ould be excluded. secretomotor) and sensory (viscerosensory). Its fibres
form the main bulk of the nerve.
3 Nucleus of tractus solitarius (gustatory): Distributed
TENTH CRANIAL NERVE through internal laryngeal nerve to the taste buds of
epiglottis and vallecula.
VAGUS NERVE 4 ucleus of s pinal tract of trigeminal.
Vagus nerve is the tenth cranial nerve. It is so called
because of its exten sive ('vague') course, through the Course and Relations in Head and Neck
head , the neck, the thorax and the abdomen. The fibres 1 In the i11tracranial course, fibres run forwards and laterally
of the cranial root of the accessory nerv e are also dis tri- through the reticular fom1ation of medulla, between the
buted through it. olivary nucleus and inferior cerebellar peduncle.
The vagus nerve bears two ganglia, s uperior and 2 The nerve is a ttached, by about ten rootlets, to the
inferior. The superior ganglion is rounded and lies in the p osterolateral sulcus of medulla (Fig. 4.1).
jugular fora men . The inferior ganglion is cylindrical and 3 In the intracranial course, the rootlets unite to from
lies near the base of the skull. a large trunk which passes laterally across the jugular
tubercle along with the glossopharyngeal and cranial
Functional Components root of accessory nerves, and reaches the jugular
1 Special visceral efferent fibres arise in the nucleus foramen.
ambiguus and s upply the muscles of the palate, 4 The nerve leaves the cranial cnvity by passing through
pharynx and larynx (Fig. 4.45). the middle part of the jugular fora men, between the
2 General visceral efferent fibres arise in the dorsal motor sig moid and inferior petrosal sinuses. In tl1e fora men,
nucleu s of the vagu s. These are preganglionic it is joined by the cranial root of the accessory nerve.
p a rasympath etic fibres. They a re dis tributed to 5 Leaving the s kull, the nerve descends within the
thoracic and abdominal viscera. The pos tganglionic carotid sh eath, in between the internal jugular vein
neurons are situated in ganglia lying dose to (withjn) (laterally), and the internal and common carotid
the v iscera to be supplied. arteries (medially) (Fig. 4.46).
BRAIN- NEUROANATOMY

6 At the root of the neck, the rightvagus enters the thorax superior cervical ganglion and the loop between first
by crossing the first part of the subclavian artery, and second cervical nerves.
and then inclining m edially behind the brachio- Cranial root of X1 nerve joins vagus nerve at the
cepha lie vessels, to reach the right side of the trachea. inferior ganglion.
The left vagus enters the thorax by passing between
the left common carotid and left subclavian arteries, Branches in Head and Neck
behind the internal jugular and brachiocephalic veins. In the jugular foramen, the superior ganglion gives off:
7 Vagus bears, two ganglia, superior and inferior. The • Meningeal, and
superior ganglion is rounded and lies in the jugular • Auricular branches.
forarnen. It gives meningeal and auricular branches The ganglion also gives off communicating branches
of vagus, and is connected to glossopharyngeal and to the glossopharyngeal and cranial root of accessory
accessory nerves and to superior cervical ganglion nerves and to the superior cervical sympathetic gangHon.
of sympa thetic chain. The inferior ganglion is The branches arising from inferior ganglion in the
cylindrical (2.5 cm) and lies near the base of skull. It neck are:
g ives pharyngeal, carotid , s u perior laryngea l • Pharyngeal (Fig. 4.48)
branches and is connected to h ypoglossal nerve, • Carotid

Nucleus o f - -- - -- - - +- ~
spinal tract of
trigeminal (GSA)
Vagus nerve
- - - - -- Auricular branch

Dorsal nucleus-----
of vagus (GVE)

.,,__-- - -- - - -- Inferior ganglion


Nucleus,- - - - - _ _ ,
ambiguus (SVE)

Cranial root of accessory nerve Pharyngeal branch

- - - - Branch to epiglottis and


taste buds

Carotid sinus - - ----- -Lo Internal laryngeal nerve


Thyrohyoid membrane

Oesophagus - - --t-- f - - - --1--ll Trachea

t Recurrent laryngeal
nerve

To heart, lung and GIT


Fig. 4.48: Distribution of functional components of vagus in head and neck
CRANIAL NERVES

• Superior laryngeal a. All intrinsic muscles of the larynx, except the


• Right recurrent laryngeal cricothyroid.
• Cardiac. b. Sensory nerves to the larynx below the level of
I Me11ingeal branch supplies dura of the posterior the vocal cords.
cranial fossa. The fibres are derived from sympathetic c. Cardiac branches to the deep cardiac plexus.
and upper cervical nerves. d. Branches to the trachea and oesophagus.
2 The auricular branch arises from the superior ganglion e. Io the inferior constrictor.
of the vagus. It passes behind the internal jugular The left rernrrent laryngeal nerve arises from the vagus
vein, and enters the mastoid cnnaliculus (within the in the thorax, as the latter crosses the left side of the
petrous temporal bone). It crosses the facial canal arch of the aorta. It loops around the ligamentum
4 mm above the s tylomastoid foramen , em erges arteriosum and reaches the tracheo-oesophagea l
throug h the tympanomastoid fissure, and ends by groove. its distribution is similar to that of the right
supplying the concha and root of the auricle, the nerve. It does not have to pass behind the subclavian
posterior hal f of the external auditory meatus, and and carotid arteries; and usually, it is posterior to
the tympanic membrane (outer surface). the inferior thyroid artery.
3 The pharyngeal branch arises from the lower part of 7 The cardiac branches are superior and inferior. Out of
the inferior ganglion of the vagus, and contains the four cardiac branches of the vagi (two on each
chiefl y the fibres of the cranial root of accessory side), the left inferior branch goes to the superficial
nerve. It passes between the external and internal cardiac plexus. The other three cardiac nerves go to
carotid arteries, and reaches the upper border of the the deep cardiac plexus.
middle constrictor of the pharynx where it takes part
in forming the pharyngeal plexus. Its fibres a re
ultimately distributed to the muscles of the pharynx CLINICAL ANATOMY
and soft palate (except the tensor veli p alatini which
is supplied by the mandibular nerve). • The vagus nerve is tested clinically by comparing
4 The carotid branches supply the carotid body and the palatal arches on the two sid es . On the
carotid sinus. paralysed side, there is no arching, and the uvula
is pulled to the normal side.
5 The superior laryngeal nerve arises from the inferior
ganglio n o f the vagus, runs downwa rds and • Paralysis of the vagus nerve produces:
forwards on the superior constrictor deep to the a. Nasal regurgitation of swallowed liquids.
internal carotid arte ry, and reaches the middl e b. Nasal twang in voice.
constrictor w here it divi des into the external and c. Hoarseness of voice.
internal laryngeal nerves. d. Flattening of the paJatal arch (Fig. 4.49).
The external laryngeal 11erve is thin. It accompanies e. Cadaveric position of the vocal cord.
the superior thyroid artery, pierces the in ferior f. Dysphagia.
constrictor and ends by supplyi ng the cricothyroid • Irritation of the auricular branch of the vagus in
muscle. It also g ives branches to the inferior the external ear (by ear wax, syringing, etc.) may
constrictor and to the pharyngeal plexus.
r eflexly cause persistent cough (ear cough),
The internal laryngeal 11erve is thick. It passes vomiting, or even death due to sudden cardiac
downwards and forwards, pierces the thyrohyoid inhibition.
m embrane with the su perior la ry ngeal vessels • Stimulation of the auricular branch may reflexly
and enters th e larynx. It supplies the muco us produce increased appetite.
membrane of the larynx up to the level of the vocal • Irritation of the recurrent la ryngeal nerve by
folds. enlarged lymph nodes in children may also
6 The right recurrent laryngeal nerve arises from the produce a persistent cough.
vagus in front of the right subclavian a rtery, winds • Some fibres arising in the genicul ate ganglion
backwards below the artery, and they nms upwards of fac ial nerve pass into the vagus through
and medially behind the subclavian and common communications between the two nerves. They
caro tid arteries to reach the trachea-oesophageal reach the skin of auricle through the auricular
groove. ln the upper part of the groove, it is intimately branch of vagus. Sometimes a sensory ganglion
related to the inferior thyroid artery. It supplies:
BRAIN- NEUROANATOMY

may have a viral infection (called herpes zoster) ELEVENTH CRANIAL NERVE
and vesicles appear on the area of skin supplied
by the ganglion . In herpes zos ter of the geniculate ACCESSORY NERVE
ganglion, vesicles appear on the skin of auricle. Accessory nerve is the eleventh cranial nerve. It has
• Injury to pharyngeal branch causes d ysphagia. two roo ts, crania l and spinal. The cra nial root is
Paralysis of muscles of soft palate results in nasal assis ting th e vagus, and is distributed through its
regurgitation of flu ids an d nasal tone of vo ice. branches as vago-accesory complex. The spinal root has
Lesions of superior lary ngeal nerve produces a more independent course (Fig. 4.51).
anaes thesia in the upper pa rt of lar yn x and
Functional Components
paralysis of cricothyroid muscle. The voice is weak
and gets tired easily. 1 The cranial root is special visceral (branchial) efferent.
• Injury to right recurrent laryngeal nerve results 1t arises from the lower part of nucleus ambiguus. lt
in hoarseness and d ysphonia d ue to paralysis of is d istributed through the branches of vagus to the
the right vocal cord (Fig. 4.50). muscles of the p alate, the pharynx, the larynx, and
possibly the heart (Fig. 4.51).
• Paralysis of both vocal cords results in aphonia 2 The spinal root is also special visceral efferen t. It
and inspiratory stridor (high pitched and harsh
arises from a long spinal nucleus situated in the
respiratory sound). It may occur d uring thyroid lateral part of the anterior grey column of the spinal
surgery. cord extending between segments Cl to CS. Its fibres
• During thyroidectomy recurrent laryngeal nerve supply the s temocleidomastoid and the trapezius
may injure resu lting in fixed and paramedian muscles.
vocal co rds.
• In severe peptic ulcer vagotomy is done to relieve Nuclei
the symptoms. The cranial root arises from the lower part of the nucleus
ambiguus.
The spinal root arises from a long spinal nucleus
situated on the lateral part of an terior grey column of
sp inal cord, extending from Cl to CS segments. It is in
line with nucleus ambiguus.

Course and Distribution of the Cranial Root


1 The cranial root emerges in the form of 4 to 5 rootlets
which are attached to the posterolateral sulcus of the
medulla. Just below, the rootlets soon join together
to form a single trunk.
2 It runs laterally with the glossophar yngeal vagus and
spinal accessory nerves, crosses the jugular tubercle,
and reaches jugular foramen .
3 Tn the jugular foramen, the cranial root unites for a
short d ista nce w ith the spin al roo t, and again
Fig. 4.49: Paralysis of muscles of soft palate on left side separates from spinal root as it passes out of the
foramen (Fig. 4.51).
4 The cranial root finally fuses w ith the vagus a t its
inferior ganglion, and is d istributed through the
branches of the vagus to the muscles of the palate,
th e pharynx, the larynx and possibly the heart.
Cord paralysis
without tensor
actJon Course and Distribution of the Spinal Root
' - - - - -- Glottis 1 It arises from the upper five segments of the spinal
cord (Fig. 4.51).
- - -.....,-- Mucus pools
on affected side 2 It emerges in the form of a row of filaments attach ed
Fig. 4.50: Injury to right recurrent laryngeal nerve to the cord midway between the ventral and dorsal
nerve roots.
CRANIAL NERVES

Medulla

Petrous part of
temporal bone
Foramen magnum
>-- -- - Superior and inferior
ganglia of vagus nerve
c1 :;::::;-i
\. + -,J--- - -- - Cranial root of accessory
joining inferior ganglion
C2 ~ of vagus nerve
Spinal segments
C3 ::2 -+-~ ~+-- - - - - - Spinal accessory nerve
C4 -=:2
cs II+- -- - -- Vagus incorporating
cranial accessory nerve

Fig. 4.51 : Course of the accessory nerve

3 In the vertebral canal, the filaments Wl.ite to fo rm a posterior triangle by passing deep to the anterior
single trunk w hich ascends in front of the dorsal border of the trapezius 5 cm above the clavicle.
nerve roots and behind the ligamentum denticula- On the deep surface of the trapezius, the nerve
tum. commwucates with spinal nerves C3 and C4, and
4 The nerve enters the cranium through the foramen ends by supplying the trapezius.
magnum lying behind the vertebral artery. 8 Distribution: The spinal accessory nerve s upplies:
5 Within the cranium, the nerve runs upwards and a. The stemocleidomastoid, the chin turning muscle.
laterally, crosses the jugular tubercle (with th_e ninth b. The trapezius, the shrugging muscle.
and tenth cranial nerves) and reaches the Jugular Cervical n erves provide a proprioceptive sensations
foramen.
to these muscles.
6 The nerve leaves the sk11/l through the middle part of
the jugular fora men where it fuses w ith a short length
of the cranial root. It soon separates from the latter CLINICAL ANATOMY
and passes out of the foramen.
• The accessory n erve is tested clliucally:
7 In its extracranial course, the nerve descends vertically
between the internal jugular vein and the internal a. By asking the patient to shrug his should_ers
carotid artery deep to the parotid and to the styloid (trapezius) against resistance and comparing
the power on the two sides.
process (Fig. 4.46). Tt reaches a poin t midw~y
between the an gle of mandible and the mastoid b. By asking the patient to turn the chin to the oppo-
process. Then it runs downwards and b_ackwar~s site side (stemocleidomastoid) against resistance
s uperfici a l to the internal jugular ve111 a nd 1s and again comparing the power on the two sides.
surrounded by lymph nodes. • Lesions of spinal root of accessory nerve cau~e
drooping of the shoulder and inability to turn chin
T h e n erve pierces the anterior border of the
to opposite side.
sternocleidomastoid at the junction of its upper one-
fourth w ith the lower three-fourths, and communi- • Irritation of the nerve during biopsy of enlarged
caseous lymph nodes, may produce torticollis or
cates with second and third cervical n erves within
the mus cle . wry neck.
• Supranuclear connections act on the ipsilateral
The n erve enters the posterior triangle of the neck sternocleidomastoid and on the contra lateral
by emerging through the posteri?r b~rder of the trapezius. Tlus results in turnin_g of t~e head away
sternocle ido mastoid a little above its middle. ln the from relevant hemisphere durmg seizure.
triangle, it runs downwards an~ backward_s
• Spasmodic torticollis -irritation of the n:rve
embedded in the fascia! roof of the tnangle. Here 1t resu lting in clon ic spasm of the sternocle1do-
lies over the leva tor scapulae. lt is related to the
mastoid and trapezius muscles.
s upe rfi cial lymph nodes. The nerve leaves the
BRAIN- NEUROANATOMY

the ling ual muscles receives bo th ipsila teral and


TWELRH CRANIAL NERVE contralateral corticonuclear fibres.
HYPOGLOSSAL NERVE Course and Relations
H ypoglossal is the twelfth cranial nerve. It supplies the 1 In their intrnneural course, the fibres pass forwards
muscles of the tong ue. lateral to the m edial longitudinal bundle, medial
lemniscus and pyramidal tract, and medial to the
Functional Components/Nuclear Columns reticular formation and olivary nucleus (see Fig. 5.5).
1 General somatic efferent column: The fibres arise from 2 The nerve is attached to the anterolateral sulcus of
the h ypoglossal nucleus wh ich lies in the medulla, the medulla, between the pyramid and the olive, by
in the floor of fourth ventricle deep to the hypoglossal 10 to 15 rootlets (Fig. 4.1).
triangle (Fig. 4.52).
The rootlets run laterally behind th e vertebral artery,
2 General somatic afferent column: The nucleus is
and jo in to form two bundles which p ierce the dura
mesencephalic nucleus of (V) cranial nerve where
mater separately near the hypoglossal canal.
proprioceptive fibres from tongue end.
The nerve leaves the skull through the hypoglossal
Nucleus (anterior condylar) canal.
The hypoglossal nucleus, 2 on long, lies in the floor of
fourth ventricle beneath the hypoglossal triangle. It is Extracranial Course
d ivided into a part for genioglossus and a part for a 1 The nerve first lies deep to the internal jugular vein,
rest of the muscles (Fig. 4.SC). but soon inclines between the internal jugular vein
Nucleus for genioglossu s muscle receives only and the internal carotid artery, crosses the vagus
contralateral corticonuclear fibres. Nucleus for rest of (laterally), and reaches in front of it (Fig. 4.46).

Cerebral cortex
,,___ _ _ __ _ Corticonuclear fibres

Medulla oblongata

---+-- -- -- - Motor fibres to all muscles


except genioglossus

' - - - - -- - - - Hypoglossal nerve

Fig. 4.52: Hypoglossal nerve with its nucleus


CRANIAL NERVES

2 lt then descends between the internal jugular vein tongue. Extrinsic muscles are styloglossus, genioglossus,
and the internal carotid artery in front of the vagus, h yoglossus and intrinsic muscles are superior longitu-
deep to the parotid gland, the styloid process, the dina l, inferior longitud inal, transverse and vertical
posterior belly of the digastric.
muscles. Only extrinsic muscle, the palatoglossus is
3 At the lower border of the posterior belly of the
digastric, it cu rves forwards, crosses the internal and supplied by fibres of the cranial accessory nerve through
external carotid arteries and the loop of the lingual the vagus and the pharyngeal plexus.
artery, and passes deep to the posterio r belly of the Branches of the lzypoglossa/ nerve containingfibres ofnerve
digastric again to enter the submandibular region . CJ. These fibres join the nerve at the base of the skull.
4 The nerve then continues forwards on the h yoglossus a. The meningeal branch contains sensor y and
and genioglossus, deep to the submandibular gland sympathetic fibres. It enters the skull through the
and the mylohyoid, and enters the substance of the hypoglossal canal, and supplies bone and meninges
tongue to supply all its intrinsic muscles and most in the anterior part of the posterior cranial fossa.
of its extrinsic muscles (Fig. 4.53).
b. The descending branch continues as the descendens
Branches and Distribution hypoglossi or the upper root of the ansa cervicalis.
Branches containing fibres of the hypoglossal nerve proper. c. Branches are also given to the thyroh yoid and
They supply the extrinsic and intrinsic muscles of the geniohyoid muscles (Fig. 4.53).

~ - - - - - - - - - Palatoglossus

Hyoglossus

Nerve to geniohyoid
.....___ _ _ Hyo1d bone

' - - - - - - Superior belly


of omohyoid

Inferior belly-~ ~ ~-::,,


of omohyoid
_ .,___ _ _ _ _ _ _ _ __ Stemohyoid

Fig. 4.53: Hypoglossal neNe and ansa ceNicalis

On protrusion of tongue, its tip deviates to para-


lysed side as normal genioglossus muscle pulls
• The hypoglossal nerve is tested clinically by asking the base towards normal side.
the p atient to protrude his/ her tongue. ormally, Bi lateral paralysis of XII nerves results in complete
the tongue is protruded straight forwards. If the paralysis of the tongue. Protrusion of tongu e is
nerve is paralysed, the tongue deviates to the not possible. Speech and swallowing are affected,
paralysed side (Fig. 4.54). taste and touch sensations are normal.
• An infranuclear unilateral lesion of the hypo- • Supranuclear lesions of the hypoglossa l nerve
glossal nerve produces paralysis of the tongue on causes paralysis without wasting. The tongue
that side. There is gradual atrophy of the paralysed moves sluggishly resulting in defective speech . On
half of the tongue. The tong ue looks shrunken. protrusion, the tongue deviates to opposite side.
BRAIN- NEUROANATOMY

• Vll nerve also carries parasympa thetic fibres from


superior salivatory nucleus to sub mandibular
gan glion fo r the supply of s u b ma ndibular,
sublingual and glands in the oral cavity.
• IX nerve carries p a rasympa the tic fi bres from
inferior salivatory nucleus to the otic ganglion for
the supply of parotid gland.
• X nerve carries parasympathetic fibres fro m dorsal
nucleus of vagus for the glands in the respira tory
tract and glands in the digestive tract till right two-
thirds of the transverse colon.
• S2, S3, S4 carry sacral o utflow of the parasym-
pathetic syste m to the distal part of d igestive tract
Fig. 4.54: XII nerve paralysis on right side
and other pelvic viscera.
• V, Vll, IX, nerves a re the nerves of 1st, 2nd, 3rd
arches respectively.
Mnemonics • X, XI, i.e. vagoaccessory complex supplies structures
developed from 4th and 6th branchfal arches.
BELL'S Palsy

Blink reflex abnormal


Ear ache CLINICOANATOMICAL PROBLEM
Lacrimation (deficient)
Loss or taste in anterior two-thirds of tong ue A 40-year-old male had viral infection. One day he
Sudden onset noticed tears running on his righ t side of face a nd
Palsy or muscles supplied by Vf/ nerve saliva dribbling from his right angle of mouth.
All sympto ms are ipsilatera l • What is this paralysis caUed?
• How d o you test fo r integrity of the facial muscles?
Ans: This paralysis is ca lled Bell's palsy. It occurs
due to viral infection of VII nerve as it exits from the
• Cranial nerves I, II, Vill are almost sensory, cranial stylomastoid foramen.
nerves ill, N , VI, XI, XII a re motor, cranial nerves
V, VII, IX, X are mixed nerves. This nerve is tested as follows:
• III nerve carries p arasympa the tic fib res from • Asking the patient to close the eye
Edinger-Westphal n ucleus of midbrain to the • Asking the patient to look upwards without
ciliaris a nd constr ictor pu piJlae muscles for moving the head, so that h orizontal lines are
accommod a tion . formed in the forehead
• VII n erve ca rries parasympa the tic fibres from
lacrimatory n ucleus to p terygopala tine gan glion • Ask him to show the teeth
for the lacrimal gland a nd g lands in nasal cavity, • Ask him to fill in air in the mouth and then force
palate and pharynx. it out.

FREQUENTLY ASKED QUESTIONS

1. D escr ibe oculomotor ne r ve unde r fo llowing b. Left recurrent laryngeal nerve


headings: Origin, nuclei, course, distribution and c. Branches of ophthalmic division of V nerve
clinical anatomy.
d. Branches of mandibular nerve
2. Distribution facial nerve under following head ings:
O rigin, nuclei, course, d is tribution and cl inical e. Roots an d branches of pterygopala tive ganglion
anatomy. f Ptosis
3. Write short notes on: g. Branches of hypoglossal nerve and effect of its
a. Chorda tympani nerve paralysis
CRANIAL NERVES

MULTIPLE CHOICE QUESTIONS

1. Cranial nerves which innervate extraocular muscles 8. Which is not a cranial nerve?
include: a. Vagus b. Glossopharyngeal
a. Oculomotor, abducent and trochlear c. Phrenic d. Hypoglossal
b. Abducent, facial and trigeminal 9. Which structure is not innervated by vagus?
c. Trochlear, oculomotor and facial a. Small intestine b. Heart
d. Oculomotor, facial and trigeminal c. Stomach d. Stemocleidomastoid
2. The 3 divisions of trigeminal nerve include: 10. Which cranial nerve innervates muscle that raises
a. Oculomotor, palatine and lingual the upper eyelid?
a. Trochlear b. Oculomotor
b. Ophthalmic, maxillary and mandibular
c. Abducent d. Facial
c. Ophthalmic, palatine and lingual
11. Which cranial nerve passes through stylomastoid
d. Frontal, maxillary and mandibular fora men?
3. Cranial nerve that does no t pass through superior a. Facial nerve
orbital fissure in skull: b. Glossopharyngeal nerve
a. Oculomotor b. Trochlear c. Vagus nerve
c. Facial d . Abducent d . Hypoglossal nerve
4. Cranial nerve that are mainly sensory of: 12. 1st pharyngeal arch give rise to:
a. Optic, vestibulocochlear and vagus a. Muscles of facia l expression
b. Ophthalmic, optic and facial b. Muscles of mastication
c. Ophthalmic, optic and vestibulocochlear c. Muscles of soft palate
d . Optic, olfactory and vestibulocochlear d. Stylopharyngeus (muscle of pharyn x)
5. Cranfal nerves that carry taste from the tongue are: 13. ucleus of tractus solitarius receives part of which
a. Trigemina l, facial and glossopharyngeal 3 cranial nerves?
b. Facial, glossopharyngeal and hypoglossal a. JIJ, JV and VJ b. VII, IX and X
c. Facial, glossopharyngeal and accessory c. IX, X and XI d . one of the ab ove
d. Facial, glossopharyngeal and vagu s 14. Nucleus ambiguus is present in:
6. The cranial nerve that arise from both brain as well
a. Midbrain b. Spinal cord
as spinal cord:
a. Hyp oglossal c. Pons d. Medulla oblongata
b. Accessory 15. Which cranial nerve is no t involved in Wallenberg's
syndrome?
c. Vagus
d . Glossopharyngeal a. XIl b. IX
7. Which cranial nerve does no t pass through jugular c. X d. XI
foramen? 16. Which of the following is the largest cranial nerve?
a. Glossopharyngeal b. Vagus a. VI b. V
c. Accessory d. H ypoglossal C . XTT d. VII

ANSWERS
1. a 2. b 3.c 4.d 5.d 6. b 7. d 8. c 9.d 10. b
11. a 12. b 13. b 14.d 15. a 16. b
CHAPTE R

5
Brain Stem
,'1C.w,,,/«/11.,,-u-n olwnu,/l,;,,fr lo-& /mcledm wmr ,v,m e•o/ llu. f?nin
-Sarvopalli Rodhokrlshnon

INTRODUCTION anterior m edian fissure ends in foramen caecum at


The brain stem consists of the medu lla oblongata, the its junction with pons. Each half is further divided
pons and the midbrain. It connects the spinal cord to into anterior, lateral and posterior regions by the
cerebrum. The various ascending and descending tracts antero lateral and posterolateral sulci (Fig. 5.1).
pass through the three components of the brain s tem. 2 The anterior region on either side of the fissure is
M ed ulla oblongata contains the respiratory an d formed of a longitudinal elevation called the pyramid.
vasomotor centres. In hanging or capital punishment, The pyramid is made u p of corticospinal and
the d ens of axis vertebra breaks and strikes on these corticobulba r fibres. ln the lower part of the medulla,
centres causing immed iate death. Most of the cranial many fibres of the right and left pyramids cross in
nerve nuclei are present in the brain stem only. the midline forming the pt;ramidal decussnfio11.
Midbrain contains nuclei of oculomotor and trochlear 3 Some fibres run transversely across the upper part
nerves. Pons has the nuclei of trigeminal, abd ucent, facial of the pyramid. These are the a11terior external arcuate
and sta toacoustic n erves while medulla houses the fibres which end in the cerebellum.
nuclei of last four cranial nerves, i.e. glossopharyngeal, 4 The upper part of the lateral region shows an oval
vagus, accessory and h ypoglossal (refer to BOC App). elevation, the olive. It is produced by an underlying
mass of grey matter called the inferior olivnry nucleus.
MEDULLA OBLONGATA A bw1.dle of fibres curving around the lower edge of
the olive is the circumolivnn; b1111dle.
The medulla is the lowest part of brain stem, extending 5 The rootlets of the hypoglossal nerve emerge from
from the lower border of pons to a plane just above the anterolateral sukus between the pyramid and
which the firs t cervical nerve arises w h ere it is the olive.
continuous with the spinal cord. It lies in the anterior 6 The rootlets of the cranial nerves IX and X and cranial
part of posterior cranial fossa, extending down to the part of the accessory nerve emerge through the
foramen magnum. Anteriorly, it is rela ted to the clivus posterola teral fissure, behind the olive.
and meninges and posteriorly, to the vallecula of the 7 The posterior region lies between the posterolateral
cerebellum. Along with other parts of the hindbrain, sulcus and the posterior median fissure. The upper
medulla occupies the infratentorial space. part of this region is marked by a V-shaped
Parts: depression w hich is the lower part of the floor of the
1 Open/superior part-the dorsal surface of the medulla
fourth ventricle. Below the floor we see three
is formed by the fourth ventricle. longih1dinal elevations. From medial to lateral side,
these a re the fasc icu 1us gracilis, the fasciculus
2 Closed/inferior part-fourth ventricle is narrowed at
cunea tus and the inferior cerebellar peduncle
the obex and continues with the central canal.
(Fig. 5.2). The upper ends of fasciculus gracilis and
cuneatus expand to form the gracile and cuneate
EXTERNAL FEATURES tubercles. These tubercles are formed by underlying
1 The medulla is divided into right and left halves by masses of grey matter called the nucleus gracilis and
the anterior and posterior median fissures. The nucleus cuneatus. La teral to cuneate nucleus is an
90
BRAIN STEM

lnfundibulum - - - ~

, -- >,-- \- -- - -- Oculomotor nerve


,.._.,__,__ _ _ _ _ Trochlear nerve

~ - , . - - - Motor root and sensory


root of trigeminal nerve

Glossopharyngeal nerve - - -
~ - - - - - Roots of vagus nerve
Hypoglossal nerve _ _ _.,..
' - - - -- -- - - - Olive
Accessory nerve - -- - 1-,1 - - - - - - - - - - Anterolateral sulcus
Cranial roots of accessory nerve - - -- - - L --->,+~

Fig. 5.1: Attachment of cranial nerves to the ventral surface of brain stem

Trochlear nerve- -- - --\=1~ ~ ~ ~ ~ J


Superior medullary velum - - - - - ~<---,1- ,..,.__-+--+-- - -- - - -- - Locus ceruleus
1--__,,,,_....,,_...;..,,_ __ _ _ _ _ _ Median sulcus
Superior cerebellar peduncle- - - ---"-

Hypoglossal tngone-----+---,.__.'--~

Middle cerebellar peduncle----

Stria medullaris----- ' - - - - - - -- - Inferior cerebellar peduncle

Obex--------
" ' - - - - - - -- Area postrema

Fig. 5.2: Dorsal aspect of brain stem


BRAIN-NEUROANATOMY

accessory cuneate. Here the unconscious propriocep- INTERNAL STRUCTURE


tive fibres of upper limb relay to terminate in the The internal structure of the medulla can be studied
cerebellum via inferior cerebellar peduncle. This conveniently by examining transverse sections through
nucleus is equivalent to Clarke's column of spinal it at three levels.
cord. These convey discriminative touch, pressure
and senses of vibration, position and movements Transverse Section through the Lower Part of the
from ipsilateral part of the bod y. The fasciculus Medulla Passing through the Pyramidal Decussation
g racilis contains fibres from lower limb and lower It resembles a transverse section of the spinal cord in having
part of the trunk, fasciculus cunea tus from upper the sa me three funiculi and the sa me tracts (Fig. 5.5).
limb and upper part of the trunk.
8 In the lower part of the m ed ulla, there is another Grey Matter
elevation the tuber cinerium lateral to the fascicu1 us 1 The decussating pyramidal fibres separate the anterior
cuneatus. It is produced by a mass of grey matter ho rn from the central grey matter. The separated
ca lled the spinal nucleus of the trigeminal nerve. anterior horn forms the spinal nucleus of the accessory
9 The med ulla is divided in two parts: The lower closed nerve laterally and the supraspinal nucleus for motor
part with a central canal; and the upper open part fibres of the first cervical nerve medially .
where the central canal opens out to form the fourth 2 The central grey matter (with the central canal) is
ventricle. pushed backwards.
3 The nucleus gracilis and the nucleus cuneatus are
Figure 5.3 shows attachment of cranial nerves as seen continuous with the central grey matter.
from lateral side. 4 Laterally, the central grey matter is continuous w ith
Figure 5.4 shows the transverse sections of spinal the nucleus of the spinal tract of the trigeminal nerve.
cord, medul1a obolongata, pons, and midbrain with A bundle of fibres overlying this nucleus forms the
their corresponding figures. spinal tract of the trigeminal nerve.

Trigeminal nerve

1-- - 1 -+ - + - - - - -- Vestibulocochlear nerve


Hypoglossal nerve

Accessory nerve--- ---'

Fig. 5.3: Attachment of cranial nerves as seen from lateral side


BRAIN STEM

T.S. of midbrain at
superior colliculus 9

T.S. of midbrain at
inferior colliculus 8

T.S. of upper part of pons 7

T.S. of lower part of pons 6

T.S. of upper part of medulla


(with vagus nerve) 5 - - -- - -- - - ·

T.S. of upper part of medulla


(floor of IV ventricle) 4

T.S. of midd le part of medulla


(sensory decussation) 3

T.S. of lower part of medulla


(pyramidal decussation) 2

Spinal cord

Fig. 5.4: Transverse sections of spinal cord (1); medulla oblongata (2-5); pons (6 and 7); midbrain (8 and 9) with their corresponding
figures
BRAIN-NEUROANATOMY

Fasciculus gracilis - - -- -- ~ ~ - -- - - - Nucleus gracilis

Spinal tract of
trigeminal nerve

Dorsal and ventral - ~__.,__


spinocerebellar tracts

Corticospinal fibres - - -- - - - - - """""''


(within pyramid)
' - - - - -- Grey matter of anterior horn separated
from central grey matter

'--- -- - 1st cervical nerve nucleus


Fig. 5.5: Transverse section (TS) of medulla oblongata at the level of pyramidal decussation

White Matfer Transverse Section through the Middle of


1 The p yramids, anteriorly. Medulla Passing through the Sensory Decussation
2 The decussation of the pyramidal tracts forms the Identify the following features as shown in Fig. 5.6.
most important features of the medulla at this level.
The fibres of each py ra mid run backward s and Grey Matfer
laterally to reach the lateral white column of the 1 Lateral to the cuneate nucleus we see the accessory
spinal cord where they form the lateral corticospinal cuneate nucleus which relays unconscious proprio-
tract. ceptive fibres from the upper limbs. It is equivalent
3 The fasciculus gracilis and the fasciculus cuneatus to nucleus dorsalis/Clarke's column.
occupy the broad posterior white column. 2 The nucleus of the spinal tract of the trigeminal nerve is
4 The other features of the w hite matter are similar to also separate from the central grey matter.
those of the spinal cord (see Chapter 3). 3 The lower part of the inferior olivary nucleus is seen.

Dorsal Nucleus gracilis


Nucleus of tractus - - - - - ~
solitarius

Dorsal nucleus of--+--+--+-


vagus nerve

Dorsal and ventral splnocerebellar tracts

Lateral spinothalamic tract

' - - -- - - Medial lemniscus

Ventral
Fig. 5.6: TS of medulla oblongata at the level of sensory decussation
BRAIN STEM

4 The central grey matter contains the following: c. The nucleus of the tractus solitarius, ventrola teral
a. Hypoglossal nucleus-a n elongated nucleus a bout to the d orsal n ucleus of vagus.
2 cm long, supplies m uscl es of tongue excep t d. The inferior and medial vestibular nuclei, medial to
palatoglossus. the inferior cerebellar ped uncle.
b. Dorsal nucleus of the vagus-gives preganglionic para- 2 Th e 11ucleus a111big11us lies deep in the re ticular
sympath etic fibres of heart and to smooth muscles forma tion of the medulla. It gives origin to motor
and glands of respira tory and alimen tary system. fibres of the cranial ner ves lX, X and XI.
c. ucleus of tractus solitarius- receives taste fibres. 3 The d orsal and ventral cochlea r nuclei lie on the
su rface of the inferior cerebellar peduncle. These
White Matter nuclei receive fibres of the cochlea r nerve.
1 The nucleus graci lis and cw1eatus give rise to the 4 The nucleus of the spinal tract of the trigeminal nerve
internal nrcuate fibres. These fibres cross to the lies in the d orsola teral part.
opposite side where they form a paramedian band 5 The inferior olivary 1111cleus is the largest mass of grey
of fibres, ca lled the medial lemnisc11s. ln the lemniscus, m a tte r seen at thi s level. It is resp on sible for
the body is represented w ith the head posteriorly producing the elevation of the o live. Its grey matter
and the feet a nteriorly. appears like a crum pled purse.
2 The pyramidal tracts lie anteriorly. Close to the inferior olivary nucleus there are the
3 The 111edinl longitudinal bundle lies posterior to the medial and dorsal accessor y olivary nuclei. The
medial lemniscus. nucleus receives the afferent fibres from cerebral
4 The spinocerebellar, lateral spinotllalamic and other cortex, red n ucleus, periaqued uctal g rey of midbrain
tracts lie in the anterolateral area. and spinal cord. The efferents form olivocerebella r
5 Eme rg ing fibres o f XII nerve. fibres w hich te rmina te as climbing fibres at the
cerebellar cortex.
Transverse Section through the Upper Part of 6 The nrcuate 11ucleus lies antero med ial to the
Medulla Passing through the Floor of Fourth py ra midal tract.
Ventricle/Open Part 7 Visceral cen tres a re:
Iden tify the following features as shown in Fig. 5.7. a. Respira tory centre
b. Card iac centre for regulation of heart rate
Grey Matter c. Vasomotor centre for regula tion of blood pressure.
1 The nuclei of several cran ial nerves are seen in the
floor of t he fourth ven tricle: White Matter
a. The hypoglossal nucleus, in a para median position . It shows the following impor tant features.
b. The dorsal nucleus of the vagus, la teral to the XII 1 Th e infe rio r cerebellar peduncle o cc up ies the
nerve nucleus. posterola teral par t, lateral to the fourth ven tricle.

Dorsal nucleus of vagus - - -- - - -- ~

Nucleus of tractus solitarius - -~


- ~ - -r- "'-.c-- - - Medial and inferior vestibular nucleus
_ _ ,,___ Inferior cerebellar peduncle

Vagus nerve - -+--~ r+-----=~"'-.::-- ---+- Medial longitudinal bundle

Ventral cochlear nucleus -=±"i~~ ~>"


---- - - Spinal tract of trigeminat nerve

Spinocerebellar tracts + - - -- - ;I!:\-- -.!>/-- - Medial lemniscus


....___ _ Lateral spinothalamic tract

Medial and dorsal _ _ .c---


accessory olivary nuclei

Fig. 5.7: TS of medulla oblongata at the level of olivary nucleus passing through floor of fourth ventricle
BRAIN-NEUROANATOMY

2 The olivocerebellarfibres are seen prominently in actual f. The sympa thetic fibres descend from h ypo-
sections. The fibres emerge at the hilum of the inferior thalamus to cells in lateral horn of spinal cord.
olivary nucleus and pass to the opposite inferior As these fibers descend in the lateral part of
cerebellar peduncle, on their way to the opposite half medulla (which is damaged), there is Homer's
of the cerebellum. syndrome, comprising ptosis, enophthalmos,
3 Striae medullaris (external arrnatefibres) are seen in the miosis and anhydrosis.
floor of the fourth ventricle. • lnj11ry to lower part of medulla oblongata: Injury in
4 Identify the various ascending tracts in the antero- this part may be fatal due to injury to the vital centres
lateral part of medulla. like respiratory centre and vasomotor centre.
5 Emerging fibres of IX, X, X] nerves • B11lbar palsy: In this condition there is weakness of
muscles supplied by VII-Xll cra nial nerves. These
BLOOD SUPPLY nerves supply muscles of facia l expression,
• Anterior spinal arten;: This supplies the w hole medial muscles of pharynx, tongue, pa late and larynx.
part of the medulla oblongata. The lesion is of lower motor neuron type. The
• Posterior inferior cerebellar artery: This supplies the patient has difficulty in speaking, swallowing and
posterolateral part of the medulla. in usage of muscles of facial expression.
• Pseudobulbar palsy: Occurs due to bilateral lesion
DEVELOPMENT of corticonuclear fibres. There is paralysis of
muscles of tongue, lips, pharynx and palate. The
From caudal m yelenceph alic part of the rhomben- causes of pseudobulbar palsy may be vascular
cephalic vesicle. euroblasts from the alar plate of the infarction, syringomyelia and increased intra-
neural tube at this level will produce the sensory nuclei cranial pressure.
of the medulla. The basal plate neuroblasts wi!J give
rise to the motor nuclei.
Medial longitudinal bundle

CLINICAL ANATOMY

• Medial 111edullary/Dejeri11e syndrome: It occurs due Spinal tract of


trigeminal nerve
to blockage of anterior spinal artery. Features are:
Vagus nerve
a. Contralatera l hemiplegia (Fig. 5.8) due to
damage to pyramid of medulla. Spinocerebellar
b . Loss of sense of vibration and position due to tracts
damage to medial lemniscus. Inferior olivar y - --
c. Paralysis of muscles of tongue on the same side nucleus
due to injury to XIl cranial nerve.
• Lateral medullary/Wallenburg syndrome: Occurs due
to blockage of posterior inferior cerebellar artery. Arcuate nucleus
Artery supplies areas behind the inferior olivary
Fig. 5.8 : Lesions of medulla oblongata. (1) Medial medullary
nucleus. Features are:
syndrome, and (2) Lateral medullary syndrome
a. Ipsilateral paralysis of most of muscles of soft
palate, pharynx and larynx due to injury to
nucleus ambiguus w hich gives fibres to IX, X
and XI cranial nerves (Fig. 5.8). PONS
b. Loss of pain and temperature on sam e side of
face due to involvement of spinal nucleus and The pons (Latin bridge) is also called metencephalon,
spinal tract of trigeminal nerve. 2.5 cm long and extends from cranial end of medulla
c. Loss of pain and temperature on opposite side oblongata to the cerebral peduncles of midbrain.
of the body due to involvement of lateral Cranial nerves V, VI, VU, VIII are attached here.
spinothalamic tract. Anterioly, it is related to clivus separated by basilar
d. Giddiness d ue to involvement of vestibular nuclei. artery, latera ll y m idd le cerebellar peduncle and
e. Damage to inferior cerebe!Jar peduncle, spino- posteriorly to the fourth ventricle.
cerebellar tracts and part of cerebellum results
in loss of equilibrium, i.e. ataxia of limbs on the EXTERNAL FEATURES
same side. The pons has two surfaces, ventral and dorsal.
BRAIN STEM

The ventral or anterior surface is con vex in both direc- Grey Matter
tions and is transversely striated . l.n the median plane, It is represented by the nuclei pontis which are scattered
it shows a vertical basilar sulcus which lodges the basilar among longitudinal and transverse fibres. The pontine
artery (Fig. 5.1).
nuclei form an important part of the cortico-ponto-
Laterally, the surface is continuous with the middle
cerebellar pathway. Some of these nuclei get displaced
cerebellar peduncle.
during development, and form the arcuate nucleus (see
The trigeminal nerve is attached to this surface at the
medulla) and the pontobulba r body. Fibres from all
junction of the pons with the peduncle. The nerve has
two roots, a small motor root which lies medial to the these nuclei go to the opposite half of the cerebellum.
much larger sensory root. White Matter
The attached abducent, facial and vestibulocochlear
nerves are at the lower border of the ventral surface at It consists of longitudinal and transverse fibres.
the junction of pons and medulla oblongata. 1 The longitudinal fibres include:
The dorsal or posterior surface is hidde n by the a. The corticospina/ and corticon11clear (pyramidal)
cerebellum, and fo rms the upper half of the floor of the tracts.
fourth ventricle (Fig. 5.2). b. The corticopontine fibres ending in the pontine
Pons has 2 borders-superior and inferio r. nuclei.
Superior border: Crus cerebri a re attached here. lil and 2 The transverse fibres are po11tocerebellar fibres
IV nerves are also seen.
beg inning from the pontine nuclei and going to the
Inferior border: Lies a t the junction of po ns and
opposite half of the cerebellum, through the middle
medulla. VI, VII and vm nerves lie at this border.
cerebellar peduncle.
INTERNAL STRUCTURE OF PONS Tegmental Part
In transverse sections, the pons is seen to be divisible H owever, the structure of the tegmental part differs in
into ventral and dorsal parts. The ventral or basilar part the upper and lower parts of the pons.
is continuous inferiorly wi th the pyramids of the
medulla, and on each side w ith the cerebellum th.rough Tegmentum in the Lower Part of Pons
the middle cerebellar peduncle. The dorsal or tegmental
Identify the following features as shown in Fig. 5.9.
part is a direct upward continuation of the medulla
(excluding the pyramids). Grey Matter
Basila r PartNentral Part 1 The sixth nerve nucleus lies beneath the facial colliculus.
The basilar part of the pons has a wuform structure 2 The seventh nerve nucleus lies in the reticular forma-
throughout its length. tion of the pons.

Medial longitudinal bundle - - - -- - -- - - - - , - - - - - - - -- - - - Facial colliculus

- -- - - Vestibular nucleus
Ventral and dorsal --._-----,;::=f•'\
cochlear nuclei

Middle cerebellar
peduncle

- - - - Spinal tract of trigeminal


and its nucleus

- - - - - - Facial nerve

~ - -- -- - Lateral spinothalamic
tract or spinal lemniscus

' - - - - - - - - - - - - - - Abducent nerve

Fig. 5.9: TS of lower part of pons or TS at the level of facial colliculus


BRAIN- NEUROANATOMY

3 The vestibular and cochlear nuclei lie in relation to 5 The inferior cerebellar peduncle lies lateral to the
the inferior cerebellar pedW1cle. The vestibular nuclei floor of the fourth ventricle.
lie deep to the vestibular area in the floor of the fourth 6 The fibres of the fac ial nerve follow a peculiar
ventricle, partly in the medulla and partly in the course. They first pass backwards and medially to
pons. They are divisible into four parts, superior, reach the medial s ide of the abducent nucleus.
inferior, medial and lateral. They receive the fibres They then form a loop dorsal to the abducent
of the vestibular nerve, and g ive efferents to the nucleus. This loop is responsible for producing
cerebellum (vesti bulocerebellar), the medial an elevation, the facial collic1tlus, in the floor of the
longitudinal b undle, the spinal cord (vestibuJospinal fourth ventricle.
tract arising in the lateral vestibular nucleus) and the
lateral lemniscus.
Tegmentum in the Upper Part of Pons
The dorsal and ventral cochlear nuclei are situated
dorsal and ventral to the inferior cerebellar peduncle. Identify the following features as shown in Fig. 25.10.
They receive the fibres of the cochlear nerve, and give
efferents mostly to the superior olivary nucleus and Grey Matter
partly to nuclei of the corpus trapezoid eum, and to The special features are the motor, and superior sensory
nuclei of the la teral lemniscus. These fibres form the nuclei of the trigeminal nerve. The motor nucleus is medial
trapezoid body. to the superior sensory nucleus.
4 The spinal nucleus of the trigeminal nerve lies in the
lateral part. White Matter
5 Other nuclei present include the salivato ry a nd 1 Immediately behind the ventral part of the pons we
lacrimatory nuclei. see bands of fibres made up (from medial to lateral
side) of the medial lemniscus, the trigeminal lemniscus,
White Matter the spinal lemniscus (spinothalamic tracts consist of
1 The trapezoid body or corpus trapezoideu:m is a trans- two adjacent pathways: Anterior and lateral. The
verse band of fibres lying just behind the ventral part anterior sp inoth ala mic tract carries information
of the pons. It consists of fibres that arise in the cochlear about crude touch and a·ude pressure. The lateral
nuclei of both sides. lt is a part of the auditory pathway. spinothalamic tract conveys sensa tions pain and
2 The medial lemniscus forms a transverse band on temperature) and the lateral lemniscus.
either side of the mid line, just behind the trapezoid The trigeminal lernniscus contains fibres arising in
body. It is joined by anterior spinothalamic tract. the spinal nucleus of the trigeminal n er ve and
3 The lateral spinothalamic tract (spinal lemniscus) lies travelling to the thalamus. The lateral lemniscus is a
latera l to the medial lemniscus. part of the auditory pathway. It is formed by fibres
4 The trigemi.nal lemniscus conveys fibres of second arising in nuclei lying in close relation to the
sensory neurons from the opposite spina l and trapezoid body (superio r o livary nucleus and
sensory n uclei of trigeminal nerve. nucleus of trapezoid body).

Superior cerebellar peduncle

Middle cerebellar peduncle

Lateral lemniscus---',---=----1--"' ~ -1---=--+-- Motor nucleus and superior


sensory nucleus of trigemlnal
Spinal lemniscus - -->.--- -=--+--"' nerve

Fig. 5.10: TS of upper pons


BRAIN STEM

2 The su perior cerebellar peduncles lie d o rsolateral to d . Absence of corneal reflex on the side of lesion
the fou rth ventricle (replacing the inferior peduncle due to damage to nucleus of V nerve including
seen in the lower part of the pons).
its spinal tract.
3 The media l longitudinal bundle is made up of fibres
that interconnect the n uclei of the cranial nerves III,
• Millnrd-G11bler's syndrome (Fig. 5.11): In this
IV, VI and VIII and the spina I root of the XI. lt coordinates condition, there is damage to fibres of VI and VII
movements of the head and neck in response to nerves along with pyram id al fibres. Features are:
stimula tion of the cranial nerve VITT. However, the a. Ipsilateral facial paralysis d ue to d amage to VII
m ajority of fib res in the med ial longi tudinal btmdle nerve; there is paralysis of facial muscles o n the
a rise in the vestibular nuclei (Fig. 5.16). same side.
b. Ipsila teral loss of abd uction of the eye due to
BLOOD SUPPLY damage to VTne rve.
The pon ti ne arteries are a numbe r of sm all vessels c. Contralateral hemiplegia due to lesion of the
which come off a t right angles from either side of the pyramidal fibres.
basilar a rtery and su pply the pons and adjacent parts • Tumours ofpons: Astrocytoma is the most common
of the brain. tumour of brain stem, usually in childhood. Signs
and symptoms va ry according to area of origin of
DEVELOPMENT tumour.
From cranial metencephalic part of rhombcncephalic
vesicle. Cells of alar lamina migrate to form the pontine
n uclei, cochlea r an d vestibu lar n uclei, trige mi nal
sensory nucleus. Basa l pla te ne uroblasts give rise to
abducens nucleus, facial nucleus, motor nucleus of Ventral and
trigeminal and superior salivatory nucleus. dorsal cochlear
/ / nuclei_
2
• Supenor
olivary nucleus
- Lateral
• Pontine haemorrhage: This entity has following features: spinothalamic
tract or spinal
a. Bila tera l paralysis of face a nd limbs due to lemniscus
involve me n t of VII ner ve nucleu s an d all ' - - - - - - Facial nerve
corticospinal fibres.
b. Deep coma due to d amage to the reticular Corticospinal and
corticonuclear
forma tion. fibres
c. Hyperpyrexia d ue to cutting o ff o f the te m- Pontine nuclei
p erature regula ting fi b res from the h ypo-
Fig. 5.11: Lesion of pons. (1) Cerebellopontine angle tumour
thalamus .
and (brown area) (2) Millard-Gubler's syndrome (blue area)
d. Pin poin t pupil due to d amage to sympa the tic
ocular fibres. Pontine haemorrhage is usually
fatal. MIDBRAIN
• Cerebellopontine angle (Fig. 5.11): The anatomical
structures located in the cerebellop ontine angle The midbrain is also called the mesencephnlon. It is 2 cm
include choroid p lexuses of IV ven tricle, flocculus, long and connects the hindbrain with the forebrain. Its
VII and VIII cranial nerves. A tumour, acoustic cavity is known as the cerebral aq ueduct of Sylvius
neurnma, in this angle arises usually in rela tion (French anatomist 1478-1555). It connects the third
to VIII nerve. Features are: ven tricle with the fourth ventricle (Figs 5.12a a nd b).
a. Ipsilateral facia l paraly is and loss of taste in The midbrain passes through the tentorial notch, and
a nterior two-thirds of tongue and hyperacussis is related on each side to the parahippocampal gyri, the
due to d amage to fibres of facial nerve. optic tracts, the posterior cerebral artery, the basal vein,
b. Deafness and vertigo d ue to d amage to both the trochlear nerve, and the geniculate bodies. Anteriorly,
the parts of VIII nerve. it is related to the interpeduncular s tructures, an d
c. Ataxia on the affected side due to involvement posteriorly to the splenium of the corpus callosum, the
of the flocculus. great cerebral vein, the pineal body, and the posterior
ends of the right a nd left thalami (see Fig. 6.8).
BRAIN-NEUROANATOMY

Cerebral peduncle Pineal body


Superior colliculus
Ill ventricle - - --t-'
Inferior colliculus
Aqueduct ~ ~ - - --

Pons
IV ventricle Medulla

i--+ - - - - Pyramidal
decussation

Figs 5.12a and b: (a) Sagittal section of midbrain with pons, and (b) ventral aspect of midbrain

SUBDIVISIONS EXTERNAL FEATURES


The major subdivisions of midbrain are as follows: Ventral surface presents crus cerebri. It is crossed by
1 The tectum is the part posterior to aqueduct. It is optic tract, basal vein, posterior cerebral and superior cere-
made up of the right and left superior and inferior bellar arteries from the medial side of this oculomotor
colliculi (Fig. 5.13). nerve and from lateral side trochlear nerve emerges.
On the dorsal aspects superior and inferior colliculi
2 Each half of the midbrain anterior to the aqueduct is are present. They are called together as corpora quadri-
called the cerebral peduncle. Each cerebral peduncle gemina ( quadruplet bodies). The superior colliculus is
is subdivided into: connected to the lateral geniculate body by the superior
a. Crus cerebri, anteriorly. brachium (see Fig. 6.8).
b . Substantia nigra, in the middle. Likewise, the inferior colliculus is connected to the
medial geniculate body b y the inferior brachium
c. Tegmentum, posteriorly (Fig. 5.13). (see Fig. 6.8) III and IV cranial nerves a re attached to
rnidbrain (Fig. 5.12b).

INTERNAL STRUCTURE OF MIDBRAIN


It is studied con veniently by examining sections, at the
level of the inferior colliculi and a t the level of the
superior colliculi.

Transverse Section of Midbrain


at the Level ot Inferior Colliculi
Grey Matter
1 The central (periaqueductal) grey matter contains:
a. The nucleus of the trochlear nerve in the ventro-
medial part.
b. The mesencephalic nucleus of the trigeminal nerve
in the lateral part. The m esencephalic nucleus
is made up of uni pola r cells (first neuron) and
receives proprioceptive impulses from the muscles
of mastication, the facial and ocular muscles, the
Fig. 5.13: Parts of midbrain teeth (Fig. 5.14) and temporomandibular joint.
BRAIN STEM

Temporo-. parieto- and


occipitopontine fibres (1/6th)

Corticospinal and corticonuclear


fibres (middle 213rd)

~ - - - - - - --Decussation of superior
cerebellar peduncles
Fig. 5.14: TS of midbrain at the level of inferior colliculus

2 The infer ior colliculus receives affe rents from the 3 The trochlear nerve passes laterally and d orsally
lateral lemniscus, and gives effe re nts to the medial round the central grey matter. Tt d ecussa tes in the
geniculate body. In the past, it has been considered superior medullary velum, and emerges lateral to
as the centre for auditory reflexes, but the available the frenulum veli.
evidence indicates tha t it helps in localizing the
source of sounds. Transverse Section of Midbrain at the
Level of Superior Colliculi
3 The s11bstn11tia nigra is a lam ina of grey matter mad e
up of deeply pigmented nerve cells. It is concerned Grey MaHer
with muscle tone (Fig. 5.14). 1 The central grey ma tter contains:
a. u cleu s o f oculomotor nerve w ith Edinger -
White MaHer Westphal nucleus in the ventromedial part.
1 The crns cerebri contains: b. Mesenceplwlic nucleus of the trigeminal nerve in the
a. The corticospinal tract in the middle. lateral part. The oculomotor nuclei of the two sides
are very close to each other (Fig. 5.15).
b. Frontopo ntine fibres in the medial one-sixth.
2 Superior colliwlus receives afferents from the re tina
c. Temporopontine, pa rie topontine and occip ito-
(visual), and various other centres. rt gives efferents
pontine fibres in the lateral one-sixth.
to the spinal cord (tectospina1 tract). It controls refl ex
2 The teg111e11t11111 contains ascending tracts as follows. movemen ts of the eyes, and of the head and neck in
a. The lemnisci (m edial, trigeminal, spinal and late ral) response to visual stimuli.
are a rranged in the form of a band in which th ey 3 Pretectal nucleus lies deep to the superolateral part
lie in the order mentioned (from medial to la teral of the su perior colliculus. It receives afferents from
side) like a necklace. the la teral roots of the optic tract. It gives effe rents
b. The decussation of the superior cerebellar ped11ncles is to the Edinger-Westphal nuclei of both sides.
seen in the median plane. The pretectal nucleus is an important part of the
c. The medial longitudinal bundle lies in close relation pa thway for light refl ex and the consensual reflex.
to the trochlear nucleus (somatic efferent colunm). Its lesion causes Argyll Robertson p upil in which the
d . The tectospinal tract and the rubrospinal tract are light reflex is lost b ut accommod a tion reflex remains
present. intact.
BRAIN- NEUROANATOMY

, - - -- - - - - - Superior colliculus

Mesencephallc nucleus of V - - - -~ - - > < - - ----'t i

Edinger-Westphal and- - - -.,,__.,,,___ _ _~ ...,.--:,c--v- Trigeminal lemniscus


oculomotor nerve nuclei u"---,------,,.,----~- - - - Medial longitudinal bundle
-+---~.,..__ _ _ Medial lemniscus
---,I---'' -"''--,.,._,,__.~--,,-,,._- Red nucleus
Dorsal and ventra1,---._....,;-";---:--c---~-..._~
tegmental decussation Temporo-, parieto- and
occipitopontine fibres

- - -- - Corticospinal and corticonuclear


fibres

Fig. 5.15: TS of midbrain at the level of superior colliculus

4 Red nucleus is about 0.5 cm in diameter. It receives end of the fibres reaches up to cervical segments of
afferents fro m the superior cerebellar peduncle, spinal cord .
g lobus pallidus, subthalamic nucleus and cerebral The bundle connects the cranial nerve nuclei of ill, IV,
cortex. ft gives efferents to the spinal cord (rubrospinal VI, Vlll and s pinal root of XI nerves. It is also connected
tract), reticular formation, thalamus, olivary nucleus, to the anterior horn cells which supply muscles of the neck.
subthalamic nucleus, etc. It has an inh.ibi tory influence
on muscle tone. - - - - Interstitial
5 Substantia nigra has already been d escribed. nucleus of
Posterior- - ----'., Cajal
White Matter commissure
t--- - - - - Medial
1 The crus cerebri has the same tracts as described above. longitudinal
2 The tegmentum contains the following: bundle
a. The same lemnisci as seen in the lower part except Oculomotor
Trochlear - - i-'L_
for the lateral lemniscus wh ich has terminated in nucleus (IV) nucleus (111)
the inferior colliculus.
i...---t'•J--- - - Abducent
b. The decussation of the tectospinal and tectobulbar nucleus (VI)
tracts forms the dorsal tegmental dewssation. Nucleus of
c. The d ecussation of the rubrospinal tracts forms lateral lemniscus
the ventral tegmental decussation.
d . Medial longitudinal bundle.
e. Emerging fibres of oculomotor nerve.
3 The /ect11 m shows the posterior commissure connecting Vestibular
nucleus
the two superior colliculi.

BLOOD SUPPLY ::------ Accessory


nucleus (XI)
Most of the blood supply is derived from branches of
th e basila r artery. Besides this it also receives from
1. Posterior cerebral 2. Superior cerebellar
3. Posterior communicating 4. Anterior choroidal
Cervical
segmient
MEDIAL LONGITUDINAL BUNDLE spinal CC)rd
Main constituent fibres of medial longitudinal bundle
(Fig. 5.16) are the fibres from left and right medial
vestibular nuclei. These fibres reach up to interstitial
nucleus of Cajal at the upper end of aqueduct. The lower Fig. 5.16: Connections of medial longitudinal bundle
BRAIN STEM

This bundle integrates movements of eyes, and neck. Mnemonics


It also maintains equilibrium.
Mahanagar Telephone Sitam (Nigam) Limited
DEVELOPMENT (MTSL) (from med ia l to latera l)

From middle vesicle or the mesencephaJon. Alar lamina M - Medial /emniscus


cells multip ly and fuse to form 4 colliculi. These cells T - Trigeminal lemniscus
also mig rate ven trally to form red nucle us and sub- S - Spinal lem niscus
stantia nig ra. The basal lamina forms the crus cerebri. L - Lateral lemn iscus

CLINICAL ANATOMY

• Weber's synd rom e (Fig. 5.17): This syndrome • Pyramidal decussation cuts off the anterior horn
involves m nerve nucleus and corticospinal fibres. which forms nucleus of 1st cervica l nerve a nd
Features are: n ucleus of spinal accessory nerve.
a. Hemiplegia on the opposite side due to involve- • Nu cle us g racilis and nucle us cunea tus ar e
ment of corticospinal fibres. equivalent of the nuclei in the posterior ho rn of
b. Pupil points downwa rds and laterally due to spinal cord. These are present in the medulla
paralysis of Ill nerve. oblon gata . Fasciculus g racilis and fascicu lus
• Benedikt's syndrome (Fig. 5.1 7): In this condition, cuneatus relay in their respective nuclei.
most of the tegm entum of midbrain is damaged. • At the lower section of pons, fibres of cochlear
Lesio n includes loss of medial lemniscus, red nuclei form trapezoid body w hk h forms lateral
nucleus, superio r cerebellar peduncle and fibres lemniscus. N uclei of VI, VII and YID cranial nerves
of Ill nerve. Features are: are present here.
• At the upper section of pons some of the nuclei
a. Loss of proprioception due to lesion of medial forming trigeminal nerve are situated. The nerve
lemniscus. lies a t the ju ncti on of pons with the middle
b. Pupil points downwards and laterally due to cerebellar peduncle.
injury to llT nerve. • Section, at the level of inferior colliculus shows 4
c. Tremors and twitching of opposite side due to lemnisci: Med ial, trigemi nal, sp inal and lateral
dam age to red nucleus and superior cerebellar (MTSL) from med ial to lateral side. It also shows
ped uncle. nucleus of IV nerve, the delicate crania l nerve.
• Parinaud's syndrome (Fig. 5.17): Lesion of superior • Section at the level of superior colliculus shows
colliculi leads to this synd rome. Features include prominent red nucleus. It also shows TIT nerve
weakness of upward gaze and vertical nystagmus nucleus w ith Edinger-Westphal nucleus.
due to lesion of superior colliculus.
• A rgyll Robertson pupil: In this condition, light reflex
is lost but accommodation reflex is retained due to CLINICOANATOMICAL PROBLEM
lesion in the vicinity of pretectal nucleus (Fig. 5.17).
A person s uffering from syphilis com p lains of
inability to see in response to light thrown in the eyes,
w hereas he can read and see nearby things:
• Where is the lesion?
• Wh at is such a lesion called?
Ans: In such cases, the light reflex is lost, whereas
accommodation reflex is retained. It is due to result
of lesion in the vicinity of pretectal nucleus. Such a
condition is called Argyll Robertson pupil. The fibres
of light reflex take following course:
Red nucleus Retina ➔ optic nerve ➔ optic chiasma ➔ optic
tract ➔ some fibres to pretectal nucleus of both sides
➔ Edinger-Westphal nucleus ➔ 3rd nerve nucleus

Fig. 5.17: Lesion of midbrain. (1) Weber's syndrome, {2) Benedikt's


and 3rd nerve ➔ ciliary ganglion ➔ short ciliary
syndrome, (3) Parinaud's syndrome and (4) Argyll Robertson nerves ➔ pupil constricts. The lesion in syphilis
p upil involves the pretectal nucleus, so light reflex is Jost.
BRAIN-NEUROANATOMY

FREQUENTLY ASKED QUESTIONS

1. Draw a labeled diagram of transverse section of 3. Write short notes on:


medulla oblongata at the level of sensory decussation. a. Medial lemniscus b. ucleioftrigeminal nerve
2. Draw a labeled diagram of midbrain a t the level of
superior colliculus. c. Lateral lemniscus d. Pontine nuclei

MULTIPLE CHOICE QUESTIONS

1. The pontine nuclei form an important part of: c. Nucleus ambiguus


a. Corticorubral pathway d. Spinal nucleus of XI nerve
b. Cortico-ponto-cerebellar pathway 4. What is true about crus cerebri?
c. Vestibulocerebellar pa thway a. The corticospinal tract is in its middle part
d. O livocerebellar pathway b. Frontopontine fibres in medial one-sixth part
2. Which of these fasciculus lies most medially? c. Temporopontine, parietopontine and occipito-
a. Fasciculus cuneatus pontine fibres in lateral one-sixth part
b . Fasciculus gracilis d. All of the above
c. Inferior cerebellar peduncle 5. Pons contains which of the following set of nuclei?
d . one of the above a. IX, X, XI, Xll
3. Which is the content of central grey matter in b. V, VI, VII, VIII
section of lower part of medulla?
a. Hypoglossal nucleus c. ill, IV
b. Nucleus of spinal tract of trigeminal nerve d. IV, V, VI, Vll

ANSWERS
1. b 2. b 3.a 4.d 5.b
CHAPT E R

6
Cerebellum
~:!The-i-utin ;J a rr.on f'let/ul l>"i!Jllll, /.II .Jta,/2 ue.o;/dn,9 /1,e n L0111Pu l r,tr gel uf. in ll,-P- 11uHnJ119

,,,,,/ ,/or, n o/ ,loft ffJ1.U t you ff<'-1 i,,lo, t/,e,o//iu


- R Frost

INTRODUCTION
Cerebellum (Latin small brain) though small in size
(weighsabout150grams),subservesimportantfunctions
for maintaining tone, posture, and equilibrium of the
body. Tt is the largest part of the hindbrain and second
largest part of the brain.
Middle/ ~~ ::;;;;Q~~
Cerebellum controls the same side of the body directly posterior
or indirectly. The cerebellwn does not initiate movement, lobe
but it contributes to coordination, precision and accurate
timing.
The grey matter is highly folded to accommodate
millions of neurons in a small area and the arrangement Flocculonodular - - ~ Superior
is called "arbor vitae" (vital tree of life). The structure lobe
of cerebellum is uniform thro ughout, i.e. homotypical. Dorsal + Ventral

Inferior
LOCATION
The cerebellum (little brain) is the largest part of the Fig. 6.1 : Anatomical lobes of the cerebellum
hindbrain. lt is situated in the posterior cranial fossa
cerebellum is marked by a w ide and deep notch in w hich
behind the pons and medulla. It is an infratentoria l
the pons and medulla are lodged. Posteriorly, there is a
structure that coord inates v oluntary movements of the narrow and deep notch in which the falx cerebelli lies.
body (Fig. 6.1). Each hemisphere is div ided into three lobes. The
Relations anterior lobe Lies on the anterior part of the superior
surface. It is separa ted from the middle lobe b y the
Anteriorly: Fourth ventricle, pons and medulla. fissura prima. The middle lobe is the largest of three lobes
Posteroinfcriorly: Squamous occipital bone. situated on both its surfaces. It is limited in front by
Superiorly: Tentorium cerebelli (Fig. 6.2). the fissura prima (on the superior surface), and by the
posterolateral fissure (on the inferior surface) . Th e
EXTERNAL FEATURES floccu/onodular lobe is the smallest lobe of the cerebellum.
Th e cerebellum consists of two cerebellar hemispheres It lies on the inferior surface, in front of the postero-
that a re united to each other through a median vermis. It la teral fissure (Fig. 6.4).
has two surfaces: superior and inferior. The supe rior
surface is slightly con vex. The two hemisph eres a re PARTS OF CEREBELLUM
continuous with each other on this s urface (Fig. 6.3a). The cerebellum is subdivided into numerous sma ll
The inferior surface shows a deep median notch called pa rts by fissures. Each fissure cuts the vennis and both
the val/ecula which separates the right and left convex he1nisph eres. Out of the numerous fissures, however,
hemis phe res (Fig. 6.3b). The anterior asp ect of the only the following are worth remembering.
105
BRAIN- NEUROANATOMY

Tentorium
Hypophysis cerebri cerebelli
JW-~- Meningeal layer
of dura mater

11-~ - Endosteal layer


of dura mater

Sphenoid
Rostral
"'------ - A rachnoid mater
Ventral + Dorsal ' - - - - -- - Subarachnoid space
Caudal
' - - - - - -- Pia mater

Fig. 6.2: Relations of cerebellum

1 The horizontal fissure separates the superior s urface the bilateral movements used for locomotion and
from the inferior surface (Fig . 6.4). maintenance of equilibrium (Fig. 6.5).
2 The primary fissure (fissura prima) separates the 2 The paleocerebellum is the next part of the cerebellum to
anterior lobe from the middle lobe on the superior appear in terrestrial vertebrates vvith the appearance
smface of the cerebellum. of limbs. It is made up of the anterior lobe (except
3 Th e posterolateral fissure separates the middle lobe lingula), and the pyramid and uvula of the inferior
from the flocculonodular lobe on the inferior surface. vermis. Its connections are chiefly spinocerebellar. It
The variou s parts of cerebellum are sh own in Fig. 6.4. controls tone, posture and crude movements of the limbs.
Where both the superior and inferior smfaces of the 3 The neocerebellum is the newest part of the cerebellum
cerebellum are drawn in one plane. The upper part of to develop. It is made up of the posterior / middle
the diagram, above the horizontal fissure represents the lobe (th e largest part of the cerebellum) except the
s uperior s urface; a nd the l ower part, below the pyramid and uvula of the in fe rior vermis. It is
horizontal fissure represents the inferior surface. primarily concerned w i th th e regulation of fine
m ovements of the body (Table 6.1).
Parts of vermis Subdivisions of the cerebellar
hemisphere FUNCTIONALLY
1. Lingula The anterior and posterior lobes are organized into 3
2. Central lobule Ala longitudinal zones- lateral, intermed iate and v ermis
3. Culmen Quadrangular lobule (Fig. 6.6).
4. Declive Simple lobule Lateral Zone
5. Folium Superior semiJunar lobule
Connected w ith association areas of the brain and is
6. Tuber Inferior semilunar lobule involved in planning, programming and coordination
7. Pyramid Biven tral lobule muscular activities of distal parts of limbs. It is done
8. Uvula Tonsil through dentate rubrothalamocortical tract, descending
9. Nodule Flocculus corticos pinal and rub rospi.nal tracts.

In Fig. 26.4, note that each part of the verm.is has a Intermediate Zone
la teral extension. H owever, the lingula does not have Concerned w ith control of m u scles of flexor group via
an y lateral exten sion. rubrospinal tract.
Median ZoneNermis
MORPHOLOGICAL AND FUNCTIONAL DIVISIONS OF
CEREBELLUM Concerned w ith control of extensor muscles trunk,
neck, shoulders and hips through vestibulospinal and
1 The archicerebellum phylogenetically is the oldest part reticulospinal tracts.
of the cerebellum to appear in ev olution in aqua tic
vertebrates. It includes of the flocculonodular lobe Flocculonodular Lobe
a nd the lingula. It is chiefly v es tibula r in its This is an extra lobe. Th.is lobe functions with vestibular
connections. It controls the axial musculature and sys tem in controlling equilibrium.
CEREBELLUM

~ = =,_......,--=:!II:,--,...,.,~~- - - Anterior cerebellar notch


for pons and medulla

"'-...,_.;-==-=-,.---:=,-E- ~!!i!=::<-,------s:!!::::::L- Posterior cerebellar notch


for falx cerebelli

- -
~ - -----'----- Tonsil

(a)
-"-- - - - - - - - Flocculus

\ L~c..L,c.L<.£...<c...L.L.t.:.u , ,..__ _ _ _ Anterior cerebellar notch


for pons and medulla

Posterior cerebellar notch


for falx cerebelli

Figs 6.3a and b: (a) (i) Superior, (ii) inferior surface of cerebellum (gross), and (b) (i) superior, (ii) inferior surface of cerebellum
(diagrammatic)
BRAIN-NEUROANATOMY

Ala

Lingula

Primary fissure
Central
lobule Quadrangular lobule

Simplex lobule
Culmen

Oeclive
Superior semilunar lobule

Folium
Horizontal fissure

Tuber
Inferior semilunar lobule

Pyramid
Biventral lobule

Anterior
Fig. 6.4: Lobes and morphological subdivisions of cerebellum. Area above horizontal fissure represents superior surface and area
below the fissure shows inferior surface

D Archicerebellum
(vestibular cerebellum)

D Paleocerebellum
(spinal cerebellum)

D Neocerebellum
(pontocerebellum)

Nodule - - - - - - - -- - - '
Fig. 6.5: Functional subdivisions of cerebellum
CEREBELLUM

'lllff.N,..Mf -- - - Planning and sequential


movements of the entire
body and conscious
assessment of movement
errors

[:=J Vermis
Posterior lobe
(middle lobe) [:=J Intermediate
zone
Lateral zone

H : Hip
A : Abdomen
T : Thorax
S : Shoulder
N : Neck
H : Head

Fig. 6.6: Functions of cerebellum according to the zones

Table 6.1: Morphological and functional divisions of cerebellum


Afferents Efferents Functions
Vestibulocerebellum Vestibulocerebellar tract Cerebellovestibular • Fixes position of body during skilled
Fastigio bulbar movements
• Maintains equilibrium of body
• Controls eyeball movements
Spinocerebellum Dorsal spinocerebellar Cerebelloreticular Receives tactile, proprioceptive,
Ventral spinocerebellar Cerebello-olivary auditory and visual impulses
Cuneocerebellar tract Control synergistic activity of agonistic
Olivocerebellar and antagonistic muscles
Reticulocerebellar Concerned with skilled movements
trigem inocerebellar
Neocerebellum Pontocerebellar tract Dentatothalamic Smooth transition of motor activity
Olivocerebellar Dentatorubral from proximal to distal muscle groups.
Planning and programming of purpose-
ful and rapid movements including
their duration and termination
• Acts as a feedback centre between
cerebral cortex and peripheral motor
movements

CONNECTIONS OF CEREBELLUM the superior cerebellar peduncle is chiefly efferent in


The fib res entering or leav ing the cerebellum are nature.
grouped to form three p eduncles (La tin small foot)
which connect the cerebellum to the mid brain, the pons GREY MATTER OF CEREBELLUM
and the medulla (Fig. 6.2). Th e constitue nt fibres in It consis ts of the cerebellar cortex and the cerebellar
them are given in Table 6.2 and f igs 6.7 and 6.8. nuclei. There are four p airs of nuclei:
Jt is clear from Table 6.2 that the middle and inferior 1 Nucleus dentatus is neocerebellar.
peduncles are chiefly a fferent to the cerebellum and that 2 Nucleus globosus
BRAIN-NEUROANATOMY

Table 6.2: Constituents of the cerebellar peduncles


Peduncle Afferent tracts Efferent tracts
A. Superior cerebellar peduncle 1. Anterior spinocerebellar 1. Cerebellorubral
(connects cerebellum to 2. Tectocerebellar 2. Dentatothalamic
midbrain) 3. Dentato-olivary
4. Fastigioreticular

B. Middle cerebellar peduncle Pontocerebellar (part of the corticopontocerebellar


(connects cerebellum to pons) pathway)
C. Inferior cerebellar peduncle 1. Posterior spinocerebellar 1. Cerebellovestibular
(connects cerebellum to 2. Cuneocerebellar (posterior external arcuate fibres) 2. Cerebello-olivary
medulla oblongata) 3. Olivocerebellar 3. Cerebelloreticular
4. Parolivocerebellar
5. Reticulocerebellar
6. Vestibulocerebellar
7. Anterior external arcuate fibres
8. Striae medullaris
9. Trigeminocerebellar

Anterior lobe - - - - - - - ~

'---4--lt-- +-- - - - Middle cerebellar peduncle

.:-....~---<--------- Vestibulocerebellar tract


(to and fro)
'---- - - - -- - - Olivocerebellar and
reticulocerebellar tract (to and fro)

' - - - - - - - - - - - Inferior cerebellar peduncle


.__ __ _ __ _ _ _ _ _ _ _ Ventral spinocerebellar tract

Fig. 6.7: Connections of cerebellum

3 Nucleus embolifonnis is paleocerebellar. axons of granu le cel ls, axons of s tellate and basket
4 Nucleus Jastigii is archicerebellar (Fig. 6.9). cells, sensory climbing fibres, dendrites of Purkinje
and Golgi cells. lt also contains steliate and basket
HISTOLOGICAL STRUCTURE cells.
The structure of cerebellum is wuform throughout, i.e. 2 Intermediate layer: It contains single la yer of cell
is homoty pical. In contrast the stru cture of cerebral bodies of Pmkinje cells.
cortex varies in different areas, i.e. it is heteroty pical.
Grey matter contains basket cells which inhibit body 3 inner layer: Made up of cell bodies and dendrites of
of Purkinje cells. granule cell, Golgi cells.
It also has stellate cell which inhibits dendrites of
Purkinje cell (Figs 6.10a and b). Neurons of Cerebellum
The cortex contains 3 layers as follows: They are 5 types in which four types of, i.e. Purkinje,
1 Molecu lar layer: lt consists of unmyelinated nerve basket, stellate, and Golgi are inhibitory. Only the
fibres which are derived from the parallel fibres of granu la r cells are excitatory.
CEREBELLUM

3rd ventricle - - - - 1 -+--+- ---t'-+-


Pulv1nar of thalamus - - - + -- + - - - + - -

1---=.------+- Superior fovea


- +-----'. ---+----J--- Facial colliculus

Hypoglossal trigone - - - --=-----=~=-----'1,- --.::::~~::::::_--- Striae medullaris


lnferior fovea - - - - - - + ----,-,i~~" ' ' " f - - - - - Taenia

Fig. 6.8: Position of cerebellar peduncles (in posterior view)

Granule cell: It is a small rounded cell w ith den drites.


the axons of these cells form parallel fibres which are
connected to other cells.
Ste/late cell and basket cell: Their cell bodies are at right
angles to the long axis of the folium.
Golgi cells: They a re the largest neurons. They receive
input from parallel fibres, climbing fibres an d mossy
fibres and output to granule cells.
Globose nucleus
Sensory Fibres of Cerebellum
The afferent connections of cerebellum are through
mossy and climbing fibres. Mossy fibres constitute all
the afferents except those of olivo-cerebellar fibres.
Mossy fibres synapse with granule and Golgi cells (Table
---- - - - - ' I - - Dentate 6.5). These fibres release neurotransmitter and glutamate.
nucleus
Climbing fibres start from inferior ol ivary n ucleus. These
olivo-cerebellar fibres climb up and make syn aptic
connection with dendrites of Pu rkinje's cells (Fig. 6.11).
These fibres release neurotransmitter aspartate.
Figs 6.9a and b: Positions of intracerebellar nuclei
BLOOD SUPPLY
Purkinje cell: It is the cha racteristic cell of cerebellum. It
is a large cell with flask shape. It gets stimulated by Cerebellum is supplied by two superior cerebell ar
cl imbing fibres coming from inferior olivary nucleus. arteries, two anterior inferior cerebellar arteries and two
The main output of this cell is to cerebella r nuclei and posterior inferior cerebellar arteries.
is inhibitory in nature . These are the main outpu t Superior cerebellar is a branch of basilar artery.
neurons . Anterio r inferior cerebellar is a branch of basilar artery.
BRAIN-NEUROANATOMY

Flocculonodular lobe is connected to vestibular


nuclei. It is involved in maintenance of muscle tone and
p osture. Spinocerebellum, vermis and intermediate
____..,___ _ _,.__ Molecular regions receive afferents from motor cortex via cortico-
layer pontocerebellar fibres.
All sensory information of muscles, joints, cutaneous,
audit01y and visual parts are relayed here. Spinocerebellar
Purkinje's tracts carry information from the same side (Fig. 6.6).
cells layer
Vermis controls axial muscles, and thus maintains
posture. Paramedian areas are involved in control of distal
i> ·,;:;,;:..-+-- Granular group of muscles to bring smooth coordinated activity.
layer Cerebellum functions as "compa rator". It receives
information from cerebrum and spinal cord. lt corrects
and modifies ongoing movements through thalamo-
Outer molecular layer and inner granular layer cortical projections, reticulospinal and rubrospinal tracts.
Purkinje's cells at the junction Neocerebellum is responsible for fine tuning of
Uniform structure motor performance for precise movements. It helps in
(a)
planning and production of skilled movements along
with cerebrum.
It has been seen by functional magnetic resonance
Dendrites o f - --,4l',~ ll,l.N.'l"ltill-
Purkinje cell
imaging (fMRI) that if fingers of right hand are moved
......•·· repetitively, the activity is seen in precentral gyrus of
left cerebral cortex and in anterior quadrangular lobule
of right cerebellar hemisphere.
Axons of
granular
cell
DEVELOPMENT
Cerebellum develops from the neurons of alar lamina
> - - - - Axon of
Purkinje cell
of metencephalic part of the rhombencephaLic vesicle.
These neurons migrate dorsally and form the rhombic
Mossy fibre lip which forms the cerebellum. The earliest part to
'-'-- - - Climbing fibre d evelop is the archicerebellum. In its centre, the paleo-
Basket
cell
(b) cerebellum develops, splitting the archicerebellar parts
into two parts, the lingula and flocculonodular lobe.
Figs 6.1Oa and b: (a) Histology of cerebellum, and (b) histological
connections of cerebellar neurons
Lastly, the paleocerebellar part is also split by the develop-
ment of neocerebellurn in its centre into two parts, the
Posterior inferior cerebellar is a branch of vertebral anterior lobe except lingula and pyramid with uvula.
artery.
Veins drain into neighbouring venous sinuses. CLINICAL ANATOMY

FUNCTIONS OF CEREBELLUM Cerebellar Dysfunction


Cerebellum controls the same side of the body. Its • Verrnis lesions lead to truncal ataxia as connection
of vermis to the vestibula r nuclei are involved .
influence is ipsilateral. This is in marked contrast to
• Nystagmus is due to loss of labyrintl1ine connec-
which control the opposite half of the body.
tions of vermis to laby rinth. Vermis is also related
Coordinates voluntary movements so that they are to emotions.
smooth, balanced and accurate. • Anterior lobe lesion: Lesion of anterior lobe causes
Cerebellum controls tone, posture and equilibrium. gait ataxia. There is i.ncoordination of the lower
This is chiefl y done by th e ar chicerebellum and limbs resulting in staggering gait and inability to
paleocerebellwn. walk in a straight line. It is also seen in alcoholics.
• Neocerebellar lesions: These lesions cause
Cerebellum controls movements of eyeballs. It
incoordination of voluntary movements of the
controls and coordinates these by affecting agonists,
upper limbs. It results in intention tremor, action
antagonists and synergists. It also helps in learning of
tremor and overshoot movements.
special motor skills. It plays a role in cognition.
CEREBELLUM

• Speech is also defective. Phonation is defective due Three arteries for • Superior cerebellar
to loss of smoothness in expiratory muscles. each hemisphere: • Anterior inferior cerebellar
Articulation is defective as there is less coordi- • Posterior inferior cerebellar
nation between muscles of lip, tongue and palate. Three functions: • Tone, posture equilibrium
• If there is thrombosis of one of six arteries nurtur- by flocculonodular lobe
ing cerebellum, "cerebellum cognitive affective • Ton e posture and crude
syndrome" d evelops. These p atients show in a tten- movements by anterior lobe
tion, grammatical errors in speech and patchy • Smooth, accurate and
memory loss. Involvement of verrnis results in balanced movements b y
dulling of emotional response. It is characterised by: middle lobe
a. Muscular h ypotonia Three main symptoms • Tnmcal a taxia in flocculo-
b. Intention tremors (tremors only during move- (one for each lobe): nodular lobe defect
ments) tested by finger-nose and heel-knee tests. • Staggering gait in a nterior
c. Adiadochokinesia which is inability to perform lobe d efect
rapid and regular alternating movements, like • Defective speech in middle
pro.nation and supination. lobe defect
d. ystagmus is to and fro oscilla tory movements
of the eyeballs while looking to either side.
e. Scanning speech is jerky and explosive speech. • Cerebellum o r a little brain acts like younger sibling
f. Ataxic or unsteady gait. of the large cerebrwn. It controls tone, posture,
equilibriwn and fine movements of the bod y. It
SUMMARY cannot initiate the movement.
• It is connected to medulla oblongata by inferior
Three p arts: • Archicerebellum cerebellar peduncle.
• Paleocerebellwn • It is connected to pons by middle cerebellar pedw1ele
• eocerebellum • It is connected to midbrain by superior cerebeUar
Three lobes: • Anterior lobe peduncle.
• Middle or posterior lobe • Nwnber of neurons are about half of the cerebrum,
• Flocculonod ular lobe though it is much smaller than the cerebrum.
Three fissures: • Fissura prima • Its structure is uniform throughout, i.e. homotypical.
• Horizontal fissure • Its control is ipsilateral.
• Posterolateral fissure
Three fw1etional zones: • Vermal zone for trunk and
girdle movement CLINICOANATOMICAL PROBLEM
• Jntennediate zone for hands/
fee t A 40-year-old female complain.e d of inability to work
• Lateral zone for planning and properly with her right hand. She would sway to
programming movem ent right side while walking. She could not do rapid pro-
Three histological nation and supination of her 1ight forearm. Magnetic
layers of grey matter: • Molecular layer resonance imaging showed a tumour in her right lobe
• Purkinje cell layer of the cerebellum
• Granular cell layer • Wh ich cerebellar fw1ctions have been lost to give
Three peduncles • Supe rior cerebellar ped- rise to above symptoms?
w1cle to midbrain • Name the peduncles of the cerebellum .
• Middle cerebellar peduncle Ans: The cerebellum controls tone, posture,
to pons equilibrium and control of fine movements of the
• Inferior cerebellar peduncle body. The Lumour has disrupted these functions,
to medulla oblongata giving rise to symptoms from which she is suffering.
Three d eeper nuclei: • Nucleus dentate with neo- Cerebellum is connected to medulla oblongata by
cerebellum inferior cerebellar peduncle.
• N ucleus emboliformis and It is connected to pons by middle cerebellar
nucleus globose with paleo- peduncle.
cerebellum It is also connected to midbrain b y superior
• ucleus fastigii with fl oc-
cerebellar peduncle.
culonodular lobe
BRAIN-NEUROANATOMY

FREQUENTLY ASKED QUESTIONS

1. Name the afferent and efferent fibers of the three 3. Write short notes on:
cerebellar peduncles. a. Dental nucleus
b . Parts of vermis and subdivision of cerebelllar
2. Discuss the func tions a nd clinical anatom y of hemisphere
cerebell um. c. Histology of cerebellar cortex

MULTIPLE CHOICE QUESTIONS

1. The ratio of cerebellum to cerebrum in an adult is: a. Intermediate zone


a. 1: 8 b. 1 : 16 b . Vermis
c. 1: 4 d. 1: 20 c. Lateral zone
2. Purkinje cells are situated in: d. Flocculonodular zone
a. Cerebral cortex 6. Which is the afferent tract of superior cerebellar
b. Junction of molecular and granular layers of peduncle?
cerebellum a. Reticulocerebellar b. Frontocerebellar
c. Granular layer of cerebellum c. Tectocerebellar d. Striae medullaris
d . Nucle us emboliformis 7. Which function of cerebellum is no t true?
3. What is the true about cerebellum? a. Its hmction as comparator
a. It is situated in posterior cranial fossa behind b. Vermis controls axial muscle and thus maintains
pons and medulla oblongata posture
b. It is an infratentorial structure that coordinate c. Archicerebellum and paleocerebellum controls
voluntary movements of body muscles of hand, finger, feet and toes
c. Its structure is homotypical d . Flocculonodular lobe is connected to vestibular
d. All of the above nuclei. It maintains posture of the body
4. Which lobe is smallest in cerebellum? 8. Superior cerebellar peduncle contains which of the
following fibres?
a. Flocculonodular b. Middle
a. Posterior spinocerebellar
c. Anterior d. Posterior
b. Olivocerebellar
5. Which of the following regions of cerebellum is
con cerned wi th planning a nd programm ing c. Vestibulocerebellar
muscular activities? d. Anterior spinocerebellar

ANSWERS
1. a 2. b 3.d 4. a 5. C 6.c 7. C 8.d
CHAPT E R

7
Fourth Ventricle
# l/<111 ~ 111ilu/, 1,11rt· .!-l1clf'l,t1I Ay " ,,, u· ;,Ira, 11< ,·c., ttfjrti11.; ;/.,., ou'gt'J1al rli,11e11.Jit>11.J
-Bovee

INTRODUCTION FLOOR
The cavity of hindbrain is called the fourth ventricle. It It is a lso called ' rhomboid fossa' because o f its
is a tent-shaped space situated between the pons and rhomboidal shape. The floor is formed by:
upper part of medulla oblongata in front and 1 Posterior (dorsal) surface of lower or closed part of
cerebellum behind. So it lies dorsal to pons and upper pons (Fig. 7.1).
part of medulla oblongata and ventral to cerebellum. 2 Posterior (dorsal) su rface of open or upper part of
It has lateral boundaries, floor, roof and a cavity medulla oblongata.
(Figs 7.1 to 7.4).
Structural Layers
LATERAL BOUNDARIES The floor is lined by
On each side, fourth ventricle is bounded (Fig. 7.1): 1 Ependyma.
1 Inferolaterally by gracile, cunea te tubercles and 2 A thin layer of the neuroglia beneath the ependy ma.
inferior cerebellar peduncles. 3 A layer of grey matter, forming the various nuclei
2 Supcrolaterally by the superior cerebellar peduncles. deep to neuroglia.

---11-----+-+ - - - - - 1~ - Facial colliculus


_ ,__----.....-----+- - Medial eminence
_...,__ _,,___,_ _ Vestibular area
~~~~
~ ~ ~::::::.__ _ _ Striae medullaris

- - - - - Taen,a

Fig. 7.1: Boundaries of IV ventricle and structures in its floor

115
BRAIN-NEUROANATOMY

Parts 5 Descending from the inferior fovea, the re is a su lcus


It is divisible into: that runs obliquely towards midline. This sulcus
1 An upper triangular part formed by dorsal surface divides medial eminence into two triangles. These
of pons. are hypoglossal triangle medially and vagal triangle
2 A lower triangular part formed by dorsal surface of laterally. These overlie the h ypoglossal nerve nucleus
medulla. and of vagus nerve, respectively.
3 The intermediate part is at the junction of pons and 6 Between the vagal triangle above and gracile tubercle
medulla. The intermediate part is prolonged laterally below there is small area called the area p ostrema
over the inferior cerebellar peduncle as the floor of which may function as chemoreceptor. An ependymal
lateral recess. This part is marked by transversely thickening called funiculus seperans separates both.
running fibres which are fibres of stria medullaris . This area is devoid of blood- brain barrier.
These fibres represent fibres from arcuate nucleus 7 Vestib ular area: This lies lateral to the infe rior fovea
to the opposite cerebellum. (sulcus limitans) which overlies the vestibular nuclei.
This area is partly in the pons and partly in the
Features of the Floor medulla.
1 Dorsa l median su lcus d ivides the fl oor into two The lowest part of the floor resembles the pointed
symmetrical halves (Fig. 7.1). nib of writing p en so it is described as ca lamus
2 Sulcu s limitans divides each h alf into median scriptorius.
eminence and lateral vestibular area. The sulcus
lim.itans presents depression at the cranial end called ROOF
s uperior fovea and towards caudal part called The roof of the ventricle is diamond-shaped and can
inferior fovea. be divided into superior and inferior p arts (Fig. 7.2).
3 Medial eminence: The eminence is wider above and The s uperior or cranial part of roof is formed by
narrow below. It presents facia l colliculus just superior cerebellar peduncles and superior medullary
opposite and medial to s uperior fovea. Deep to the velum. The superior cerebellar peduncles on emerging
colliculus is the genu of the facial nerve formed by from central white matter of cerebellum pass first
this nerve looping around the abducent nucleus. cranially and ventra lly forming at fir st lateral
4 In the uppermost part (pontine part) the sulcus boundaries of ventricles. On approaching the inferior
limitans overlies an area that is bluish in colour and colliculi, they converge and then intermingle over the
is called locus coeruleus . The colour is due to ventricles and form part of the roof. The superior
presence of pigmented n eurons which conshtute medullary ve lum which is made up of nervous tissue
substantia ferruginea. These neurons belong to the fills the angular interval between the two superior
reticular formation. They are rich in noradren aline cerebellar peduncles. It is covered on the dorsal surface
and help in paradoxical sleep. by lingula of superior vermis.

Lingula

Nodule

' - - - - - - - Lateral recess and lateral aperture


(foramen of Luschka)

Median aperture- - - - _ . , ,
(foramen of Magendie)

Fig. 7.2: Schematic diagram of roof of IV ventricle


FOURTH VENTRICLE

The caudal inferior part of roof in most of its extent with vascular fringes covered by secretory ependyma
consists of an exceedingly thin sheet, entirely devoid form the choroid plexuses of fourth ventricle. These
of nervous tissu e and formed by the ventricular project into lower part of roof of fourth venh·icle. Each
ependyma and double fold of pia mater or the tela plexus (left or right) consists of a vertical limb lying
ch oroidea of the fo urth ventricle which covers it next to midline and a horizontal limb extending into
posteriorly. Caudally, the continuity of sheet is broken latera l recesses. The vertical limb of the two plexuses
by a gap termed the median aperture through which the lie side by side so that whole structure is T-shaped. The
cavity of ventricle communicates freely w ith the vertical limbs of the T-sha ped structure reach the
subarachno id space in the region of the cerebello- median aperture and project into the suba rachnoid
medullary cistern. The inferior medullary velum forms space through it. The lateral ends of horizontal limbs
a small part of roof in the region lateral to the nodule reach the lateral apertures. The arterial supply of these
of cerebellum. plexuses is from the posterior inferior cerebella r arteries
Superior to the region of inferior medullary velum (Fig. 7.2).
on each side, the layer of tela choroidea in contact w ith
the ependyma of caud al part of roof reaches the Communication
inferolateral boundary of ventricular floor, which is The cavity of the fourth ventricle co mmunicates
marked b y a narrow, white ridge termed taenia. The inferiorly w ith the central can al and superiorly with
two taeniae are continuous below with a small curved cerebral aqueduct (Fig. 7.3a).
margin, the obex often used to denote the inferior an gle
itself. Openings in the Roof
In the caudal part of roof of fourth ventricle there are
Tela Choroidea of Fourth Ventricle three openings, one median and two lateral (Fig. 7.3a).
It is a double layer of pia mater which occupies the The median aperture of fourth ventricle alternatively
interval between the cerebellum and the lower part of known as foramen of Magendie is a large opening situated
the ventricle. Its posterior layer provides a covering of ca udal to nodule. This opening provides the p rincipal
pia mater to the inferior vermis, and after covering communication between ventricular syste m a nd
the nodule, is reflected ventrally, a nd caudally in subarachnoid space. The lateral apertures, also known
immed iate contact w ith ependyma. The tela choroidea as fornminn of Luschkn, are situated at the ends of lateral

Cerebral a q u e d u c t t - - - - - - - - ~ - - Median dorsal recess


(of Sylvius)

Lateral aperture - - - - - - l+lf----- - - - - - - lf4!\


(foramen of Luschka)

~ - - - Cerebellomedullary cistern
Dura mater (meningeal layer)-- - - - --,.. (cisterna magna)

~ - - Median aperture
(foramen of Magendie)
Subarachnoid space - - - - - - --+-\

,..__....._,__ _ _ _ _ _ Central canal

Fig. 7.3a: Sagittal section of brain stem and cerebellum to show IV ventricle
BRAIN-NEUROANATOMY

2 One recess p resent in the median plane, is known as


Superior and - - Aqueduct median dorsa l recess. It extends dorsally into white
inferior colliculi
core of cerebellum and lies cranial to nodule.
IV ventricle
Cerebral 3 Two lateral dorsal recesses, one on each side. Each
peduncle
Cerebellum la teral dorsal recess extend d orsally lateral to the
Pons nodule and cranial to the inferior medullary velum.
These lie on either side of median dorsal recess.

CLINICAL ANATOMY

• Vital centres are situated in the vicinity of vagal


triangle. An injury to this area, therefore, would
prove fa ta 1.
Fig. 7.3b: MRI showing fourth ventricle • lnfratentorial brain tumours block the foramina
of Luschka and Magendie situated in the roof of
recesses and are partly occupied by parts of choroid fourth ventricle. This results in marked early rise
p lexuses w hich protrude into subarachnoid space. of intracranial pressure which causes headache,
Through these also fou rth ventricle communicates with vomiting, papilloedema, etc.
subarachnoid space.

ANGLES
Superior angle: Continuous with cerebral aqueduct. • Vital centres like respiratory and ca rdiovascular
are situated in the floor o f rv ventricle.
Inferior angle: Continuous below with central cana 1 of • Fourth ventricle h as 3 open ings, o ne foramen
spinal cord (Fig. 7.3b). of Magendie and two foramina of Luschka for
Lateral angles: One on each side towards the in ferior the exit of used CSF into the subarachnoid space
cerebellar peduncles. for absorption in the superior sagi tta l venous sin us.
• It also h as 5 recesses to keep the CSF
RECESSES OF FOURTH VENTRICLE • ln its floor are nuclei of VI, VII, VUI, X and XII
These are extensions of the main cavity of ventricle. cranial n erves.
Fine recesses have been identified (Fig. 7.4).
1 Two lateral recesses one on each side. Each lateral
recess passes la terally in the interval between the CLINICQAN!4\'[_0_Ml~~L-PROBLEM
inferior cerebe llar peduncle (ventrally) and the ped- A criminal was hanged to death
uncle of flocculus dorsally reaching as far as the • How does death occur in hanging?
medial part of flocculus.
• Name the ligaments rela ted to a tlanto-occipital,
a tlantoaxial joints and ligaments between axis and
Median dorsal occipital condyles.
Lateral dorsal recess
Ans: The death during hanging occurs due to injury
recess
to transverse ligament of the atlas providing freedom
to the bound dens of axis. The freed dens hits
backwards on the vital centres in floor of fourth
ventricle, resulting in immediate death.
Ligaments in this region are:
• Membrana tectoria
Lateral
recess • Vertical band of cruciate ligament
and lateral • Apical ligament
aperture
• Alar ligament
• Anterior atlanto-occipital membrane
Median aperture
• Posterior atlanto-occipital membrane
Fig. 7.4: Recesses and apertures of the fou rth ventricle
FOURTH VENTRICLE

FREQUENTLY ASKED QUESTIONS

1. Name the lateral boundaries, structure in the floor 2. ame the recesses of 4th ventricle
and roof of the fourth ventricle. 3. ame the openings in the roof of 4th ventricle.

MULTIPLE CHOICE QUESTIONS

1. What is situated in the vicinity of vagaJ triangle? c. Vestibular n uclei


a. Vital centres d. All of the above
b. Respiratory centre 4. Area postrema functions as:
c. Cardiovascular centre a. Chemoreceptor
d. Vasomotor centre b. Osmoreceptor
2. lnferolaterally IV ventricle is not bo unded by:
c. Nocireceptor
a. GraciJe tubercles
d. None of the above
b. Cuneate tubercles
5. Which structure form choroid plexus?
c. Inferior cerebellar peduncles
d. Superior cerebellar peduncles a. Tela choroidea with secretory ependyma
3. Which of the following nuclei is related to IV ventricle? b. Obex
a. Facial nerve nucleus c. Lateral recess
b. Hypoglossal nucleus d. Secretory ependyma

ANSWERS
1. a 2.d 3.d 4.a S. a
CHAPTER

8
Cerebrum
,J(11<,.u·lulg,• iJ irlk, llw,,, u;;,nlll,. .1/011 /,fir(' lo lo,;/. a/In INrtlll,, l.1101t,lulfle loo/..; ,,fie, ,1011.
(I,,. life i• ,r.l,o/ 010 ll,ougl,/.; nwl.~ ii
-M Aurelius

INTRODUCTION
the anterior commissure just at the anterior end of the
The cerebrum (Latin brain) is the la rgest pa rt of the anterior column of fornix.
brain. It is also known as pallium. It occupies anterior, Tum the brain upside down and identify optic chiasma
middle cranial fossae and the supra tentorial part of the (Fig. 8.4). Divide the optic chiasma, anterior communi-
posterior cranial fossa (Figs 8.la, b; 8.2 to 8.5). It is made cating artery, infundibulum and a thin groove between
up of outer grey matter and inner w hite ma tter and the adjacent mammillary bodies, posterior cerebral
some neuronal masses caUed basal ganglia within the artery close to its origin. Carry the line of division around
white matter. Besides this each hemisphe re contains a the midbrain to join the two ends of the median cut.
cavity called lateral ventricle. Separate the right and the left cerebral hemispheres.
Th ere is free flow of informa tion in the central
In the two hemisphere, identify the three surfaces,
nervous system; between two he mispheres through the
four borders, three poles. Identify the central sulcus,
commissural fibres; between va rious pa rts of one
posterior ramus of lateral sulcus, parieto-occipital sulcus
hemisphere through the association fi bres and between
and preoccipital notch. Join parieto-occipital sulcus to
upper and lower parts through the projection fibres.
preoccipital notch. Extend the line of posterior ramus
Inte rnal capsule contains lots of fibres p acked in its
of lateral sulcus till the previous line. Now demarcate
"limbs". It is supplied by the "end a rtery". The rupture
the four lobes of the superolateral surface of each
of "end artery" may cause the "end" of the human being
cerebral hemisphere (Figs 8.1 a and b).
concerned, if not treated properly.
Strip the meninges from the surfaces. Identify the
vessels on the surfaces of hemisphere. Demarcate the
DISSECTION main sulci and gyri on the superolateral surface, medial
Keep the cerebrum in a position so that the longitudinal surface and inferior surface of hemisphere (refer to BOC
fissure faces superiorly. Identify the convex strong band App).
of white matter, the corpus callosum, binding parts of Make thin slice through the part of the calcarine
the medial surfaces of the two cerebral hemispheres. sulcus, posterior to its junction with the parieto-occipital
Define splenium as the thick rounded part of corpus sulcus. Identify the stria running through it. On cutting
callosum (Fig. 8.3). series of thin slices try to trace the extent of visual stria.
Divide the corpus callosum in the median plane
starting from the splenium towards the trunk, genu and
Features
rostrum. Inferior to the trunk of corpus callosum extend
the incision into the tela choroidea of the lateral and Th e cerebrum is made of two ce rebral hemispheres
third ventri cles , and the interthalamic adhesion which are incompletely separated from each other by
connecting the medial surfaces of two thalami. the med ian longitudinal fissure. The two hemispheres
Identify the thin septum pellucidum connecting the are connected to each other across the median plane
inferior su rfaces of corpus callosum to a curved band by the corpus callosum. Each hemisphere contains a
of white matter-anterior column of the fornix. Look for cavity, called the la teral ventricle. The surface area of
cerebrum is 2000 cm.2
120
Cerebral Sulci and Gyri
CEREBRUM

5th-6th month and ends almost at the end of ninth


1
..J
Cerebral cortex is folded into gyri (Greek circle) wh ich month.
are separated from each o ther by sulci. This pattern
increases the surface area of the cortex. In human brain,
CEREBRAL HEMISPHERE
the total area of the cortex is estimated to be more than
2000 cm2, and approximately two-thirds of this area is
EXTERNAL FEATURES
hidden from the surface within the sulci. The pattern
of folding of the cortex is not entirely haphazard. It is Each hemisphere has the following features:
largely determined b y the differential growth of specific
functional areas of the cortex, because many of the sulci Three Surfaces
bear a definite topographical relation to these areas. The 1 The s11perolateral surface is convex and is related to
formation of sulci in the intrauterine life begins from the cranial vault (Figs 8.la and 8.2).

.-.----.✓------.....---r--------- Superomedial border


Central sulcus - - - - - - - - - - : : : ; i , -~

Parieto-occipital sulcus - ------,,, Panetal lobe


and preoccipital notch
Frontal lobe

2nd imaginary line

Preoccipital notch - - - - - - - - ~
(b)

Figs 8.1a and b: Superolateral surface of cerebral hemisphere


BRAIN-NEUROANATOMY

Precentral gyrus
Posterior ramus of lateral sulcus
Central sulcus - - - - - - - ~
Precentral sulcus
Postcentral gyrus - - - - - - - - - -
~ - - - - - Superior frontal sulcus
Postcentral sulcus - - - - - - - - .
Superior frontal gyrus

Superior parietal lobule---~ _,,---- Middle frontal gyrus

Inferior parietal lobul e - - -+


Parieto-occipital sulcus
Inferior frontal gyrus
lntraparietal sulcus - ----f--+- - ...;

1 - - - - -- --+-- Ascend ing ramus of


Supramarginal and angular gyri - -?--C,,_J,.-_-<_
lateral sulcus
Superior occipital gyrus _ _ __.,.._

Lunate sulcus

Occipital pole - - - - - - - - - - Superior temporal gyrus


Lateral occipital sulcus ~ - - - - - - - - Superior temporal sulcus
Inferior occipital gyrus - - - ~ ' - - - - - - Middle temporal gyrus
Inferior
temporal gyrus Inferior temporal sulcus

Fig. 8.2: Sulci and gyri on superolateral surface of right cerebral hemisphere

Gyri longa
- ~ - --'-~--'--~ - - -- Insular cortex
(island of Reil)

Fig. 8.3: The region of insula

2 The medial su,face is flat and vertical. It is separated from Four Borders
the corresponding surface o f the opposite hemisphere 1 Superomedial border separates the superolateral surface
by the falx cerebri and the longitudinal fissu re (Fig. 8.3). from the medial surface (Fig. 8.1).
3 The inferior surface is irregular. It is divided into an 2 Inferolateral border separa tes the superolateral surface
anterior part, the orbital surface, and a posterior part, from the inferior surface. The anterior part of this
the tentorial surface. The two parts a re separated by a border is called the superciliary border. There is a
deep cleft called the stem of the lateral sukus. depression on the inferolateral border situa ted about
Central sulcus- - - - - -- - ---~ Paracentral
lobule
CEREBRUM 1
.J
- - - - - - - Corpus callosum
Cingulate g y r u s - - - - - -
~ - - - - Precuneus

,,--- - Suprasplenial sulcus

Medial occipitotemporal gyru s - - - - - - - - _ _ ,


~ - - - - - - Parahippocampal gyrus
Lateral occipitotemporal gyrus ' - - - - - - - - - Fornix
Fig. 8.4: Sulci and gyri on the medial surface of right cerebral hemisphere

::::;
Olfactory bulb

Orbital gyri
[ La te r a l - - - -- --+--
Posterior - - - - ---+--- -
Olfactory tract in olfactory sulcus

Olfactory stria clateral


Medial - -- - - +- - 1 ' - - - ~r-\o\

Fig. 8.5: Gyri and sulci on the inferior aspect of cerebral hemisphere

5 cm in front of the occipital pole, i t is called the Three Poles


preoccipital notch (Fig. 8.1). 1 Frontal pole, a t the anterior end .
3 Medial orbital border separates the media l s urface from
the orbital s urface (Fig. 8.4). 2 Occipital pole, at the pos terior e nd .
4 Medial occipital border sepa rates the medial s urface 3 Temporal pole, at the a nterior end of the temporal lobe
from the tentorial surface (Fig. 8.4). (Fig. 8.1).
BRAIN-NEUROANATOMY

Lobes of Cerebral Hemisphere 1 The central sulrns (Latin furrow) has been d escribed
Each cerebral hemisphere is divided into four lobes- earlier. The upper end of the su lcus extends for a
frontal, parietal, occipital and temporal. Their positions short distance on to the medial surface (where it w ill
correspond, very roughly, to that of the corresponding be examined la ter).
bones. The lobes are best appreciated on the supero- 2 We have seen that the lateral sulcus begins on the
late ral surface (Fig. 8.2). The sulci separating the lobes inferior surface. On reaching the lateral surface, it
on this surface are as follows: divides unto three rami. The largest of these is the
1 The central sulcus begins at the superomedial border posterior ramus. The posterior end of this ra mus turns
o f the hemisphere a little behind the midpoint upwards into the temporal lobe. The other rarni of
between the frontal and occipital poles. It runs on the lateral sulcus are the anterior horizontal and anterior
the superolateral surface obliquely downwards and ascending rami. They extend into the lower part of
forwards and ends a little above the posterior ramus the frontal lobe.
of the lateral sulcus (Fig. 8.2). 3 The frontal lobe is further divided by the following
2 lt is seen that the lateral sulcus separates the orbital sulci.
and tentorial parts of the inferior surface. Laterally, a. The precentral sulcus rw1S parallel to the central
this sulcus reaches the supe rolateral surface w here su lcus, a little in front of it. The precentral gi;rus
it divides into anterior, ascending and posterior lies between the two sulci (Table 8.1).
branches. The largest of these, the posterior mmus of
b. The area in front of the precentral SLLlcus is divided
t/Je lateral sulcus passes backwards a nd slightly
into superior, middle and inferior frontal gyri by the
upwards over the superolateral surface.
superior and inferior fronta l sulci.
3 The parieto-occipital sulcus is a sulcus of the medial
surface. Its uppe r end cu ts off the supero medial c. The anterior horizontal and anterio r ascending
border about 5 cm in front of the occipital pole. rarni of the lateral sulcus subdivide the inferior
4 The preoccipital notch is an indentation on the infero- frontal gy:rus into three parts pars orbitnlis, pars
la teral border, about 5 cm in front of the occipital pole. triangularis, and pars opercularis.
The div is ion is completed by drawing o ne line 4 The parie ta l lobe is furth e r s ubdiv ided by the
joining th e parieto-occipital sulcus to the preoccipital following; sulci:
no tch; and another line continuing backwards from the a. The postcentral sulcus runs pa rallel to the central
posterior ramus of the lateral sulcus to meet the first sulcus, a little behind it. The postcentral gyrus lies
line. The bounda ries of each lobe will now be clear fro m between the two sulci.
Fig. 8.l b. b. The area behind the postcentral gi;rus is divided into
the superior and inferior parietal lobules by the intra-
lnsula parietal sulcus.
lnsula lies d eep i.n floor of lateral fissure surrounded c. The inferior pa rietal lobule is invaded b y the
by a circular sulcus and overlapped by adjacent cortical upturned ends of the posterior ram us of the latera l
areas, the opercula (Fig. 8.3). sulcus, and of the superior and inferior temporal
lnsula comprises frontal operculum between anterior sulci. They divide the inferior parietal lobule into
and ascending rami of lateral sulcus. a nterior, middle and posterior parts. The anterior
Pa rietal operculu m lies between ascending a nd pa rt is cal led the s11pra111argi11al gi;rus, a nd the
posterior ram.i of lateral sulcus. middle part is ca lled the angular gi;rus.
The temporal opercula below posterior ra mus of
5 The superior and inferior ternporal sulci divide the
la teral sulcus formed by supe rior temporal gyri.
temporal !lobe unto superior, middle and inferior temporal
Insula is a p y ramidal area, apex near an terior
perforated substance. gyri.
Three zones a re seen here- affere nts reach from 6 The occipital lobe is further subdivided b y the
ventral posterio r nucleus of the thalamus, medial following sulci.
geniculate body and part of pulvi.nar. a. The lateral occipital sulcus divides this lobe into the
Efferents reach from areas 5, 7, o lfactory, limbic superior and inferior occipital gyri.
system and amygdala. b. The lunate sulws separates these gyri fro m the
Role of anterior insular cortex is in olfaction and taste. occipital pole.
Role of posterior insular cortex is in language function. c. The area around the parieto-occipital sulcus is the
arcus p,arieto-occipitalis. It is sepa rated from the
Sulci and Gyri on Superolateral Surface superior occipital gyms by the transverse occipital
These are shown in Fig. 8.2 and Table 8.1. s11/cus.
CEREBRUM

Table 8.1: Sulci and gyri of the cerebrum


Surface/Lobe Sulci Gyri
I. Superolateral surface (refer to BOC App)
1. Frontal lobe A. Precentral a. Precentral
8. Superior frontal b. Superior frontal
C. Inferior frontal C. Middle frontal
d. Inferior frontal which also contains anterior horizontal and
anterior ascending rami of the lateral sulcus, and the pars
orbitalis, pars triangularis and pars opercularis
2. Parietal lobe A. Postcentral a. Postcentral
8. lntraparietal b. Superior parietal lobule
C. Inferior parietal lobule, which is divided into 3 parts:
i. The anterior, supramarginal
ii. The middle, angular
ii i. The posterior, over the upturned end of inferior temporal
sulcus
3. Temporal lobe A. Superior temporal a. Superior temporal
8. Inferior temporal b. Middle temporal
C. Inferior temporal
4. Occipital lobe A. Transverse occipital a. Arcus parieto-occipitalis
8. Lateral occipital b. Superior occipital
C. Lunate C. Inferior occipital
D. Superior and inferior polar d. Gyrus descendens
E. Calcarine
II. Medial surface A. Anterior parolfactory a. Paraterminal
(refer to BOC App) 8. Posterior parolfactory b. Paraolfactory (subcallosal area)
C. Cingulate C. Medial frontal
D. Callosal d. Paracentral lobule
E. Suprasplenial or subparietal e. Cingulate
F. Parieto-occipital f. Cuneus
G. Calcarine g. Precuneus
Ill. Inferior surface A. Olfactory a. Gyrus rectus
(refer to BOC App) 8. H-shaped orbital sulci b. Anterior orbital
C. Collateral C. Posterior orbital
D. Rhinal d. Medial orbital
E. Occipitotemporal e. Lateral orbital
f. Lingual
g. Uncus
h. Parahippocampal
i. Medial occipitotemporal
j. Lateral occipitotemporal

Sulci and Gyri on Medial Surface superomedial border a little behind the upper end
Confirm the following facts by examining (Fig. 8.3). of the central sulcus (Table 8.J).
The central part of the m edial aspect of the hemi- 2 The supmspleninl su/cus lies above and behind the
sphere is occupied b y the corpus callosum. The corpus splenium.
callosum is divisible into the gen11 (anterior end), the 3 The calcarine sulcus begins a little below the splenium
body, and the splenium (posterior end). It is mad e up of and runs towa rds the occipital pole. It gives off the
nerve fibres c01mecting the two cerebral hemispheres. parieto-occipital sulcus which reaches the superolateral
Below the corpus ca ll osum, there a re the septu m surface.
pellucidu.111, the forn ix and the thalamus. In the remaining
4 A little below the germ, there are two small anterior
part of the medial surface, identify the following
and posterior paraolfactory su/ci.
sulci.
1 The cingulnte sulcus starts in front of the genu and The following gyri can now be identified.
runs backwards parallel to the upper margin of the 1 The cingulate gyrus lies between the corpus callosum
corp us ca llosum. Its posterior e nd reaches the and the cingulate sulcus. Its posterior part is bounded
~ I BRAIN-NEUROANATOMY

above by the suprasplenial sulcus and is divided into Limiting sulcus Axial su lcus
anterior and posterior parts.
2 The U-shaped gyrus around the end of the central
s ulcus is the paracentral lobule. It is usually divided
into anterior and posterior parts.
3 The area between the cingulate gyrus and the
s uperomedial border in front of the paracentral ~, (~
lobule is called the medial frontal gi;rus. Operculated sulcus
4 The quadrangular area between the suprasplenial sulcus ·, .
and the superomedial border is called the precuneus.
5 The triangular area between the parieto-occipital
su lcus (above) and the calcarine sulcus (below) is
called the cuneus.
6 A narrow strip between the splenium and the stem (c)
of the calcarine s ulcus is the isthmus. Figs 8.6a to c: Types of sulci
7 The pnraterminal gyrus lies just in front of the lamina
terminalis. For example, the postcalcarine sulcus in the long axis
8 The paraolfnctory gyrus lies between the anterior and of the striate area (Fig. 8.6b).
p osterior parolfactory suki. 3 Opercula ted sulcus sep arated b y its lips in two areas,
Sulci and Gyri on the Orbital Surface and contains a third area in the walls of the su.lcus.
For example, the lunate sulcus (Fig. 8.6c).
1 Parallel to the medial orbital b order there is the
olfactory sulcus; between these two there is the gyrus According to Formation
rectus. The rest of the orbital surface is subdivided
1 Primary sulci formed b efore birth , independently.
by an H-shaped sukus into anterior, posterior, medial
Example is central sulcus.
and lateral orbital gyri.
2 Secondary sulcus is produced by factors other than
2 The stem of the lateral sulcus lies deep between the
the exuberant growth in the adjoining areas of the
temporal pole and orbital surface (Fig. 8.4).
cortex. Examples are the lateral and parieto-occipitaJ
Sulci and Gyri on the Tentorial Surface sulci.
This area presents two sulci numing anteroposteriorly.
According to Depth
The medial one is the collateral sulcus, and the la teral is
the occipitotemporal sulws. On the medial side of the 1 Complete s ulcus is very deep so as to cause elevation
temporal p ole, there is the rhinal sulcus. in the walls of the lateral ventricle. Examples are the
The gyri are as follows: collateral and calcarine suki.
2 Incomplete sulci are superficially situated and are
1 The part medial to the rhinal s ulcus is the uncus.
2 The part medial to the collateral s ulcus is the para- not very deep, e.g. precentral sulcus.
hippocampal gyrus. Its p oste rior p a rt is limite d
medially by the calcarine sulcus. It is joined to the Structural and Functional Types of the Cortex
cingulate gyrus through the isthmus (Fig. 8.3). 1 Allocortex (archipallium): It is the original olfactory
3 The part la teral to the collateral sulcus is divided into cortex, and is represented by rhinencephalon (piliform
medial and lateral occipitotemporal gtJri by the occipito- area and hippocampal formation). Structurally, it is
temporal sulcrts. simple and is made up of only three layers.
4 The part medial and above parahippocampal gyrus 2 lsocortex (neopallium): It is the lately acquired cortex,
contains dentate gyrus which is continuous in front containing various centres other than those for smell.
with w1eus. Structurally, it is thick and six layered. Jt is subdivided
into the following.
Types of Sulci a. Granular cortex (koniocortex or dust cortex). It is
According to Function basically a sensory cortex.
1 Limiting sulcus separates at its floor two areas which b. Agranular cortex. This is the motor cortex.
are different functionally and structurally.
For example, the central s ulcus between the motor FUNCTIONAL OR CORTICAL AREAS
and sensory areas (Fig. 8.6a). OF CEREBRAL CORTEX
2 Axial sulcus d evelops in the long axis of a rapidly Functionally, the cortex is divided into number of areas
growing homogeneous area. by many n eurobiologists. Brodmann's ar eas are taken
CEREBRUM

no rm a 11y according to whom there are 200 a reas. The re of paracentral lobule on the medial surface of cerebral
arc three basic functional di visions of cerebral cortex: hemispheres. This corresponds to area 4 of Brodmann.
1 Motor nreas: The primary motor area has been Electrical stimulation of primary motor area elicits
identified on the basis of elicitation o f motor contraction of muscles that are mainly on the opposite
responses at a low threshold of electric stimula tion side of body. Although cortical control of musculature
which gives rise to contraction of skeletal muscula- is mainly contralatera1, there is significant ipsilateral
ture. These areas g ive origin to corticospinal and control of most of the muscles of the head and axial
corticonuclear fibres (figs 8.7 and 8.8). muscles of the body. The con tra lateral half of the body
is represented as upside down, except the face. The
2 Sensory areas: In these areas, electrical activity can be
pharyngeal region, tongue a re represen ted in the most
recorded if appropriate sensory stimuJus is applied
ventral and lower part of precentral gyrus, followed
to a particular part of the body (Fig. 8.8).
by the face, hand, arm, trunk and thigh. The remainder
The ventral posterior nucleus of thalamus is main of leg, foot and perineum is on the medial surface of
source of afferent fibres for the first sensory area. hemisphere in the paracentral lobule (Fig. 8.7).
This thalamic nucleus is the s ite of termination of all Another significant feature in this area is that the
the fib res of the medial lemniscus and of most of the size of the cortical area for a particular part of the body
spinothalamic and trigem.i.nothalamic tracts. is determined by the functional importance of the part
3 Associatio11 areas: In these regions, the direct sensory a nd its need for sensitiv ity and intricacy of th e
or motor responses are not elicited. These a reas movements of that region. The a rea for the face,
integrate and analyse the responses from various especia lly the larynx and lips, is therefore dispro-
sources. Many such areas are known to have motor portionately large and a la rge area is assigned to the
or sensory functions. hand particularly the thumb and index finger.
The motor and sensory functions also overlap in the Movements of joints are represented rathe r than
sa me region of cortex. If the motor function is individual muscles (Table 8.2).
predominant, it is known as motor-sensory (Ms) and Connections of motor area:
where sensory function is predominant, it is called Affermfs:
sensorimotor (Sm). • From the ventra l nuc leus of thalamus and
contralatera l cerebellar hemispheres
Motor Areas
• From the opposite hemispheric cortical areas.
Primary Mofor Area Efferents:
It is located in the precentral gyrus, including the • Corticonuclea r, corticobulbar and corticospinal
a nte rior wall of central sulcus, and in the anterior part tracts
• Frontopontine fibres
• Projection fibres to basal ganglia
Arm - - - ~
Trunk Premotor Area (refer to BOC App)
~ - - Thumb
This area coincides with the Brodmann's area 6 and is
situated anterior to motor area in the superolateral and
Leg medial surfaces of the hemisphere. The premotor area
contrib utes to motor fw1ction by its direct contribution
Foot
to the pyramidal and other descending motor pa thways
and by its influence on the primary moto r cortex
(fig. 8.8).
In genera l, the primary motor area is the cortex in
which execution of movements originates and relatively
simple movements are maintained. ln con trast, the
premotor area programmes skilled motor activity and
thus directs the primary motor area in its execution.
The premotor and p rima ry motor areas are together
referred to as the primary somatomotor area (Ms I).
'( Tongue
Both these a reas give o rigi n to corticospinal a nd
corticonuclear fibres and receive fibres from cerebellum
after relay in venh·al intermed iate nucleus of thalamus.
Fig. 8.7: Motor homunculus on the precentral gyrus It has ame connections as motor area.
BRAIN-NEUROANATOMY

Ms 1 - - -- - - - - - - - - - ~
Sml - - -- - - - - - - - - - , : = ":::........
--~--
9

Sensory speech area - - --+-- -- +-


(Wernicke's area) 10
Visual 111- -+--
19
----- - - - ----+-- - Motor speech area
11 (Broca's area)
18

Visual I

Sml

Cingulate gyrus 31
24

10
( Precuneus

--- --
- -_____:},7_
--
20
18
17

(b)

Figs 8.8a and b: Functional areas: (a) Superolateral surface, and (b) medial surface of cerebral hemisphere

Supplementary Motor Area (Ms II) is again present in left hemisphere. Only in 30%, it is
It is pred ominantly m otor in frmction . Thjs mo tor a rea situa ted in right hemisphere (Fig. 8.8).
is in the part of ruea 6 that lies on the medial surface of Frontal Eye Field
th e h emispher e anterior to the p aracentral lobule.
It lies in the middle frontal gyrus jus t anterior to pre-
Different parts of body a re represented w ithin this area.
central gyrus. It is the lower part of area 8 of Brodmann
It differs from the main motor a rea in that its stimulation
on the la teral surface of cerebral hemisph ere, extending
produces b ila ter al movem ents (Fig. 8.8). Its function
slightly beyond that area. Electrical stim ulation of this
is to control complex m ovem ents w hi ch req u ire
area causes dev iation of both the eyes to the opposite
sequential organisation.
side. This is called conjug ate m ovem ents o f eyes.
Motor Speech Area of Broca
Movem ents of the head and dila tation of p upil may
(French Neurologist 1824- 80) also occur. This area is connected to the cortex of
occipital lobe which is concerned with vision .
This area occup ies the opercular and triangular portions
of the inferior frontal gyrus corresp onding to the areas 44 Prefrontal Cortex
and 45 of Brodmann. This is p resent on the left side in Prefron tal cortex is a la rge area lying anterior to the
98% of right-h anded p erson s. In 70% of left handers, it precen tral area. It includes the superior, middle, an d
Table 8.2: Functional areas of the cerebral cortex
CEREBRUM 1
.J
Lobe Area Area Location Representation Function Effect of lesion
no. of body parts
Frontal Motor 4 Precentral gyrus Upside down Controls voluntary Contralateral
and paracentral except face activities of the paralysis and
lobule opposite half of body Jacksonian fits

Premotor 6 Posterior parts of Controls extrapyramidal Often mixed with


superior, middle system pyramidal effect
and inferior frontal
gyri

Frontal eye field 6, 8 Posterior part of Controls horizontal Horizontal conjugate


middle frontal conjugate movements movements are lost
gyrus of the eyes

Motor speech 44, 45 Pars triangularis Controls the spoken Aphasia (motor)
(Broca's area) and pars speech
opercularis

Prefrontal 9,10,11 The remaining Controls emotions, Loss of orientation


12 large, anterior concentration, attention
part of frontal initiative and judgement
lobe

Parietal Sensory 3, 1, 2 Postcentral gyrus Upside down Perception of Loss of appreciation


(somesthetic) and paracentral except face exteroceptive (touch, of the impulses
lobule pain and temperature) received
and proprioceptive
impulses

Sensory 5,7 Between sensory Stereognosis and Astereognosis and


association and visual areas sensory speech sensory aphasia
(Wernicke's area) 40 Inferior part of Sensory speech Sensory aphasia
parietal lobule

Occipital Visuosensory 17 In and around the Macular area Reception and Homonymous
area or striate postcalcarine has largest perception of the hemianopia with
sulcus representation isolated visual macular sparing
impressions of colour,
size, form, motion,
illumination and
transparency

Visuopsychic 18, 19 Surround the Correlation of visual Visual agnosia


area, parastriate striate area impulses with past
and peristriate memory and recognition
of objects seen, and
also the depth

Temporal Auditosensory 41 , 42 Posterior part Reception and Impaired hearing


of superior perception of isolated
temporal gyrus auditory impressions
and anterior of loudness, quality
transverse and pitch
temporal gyrus
Auditopsychic 22 Rest of the Correlation of auditory Auditory agnosia
superior impressions with past
temporal gyrus memory and identification
(interpretation) of the
sounds heard
BRAIN-NEUROANATOMY

inferior frontal gyri, medial frontal gyrus, orbital gyri Sensory Areas
and anterior half of the cingulate gyrus. These include First Somesthetic Area
Brodmann's areas 9, 10, 11 and 12. This area is connec-
Firs t sornesthetic (general sensory) a rea is also called
ted to other areas of the cerebral cortex, corpus striatum,
first sornatosensory area (Sm I). It occup ies postcentral
thalamus an d h ypothalamus. I t is also connected to
cerebellum through the pontine nuclei. It controls emo- gyrus on the s u perolateral s u rface of the cerebral
tions concentration, attention, ini tia ti ve and judgement. hemisphere and posterior part of p aracentral lobule on
It has reciprocal connections with thalamic dorsomediaJ the med ia l s urface. It corresponds to areas 3, 1 and 2 of
nucleus, hypothalamus, and limbic system. Brodmann (Figs 8.8 and 8.9).
Th e representation of the body in this area corres-
ponds to that in the m otor area that is contrala teral half
CLINICAL ANATOMY
o f body is rep resented upsid e down except the face. The
Motor areas area of the cortex th a t receives se nsat io n s from a
• Destructive lesion of primary motor area 4 results particular part of body is not propor tional to the size of
in voluntary paresis of the affected part of body. that part, but rather to the intricacy of sensations recei-
Spastic volw1tary paralysis of the opposite s ide ved from it. Thus, the thumb, fingers, lips and tongue
of body characteristically follows if the lesion have a disprop ortionately large representation. The
spreads beyond area 4 or that interrupts projection different sensations, i.e. cutan eous and prop rioceptive
fibres in the medullary centre or internal capsu le. are represented in differen t parts with in sensory area.
Irritative lesion of the motor area leads to focal The ventral posterior nucleus of thalamus is the main
convulsive movements of the corresponding part source of afferent fibres for the sensory a rea. This
of body, referred to as Jacksonian epilepsy.
thalamic nucleus is the site of termination of all the
• Lesion of supplementary motor area 6 leads to
fibres of the medial lemn.iscus. Most of the fibres of the
apraxia and akinesia. This is the condition which
in vo lves d iffic ulty in performing th e sk illed spinothalamic and trigeminothalamic tracts carrying
movements on ce learnt, in absence of paralysis, fibres for cutaneous sensibility end in anterior part of
ataxia or sensory loss. When the disabili ty affects the area and th ose for d eep sensibility end in the
writing, it is called agrapllia. posterior part.
• Frontal eye field: Des truction of this area causes
conjugate deviation of the eyes towards the side Second Somesthetic Area
of lesion. The patient cannot voluntarily move his Second somesthetic area also known as second somato-
eyes in the opposite direction, but this movem ent sensory area (Sm II) has been demonstr ated in primates
occurs invo luntarily when he observes an object including humans. This is situated in the superior lip
moving across the field of vision. of the posterior ra m us of la tera1 sulcus with postcentral
• Speech area: Lesion of Broca' s area on the dominant gyrus. The parts of bod y a re rep resented bilaterally
side of hemisphere causes expressive aphasia. It is (Fig. 8.8).
characterised by hesitant and distorted speech with
relatively good comprehension.
• A lesion involving language areas (Wernicke 's area
and Brocn's area) leads to receptive aphasia. In this
condi ti on, a uditory and visual comprehension of Lower
language that is naming of objects and repe tition limb
of a sen tence spoken by the examiner are all
defective (Fig. 8.8a).
• A lesion involving Wernicke's area and superior
longi t udinal fascicul u s or arcua te fasc ic u I us
results in jargon nphasin in which speech is fluent
but W1intelligible jargon. Teeth
• Voluntary smile in a stroke patient will accentuate Tongue
the asymmetry. A genu ine s mile w hich uses only Pharynx
extrapyramidal pathways, will be symme trical
and there will be no asymme try for the duration
of the smile. One needs to remember tha t m otor
cortex is required only for voluntary moment.
Fig. 8.9: Sensory homonculus of the postcentral gyrus
CEREBRUM

Somesthefic Association Cortex The cl1ief source of afferent fibres to area 17 is the
Somesthetic association cortex is mainly in the superior Intern/ genic11lnte 1111cle11s of thalamus by way of genicu1o-
parie tal lobule on the s uperolateral surface of the calcarine tract. Area 17 constitutes the first visual area.
hemisphere and in the precuneus on the medial surface. It is continuous both above and below w ith area 18 and
beyond this with area 19 of Brodmann which are a1so
It coincides with areas 5 and 7 of Brodm ann. This
known as v isual association o r psychovisual areas.
receives afferen ts from first sensory a rea a nd has
Since fib res of geniculocalcarine tract (optic radiation)
reciprocal connection with dorsal tier of nuclei of latera l terminate in these regions also, therefore, these areas
mass of thalamus. Data pertaining to the general senses are regarded as second and the third visual a reas
are integra ted, permitting a comprehensive assessment respectively (Fig. 8.8).
of the characteristic of an object held in ha nd and its
The role of the second and third visual areas includes
identification wi thou t visual aid. among other complex aspects of vision, the relating of
present to past visual experience, w ith recognition of
Receptive Speech Area of Wernicke what is seen and appreciation of its significance. The
(German Neurologist 1848-1903) three areas a re linked together by association fibres.
This is also known as sensory language area. Tt consists The visual areas give efferent fibres whicl1 reach frontal
of auditory association cortex and of adjacent parts of eye field.
the inferior parietal lobule (Fig. 8.8).
Hearing
---- The auditory (acoustic) area lies in the temporal lobe.
-. CLINICAL ANATOMY Most of it is concealed as it lies in that part of superior
temporal gyrus w hich forms inferio r wall of the
Sensory areas posterior ramus of lateral sulcus. It corresponds with
• Firs t somesthe tic or general sensory a rea (areas 3, areas 41 and 42 of Brodmann.
1 and 2 of Brodmann). When this part of cortex is The medial genirnlate body of the thalamus is the
the site of d estructive lesion, a crude form of principal source of fibres ending in the auditory cortex
awareness persists for the sensation of pain, heat with these fibres constituting the auditory radiation.
and cold on the opposite side of lesion. There is There is spatial representation in the auditory area with
poor locali za tio n of stimulus. There is loss of respect to pitch of sounds. Impulses of low frequencies
discriminative sensations of fine to uch, move- impinge on anterolateral part of area and impulses of
ments and posi tion of part of the body. high frequencies get heard on the posteromedial part.
• Somesthetic association cortex (su perior parietal Cortex gets afferents from both cars. Body receives
lobu1e) a reas 5 and 7 of Brodmann: A lesio n in information that originates mainly in the organ of Corti
this area leads to defect in understanding the of opposite side, the in complete decussa tio n of
significance of senso ry info rmation, which is ascending path ways ensures a substan tial input from
called agnos ia. A lesion tha t des troys a large the ear of same side as well (Fig. 8.8).
portion of this association cortex causes tactile The auditory radiation does not only end in first aud i-
agnosia a nd astereognosis which are closely related. tory area but extends to neighbouring a rea as well, tha t
is known as auditory association area or second auditory
This is the condition when a person is unable to
area. This area lies behind the first auditory area in
recognize the objects held in the hand, while the
superior temporal gyrus. lt corresponds to area 22 of
eyes are closed. He is una ble to correlate the
Brodmann on the lateral surface of superior temporal
surface, tex ture, shape, size and weight of the gyrus. This region of the cortex is also known as Wernicke's
object or to compare the sensa tions with previous area and is of major importance in language functions.
experience.
Taste
Areas of Special Sensations The taste area (gustatory area) is located in dorsal wall
of posterior ram us of lateral sulcus, with extension into
Vision insula a nd corresponds to area 43 of Brodmn1111. It places
The visual area is loca ted above and below the calcarine the taste area adjacent to first sensory area of cortex for
sukus on the medial surface of occipital lobe. It corres- tongue and pharynx. Its location is similar to second
po nds to area 17 of Brodmann. The visual area is also somesthetic area.
called the stri ate a rea because the cortex here contains
the line of Ge1111ari, which is just visible to the unaided Smell
eye. Ends in pyrifo1m lobe.
BRAIN-NEUROANATOMY

CLINICAL ANATOMY 3 Associative functio11s: The info rmation thus discri-


minated and classified is correlated w ith previous
Special sensory areas experience. Thi s association forms the basis of
a. Primary visual area 17: Lesion of this area, leads memory patterns. These are transmitted to frontal
to loss of vision in the visual field of the opposite cortex which synthesize it and forms basis of
side- homonymous hemianopia. thinking and related intellectual activities.
b. Auditory area:
- Primary auditory areas 41 and 42: A unilateral
lesion involving the a uditory area causes CLINICAL ANATOMY
diminution in the acuity of hearing in both ea rs • Table 8.3 depicts summary of functions and effects
and the loss is g rea ter in the opposite ear. of damage of lobes of brain. Figures 8.10a and c
However, the impairment is slight because of show normal brain.
the bilateral projection to the cortex and the
• Ageing: Usually after 60- 70 years or so there are
deficit is difficult to detect by clinical tests. changes in the brain. These are:
- Auditory association cortex or secondary area
a. Prominence of sulci due to cortical shrinkage
22. In lesions of this area, interpretation of the
(Fig. 8.10b).
sounds is lost.
b. The gyrigetnarrow and sulci get broad (Fig. 8.10d).
c. The subaraclmoid space becomes wider.
Functions of Cerebral Cortex d. There is enlargement of the ventricles.
1 Cerebral dominance: One cerebral hemisphere domi- • Dementia: In this condition, there is slow and pro-
nates the ot er one in relation to handedness, speech, gressive loss of memory, intellect and personality.
perception of language and spatial judgement. In The consciousness of the subject is norma I. Dementia
80-95% subjects, the left hemisphere dominates the usually occurs due to Alzheimer's disease.
right one. The dominant lobe contains the Broca's motor • Alzheimer's disease: The changes of normal ageing
speech area. Since left hemisphere controls the right half are more pronounced in the parietal lobe,
of the body, all these subjects are right-handed. The left te mporal lobe, and in the hippocampus.
hemisphere is verbal, mathematical, analytical, scientific,
calculative and has direct link to conscious ness.
The right hemisphere is active in unders tanding
geometrical figures imaginative, artistic, religious,
and important for temporal synthesis and spatial
comprehension. It helps in recognition of faces,
figures and appreciating music.
Localisation of speech on left side in 70% of left
handed and 98% of right handed is well known.
Association of nega ti ve e motions with right
prefrontal activity and of positive emotions with left
prefrontal activity is also known. Mahatma Gandhi,
fa ther of the nation, Bill Clinton, Bill Gates, Amitabh
Bachchan and Abhishek Bachchan, are all left handed . (b)
Functional asymmetry in a structurally symmetrical Normal brain Alzheimer's disease of brain
structure is a great and ingenious way of econo-
Normal Enlarged
mising on neural tissue. It practically d oubles the arachnoid villi arachnoid villi
capabilities of the brain. Women mos tly operate
through right hemisphere while men mostly use their __A_
dominant left hemisphere.

~
2 Discrimi11a tory aspects: Sensory co rtex is not Enlarged
subarachnoid
concerned with recognition only, but is also involved space
with discrimination of sensory function as:
a. Recognition of spatial relationship (c) Normal
Grey matter
grey matter gets thin
b. Graded response to stimuli of different intensities
c. Appreciation of similarities and differences in Figs 8.10a to d: (a) Normal brain, (b) Alzheimer's disease
external objects, brought into contact with surface of brain, (c) normal grey matter and arachnoid villi, and
(d) changes in the elderly brain
of body.
CEREBRUM

Table 8.3: Summary of functions and effects of damage of lobes of brain (Fig. 8.1 )
Lobes of brain Functions Effects of damage
Frontal Personality, emotional control, social behaviour, Lack of initiation, antisocial behaviour, impaired
contralateral motor control, language and memory and incontinence
micturition
Parietal Spatial orientation, recognition of faces, Spatial disorientation, non-recognition of faces
(non-dominant) appreciation of music and figures
Parietal Language, calculation, analytical, logical, and Dyscalculia, dyslexia, apraxia (inability to do
(dominant) geometrical complex movements) and agnosia (inability to
recognize)
Temporal Auditory perception, pitch perception, non-verbal Reception aphasia and impaired musical skills
(non-dominant) memory, smell and balance
Temporal (dominant) Language, verbal memory and auditory perception Dyslexia, verbal memory impaired and receptive
aphasia
Occipital Visual processing Visual loss and visual agnosia

Wernicke's area organizes the matter to be u tte red by


HUMAN SPEECH articulatory system. This area also makes complex
sentences. A bundle of fibres, arcuate fibers connect
There have been many evolutionary changes in human Wernicke's and Broca's areas. This bundle carries the
for the p urpose of articulation. These are
organized and composed speech of Wernicke's area to
i. Biped al position the Broca's area for speaking.
ii. Flexed sku 11 Tempor al lobe on its inner aspect con tain s
iii. increased growth of prefronta] part of brain hippocampus and globular amygdala on its anterior
iv. Reced ing of the lower jaw aspect. H ippocampus area stores long-term memories.
v. Decreased distance between posterior border of Amygdala is concerned with primary emotions. It
h ard palate and anterior margin of foramen receives as well as initiates emotions and recognizes
magn u m faces . Limbic system comprises hippocampus,
amygdala, cingulate gyms and basal nuclei.
vi. Larynx pulled downwards
Frontal lobe's functions are intelligence and cognitive
vii. Posterior one-third of tongue pulled downwards
ability.
and facing backwards forming the an terior wall
of the Jaryngopharynx In modern human, inferior parietal lobule area is
considerably enlarged. The gyri are sup ramarginal and
viii. Cavity of mouth and of pharynx being a t right
angular gyri.
a ngle to each other
Sup ramarginal gyrus is used for fi ne finger
ix. An terior two-thirds of tongue being thin and movement, tongue movement, fine facial movement.
more agile, voice produced due to tongue In this area, visual perception, perception of auditory
touching the palate was clear and sharp. sense, and knowledge of position of joints come
Before the origin of language was the evolution of together. Inferior parietal lobule is important for speech.
music . Music is in bio logy of all living beings; it Phenome is the smallest unit of speech.
generates d ifferent emotions and is universal. Music
Word is the smallest unit of language. Words are
was the only way to communicate with or attract the
composed of phenomes.
female. Language generates much less or no emotions
a nd is not universal. Prosodic functions (high and low of voice) are related
to th alamus and basal ganglia . Prosod ic aspect of
Broca's area on left side is related to speech; on the speech is less in parkinsonism wherein the speech gets
right side is related to music, poetic expressions, figures, monotonous without any prosodic effects as there is
faces, etc. Broca's area: eu.ral circuits are formed fo r
lack of dopamine.
a rticulation of different phenomes.
The temporal lobe contains auditory area which So u rce :Lele, DN: The Evolu tions of Speech and
receives the sound waves. Above and behi nd auditory Language, CBS Publishers & Distributors, New Delhi,
area is Wernicke's area. This area is responsible for 2016. (Dr DN Lele, Director, Lele Hospital and Research
comprehension of stimuli received by auditory area. It Centre, Nashik, Maharashtra, is an otolaryngologist of
is seven times larger in h uman than in a chimpanzee. international repute).
BRAIN-NEUROANATOMY

The posterior end is expanded, and is known as the


DIENCEPHALON p ulvinar. It overhangs the lateral and medial geniculate
The diencephalon is a middle structure which is largely bodies, and the superior coll iculus with its brachium
embedded in the cerebrum, and therefore hidden from (Fig. 8.lla).
surface view (Figs 8.lla and b). Its cavity forms the The superior su,face is d ivided into a la teral ventricular
greater part of the third ventricle. The hypothalamic part which forms the floor of the central part of the lateral
sulcus, extending from the interven tricular fora men to ven tricle, and a medial extraventricular part which is
th e ce rebral aqued uct, div ides each half of the covered by the tela choroidea of the third ventricle b y
d iencephalon into dorsal and ventral parts. Fu rther the free margin of bod y of fornix. It is limited laterally
subdivisions are given below. by the caudate n ucleus, the stria terminalis and the
thalamostriate vein, and medially by the habenular stria
DORSAL PART OF DIENCEPHALON (stria medullaris thalami) (Fig. 8.17).
1 Thalamus (d orsal thalam us). The inferior s11,fnce rests on the subthalamus and the
2 Meta thala mus, inclu d ing the med ia l and lateral hypothalamus (Fig. 8.18).
geniculate bodies, described with thalamus. The medial surface forms the posterosuperior part of
3 Epithalamus, including the pineal body and habe- the lateral wall of the third ventricle (see Fig. 9.3). The
nula. med ial surfaces of two thalami are interconnected by an
interthalamic adhesion (Fig. 8.12).
VENTRAL PART OF DIENCEPHALON The Intern/ surface forms the medial bow1dary of the
1 Hypothalamus, and posterior limb of the internal capsule (Fig. 8.20).
2 Sub thalam us (ven tral thalamus) . Structure and Nuclei of Thalamus
Thalamus White matter
The thalamus (Greek inner chamber) is a large mass of The external 111edullnn; lnmina cov1ers the lateral surface.
grey m atter4 cm each in transverse, vertical and antero- The internal medullary lamina divides the thalamus into
posterior diame ters situated in the lateral wall of the th ree parts-anterior, medial and lateral.
thi rd ventricle and in the floor of the central part of the Gm; matter
la teral ventricle. The grey matter is d ivided to form several nuclei.
Mens11re111ents: 1 Anterior n11cleus in the an terior part (Fig. 8.13).
Anteroposterior-4 cm 2 Medin/ nucleus in the medial part.
Yertica 1-4 cm 3 The lateral part of the thalamus is largest and
Transverse-4 cm represents the neothalnmus. It is divided into the lateral
It has anterior and posterior ends; su perior, inferior, nucleus in the dorsolateral part, and the ve11trnf nucleus
med ial a nd la teral su rfaces. in the ven tro med ial part. The ventral nucleus is
The anterior end with anterior nucleus is narrow and subdivided into anterior, intermediate and posterior
forms the posterior bow1dary of the interventricular g roups. The posterior group iis further subdivided
foramen (Figs 8.1 l a and b). into the posterolateral and posteromedial groups.

1. Anterior nucleus
2.
3.
Medial nucleus
Lateral nuclei:
:r-- lntralaminar nuclei
a Lateral dorsal -',-'""'-<c---c,,'L___ Midline nuclei
b Lateral posterior
c Pulvinar Medial nuclei

Ventral nuclei:
4 . Ventral anterior
--;:;.- -==~- Internal medullary
lamina
5. Ventral lateral
6. Ventral posterior late ral
7. Ventral postenor medial
8. Lateral geniculate body 8
7
9. Medial geniculate body

Figs 8.11 a and b: (a) Location of thalamus in the cerebral hemisphere, and {b) three-dimensional view of thalamus
CEREBRUM 1
.J
Lamina terminalis _ _ _ _ _ __,,_ ,_,__ _ _ Pineal body
Mammillary body - - - - - -.....+-- ~ - - - ~ - t - -- - - Hypothalamic sulcus
Optic chiasma - - - - - . ' IF-

Fig. 8.12: Thalamus and hypothalamus as seen in sagittal section

Table 8.4: Connection of thalamus


Name Afferents Efferents Functions
Anterior nucleus Mammillothalamic tract To cingulate gyrus Relay station for
(Fig. 8.13) (Fig. 8.15) hippocampal impulses
Medial nucleus From hypothalamus, frontal lobe To same parts from which Relay station for
in front of area 6, corpus striatum, the afferents are received visceral impulses
and other thalamic nuclei
Lateral nuclei: Lateral From precuneus and superior To precuneus and superior Correlative in function
dorsal. lateral posterior parietal lobule; also from parietal lobule
and pulvinar ventral and medial nuclei Temporal and occipital
Temporal and occipital lobes lobes
Ventral nuclei: Ventral From globus pallidus (subthalamic To areas 6 and 8 of cortex Relay station for striatal
anterior fasciculus) (Fig. 8. 18) impulses
Ventral lateral From cerebellum (dentatothalamic To motor areas 4 and 6 Relay station for
fibres) and red nucleus cerebellar impulses
Ventral posterolateral Spinal and medial lemnisci To postcentral gyrus Relay station for exteroceptive
(Figs 8.14 and 8.15) (areas 3, 1, 2) (touch, pain and temperature)
and proprioceptive impulses
from body, except face and head
Ventral posteromedial Trigeminal and solitariothalamic To postcentral Relay station for impulses from
(Fig. 8.15) lemnisci gyrus (areas 3, 1, 2) the face, head and taste impulses
lntralaminar, midline, Reticular formation To all parts of cerebral Participate in arousal
and reticular nuclei of brain stem cortex reactions/ascending reticular
(Fig. 8.11 ) activating system (ARAS)
Centromedian nucleus From parts of corpus striatum; Not connected to cerebral Receive pain fibres
(Fig. 8.13) collaterals from spinal, medial, cortex, connected to other
trigeminal lemnisci, ascending thalamic nuclei, corpus
reticulothalamic fibres. Impulses striatum
from areas 4, 6 of cerebral cortex
Medial geniculate body Auditory fibres from inferior Primary auditory areas Relay station for auditory
colliculus 41 , 42 (Fig. 8.18) impulses and perception of
painful and nociceptive stimuli
Lateral geniculate body Optic tract Primary visual cortex area 17 Relay station for visual impulses
BRAIN-NEUROANATOMY

~ - -- - From globus pallidus


1. Anterior nucleus
2. Medial nucleus
3. Lateral nuclei:
a Lateral dorsal,
b Lateral postenor
c Pulvinar
Ventral nuclei:
2
4. Ventral anterior
5. Ventral lateral
Centromedian nucleus---+-+----➔ 6. Ventral posterior lateral
From areas 4,6 of cerebral 7. Ventral posterior medial
c;....r:;:'"<-"- - Spinal lemniscus
cortex. corpus striatum, lemnisci 8. Lateral geniculate body
(lateral spinothalamic
tract) 9. Medial geniculate body

Trigeminal lemniscus

From inferior colliculus- - - -...,

Fig. 8.13: Parts of the thalamus. The afferents to the nuclei of thalamus are also indicated (colour coding in Figs 8.14 to 8.16 is
same)

Lateral dorsal and lateral - - - - - - - ~,1--


posterior nuclei

- - ---,-- Medlodorsal nucleus


(medial)

Fig. 8.14: Projection from thalamic nuclei to superolateral surface of cerebral hemisphere

Lateral dorsal and _ _ __,,,.__


lateral posterior nuclei

-----,- - Mediodorsal
(medial) nucleus

Fig. 8.15: Projection from thalamic nuclei to medial surface of cerebral hemisphere
CEREBRUM

4 lntralaminnr nuclei including ce11tromedim1 nucleus Lateral Gen/cu/ate Body


(located in the internal medullary lamina), midline It is a sma ll oval elevation situated anterolateral to the
nuclei (periventr.icular grey on the medial surface) and media l gcniculate body, below the thalam us. lt is
reticular nuclei (on the lateral surface) are also present. overlapped by the medial part of the temporal lobe,
Connections 1111d f 1111ctio11s of thalamus and is connected to the superior colliculus by the
Afferent impulses from a large number of subcortical superior brachium (see Fig. 6.8).
centres converge on the thalamus. Exteroceptive and
proprioceptive impulses ascend to it through the medial Structure
lemniscus, the spinothalamic tracts and the trigemino- It is six-layered structure. Layers 1, 4 and 6 (blue) receive
thalamic tracts. contralateral optic fibres, and layers 2, 3 and 5 (pink)
Visua l and auditory impulses reach the media l and receive ipsilateral optic fibres (Fig. 8.16).
lateral geniculate bodies. Co1111eclio11s
Sensations of taste are conveyed to it through
solitariothalamic fibres. Although the thalamus does Affrrents: Optic tract (lateral root).
not receive di rect olfactory impulses, they probably Efferents: Tt gives rise to optic radiations going to the
reach it through the amygdaloid complex. visual area of cortex tluough retrolentiform part of
Visceral information is conveyed from the hypo- internal capsule.
thalamus and probably through the reticular formation.
In addition to these afferents, the thalamus receives F1111ctio11
p rofuse connections from all parts of the cerebral cortex, Lateral geniculate body is the last relay station on the
the cerebellum and the corpus stria tum. The thalamus visual pathway to the occipital cortex.
is, therefore, regarded as a great integrating centre where
information from all these sources is brought togeth er.
This infor mation is projected to almost the whole of CLINICAL ANATOMY
the cerebral cortex through p rofuse thalamocortical
• Lesions of the thalamus cause impairment of all
projections. Efferent projections also reach the corpus
types of sensibilities; jo int sense (posture and
stria tum, the hypothalamus and the reticular formation.
Besides its integrating function, the thalamus has passive movements) being the most affected.
some degree of ability to perceive exteroceptive sensa- • The thalamic syndrome (occurs due to vascula r
tions, especially pain. The connections and functions impairment) is characterized b y disturbances of
of nuclei of thalamus are shown in Table 8.4. sensations, hemiplegia, or hemiparesis together
with hyperaesthesia and severe spontaneous pain.
Metathalamus (Part of Thalamus) Pleasant as well as unpleasant sensatio ns or
The metathalamus consists of the medial and lateral feelings are exaggerated. It is associated wi th
geniculate bodies, which are situated on each side of abn ormal movements like choreoathetosis.
the midbrain, below the thalamus. • Damage to medial nucleus of thalamus results in
decrease in tension aggression and a nxiety. It
Media/ Gen/cu/ate Body increases forgetfulness.
Tt is a n oval e levation situated just below the pulvinar
of the thalamus and lateral to the s uperior colliculus.
The inferior brachium connects the medial geniculate 'Tl

body to the inferior colliculus. The connections of the '°


'O
C
0
3
medial geniculate body are as follows (see Fig. 6.8). (0
(")
0
'O
'O
0
Afferents N
!1?.
Q) <ii
(1) La tera l lemniscus, (2) fibres from both inferior 'O
"iii VJ
a:
colliculi, and (3) ascending reticu la r pa thway and Q) (0
E
perception of painful and nociceptive stimuli. (0
VJ
~

.ts
E
Effenmts ~ "'::,a.
LL
1 It g ives rise to the acoustic (auditory) rad iation going ~
to the auditory area of the cortex (in the temporal lobe)
through the sublentiform part of the internal capsule.
2 To secondary somatosensory area.
f 1111ctio11
Medial geniculate body is the last relay station on the
pathway of auditory impulses to the cerebral cor tex. Fig. 8.16: Six layers of lateral geniculate body

_ j
BRAIN-NEUROANATOMY

Epithalamus Morphological Significance


The epithalamus (Fig. 8.17) occupies the caudal part of In many reptiles, the epiphysis cerebri is represented by
the roof of the diencephalon and consists of: a do uble s tructure. Th e anterior part (parapineal organ)
1 The right and left habenular nuclei, each situated develops into the pineal or parietal eye. The posterior part
beneath the floor of the corresponding habenular is glandular in nature. The human pineal body represents
trigone. the persistent posterior glandular p art only . The p a rietal
2 The pineal body or epiphysis cerebri. eye has disappeared.
3 The habenular cornmissure.
4 The posterior cornmissure. Structure

Habenu/ar Nucleus The p ineaJ gland is composed of two types of cells,


pinealocytes and neuroglial cells, w ith a rich network
The nucleus lies beneath the floor of the h abenu lar
of blood vessels and sympathetic fibres. The vessels and
trigone. The tiigone is a small, depressed triangular area,
nerves enter the gland through the connective tissue
situated above the superior colliculus and medial to the
pulvinar of the thalamus. Medi.ally, it is bounded by the septa which partly separate the lobules. Sympathe tic
stria medullaris thalami and stalk of the pineal body. The ganglion cells may be present.
habenular nucleus forms a part of the limbic system. Calcareous concretions are constantly present in the
p ine al after the 17th y ea r of life a nd m ay form
Afferents
aggregations (brain sand). Spaces or cysts may also be
• H ypothalamus
present. Pineal gland has no neural tissue in it.
• Amygdaloid body
• Hippocampus Functions
Efferents: To interpeduncular nucleus Th e pineal body has for long been regarded as a vesti-
Functions: Acts as n odal point for convergence of basic gial organ of no importance. Recent inves tiga tions have
emotional drives. shown that, it is an endocrine gland of great imp ortance.
Pineal Body/Pineal Gland
It produces hormones that may have an important
regulatory influence on many other endocrine organ s
The pineal (Latin pine, cone) body is a small, conical (including the adenoh ypoph ysis, the n eurohyp ophysis,
organ, projecting backwards and downwards b etween
the thyroid, the parathyroids, the adrenal cortex and
the two s uperior collic uli. It is placed below the
medulla, and the gonads). The best known hormone is
splenium of the corpus callosum, but is separated from
melatonin which causes changes in skin colour in some
it by the tela choroidea of the third ventricle.
It consists of a conical body about 8 mm long, and a species. The synthesis and discharge of melatonin is
stalk or peduncle w hich divides anteriorly into two remarkably influenced by exposure of the animal to
laminae separated by the pineal recess of the third light and is more during dark period.
ventricle. The superior lamina of the stalk contains the
habenular commiss ure; and the inferior lamina contains Hypothalamus
the posterior commissure (Fig. 8.17). Th e hypothalamus is a pa rt of the diencephalon
(Fig. 8.18). It lies in the floor and lateral wall of the third
Tela choroidea of third ventricle
ventricle. It has been designated as the head ganglion
~ - - S t ria medullaris of the au tonomic nervous system because it takes p a rt
thalami
in the control of many visceral and m etabolic activities
Habenular of the body.
nucleus
Anatomically, it includes:
~ Suprapineal a. The floor of the third ventricle, o r structures in
recess the interpeduncular fossa.
-r---- - Pineal gland b. The lateral wall of the third ventricle below the
'--- - Posterior
h ypothalamic sulcus.
commissure
Boundaries
As seen on th e base of the brain, the h ypothalamus is
bo unded anteriorly b y th e posterior perfora ted sub-
lnterthalamic adhesion stance; and on each side by the optic tract and crus cerebri
Fig. 8.17: Components of the epithalamus (Fig. 8.4).
CEREBRUM

Corpus callosum - - -- - --, Fornix is also con nected to several centres associated with
olfac tory pathways, including the piriform cortex,
cerebellum; and retina.
Dorsomedial nucleus - ..,.__- + - ~ Effermts
lnterventricular _ __,._.,,___, 1 Supraoptico-hypophyseal tract from the optic n uclei
foramen to the pars posterior, the pars tuberalis and the pars
Preoptic nucleus - - -Ha intermedia of the hypophysis cerebri.
Paraventricular nucleus - --+-........., 2 Mammillothalamic tract.
3 Mammillotegmental tract (periventricular system of
Ventromed1al nucleus - - - ~
fibres).
Supraoptic nucleu s - - -- - - 4 Tubero-inftmdibular tract.
Mammillary nucleus - - - - -- ~
Functions of Hypothalamus
Posterior nucleus - - - - -- -
Hypothalamic sulcus - - - - - -- --~
The hypothalamus is a complex neurog landular
mechanism concerned with regulation of visceral and
Fig. 8.18: Nuclei of medial zone of hypothalamus vasomotor activities of the body. Its functions are as
follows:
As seen in a sagittal section of the brain, it is bounded
mrteriorly by the lamina terminalis; inferiorly by the fl oor Endocrine co11tro/
of the third ventricle (from the optic ch iasma to the By forming releasing hormones o r release inhibiting
posterior perforated substance); and posterosuperiorly hormones, the hypothalamus regulates secretion of
by the hypothalamic sulcus. thyrotropin (TSH), corticotropin (ACTH), somatotropin
(STH), prolactin, luteinizing hormone (LH), follicle-
Parts of the Hypothalamus stimulating hormone (FSH) and melanocyte-stimula ting
The hypothalamus is subdivided into optic, tuberal and hormone, by the pars anterior of the hypophysis cerebri.
mammillary parts. The nuclei present in each part are
as follows: Ne11rosecretio11
Oxytocin and vasopressin (antidiuretic hormone, A DH)
Optic part are secreted by the h ypothalamus and transported
1 Preoptic and supraoptic nuclei. to the infundibulum a nd the p osterior lobe of the
2 Paraventricular nucleus, just above the supraoptic hypophysis cerebri.
nucleus and la teral nucleus in lateral zone.
3 Suprachiasmatic nucleus-above the optic chiasma. General aufo110111ic e.ffect
The a nterior parts of the hypothalamus chiefly mediate
T11beral part
parasympathetic activity; and the posterior parts, chiefly
4 Ventromedia l nucleus. media te sympathetic activi ty, but the effects o ften
5 Dorsomedial nucleus. overlap . Thus the h ypo thalamus contro ls car dio-
6 Tuberal nucleus, la teral to the ventromedial nucleus. vascular, respiratory and alimentary ftmctions.
7 Arcuate nucleus-i n floor of third ven tricle.
Temperature reg11latio11
Mammillary part The hypothalam us maintains a ba lance between hea t
8 Posterior nucle us, caudal to the ventromedial and production and hea t loss of the body. Raised body
dorsomedial nuclei and mammillary nucleus. temperature is decreased through vasodilation, sweat-
9 Lateral nucleus, la teral to the posterior nucleus. ing, panting and reduced heat production. Lowered
The nuclei 3, 4 and 6 (medial) are separated from bod y temperat ure is eleva ted b y shivering and in
nuclei 5 and 7 (la tera l) by the column of the fornix, prolonged cases by hy peractivity of the thyroid.
the mammillothalamic tra c t and the fa sc ic ulu s
retro fl ex us. Regulation offood and water intake
The hunger or feeding centre is placed laterally, the satiety
Important Connections centre, medially. Stimulation of the feeding centre or
A.ffere11/s damage of the satie ty centre ca uses h y perphagia
The hypothalamus receives visceral sensations through (overea ting) leading to obesity. Stimu lation of the
the spinal cord and brain stem (reticula r formation). It satiety cen h·e or damage of the feed ing centre causes
~ I BRAIN- NEUROANATOMY

h ypophagia or even aphagia and death from starva-


tio n.
The thirst or drinking centre is situa ted in the la teral Fasciculus - -----
lenticularis
pa rt of the h yp oth alamu s. Its s timula tion causes
copious drinking and overhydration. Internal---...._
capsule
Sexual behaviour and reproduction Thalamus
Through its control of the anterior pituitary, the hypo- Putamen ' - i t --Zona incerta
thalamus controls gametogenesis, va rious reproductive
H L - - Subthalamic
cycles (uterine, ovarian, etc.) and the maturation and nucleus
maintenance of secondary sexual ch ar acteristics. Globus - - -....
pallidus
Through its connections with the limbic system, it > - - - - Ansa
p articipates in the elementary drives associated w ith lenticulans
food (hunger and thirst) and sex. Fig. 8.19: Important fibre bundle running through subthalamic
region
Biological clocks
Many tissues and organ-systems of the body show a Grey Matter
cyclic variation in their fw1ctional activity during the
1 The cranial ends of the red nucleus and s ubstantia
24 hours of a day (circadian rh yth m). Sleep a nd
nigra extend into it.
wakefulness is an outs tanding example of a circadian
2 Subthalamic nucleus.
rhy thm. Wakefulness is maintained b y the reticular
activating system. Sleep is produced by the lzypnogenic 3 Zona incerta.
zones, mainly of the tha la mus and hypothalamus and White Matter
partly by the brain stem. Lesions of the anterior
1 Cranial ends of lemnisci, la teral to the red nucleus.
hypothalamus seriously disturb the rhythm of sleep and
2 Dentatothalamic tract a long w ith th e rubrothalantic
wakefulness.
fibres.
Emotion, fear, rnge, aversion, pleasure and reward 3 Ansa lenticularis (ventral) (Fig. 8.22).
These faculties are controlled by the hypothalamus, the 4 Fasciculus lenticularis (d orsal).
limbic system and the prefrontal cortex. 5 Subthalamic fasciculus (intermediate fibres) .
The subthalamic nucleus is bicon vex (in corona l
section) and is situated dorsolateral to the red nucleus
CLINICAL ANATOMY
and ventral to the zona incerta. From its connections, it
Lesions of the hy pothalamus give rise to one of the app ears to be an important site for integration of a
following syndrom es. number of motor centres.
• Obesity: Frolich 's syndrome, or Lau rence-Moon- The zona incerta is a thin la mina of grey matte r
Biedl syndrome. situated between the thalamus and the subthalamic
nucleus. Laterally, it is continuous with the reticular
• Diabetes insipidus.
nucleus of the thalamus. Its activity influences drinking
• Dien cephalic a u tonomic epilepsy. This is charac- of water.
terized by flu shing, sweating, salivation, lacri-
mation, ta chycardia, retardation of respirato ry
rate, unconsciousness, etc. CLINICAL ANATOMY
• Sexual dis tu rbance. Either precocity or impotence.
• Dis turba n ce of sleep. Somnolence (persis ten t Discrete lesions of the subtha lamic nucleus resul t in
sleep), or narcolepsy (paroxysmal sleep). ltemiballismus charac terised b y in voluntary
• H yperglycaemia and glycosuria. choreiform movements on the opposite side of the
body. The condition is abolished by ablation of the
• Acute ulcerations in the upper part of the gastro-
globus pallid us or of its efferent tracts, th e anterior
intestinal tract.
ventral nucleus of the thalamus, area 4 of the cerebral
cortex, or of the corticospinal tract. From these facts,
Subthalamus
it appears that the subtha lamic nucle us has a n
The s ubthalamus lies b e t ween the midbrain and inhibitory control on the globus pallid us and on the
thalamus, medial to internal capsule and the globus cerebral cortex.
pallidus (Fig . 8.19). It con sists of the following:
CEREBRUM

Features
BASAL NUCLEI
The basal nuclei are subcortical, intracerebral masses
DISSECTION o f g r ey ma t t er formin g i~portant p ar ts o_f th e
extrapy ramidal system . They mclud e the followmg:
Raise the lower border of the insula, stripping a thin 1 The corpus striatum (Fig. 8.20), w h ich is p art ially
layer of grey matter situated deep to the white matter divid ed by the internal capsule into two nuclei :
of insula. This grey matter is known as the claustrum. a. The ca11dnte nucleus.
As the insula is gradually raised, the external capsule b. The lentifor111 nucleus.
and on a deeper plane, a fan-shaped layer of white These two n uclei are interconnected by a few bands
matter, the corona radiata, is identifiable. Its fibres pass
of grey m atter bel ow the anterior limb of the internal
on a deeper plane than that of superior longitudinal capsule. The band s give it a striped appearance, hen ce
fasciculus. the nam e. The len tiform n ucleus is div id ed into a
To explore the lentiform nucleus, strip the external later al p art, the putamen and a medial part, theglo~us
capsule and identify rounded lentiform nucleus. Dissect pallidus. Th e caudate nucleus and putamen (neostna-
the striate branches of the middle cerebral artery on tu m) are often grouped as the striat11111, w hereas the
the lateral surface of the lentiform nucleus (Fig. 8.20). globus pallid us (pal eostriatum) is the pallidum.
Remove the genu and rostrum of corpus callosum 2 The amygdaloid body forms a part of the limbic system .
from the cerebral hemisphere, identify the head of the 3 Claustrum.
caudate nucleus and the anterior part of the corona The four nuclei (caudate, lentiform, amygdaloid and
radiata emerging from between the caudate and the claus trum) are joined to th e cortex at the anterior
lentiform nuclei. Identify the anterior commissure and per forated substance.
trace its fibres reaching till the temporal lobe.
CORPUS STRIATUM
Internal Capsule
To expose the internal capsule, remove the lentiform Corpus str i atu m (Latin striped body) compri ses the
nucleus as it forms the lateral boundary of the internal caudate nucleus and lentiform nucleus.
capsule. It is difficult to separate as many fibres of Caudate Nucleus
internal capsule enter the lentiform nucleus. Some fibres
form two medullary laminae and divide the lentiform
It is a C-sh aped or comma-shaped nucleus w h ich is
su rrounded by the lateral ventricle. The concavi ty of 'C'
nucleus into outer dark part- the putamen and two paler
encloses the thalamus and the internal capsule (Fig. 8.21).
inner parts-the globus pallidus. Putamen is continuous
The nucleus has a head, a body, and a tail.
with the caudate nucleus. Trace the continuity of the
The head forms the fl oor of the anterior horn of the
corona radiata with the internal capsule and of the
lateral ventricle, and the medial w all of the anterior limb
internal capsule with the crus cerebri. The latter part is
of the internal capsule. Bands of gr ey matter connect it
visible after stripping the optic tract from the lateral side
to the putamen across the anterior limb of the internal
of the internal capsule.
capsule near the anterior per forated substance.
The body forms the floor of the central par t of the
lateral v entricle, and lies medial to the posteri or li mb
Fibres converging to the crus
Headof - - 0
caudate cerebri of midbrain
nucleus

•-+--+-- External Lateral ventricle


Globus - - - --..-~ ......--
pallidus capsule Caudate
Posterior horn of
nucleus
lateral ventricle
Internal - t-----s- Claustrum
capsule

Thalamus

Concave margin - - -- '--- - - - - Inferior horn of


of choroid fissure lateral ventricle
Fig. 8.20: Horizontal section through corpus striatum, thalamus Fig. 8.21 : Relations of caudate nucleus to lateral ventricle,
and internal capsule thalamus and internal capsule
BRAIN-NEUROANATOMY

o f the internal capsule. It is separated from the thalamus


by the s tria terminalis and the tha lam ostria te vein.
Superiorly, it is rela ted to the fronto-occipital bundle
and the corpus callosum.
The tail forms the roof of the inferior horn of the la teral
ventricle, and ends by joining the amygdaloid body at the
temporal pole. It is related medially to the stria terminalis,
laterally to the tapetum, and superiorly to the sublentiform -+---t--+--- Globus
part of the internal capsule and to the g lobus p allidus. pallidus

-+- - Putamen
Lentiform Nucleus
r - - - - --Lenticular
This is a large lens-shaped (biconvex) nucleus, forming fasc,culus
the la teral bound a ry of the interna l cap sule. It lies
beneath the insula and the claustrum.
The lentiform nucleus has three s urfaces:
a. The lateral swfnce is convex. !tis rela ted to the external
caps ule, the cla ustrum, the o ute rmost cap s ule,
insula, and is grooved by the lateral striate arteries. Substanlia nigra
b. The medial surface is mo re con vex. It is rela ted to
the internal cap sule, the cauda te nucleus and the ---,...---..----- Reticular
thalamus (Fig . 8.22). formation
in midbrain
c. The inferior surface is rela ted to the sublenti fo rm
part of the internal capsule w hich separates it from
the optic tract, the tail of th e ca uda te nucleus, and
the inferior h orn of the la te ra l ventricle. The
s urface is grooved by the anterior commissurc jus t Fig. 8.22: Connections of corpus striatum
behind the ante rior perfora ted subs tance.
The lentiform nucleu s is divid ed into two parts by a controls the coordinated m ovements of d ifferent
thin lamina of w hite matter. p arts of the body for emotional expression .
3 Tt influences the precentra l motor cortex w hich is
The larger lateral pa rt is called the putamen (La tin to
cut). Structurally, it is similar to the caudate nucleus
supposed to conh·ol the extrapy ra rnidal activities of
and con ta ins small cells. the body.
The sm aller m edial part is called the glob11s pnllidus. 4 These do not receive an y sensory input from spinal
It is made up of large (motor) cells. cord unlike the cerebellum. Basal ganglia contribute
to cognitive function of the brain.
Morphological Divisions of Corpus Striatum 5 These h elp cortex in execution of learned patterns of
movements subconsciously.
1 The paleostriatum is the older and primitive p art. It is 6 Corpus s triatum, cerebellum and moto r a reas of
represented by the globus pallidus (pallidum). cerebrum jo intl y are res p on s ible for pla nn in g,
2 The neostriatum is more recent in development. It is execution and control of m ovem ents.
represented by the cauda te nucleus and the putam en 7 Corpus stria tum and cerebellum without sending fibres
of the lentiform nucleu s. The neostriatum is often to spina l cord modify the effect on spinal cord through
called the s triatum. projections to motor cortex and extrapyramidal fibres.
8 Basal ganglia and cerebellum d o not initiate mov-
Connections of Corpus Striatum em ents but are able to adjus t m otor commands.
The cauda te nucleus and putam en are afferent nuclei,
w hile the globus p allid us is the e ffe re nt nucleus, of the AMYGDALOID BODY
corpus s triatum (Fig. 8.22). The connections are shown This is a nuclea r mass in the temp oral lobe, lyi ng
in Table 8.5. anteros u perior to the inferior horn of the lateral ventricle.
Topogra phically, it is continuous w ith the tail of the
Functions of Corpus Striatum cauda tc nucleus, but functionally, it is related to the stria
1 The corpus stria tum regulates muscle tone and th us terminalis. It is a pa rt of the limbic system (Fig. 8.22).
helps in sm oothening voluntary movements. Tt is continuous w ith the cortex of the uncus, the
2 Tt conh·ols automatic associated movements, like the lin1en insulae a nd the anterior p erforated s ubstance.
swing ing o f a rms d uring wa lking . Similarly, it Afferents: From the olfactory tract.
CEREBRUM

Table 8.5: Connections of the corpus striatum


Nucleus Afferents Efferents
A. Caudate nucleus and putamen From: Chiefly to globus pallidus, but also to substantia
1. Cerebral cortex (areas 4 and 6) nigra and thalamus
2. Thalamus (medial, intralaminar and
midline nuclei)
3. Substantia nigra
B. Globus pallidus Mainly from: Efferents form three bundles, namely:
1. Caudate nucleus 1. Ansa lenticularis, ventrally (Fig. 8.22)
2. Putamen 2. Fasciculus lenticularis, dorsally
Also from : 3. Subthalamic fasciculus from the middle part
1. Thalamus of the globus pallidus
2. Subthalamic nucleus These bundles terminate in the following:
3. Substantia nigra 1. Thalamus
2. Hypothalamus
3. Subthalamic nucleus
4. Red nucleus
5. Olivary nucleus
6. Substantia nigra
7. Reticular nuclei

Efferents: It gives rise to the stria terminalis which e nds • L-dopa (a precursor of dopamine) is used as a
in the anterior commissure, the anterio r perfora ted re placem ent therapy in parkinsonis m beca use
s ubsta nce and in hypothalamic nuclei. dopamin e the n ormal ne urotrans mitter in the
Funct ions: Emotional control. s triahun, is reduced in these cases. The nigrostriate
fibres a re considered impo rta n t in the genesis of
CLAUSTRUM
p arkinsonis m tr emor, since its n eu rons u tilize
It is sa ucer-shap ed nucleus situated be tween the dopamine in the neurotransmission .
putamen and the insula, with which it is coextensive. eurosurgicall y, pallidectom y a nd th a lamo-
Inferiorly, it is th ickest and continuous w ith the anterior dectomy h ave been used with su ccess to control
perfora ted substance. the contralateral tremors in d ifferent ty pes of
disease of corpus s triatum.
CLINICAL ANATOMY
• Lesions of basal ganglia and cerebellum d o not
ca u se paralysis. These p roduce a bnorma l
movements or posture or changes in ton e.
• Parkinsonism: Lesions of corpus stria tum leads to
p a rkinsonism (Fig. 8.23). Its features a re:
a. Hypertonicity or lead p ipe rigidity.
b. Loss of automa tic associated movem ents and
also of facial expression .
c. Involuntary movemen ts like tremors, choreiform
movements, a thetoid movements.
d. Continuous writhing movements of trunk and
Flexed attitude
limbs may continue even in sleep. Voluntary
movements m ay be impossible. '\
• Chorea: Ch orea means dancing. Chorea is form of
involuntary m ovement ch aracterised by fine
ra ndom m ovements of h a nds and feet. These
movements are ra ther disorganized .
This occurs due to disease of caudate n ucleus.
• Atl1etosis: Tt is a form of m ovement w hich is slow
repetitive and writhing in nature. It is d ue to lesion
of putamen .
• Bnlfism11s: This is characterized by irregul a r
movem ents of tru nk, g irdles and both the limbs.
lt is d ue to disease of s ubthalamic nucleus. Fig. 8.23: Posture in parkinsonism
~ I BRAIN-NEUROANATOMY

WHITE MATTER OF CEREBRUM Lift up a strip of superficial fibres of the genu of corpus
callosum and tear these laterally. Identify the
DISSECTION intersectioning fibres of corpus callosum and those of
Scrape the grey matter between adjacent gyri till the the vertically disposed fibres of the corona radiata.
white matter connecting the adjacent gyri is visible. This
will expose the short association fibres. Identify the
SUBDIVISIONS
cingulate gyrus on the medial surface of the left
hemisphere. Scrape the grey matter of this gyrus till a Th e w hite matter of the cerebru m consists chiefly of
band of white matter-the cingulum is exposed. Define myelinated fibres which connect various parts of the
the extent of cingulum from the anterior end of corpus cortex to one another and also to the other parts of the
callosum, around its convex trunk and splenium into C S. The fibres are classi fied into three groups, associa-
the parahippocampal gyrus (Fig. 8.24). tion fibres, and commissural fibres and projection fibres.
Similarly scrape the cortex between temporal pole,
motor speech area and the orbital cortex to expose ASSOCIATION (ARCUATE) FIBRES
uncinate fasciculus. Also expose superior longitudinal These are the fibres which connect different cortical
fasciculus joining the frontal lobe to the occipital and
areas of the same hemisphere to one another. These are
temporal lobes. Lastly, scrape the grey matter between
subdivided into the following two types.
occipital and temporal lobes to expose the inferior
longitudinal fasciculus (refer to BOC App).
Short Association Fibres
Identify the various parts of the corpus callosum.
Remove the fibres of the cingulum and identify the These fibres connect adjacent gy ri to one anoth er
superficial fibres of the genu of corpus callosum passing (Fig. 8.24).
into the medial aspect of hemisphere. Such fibres of
the two sides form the forceps minor. Long Association Fibres
Expose the band of fibres passing from splenium of These fibres connect m ore w idely sepa rated gyri to one
corpus callosum towards the superior part of occipital another. Some examples are:
lobe. Trace the fibres of tapetum arising from the trunk 1 The uncinnte fascicu l11s, connecting the temporal pole
and splenium of corpus callosum curving to reach the to the motor speech area and to the orbital cortex.
inferior parts of the occipital and temporal lobes. 2 The cingulwn, connecting the cingulate gyrus to the
Identify the anterior commissure lying just anterior parahippocampal gyrus seen on the m edial surface.
to column of fornix and the interventricular foramen. 3 The superior longitudinal fasciculus, connecting the
Examine the posterior commissure situated dorsal to frontal l obe to occipital and temporal lobes.
the upper part of aqueduct and inferior to the root of the
4 The inferior longitudinal fasciw/11s , conn ecting the
pineal body. Look for habenular commissure present at
occipital and temporal lobes (Fig. 8.24, inset).
the root of the pineal body. Lastly, identify the commissure
of the fornix and the hypothalamic commissures. 5 Fronto-occipital fasci culus seen on the m edial
surface

~'<"""'<'..-:------"-s..,..,.---...,_-- Corpus callosum

/2¥=~.£._.,-;+_ ___::~-----\- - Fornix

Uncinate
fasciculus
~ - - - ----Thalamus
' - - - - - - - - - - - - - - Anterior commissure
Fig. 8.24: Association fibres of cerebrum
CEREBRUM

COMMISSURAL FIBRES Parts of Corpus Cal/osum


These are the fibres which connect corresponding parts 1 The genu is the anterior end. It lies 4 cm behind the
of the two hemispheres. They constitute the commissures frontal pole. It is related anteriorly to the anterior
of the cerebrum. They are: cerebral arteries, and posteriorly to the anterior horn
1 The corpus callos11111 connecting the cerebral cortex of
of the lateral ventricle (Fig. 8.25, also see Fig. 11.5).
2 The rostrum is directed downwards and backwards
the two sides (Fig. 8.25).
from the genu, and ends by joining the lamin a
2 The anterior com111issure, connecting the archipallia terminalis, in front of the an terior commissure. It is
(olfactory bulbs, piriform area and anterior parts of related superiorly to the anterior horn of the lateral
temporal lobes) of the two sides (Fig. 8.12). ventricle, and inferiorly to the indusium griseum and
3 The posterior co111111iss11re, connecting the superior the longitudinal striae.
colliculi, and also transmitting corticotectal fibres and 3 The trunk or body is the middle part, between the genu
fibres from the pretectal nucleus to the Edinger- and the splen ium. Its superior surface is convex from
Westphal nucleus of the opposite side. before backwards and concave from side to side. It is
related to the anterior cerebral arteries (see Fig. 11.5)
4 The commissure of the fomix (/1ippocn111pnl commissure),
and to the lower border of the falx cerebri. lt is
connecting the crura of the fomix and thus the hippo-
overlapped by the cingulate gyrus and is covered by
campal formations of the two sides.
the ind usiu m griseum and the longitud inaJ striae. The
5 The lwbenulnr co111111iss11re, com1ecting the habenular inferior surface is conca ve from before backwards and
nuclei. convex from side to side. It provides attachmentto the
6 The hypothnln111ic com111iss11res, including the anterior septum pellucid um and the fomix, and forms the roof
hypothalamic commissure of Ganser, the ventral of the central part of the lateral ventricle.
supraoptic commissure of Gudden and the dorsal 4 The splenium is the posterior end forming the thickest
supraoptic conunissure of Meynert. part of the corpus callosum. It lies 6 cm in front of
the occipital pole. Its inferior surface is related to the
Corpus Callosum tela choroidea of the third ventricle (see Fig. 9.1), the
pulvinar, the pineal body, and the tectum of the
The corpus callostun is the largest commissure of the
midbrain. The superior surface is related to the inferior
brain. It connects the two cerebral hemispheres. Since sagittal s inus and the falx cerebri. Posteriorly, it is
it is the neopallial corrunissure, it attains eno rmous size related to the great cerebra l vein, the straight sinus
in man (10 cm long). and the free ma rgin on the tentorium cerebelli.
Parts of Brain Connected Fibres of Corpus Callosum
The corpus callosum connects all parts of the cerebral 1 The rostrum com1ects the orbital surfaces of the two
cortex of the two sides, except the lower and anterior frontal lobes.
parts of the tempo ral lobes which are connected by the 2 The forceps minor is made up of fibres of the genu
anterior comrnissure. that connect the two frontal lobes (Figs 8.26a and b).
3 The forceps major is made up of fibres of the splen ium
connecting the two occipital lobes.
Trunk
4 The tapetum is formed b y some fibres from the trunk
Genu and splenium of the corpus callosum. The tapetum
forms the roof and lateral wall of the posterior horn,
and the lateral wall of the inferior horn of the lateral
ventricle (Figs 8.26a and b).
Functional Significance
The corpus callosum helps in coordinating activities of

t Fornix
the two hemis pheres.

PROJECTION FIBRES
These are fibres which connect the cerebral cortex to
Antenor commissure Splenium other parts of the CNS, e.g. the brain stem and spinal
cord. Many important tmcts, e.g. corticospinal and
corticopontine, are made up of projection fibres.
Fig. 8.25: Parts of corpus callosum Examples: (a) Corona radiata and (b) internal capsule.
BRAIN-NEUROANATOMY

Forceps minor

Corona radiata
Trunk (body) of
corpus collasum

Forceps major

Fig. 8.26: Fibres of corpus collosum

Internal Capsule Whe n traced downwards, its fibres conve rge a nd man y
Gross Anatomy of them are continuous with the crus cerebri of the
mid brain.
The internal caps ule is a large band of fibres, situa ted
The internal cap sule is divid ed into the following
in the inferomed ia l part of each cerebral hemisphe re.
p arts.
In_ho~iz ontal se~tion~ of the brain, it appears V-shap ed
a. The anterior limb lies be tw een the head of the
w ith ,~s conca vity d~ected laterally . The concavity is
ca udate nucleus and the le n tifor m nucle us
occupied by the len t,form n u cleus (Fig. 8.27).
(Figs 8.27 and 8.28).
The interna l caps ule contain s fibres going to a nd
b. Th e ge1111 is the ben d between the an terior and
coming from the cerebral cortex. It can be compared to
posterior limbs.
a na rrow gate w here the fibres are d ensely crowd ed.
c. The posterior limb lies behveen the thalamus and
Small lesions of the capsule can give rise to w idespread
the len tiform nucleus.
d erangements of the body .
d . T he sublentiform part lies below the le ntifor m
. Wh en traced upwards, th e fibres of the ca p s ul e
nucleus. It can be seen in a coronal section, w hereas
diverge and are continuous w ith the corona radia ta.
the rest of the pa rts are seen in a horizontal section.
~ - - - - Head of e. The retrolentifonn part lies behind the lentiform
caudate nucleus nucleus.
Anterior - - - +- Putamen of lentiform
limb nucleus Relations
Medially: H ead o f ca udate n ucleus a nd tha lamus
l.Jiternlly: Lentiform nucleus
Globus pallidus
of lentiform nucleus Fibres of Internal Capsule
Posterior --+----\-- Motor fibres
limb
-+-.£-- External capsule Corticopontine lie in anterior limb, genu a nd posterior
Claustrum limb (Fig. 8.29).
Sublentiform part Frontopontine s ta rt from fronta l lobe to reach the
p ontine nucle i_ wher e th ese relay to reach opposite
Thalamus Retrolentiform part
cerebellar h emisphere. These are called corticoponto-
Fig. 8.27: Boundaries and parts of internal capsule cerebel lar fib res.
CEREBRUM

Superior thalamic radiation - - --+-- -- ---


(through genu and posterior
limb of internal capsule)
- ---t--1-- Anterior thalamic radiation
(through anterior limb of
internal capsule)
Posterior thalamic radiations - - -+--
(through retrolentiform
part of internal capsule) - - - - -- - - Inferior thalamic radiations
(through sublentiform part of
internal capsule)

Fig. 8.28: Fibres of various parts of internal capsule

,ra..-..,...~ ___,~-- - Frontopontine fibres


(motor)

Anterior thalamic radiation - - - -- -- - - -- -


(sensory)

Corticonuclear fibres - -------:~ ---'~ '-


for head and neck (motor)
Corticospinal fibres _ __,__ __ _ ...,... Corticorubral fibres
for upper limb (motor) (motor)

Corticospinal for - --t- - - -+--'."-c<"".


trunk (motor)
Auditory radiation (sensory)
Cort,cospinal fibres for - -I- _,,,,
lower limb (motor)
.......- -- - -- -- Parietopontine and
Superior thalamic radiation 0....a:iSP<" occipitopontine fibres (motor)
(sensory)

Medial geniculate body

Lateral geniculate body

Fig. 8.29: Fibre components of internal capsule

Pa ri e topon tine and occipitopontine lie in re tro- Extrapyra111idal fibres


lentiform part of internal capsule. These fibres start from cerebral cortex as corticostriate
Temporopontine lie in s ublentiform part of internal and corticorubral fibres and reach corpus striatum a nd
capsule. red nucleus.
Pyramidal fibres Senson; fibres
Corticonuclear to nucle i of m, lV, V, VI, VII, Xll and Thalamocortical fibres form thalamjc radiations (3rd
nucle us ambig uus for lX, X, XI nerves of opposite side.
order neuron fibres):
Corticospi11nl: Fibres for anterior horn cells of muscles
of head and neck lie in genu. 1 Anterior thalam.ic radiation: Fibres from anterior and
Fibres for upper limb, trunk and lower limb lie in poste- dorsomedial nuclei of thalamus terminate in cortex
rior limb of inte rnal capsule in sequentiaJ order (fig. 8.29). fronta l lobe.
BRAIN-NEUROANATOMY

2 Superior thalamic radiation: Fibres of ventral group Co11stitue11t fibres


of nuclei of thalamus reach sensory areas of frontal The fibres of internal capsule are shown in Fig. 8.30
and parieta l lobes. and presented in Table 8.6.
3 Inferior thalamic radiation: Connect medial geniculate
body w ith primary auditory cortex. Blood Supply
4 Posterior thalamic radiation: These fibres connect lateral The arteries supplying different part of the internal
genkulate body to area 17 forming optic radiation. capsule are shown in Fig. 8.30.

Table 8.6: Fibres in the internal capsule


Part Descending tracts Ascending tracts Arterial supply
Anterior limb Frontopontine fibres (a part of the Anterior thalamic radiation (fibres from 1. Recurrent branch of
(Fig. 8.29) cortico-pontocerebellar pathway) anterior and medial nuclei of thalamus) anterior cerebral
2. Direct branches from
anterior cerebral
Genu Corticonuclear fibres (a part of the Anterior part of the superior thalamic 1. Direct branches from
pyramidal tract going to motor nuclei radiation (fibres from posterior ventral internal carotid
of cranial nerves and forming their nucleus of thalamus) 2. Posterior communicating
supranuclear pathway
Posterior limb 1. Corticospinal tract (pyramidal 1. Superior thalamic radiation 1. Lateral striate branches
tract for the upper limb, trunk and 2. Fibres from globus pallidus to of middle cerebral
lower limb) subthalamic nucleus 2. Medial striate branches
2. Corticopontine fibres of middle cerebral
3. Corticorubral fibres 3. Anterior choroidal
Sublentiform 1. Parietopontine and temporopontine 1 . Auditory radiation 1. Branches of posterior
part fibres cerebral
2. Fibres between temporal lobe and 2. Fibres connecting thalamus to 2 . Anterior choroidal
thalamus temporal lobe
Retrolentiform 1. Parietopontine and occipitopontine Posterior thalamic radiation made up of: Branches of posterior
part fibres 1 . Mainly optic radiation cerebral
2. Fibres from occipital cortex to 2. Partly fibres connecting thalamus to
superior colliculus and pretectal the parietal and occipital lobes
region

Recurrent branch of anterior cerebral

Middle
cerebral

Basilar artery

,-,~~ ----1-r - - - - Branches of posterior cerebral


(retrolentiform part)
Fig. 8.30: Arteries supplying the internal capsule
CEREBRUM

CLINICAL ANATOMY

• Lesion s o f the in ternal ca ps ule a rc us ually • Human's status as the most hlghly evolved animal
vascular, d ue to involvement of the medial and so far is due to larger s.i ze of the cerebru m,
lateral striate branches of the middle cerebral especially the frontal lobes.
arter y. They give rise to hemip legia on the • Cerebrum comprises 3 borders: superomedial,
opposite half of the bod y (paralysis of one-half of inferolateral and medial; 3 surfaces: superolateral,
the body, including the face). medial and inferior; 3 poles: fron tal, occipital and
lt is an upper motor neuron type of paralysis tempo ral and 4 lobes: frontal, parietal, temporal
(Fig. 8.31). The larger lateral striate artery is called, and occipital.
"Charcot's artery of cerebral haemorrhage". • Cerebrum receives sensations from the opposite
• Thrombosis of the recurrent branch of the anterior side of bod y. It controls the movements of the
cerebral artery gives rise to an upper motor neuron opposite sid e of bod y, a few structu res are
ty pe of paralysis of the opposite upper limb and controlled by both sides.
of the face. • Bod y is represented upside down, only the face
• A lesion in the genu of the internal capsule would and area of vocalization is represented straight.
prod uce sensory and motor loss in the contra- • Tha lamus is the inner ch amber receiving an d
lateral side of the head . This may not be complete coord ina ting m o to r, sensor y, v isceral, visu a l,
since there is bilateral cortical innervation of most auditory and emotional impulses.
cranial nerve nuclei. - Comm issural fibre components are anterio r
comm issure, posterio r commissure, habenular
commissm e. The largest is the corpus callos um.
These connect identical areas of 2 hemispheres.
Associa tion fibres connect d ifferent areas of
Upper limb flexed same hemisphere
- Projection fibres connect upper areas of brain
w ith lower ones.
• In ternal cap sule is the most typical example of
projection fibres.
• Its posterior limb is supplied by lateral and med ial
striate arteries. These are end arteries. Blockage or
haemorrhage of these arteries causes upper mo tor
neuron type of paralysis on the opposite side of
the body.

CLINICOANATOMICAL PROBLEMS

Lower limb extended Case 1


Fig. 8.31: Posture in left-sided hemiplegia
A h yp ertensive old lady of 88 years complained of
severe headache on her rig ht side. After two hours
she could not move her left upper and left lower
DEVELOPMENT limbs. Her voice was also altered. CT scan showed
Cerebral hemispheres arise as o utgrowths from the bleeding in the area of internal capsule.
lateral wall of prosencephalon d uring 5-6 weeks. These • Where is the lesio n in brain responsible for her
g rad ually enlarge to cover thalamus, mid bra in and symptoms?
pons. Further grow th results in formation of lobes and • What are the d ifferen ces between central and
poles. Increased grow th in a li mited area resu lt in cortical b ranches?
for mation o f sulci and gyri. The basa l part of the
Ans: There has been a haemorrhage in the area of
hemisphere increases in size to form two big nuclei
internal capsule on right side of the cerebrum,
connected together by fibres. These nuclei are the
leading to upper motor neuron paralysis of her left
ca udate and len tiform nucle i. Both ascend ing and
upper and lower limbs. The laleral striate branches,
descending fibres pass. These form internal capsule
the central branches of middle cerebral arterv are
(projection fibres). The commissural fibres develop in
most Yulnerable to injury. -
the lamina terminalis .
BRAIN-NEUROANATOMY

Differences between central and cortical branches: pipe rigidity. These are also associated with
Central branch Cortical branch involuntary movements like tremors.
1. Thin, long, arise Arise singly, thicker The line of treatment is "L-dopa", given as a
in groups in size and shorter replacement therapy, because dopamine the normal
2. These do not These anastomose neurotransmitter in globus pallidus is reduced in
anastomose freely on the surface these conditions. Surgical treatment include pallidec-
and are end arteries tomy to control tremors.
3. If these get blocked, If these get blocked, Case 3
there is large infarct there is small infarct A 45-year-old officer complained of resting tremors
Case 2 of his hands, with inability to eat his food . He would
A 65-year-old person developed tremors in his walk with a forward bend as it trying to catch centre
h a nds. He canno t ea t his food com fortably. His of gravity.
m ovem e nts h ave slowed d ow n, an d walks by • What is the d iagnosis and wh a t neurotransmitter
bending forw ards. There is m ostly a s tare in his eyes is d eficient in such a case?
with n o em otional expression . • What are the other features?
• What is the likely diagnosis? Ans: The patient is suffering from 'parkinsonism'. 1t
• What is the line of treatment? occurs due to degeneration of nigrostriate fibres.
Ans: The likely diagnosis is parkinsonism. In this Patient has pill-rolling movements of hands
condition, there is paucity of movements with lead- including resting tremors, and mask like face.

FREQUENTLY ASKED QUESTIONS

1. Describe the superolateral surface of the cerebral c. Lateral gen icula te body
hemisphere und er the following head ings: Suki, d. Components of basal ganglia and their functions
gyri and ftmctiona l areas.
e. lnterpen duncular fossa
2. Describe the connections of the various including
the n uclei of thalamus. What are their functions? f. Association fibers
3. Write short n o tes on: 4. Describe the parts of internal capsule. Name their
a. Corpus calloswn component fibres. Enume rate its artelies. Add a
b. Motor sp eech area note on its clin ical imp ortance.

MULTIPLE CHOICE QUESTIONS

1. Anterior limit of forebrain is represen ted by: 5. Brodmann's number given to aud itosensory area is:
a. Stria medullaris b. Stria terminalis a. 41, 42 b . 44, 45
c. Lamina tenninalis d. Stria medullaris thalami c. 3, 1, 2 d . 18, 19
2. Broca's area is located in which lobe? 6. Afferents to lateral geniculate body is:
a. Parietal b. Frontal a. Optic tract
c. Temporal d . O ccipital b. Globus pallidus
3. All o f following a re parts of basal ganglia except: c. Auditory fibres from inferior colliculus
a. Caudate nucleus b. Thalamus d. Reticular formation of brain s tem
c. Putamen d . Globus pallidus 7. A sa ucer-shaped nucleus si tua ted between
4. Which of the foll owing structu res is related to putamen and insu.la is:
auditory pathway? a. Claustrum b. Globus pallidus
a. La teral gen icu late body c. Zona incerta cl. Subtha lamic n uclei
b. Trapezoid body 8. Parkinsonism is due to lesion in :
c. Medial lemniscus a. Corpus luteum b. Corpus striatum
cl. Spina] lemniscus c. Corpus callosum d. Substantia gelatinosa

ANSWERS
1. c 2. b 3. b 4. b 5. a 6. a 7. a 8. b
CHAPTER

9
Third Ventricle,
Lateral Ventricle and Limbic System
~<.,l',,;flJ ,:, f,Ju j,eux11l iJ1Jj,i?nlion aurl 11i11rly - 11t"11e j,cue11Ij,r,.,j,iir1li£11
-Thomas

INTRODUCTION FEATURES
Third and lateral ventricles of brain secrete the cerebro- The third ventricle is a median cleft between th e two
spinal fluid with the he lp of their ch oroid plexuses. thalami. Developmentally, it represents the cavity of
Rhinencepha lon and limbic system a re related to smell the d ie ncepha lon , except for the area in front of the
and various visceral acti vities. interventricular foram en w hich is d erived from the
median part of the telencephalon. The cavity is lined
THIRD VENTRICLE by epen dyma (Fig. 9.1).

COMMUNICATIONS
DISSECTION
Identify the extent of the third ventricle from the lamina Anterosuperiorly, on each side, it communica tes with
terminalis anteriorly to the uppe r end of the aqueduct the la te ral ventricle through the inter ven tric ula r
and root of pineal body posteriorly. Examine its anterior foramen (forarnen of Monro). This foramen is bounded
wall, posterior wall, roof, floor and lateral walls (refer to anteriorly by the column of the fornix, and posteriorly
BOC App). by the tubercle of the thalamus.

Hypothalamic sulcus - - -- - - ~
~ - - - - - - - - Septum pellucidum
Anterior column of fornlx - - - - - - . . . _
~ -- -- - - - Tela choroidea of third ventricle

Anterior Posterior
- - -- - lnterthalam1c adhesion
Antenor wall - - - - -___,,,,--ll>..__
----- - - Pineal body
Anterior comm1ssure - - -- - -...+<~,
Lamina terminalis _ _ _ ___,,.,_.,

Optic chiasma - - - -- .,,


Optic recess _ _ _ _ _..J

lnfundibular recess _ _ __ _ __,


and infundlbulum

Posterior perforated substance

Fig. 9.1 : Boundaries of third ventricle

151
BRAIN-NEUROANATOMY

Posteroinferiorly, in the median pl a ne, it com- Note that


municates with the fou rth ventricle through the cerebral a. The interthaJamic adhesion connects the medial
aqueduct (Fig. 9.1). s urfaces of the two thalami and crosses the
ventricular cavity.
RECESSES
b. The habenular stria lies at the junction of the roof
Recesses are extensions of the cavity. These a re: and the lateral wall. The two striae join posteriorly
1 Suprapineal. at the habenular commissure.
2 Pineal-upper lamina of the recess is traversed by c. The columns of the fornix, as already indicated,
habenular com missure and lower lam ina by the run d ownwards and backwards to reach the
posterior conunissure. ma mmillary bodies. The columns lie beneath the
3 Infundibular (Latin f u1111el). lateral wall of the ventricle.
4 Optic (Fig. 9.1).
5 Vulva-between the diverging columns of fornix.
CLINICAL ANATOMY
BOUNDARIES
Anterior Wall • The third ventricle is a narrow space which is
1 Lamina terminalis. easily obstructed by loca l brain tumours or by
2 Anterior commissure. d evelopmental defects. The obstruction leads to
3 Anterior columns of fornix. The two columns of the raised intracranial pressure in adults and hydro-
fornix diverge, pass downw ards and backwards, and cephalus in infants.
sink into the lateral wall of the third ventricle to reach • Tumours in the lower part of the third ventricle
the mammrnary body. give rise to h ypothalamic symptoms, like diabetes
insipid us, obesity, sexual disturbance, disturbance
Posterior Wall of sleep, hyperglycaemia and glycosuria.
1 Pineal body. • The site of obstruction can be found out by CT
2 Posterior commissure (in the lower lamina of the scan/ MRI (magnetic resonance imaging) scans,
pineal stalk). where, the third ventricle is seen, normally, as a
3 Cerebral aqueduct. narrow, vertical midline shadow. Dilatation of
Roof the third ventricle would indicate obstruction
a t a lower level, e.g. the cerebral aqueduct. If
lt is formed by body of fornix and the ependyma lining the obstruction is in the third ventricle, both the
the under surface of the tela choroidea of the third la teral ventricles are dilated sy mme trically.
ventricle. The choroid plexus of the third ventricle Obstruction a t an interventricular foramen causes
projects downwa rds from the roof. unilateral dilatation o f the lateral ventricle of that
At the junction of the roof with the anterior and side.
latera l walls, there are the interventricular foramina.
Floor
It is formed by hypothalamic structures:
LATERAL VENTRICLE
1 Optic chiasma.
2 Tuberci..neri um.
DISSECTION
3 Tnfundibulum (pituitary stalk). Take the right hemisphere and put the tip of the knife at
4 Mammillary bodies. the interventricular foramen. Give a vertical incision
5 Posterior perforated substance. through the fornix, septum pellucidum, body of corpus
6 Tegmenh1m of the midbrain. callosum , the medial surface of the hemisphere till the
At the junction of the floor w ith the anterior wall, superomedial border (Fig. 9.2a).
there is the optic recess (Fig. 9.1). Turn the brain so that superolateral surface points
towards you. Continue the previous incision on this
Lateral Wall
surface for 2 cm. Carry the incision posteriorly and then
It is formed by the following: curve it downwards till the end of the posterior ramus
1 Medial surface of thalamus (in its posterosuperior of the lateral sulcus (Fig . 9.2b).
part). Expose the insula by depressing the temporal lobe.
2 Hypothalamus (in its anteroinferior part).
Cut through the medial part of the gyri situated on the
3 The hypothalarrtic sulcus which separates the thalamus superior surface of the temporal lobe till the stem of the
from the hypothalamus. The sukus extends from the lateral sulcus (Fig. 9.2c).
interventricular foramen to the cerebral aqueduct.
THIRD VENTRICLE, LATERAL VENTRICLE AND LIMBIC SYSTEM

Now try to separate the frontal lobe from the temporal FEATURES
lobe, and open up the stem of the lateral sulcus. Put The lateral ventricles are two irregular cavities situated
the knife in the anterior part of stem of the lateral sulcus one in each cerebral hemisphere. Each lateral ventricle
and extend the incision medially to the inferior part of communicates with the third ventricle through an
stem of the lateral sulcus. Keep on opening the cut while interventricular foramen (foramen of Monro). Each
making it and identity the choroid plexus entering the lateral ventricle consists of:
inferior horn of the lateral ventricle from its medial side.
1 A central part.
Now brain is easily separable into an upper frontal
part and a lower occipitotemporal part. Lift the fornix 2 Three ho rns: Anterior, posterior and inferior (Figs 9.3
from the thalamus, separating the fornix from the and 9.4).
choroid plexus. Identify the choroidal branches of the
posterior cerebral artery. Central Part
Identity structures in all horns of lateral ventricle with This part of the lateral ventricle extends from the
the help of the two parts, i.e. frontal and occipitotemporal inter ventricular fora men in front to the splenium of U1e
parts of the cerebral hemisphere. corpus callosum behind (Fig. 9.1).
Expose the anterior column of fornix by scraping the
ependyma of anterior part of third ventricle. Trace the Boundaries
anterior column of fornix till the mammillary body. Trace Roof
another bundle, the mammillothalamic tract till the
It is formed by the undersurface of the corpus callosum
anterior nucleus of the thalamus.
(Fig. 9.Sa).

Medial surface Superolateral surface Stem of the lateral sulcus

Central part - -,1--=--


of lateral
ventricle

Cut edge or + .-::::C.~-,-:2:r-F(:


white matter
passing to
temporal lobe
Posterior ramus Hippocampus in
(a) (d)
of lateral sulcus inferior horn of
lateral ventricle
Figs 9.2a to c: Drawing to show: (a) The first incision to be made in the dissection to expose the lateral ventricle, (b) the second
part of the incision to be made in the dissection to expose the lateral ventricle, and (c) the third part of the incision to complete the
exposure of the lateral ventricle

Inferior . . + - - t - - - - -- lnterventricular
horn foramen

Third - +---+----<--+-", -+---+--+-- Central part of


ventricle lateral ventricle

Fourth- - -- - -
ventricle

Posterior - ---
horn ' - - - - - - - Lateral dorsal
recess
Fig. 9.3: Ventricles seen from the ventral surface Fig. 9.4: Ventricles of brain (superior view)
BRAIN-NEUROANATOMY

Caudate nucleus

Fig . 9.Sa: Boundaries of third ventricle and central part of lateral ventricle (coronal section)

lobe). Thus, it is present only in relation to the central


Lateral part and inferior horn of the lateral ventricle. its convex
Corpus ventricle
margin is bounded by the fornix (body and crus), the
callosum
Caudate fimbria and the hippocampus (Fig. 9.6) and the concave
nucleus
m a rgin is bound ed by the thalamus (s uperio r a nd
posterior SLrrfaces), the tail of the caudate nucleus and
Thalamus
Third the s tria terminalis (Fig . 9.Sa). At the fissure, the pia
ventricle mater and ependyma come into contact with each other
and both a re invagina ted into the ventricle by the
choroid plexus.
In the centra l part of lateral ventricle, the cho roid
fissure is a narrow gap between the edge of the fornix
and the up p er s u rface of the th alamus. The gap is
invaginated by the choroid p lexus (Fig. 9.5).
Anterior Horn
Fig. 9.Sb: MRI showing third ventricle and part of lateral ventricle This is the part of the lateral ventricle which lies in front
of the interventricular foramen and extends into the
Floor
It is formed (from lateral to medial side) by:
1 Body of caudate nucleus (Fig. 9.Sb).
2 Stria terminalis.
3 Thalamostriate vein.
4 Lateral p ortion of the upper surface of the thalamus.
5 Choroid plexus.
6 Upper s urface of symmetric half of body of forn ix. Anterior

Medial wall lnterventricular - -- -1---1


It is formed by: foramen
1 Septum pellucid um.
2 Body of fornix (Fig. 9.5).
Choroid fissure
The line along w hich the choroid plexus invaginates
into the late ra l ventricle is called the ch oroid fissure. It
is a C-sh aped slit in the medial wall of the cerebra l
hemisph ere. It s tarts at the interventricular foramen
(above and in front) and passes arou nd the thalam us
and cerebral peduncle to the uncus (in the temporal Fig. 9.6: Ventricle seen from the lateral surface
THIRD VENTRICLE, LATERAL VENTRICLE AND LIMBIC SYSTEM

Septum pellucidum

"

Fig. 9.7a: Boundaries of anterior horn of lateral ventricle (coronal section)

Posterior Horn
This is the part of the lateral ventricle w hich lies behind
the s plenium of the corpus callos um and extends into
the occipital lobe. It is directed backwards and m ed ially
(Fig. 9.8).
Boundaries
Floor and medial wall
1 Bulb of the posterior horn raised by the forceps m ajor.
2 Calcara vis raised by the anterior part of the calca rine
sulcus.
Roof and Intern( waU
Tapetum fibres of optic radiation.

Occipital Inferior Horn


horn of
lateral This is the largest horn of the lateral ventricle. It begins
ventricle a t the junction of the central part w ith the posterior horn
of the lateral ventricle; and extends into the te mporal
lobe (Fig. 9.9).
Fig. 9.7b: MRI of anterior and occipital horns of lateral ventricles Boundaries
Roof and lateral wall
fronta l lobe. lt is directed forwa rds, la terally and down-
wards, and is triangular o n cross-section (Fig. 9.7 ). 1 Chiefly the tapetum.
2 Tail of caudate n ucleus.
Boundaries Optic
radiation
Anterior
Poste rio r s urface of genu and rostrum of the corpus Bulb of
Cavity of
callosu m. posterior
poslerior horn
horn
Roof
Anterior p art o f the trunk of the corpus ca llosum . Forceps Tapetum
major
Floor Inferior
1 H ead of the caudate nucleus. Calcarine longitudinal
sulcus fasciculus
2 Upper surface of the ros trum o f the corpus callosum.
Occipital lobe
Medial Calcar of cerebral
1 Septum p eHucidum. avis hemisphere
2 Column of fornix. Fig. 9.8: Boundaries of posterior horn of lateral ventricle
BRAIN-NEUROANATOMY

Tail of caudate This system helps us to select various events which


we need to remember. Lesions of limbic system cause
disturbances of motivation, memory and emotions as
occurs in schizophrenia.
CONSTITUENT PARTS
_..,.........._-+-+-- Inferior horn 1 Olfactory nerves, bulb, tract, striae and trigone.
or lateral 2 Anterior perforated s ubstance (Fig. 9.11).
ventncle
3 Pyriform lobe, consisting of the uncus, the anterior
Dentate ---"b:r-t?
gyrus
part of the parahippocampal gyrus, and a few small
~ - - 1 - t - - Collateral
areas in the region.
eminence
4 Posterior part of the parahippocampal and cingulate
- - - -+ - -- Collateral gyn.
sulcus 5 Hippocampal formation, including the hippocarnpus,
Hippocampus the dentate gyrus, indusium griseum and longitudinal
striae (Fig. 9.12).
6 Amygda/oid nuclei: It is a part of limbic system. Amygdala
Fig. 9.9: Boundaries of inferior horn of lateral ventricle evokes anxiety and rage. Its afferents are from olfactory
area and from cerebral cortex. Its efferent pass via shia
3 Stria terminalis.
terminalis and also go to uncus. Injury to arnygdala
4 Amygdaloid body. causes placity, orality and hypersexuality (Fig. 9.13).
Floor 7 Septa! region
1 Collateral eminence raised by the collateral sulcus 8 Fornix, stria terminalis, stria habenularis, and anterior
(Fig. 9.10). conunissure.
2 Hippocampus, medially.
FUNCTIONS
In the inferior ho rn, the line of ependymal invagi-
nation by the choroid plexus (i.e. the choroid fissu re) 1 Lt controls food habits necessary for survival of the
lies between the stria terminalis and the fimbria. individual. Regulates autonomic functions and
endocrine glands.
2 It controls sex behaviour necessary for s urvival of
LIMBIC SYSTEM the species. Controls endocrine glands.
3 lt controls emotion.al behaviour expressed in form
The main objects of primitive life are food and sex. Food of joy and sorrow, fear, fight and friend ship, liking
is necessary for survival of the individual, and sex, for and disliking, associated with a variety of somatic
survival of the species. The primitive brain is, therefore, and autonomic bodily a lterations. This requires
adapted to control and regulate behaviour of the animal integration of olfactory, somatic and v isceral
wi th regards to seeking and procuring of food, impulses related to memory and learning.
courtship, mating, housing, rearing of young, rage,
aggression and emotions. TERMS
The parts of the human brain controlling such
Following are the terms with their components related
behavioural patterns constitute the limbic system.
to limbic system.
These parts represent the phylogenetically o lder areas
of the cortex (archipallium and paleopallium) which Rhinencephalon
have been grouped in the past with the rhinencephalon Rhinencephalon comprises the following:
and were earlier considered to be predo minantly 1 Olfactory mucosa
olfactory in function. H owever, their important role in 2 Olfactory bulb
controlling the behaviour patterns is now increasingly 3 Olfactory tract-3 roots:
real ized. a. Medial root ends in subcallosal or parolfactory
Structures comprising li mbic system form a ring gyrus (Flowchart 9.la).
along medial wall of cerebral hemisphere. These are b. Intermediate root ends in anterior perforated sub-
interposed between hypothalamus and the neocortex. stance and diagonal band of Broca (Fig. 9.11).
Limbic structures process and monitor emotional c. Lateral olfactory root ends in pyriform lobe (uncus,
aspects of experience and direct emotional responses. anterior part of parahippocampal gyrus, cortex in
These aid in understanding the behavioural con- region of li.men insulae, dorsomcd.ial part of amygda-
sequences of our deeds with the help of frontal lobe. loid nucleus) (Fig. 9.12 and Flowchart 9.la).
THIRD VENTRICLE, LATERAL VENTRICLE AND LIMBIC SYSTEM

(a)

Anterior horn of- - - - -~ ~ -___.:----,~


lateral ventricle

Inferior horn of - - - ----':--=-------r


lateral ventricle
;:.__ ___,,~'---- - - Posterior horn of
lateral ventricle

{b)

Figs 9 .10a and b: Cavity of lateral ventricle including its anterior horn, body, inferior and posterior horns
BRAIN-NEUROANATOMY

~ - - - - - - 1 - -- - Anterior perforated su bstance/


intermediate olfactory area

Fig. 9.11 : Olfactory bulb and olfactory stria

,---- - Corpus callosum

Olfactory tract , ..i:--~-- - - lnterpeduncular nucleus


Lateral olfactory area ~->n---- Raphe nuclei of midbrain
Entorhinal area (reticular formation)
Intermediate olfactory area _ _ __ _ _ _ _ _....:::::::.._;;~_ __!:::==="- ========:::.._--- Cortex of uncus and
amygdaloid body
Fig. 9.12: Some connections of the olfactory cortical areas

)
~\ ~ - - - - - - Fornix
lndusium griseum and - - + - - - ----..._
longitudinal striae
Anterior nucleus of thalamus - -+---"~- - - -<+---r--~ .n+-- - lndusium griseum continues
Lamina terminalis - -+---- ---..Y..~~ with dentate gyrus
Septal area - --....-..---'-- - - -- ~0t1' Mammillothalamic tract
Medial olfactory stria/root--->-s::-"<--- -----:~i"/ Mammillotegmental tract
Olfactory lract - -,,--- ---},--:::::::::::::=---:::;::::,,..;::._
Olfactory bulb - -=__,- Mammillary body
??5""'--"7""--- - - - Alveus
Lateral olfactory stria - - - - -- - ~ c::::::::====
,...
.J!:: . _p~c;___-:;,-L-- -- - - - - Dentate gyrus
Uncus - - - - - --
'1--..:::::::::~_,....'-----'r--_-_-_-_--~---- Amygdaloid body
Hippocampus - - - - -- ~---~ - and stria terminal is

Fig. 9.13: Fornix and related pathways of limbic system


THIRD VENTRICLE, LATERAL VENTRICLE AND LIMBIC SYSTEM

Flowchart 9.1a: Olfactory tracts Cingulate gyrus Corpus callosum


Medial Subcallosal Fornix
Olfactory tract
olfactory root gyrus
Septu m
pellucid um

Lateral UNCUS lndusium griseum Anterior


olfactory root with medial and commissure
lateral longitudinal
striae Subcallosal
area and
para terminal
gyrus
Uncus Dentate gyrus I \
Orbital gyri
Flowchart 9.1 b: Hippocampus

~ Alveus 1-I- - - • • Fimbria. fornix

Entorhinal cortex - -~
Mammillary body
Fig. 9.14: Parts of limbic system

HIPPOCAMPUS I Papez Circuit


It interconnects limbic structures, hippocampus, fomix,
rnammillary body, mammillothalarnic tract, anterior
nucleus of thalamus, cingulate gyrus, cingulum, para-
Continuous
Parahippocampal gyrus - -I---- with- - Cingulate gyrus I hippocarnpal gyrus (Fig. 9.15 and Flowchart 9.lc). It is
important for long-term permanent memory.
Flowchart 9.1c: Papez circuit
Mammillary body 1-I- - - - • • Anterior nucleus of thalamus Cingulum-715;:;:,g;::::;- ~ -
~ ~ - ~ ~ ~- ~ - Anterior
thalamic
Thalamocingulate ~ ~--C~~~,f7~;;:,,. nucleus
tract ~
PAPEZ CIRCUIT I Mammillothalamic -----',"-',~_,.\:
tract Forn ix

Mammillary body ----='::::::,~=..,

Hippocampal formation 11------ Cingulate gyrusl Uncus - -----'"-='-.,"'--.J __.::::;,~--7t--


Hippocampus
Fornix from
hippocampus
Parahippocampal lo mammillary
Connecting Pathways gyrus body

Al veus, fimbria, fornix, mammillary body, mammillo- Fig. 9.15: Uncus and Papez circuit
thalamic tract, and sh·ia terrninalis (Fig. 9.1 3).
Limbic Lobe CLINICAL ANATOMY
Hippoca mpu s, parahippocampal gy rus, cingulate • Hippocampus can be regarded as the cortical
gyrus, subcallosal gyrus, and amygdala. These are non-
centre fo r a utonomic reflexes. Hippocarnpal-
neocortical structures (Fig. 9.14).
amygdala complex is related to the memory of
Hippocampal Formation recent events . Lesions of this complex a re
Hippocarnpus, dentatc gyrus, a nd part of parahippo- associated with a loss of memory for recent events
campal gyrus (Flowcha rt 9.lb). only. Patient is unable to commit any new facts to
memory and does not remember recent events. In
Limbic System spite of this, his general intelligence remains
This is a functioning group. It includes hypothalamus, unaltered.
some nuclei of thalamus, tectum of midbrai..n, frontal • Destruction of olfactory nerves results in loss of
lobe, insula r cortex. These are all concerned with the sense of smell (anosrnia).
emo tional sta tes and behaviour.
BRAIN- NEUROANATOMY

• A tumour, usually a meningioma, in the floor of CLINICOANATOMICAL PROBLEM


anterior cranial fossa may interfere with the sense
of smell because of pressm e on olfacto ry bulb and A patient complained of severe headache and vomit-
the olfactory tract. It is necessary to test each ing off and on for a few months. Later these became
nostril separately because the olfactory loss is persistent. On examination and investigations, there
was a tumour below third ventricle which p revented
likely to be unilateral.
the normal flow of CSF. He also showed papillo-
• A lesion that affects the uncus and amygdaloid edema.
body may cause, " uncinate fits" characterised • Which organ would usually be involved in tumour?
by an imaginary disagreea ble odour, by movem-
• Name the nuclei of thalamus.
ents of lips and tongue, and often by a "dream y
s tate". Ans: Mostly the thalamus is involved in this case.
Since third ventricle is a very narrow space between
the two thalami, it gets blocked easily causing
headache and vomiting. The meninges and CSF travel
• The right and left lateral ventricles communicate along the optic nerve till the optic disc. The raised
with the single third ventricle through the inter- intracranial pressure is projected at the optic disc in
ventricular fora.men. the form of papilloedema.
• Third ventricle is a slit-like ventricle in between Nuclei of thalamus: Anterior, medial and lateral
the two thalami. groups.
• Aqueduct is the na rrow du ct connecting 3rd Group lateral is divided into:
ventricle above with the fourth ventricle below. • Dorsola teral w hich comprises-lateral dorsal,
• Limbic system comprises connections of fomix and lateral posterior and pulvinar.
Papez circuits. These are mostly present on the flat • Ventromedial which comprises-anterior, inter-
media] surface of cerebral hemisphere. mediate and posterior.

FREQUENTLY ASKED QUESTIONS

1. Write an essay on third ventricle of brain. 3. Write sho rt notes on:


2. Describe the structures seen in the body and inferior a. Papez circuit
horn of lateral ventricle. b. Limbic system

MULTIPLE CHOICE QUESTIONS

1. Forame.n of Monro connects: 4. What is correct form of Papez circuit?


a. Lateral ventricle to 4th ventricle a. Mammillary body-anterior nucleus of thalamus-
b. 3rd ven tricle to 4th ventricle cinguJate gyrus-hippocampal forma tion
c. 3rd ventricle to aqueduct b. Mammillary b od y-cingulate gyrus- anterior
d. Lateral ventricle to 3rd ventricle nucleus of thalamus-hippocampal formation
2. Which of the followi ng is largest horn of lateral c. Mammillary body-hippocampa l formation-
ventricle? anterior nucleus of thalamus-<:ingulate gyrus
a. Posterior horn b. Inferior horn d. Anterior nucle us of thal amus-mammillary
c. Anterior horn d. Central part bod y-cingulate gyrus-hippocampal formation
3. Which is not a part of limbic system? 5. H ippocampal amygdala is related to:
a. Hypophysis cerebri a. Memo ry for recent events
b. Amygdaloid nuclei b. Movements
c. Olfactory nerve, bulbs, tracts and stria c. Emo tional behaviour
d. Fornix d . one of the above

ANSWERS
1.d 2.b 3. a 4. a 5. a
CHAPTER

10
Some Neural Pathways and
Reticular Formation
g;j} i.J ,, ron..Jln,,I Jl,"f/7/r la 1:-<<'j, "f nffrr,1,u1J1N!., rnu/ he~f rltHCII l!.tj,e11Je.>
-P Syrcus

INTRODUCTION Origin
Course of pyramidal tracts responsible for voluntaiy Each p yramidal tract contains about one million fibres
movements is described here. The sensory pathways which origina te from:
for ex terocep tive, unconsciou s a nd consciou s 1 The motor area 4 of the cortex
proprioceptive are o utlined. 2 Premo tor a rea 6 and also
3 The somesthetic a reas 3, 2, 1.
PYRAMIDAL TRACT: CORTICOSPINAL
AND CORTICONUCLEAR TRACTS Certain notable fea tures of the motor cortex are given.
1 The body is represented upside d own. The areas for
This is a descending tract, extending fro m the cerebral the legs and perineum lie in the paracentral lobule.
cortex to various motor nuclei o f the cranial and sp inal 2 The angle of mouth, tongue, la ry nx, the thumb and
nerves. lt constitutes the upper motor ne u ron in the the great toe are represented by relatively large
motor pathway from the cortex to voluntary muscles. areas.
Corticonuclear fibres reach the nuclei of crania l 3 It is the movements which are represented in the
nerves (Fig. 10. ] ). cortex rather than the individual muscles.

Facial area of motor cortex Course


The tract passes through the following parts of the C S.
1 Corona radiata.
2 Inte rnal capsul e, occupying the genu a nd the
posterior limb.
3 Middle two-thirds of the crus cerebri of the mid brain.
4 Basilar part of the pons.
5 Pyramid of the medulla . In the lower part of the
medulla, about 75 to 80% of the fib res cross to
opposite side and descend as the la teral (crossed)
corticospinal tract. About 20% fibres remain
uncrossed and run down as the anterior (uncrossed)
corticospinal tract (see Fig. 3.11 ).
6 Thus, in the spinal cord, there are two corticospinal
tracts: Lateral (crossed) and anterior (uncrossed) .
Ultimately most of the uncrossed fibres also cross to
the opposite side before termination (see Fig. 3.12).
Termination
' - -- I - - - -- - Ambiguus nucleus
Before termination, all fibres of the pyramidal tract cross
~ - - -- - Hypoglossal nucleus to opposite side. They terminate, mostly through an
Fig. 10.1: Pathway of corticonuclear fibres interneuron, in the motor nuclei of cranial nerves and
161
BRAIN-NEUROANATOMY

in relation to the anterior horn cells of the spinal co rd. PATHWAY OF PAIN AND TEMPERATURE
The fibres which terminate in the moto r nuclei of the Receptors
cranial nerves collectively form the corticonuclear tract.
1 Free nerve endings for pain.
2 End bulbs of Krause for cold.
Functions
3 Organs of Ruffini for warmth, and of Golgi-Mazzoni
1 The pyramidal tract is concerned w ith voluntary for heat.
movements of the body.
2 Possibly, it is also the pathw ay for superficial reflexes. First Neuron
Firs t n euron is located in the d orsal root gan glia.
Peripheral processes of neurons in the gang li a
CLINICAL ANATOMY
constitute the sensory nerves. These processes end in
• Effects of lesion of the pyramidal tract: relation to the receptors. The central processes of the
Lesions above the level of decussa tion cause neurons pass through the dorsal nerve roots to enter
contralateral para lysis (Fig. 10.2), w hile lesions the spinal cord, where they synap se w ith the second
below the decussation cause ipsilateral paralysis. neuron.
It is an upper m otor neuron type of paralysis
Second Neuron
which is characterized by the foll owing.
a. Loss of the power of volunta ry movements. Second neuron is located in the grey matter of the spinal
b. Clasp-knife type of rigidity (h ypertonia). cord. Their axons form the lateral spinothalamic tract.
c. Tendon reflexes are exaggerated. Th is tract is crossed . lt ascends through the lateral white
d. Superficial reflexes are lost. column of the spinal cord to enter the brain stem. In
e. Babinski's sign is positive. the brain stem, this tract is referred to as the spinal
f. Reaction of degeneration is absent. lemniscus to end in the thalamus (Figs 10.3a and b).

Lower limb
Third Neuron
Third neuron lies in the posterolateral ventral nucleus
of the thalamus. Fibres arising in this nucleus pass
through the internal capsule and the corona radiata to
Motor cortex reach the somatosensory areas 3, 1, 2 of cerebral cortex.

PATHWAY OF TOUCH
Basal--1/-....,..~':r----'.-
ganglia
Receptors
1 Tactile (Messiner's) corpuscles.
4 ~~2~contralateral 2 Merkel's discs.
hem1plegla 3 Free nerve endings around the hair follicles.

First Neuron
First neuron is similar to that for pain and temperature
Decussation of ----1-- pathway. The 2nd neuron is different for fine touch and
pyramids (medulla)
+-- - - - Quadriplegia/ for crude touch.
Lateral corticospinal tetraplegia
tract (pyramidal)
"E
0
PATHWAY OF FINE TOUCH
u Upper limbs
oi
C ~
1 The central processes of the neurons in th e d orsal
·a. nerve root ganglia en ter the posterior white column
en
of the spinal cord and form the fasciculus gracilis and
the fasciculus cuneatus. These are uncrossed tracts.
2 The second neuron lies in the nucleus gracilis o r
nucleus cuneatus. It gives off the internal arcua te
fibres which cross to the opposite side through the
Skeletal muscles sensory decussation. Reaching the other side they
of lower limbs
run upwards as the med ial lenmiscus. The medial
Fig. 10.2: Effects of damage to motor pathway
lemniscus ends in the posterolateral ventra l nucleus
of the thalamus.
SOME NEURAL PATHWAYS AND RETICULAR FORMATION

Cerebral hemisphere PATHWAY OF PROPRIOCEPTIVE (KINAESTHETIC)


IMPULSES
Caudate nucleus - - ------. Face Receptors
Internal capsule - -- -~ d 1 Muscle spindles
<'+ --->,->,- Lentiform
nucleus 2 Golgi tendon organs
3 Pacinian corpuscles
Trigeminal lemniscus - - ------..,
Pons
II 4 Uncapsulated nerve endings.

Pain
Fif1h nerve
sensory nucleus
~
TA !;· Medial lemniscus
and lateral
First Neuron
First neuron is similar to that for pain and temperature.
from spinothalamic ln their further course, the proprioceptive pathways
face tract or spinal are different for conscious and unconscious impulses.
lemniscus
Medulla:
Upper part PATHWAY OF CONSCIOUS
Nucleus gracilis - ~ ,...._, PROPRIOCEPTIVE IMPULSES
v 1 - -->r-- Medial lemniscus
Nucleus cuneatus Their course is similar to that for fine touch described
Lateral
Posterior columns spinothalamic earlier.
(no relay) I tract
Vibration] ~ 1 PATHWAY OF UNCONSCIOUS
- ~" - . ~-, I
Position ~ Spinal cord
PROPRIOCEPTIVE IMPULSES
1/2 touch ,
Painj ,,. Medulla: La_teral .
These impulses end in the cerebellwn (see Figs 3.16
Temperature
L
ower
part (
a)
spinothalam1c
tract
and 3.17).
1 The first neuron has been described above.
2 The second neuron fibres a re represented by three
Lateral tracts, namely the pos terio r a nd anterior spino-
spinothalamic
tract (pain and cerebellar tracts (from the lower limb and trunk) and
temperature) the cuneocerebellar tract (posterior external a rcuate
fibres) from the upper limb.
The posterior spinocerebellar tract contains ipsilateral
fibres arising in dorsal (thoracic) nucleus of the spinal
(b) cord. It enters the ipsilateral cerebellar hem isphere
through the inferior cerebellar peduncle.
Figs 10.3a and b: Pathway of: (a) Pos terior column, and
(b) pain and temperature impulses The anterior spinocerebellar tract is made up mainly
of crossed fibres arising from the spina l g rey matter
(posterior grey column). The fibres ascend to the upper
3 Fibres sta rting in the thalamus pass through the part of pons and then tum down into the superior cere-
internal capsule and the corona radia ta and end bellar peduncle to reach the cerebellum of same side.
in the somatosensory area of the cerebral cortex The cuneocerebellar tract (posterior ext£'rnal arcuate
(areas 3, 1, 2). fibres), is functionally similar to the posterior spino-
cerebellar tract. It arises from the accessory (external)
PATHWAY OF CRUDE TOUCH cunea te nucleus which receives afferents from the
1 The cenh·al processes of neurons in the dorsal nerve fasciculus cunea tus. The tract enters the ipsilateral
root ganglia terminate in the grey matter of the spinal cerebellar hemisphere through the inferior cerebellar
cord. peduncle.
2 The second neuron lies in the spinal cord (mainly
the posterior grey column). Axons of those neu rons TASTE PATHWAY
cross the midline a nd form the anterior spino- 1 The taste from anterior two-thirds of tongue except
thalamic tract. ln the brain stem, this tract merges from vallate papillae is ca rried by chorda tympani
with the medial lemniscus. branch of facia l till the genicula te ganglion. The
3 The third neuro n and termination of the pathway central processes go to the tractus solitarius in the
are the same as for fine touch . medulla (Fig. 10.4).
BRAIN- NEUROANATOMY

Greater petrosal - -- -- - -~

J-- From receptors in palate and nasopharynx

- - - Pterygopalatine ganglion
~ - -- - Pterygoid canal

0 Lingual nerve
f
2:-
-0~
(/)

0
(/) ::::::-➔- From taste receptors in anterior
:,
Q) two-thirds of tongue and oral cavity
13
:,
C ~ - -- Submandibular ganglion
~ IX

"'-,!r-- - - - - From taste receptors in posterior one-third of tongue


X and oropharynx

~ -- - -- From taste receptors in epiglottis and pharynx

Fig. 10.4: Taste pathway

2 Tas te from posterior one-third of tongue including 2 It is very diffuse in its distribution, and has ill-d efined
the vallate p apillae is carried by cr anial nerve IX till bounda ries.
the inferior ganglion. The central processes also reach 3 It is be tter d efined physiologically than an atomically
the tractus solitarius.
(see Figs 5.5, 5.12 and 5.13).
3 Tas te from p os terio r mos t part of tongue and
epiglottis travel through vagus nerve till the inferior
ganglion of vagus. These central processes also reach CONNECTIONS
tractus solitarius. The reticular form a tion is connected to all the p rincipal
4 After a relay in tractus so litar iu s, th e solita rio- pa rts of th e n e rvou s system , includ ing the motor,
thalamic tract is formed which becom es a p art of sensory and a utonomic p athways w ith their centres.
tri geminal le mniscu s and reach es the ven tro- The connections a re reciprocal (to and fro) p roviding
posteromedial nucleus of tha lamus of opposite sid e. feedback mechanisms. Thus, the reticular formation is
Another relay here takes the fibres to lowest p art of connected to:
postcentral gyru s, which is the area for taste.
1 The motor neurons of the cerebral cortex, the basal
gan glia, the cerebellum, various m asses of grey
RETICULAR FORMATION matter in the brain s tem including the nuclei of
cranial and sp inal nerves.
The reticular formation is a diffuse n etwork of fine
ne r ve fibres interming led with numerou s poo rly 2 The sensory 11e11rons of the somesthe tic path ways
defined nuclei. Phy logen e tically, it is very old: ln (cortex, thalamu s and s pinal cord), visual pathway,
primitive vertebra tes, it represents the largest p a rt of audito ry pa thw ay, and equilibratory pathways. In
the C S. In m an, it is best developed in the brain s tem, this group, the ascending reticular activating system
although it can be traced to all levels of the C S. (ARAS) is of prime importance. It is formed by a great
num ber of collate ra ls from the spinoth a la m ic,
LOCATION AND IDENTITY trigeminal and auditory pathways to the lateral parts
1 The reticular forma tion , in general, is placed in the of the reticular forma tion, which themselves project
deep and d orsal p arts of the neural axis. to the re ticular and intral a mina r nuclei o f the
SOME NEURAL PATHWAYS AND RETICULAR FORMATION

thalamus. These nuclei, in tum, project to widespread p recise effects of w hich depend up on the type of
area of cerebral cortex. narcotics used and its d osage. Narcotics depress the
3 The autonomic neurons of the hypothalam us, limbic diffuse thalam ocortical system as well.
system and the general viscera l efferent columns. 2 Barbiturates depress the afferent impulses reaching
the reticular-activating pathways.
FUNCTIONS 3 Analgesics act by suppression of reactions concerned
with activation of reticular-activating pathways.
Inhibitory and Facilitatory Influences 4 Morphine suppresses the corticoreticular pathways,
Through its connections w ith the mo tor areas of the and stimulates the nonspecific thala mic system,
nervous system, certain areas of the reticular forma tion rhinencephalon and its p rojections. It also depresses
inhibit voluntary and reflex activities of the bod y, while conduction along specific sensory pathways.
certain o ther areas fac ilitate them.

State of Arousal, General Awareness and Alertness


The ascending reticular activating system (ARAS) is • Corticonuclear fibres give fibres to cranial nerve
responsible for maintaining the state of wakefulness nuclei.
and alertness, by its connections with a great number • The corticonuclear fibres of one s ide of cortex reach
of collaterals from sensory tracts. Thus, se nsory percep- VII nerve nucleus of both sides w hich supply the
tion of any type is quickly and acutely appreciated, so m uscles of upper half of face on both sides. lt also
that an appropriate motor response by the body may gives fibres to nucleus of VII and supply to lower
be synthesized and actuated . half of facial m uscles only on the contralateral side.
Sleep is a normal, period ic inhibition of the reticular • Unconscious impulses reach ipsilateral cerebellum,
formation. Hypnotics an d general anaesthetics prod uce while conscious impulses reach the con tralateral
their effects by acting on this system . cerebrum.
• Anterior spinoth alamic carrying crude touch and
Autonomic Influences
pressure joins the m ed ial lemniscus during its
Through its autonomic connections and certain specific upward jou rney thro ugh the bra in stem. Thus,
centres, the reticular formation influences respiratory med ial lemniscus carries conscious proprioceptive
and vasomo to r activities . Th ey a re s timul ated o r sensations, i.e. movement, vibration and position
sup pressed accord ing to the needs. includin g w h o le touch a nd pressure to the
Through its connections with the limbic system, it thalamus.
participa tes in regu lating em otional, behavioural and • ucleus of tractus soLita rius receives impul ses of
visceral activities. It also takes part in neuroendocrine taste through chorda tympani, branch of VII from
regulation and the development of cond itioned an d
most of anterior two-thirds of tongue; through
learned refl exes.
glossopharyngea l from circum valla te papillae and
ACTION OF DRUGS
pos terior one-third of tong ue. It also receives
impulses from posterior most part of tongue and
1 Narcotics act more on nonspecific sensory system vallecuJa v ia in ternal laryngeal branch of vagus
and less on the specific sensory system. Their main nerve.
action is depression of reticular-activating system,

FREQUENTLY ASKED QUESTIONS

1. Describe the pyramidal tract under the following 3. Write short notes on :
headings: a. Pa th way of un con scio u s p rop ri ocp tive
a. Origin imp ulses
b. Course b. Pathway of taste
c. Termination and fu nctions c. Location an d main connectio ns of reticular
2. Describe the pathway of crude touch and fine to uch. formation
BRAIN- NEUROANATOMY

MULTIPLE CHOICE QUESTIONS

1. Nucleus receiving impulses of taste: 3. Ascending reticular-activating system is formed by:


a. Dorsal nucleus of vagus a. Great number of collaterals from spinothalamic
b. Spinal nucleus of trigeminal nerve tract
c. ucleus ambiguus b. Trigeminal lemniscus
d. Tractus solitarius c. Auditory pathway
2. Action of barbiturates is: d . All of these
a. Suppress the corticoreticular pathways 4. Upper motor neuron type of paralysis is charac-
terised by:
b. In crease the ac tiv ity of reticu 1ar-activa ting
system a. Clasp knife type of rigidity
c. Depress the afferent impulses reaching reticular- b. Tendon reflexes are exaggerated
activating pathway c. Babinski's sign positive
d. one of these d. All of these

ANSWERS
1. d 2.c 3.d 4. d
CHAPTER

11
Blood Supply of
Spinal Cord and Brain
,37,c 0 11~'1 rrrn/u,;11 1rillt 1tt-l,irl, //,e 1111ro11Jrio r,.J. j,oli, nl ra11 i,11,urrlir,lel11 ulnlk,le uj,0 11 llu• l11eo,11/u~lc11I ,11n9con ,J ltae1116nl,ntl"
-William S Halsted

INTRODUCTION Many of these radicular branches are small and end


The nervous tissue is too delicate to bear anoxia beyond by supplying the nerve roots. A few of them, w hich
three minutes. The blood supply to nervous tissue per a re larger, contribute blood to the s pinal arteries.
unit tissue is maximum in the body. It shows the Frequently, one of the anterior rad.icular branches is
importance of the grey matter. The blood supply may very large and is cal.led the arteria rndicularis magna. Its
be erratic due to haemorrhage, thrombosis or embolism position is variable. TI1is artery may be responsible for
of the arteries supplying the nervous tissue. Further supplying blood to as much as the lower two-thirds of
the arteries are "end arteries" once these reach the the spinal cord.
dee per level. eurons die, in bits and pieces; an The veins draining the spinal cord are arranged
individu al also walks slowly a nd steadi ly towards in the form of six longitudinal channels. These are
death, and tha t is the end of this physical life. anteromedian and posteromcdian channels that lie in
the midline; also a n tero la teral and posterolateral
channels that are paired. These channels are inter-
BLOOD SUPPLY OF SPINAL CORD connected by a plexus of veins that form a venous
vasocorona. The blood from these veins is drained by
The spinal cord receives its blood supply from three radicu.lar veins that open into a venous plexus lying
longitudinal a rterial channels that extend along the between the dura and the vertebral canal (epidural or
leng th of the cord. The anterior spinal artery is present internal vertebral plexus) and through it into various
in relation to the anterior median sulcus. Two posterior segmental veins.
spinal a rteri es (one on each s ide) run along the
~ Posteromedian vein
posterolateral sulcus (i.e. along the line of attachment
of the dorsal ne r ve roots). In a dd it ion to these •L Posterior median septum
channels, the pia ma ter covering the s pinal cord
has an a rterial plexus (called the arteria vasocorona)
• - - - Posterolateral

Posterior---,,L--- ""°'
which also sends branches into the substance of the horn
cord (Fig. 11.1). ~ - ------ Posterior
funiculus
The main source of blood to the spinal arteries is from
the vertebral arteries (from which the anterior a nd Anterior ------~
_ __,_ Lateral
posterior spinal arteries take origin). However, the horn funiculus
blood from the vertebral a rteries reaches only up to the
cervical segments of the cord. The spinal arteries also
receive blood through radicular arteries that reach the
cord along the roots of spinal nerves. These radicular
arteries arise from spinal branches of the vertebral,
ascending cer vical, deep cervical, intercostal, lumbar
and sacral arteries.
167
BRAIN- NEUROANATOMY

CLINICAL ANATOMY
Ophthalmic
Anterior spinal artery supplies anterior two-thirds while Posterior artery
posterior spinal artery s upplies posterior one-third of cerebral
spinal cord. Posterior column gets affected in posterior artery
spinal artery thrombosis. Anterolateral columns get
affected in anterior spin a I artery thrombosis (Fig. 11.2). Basilar - --\- --
' - - - - - ---".:..,::::.._ Posterior
artery
l""li,,,,,.-_,--,----i,--..._,.~_ Posterior spinal Junction of
communicating
artery
artery terntory
vertebral a.•- - - ---.'-- External
arteries carotid

'--__,__- - - - Internal
carotid
Vertebral-+---- ---
artery -......._ _ __ Common
carotid

Fig. 11 .3: Carotid and vertebral arteries

Posterior Inferior Cerebellar Artery


It is the largest bran ch w hich arises from vertebral
artery after it pierces the meninges. It pursues a tortuous
Anterior spinal
cou rse, passes between rootlets of hypoglossal, vagus
artery territory and glossopharyngeal nerves supplies almost lateral
half of medulla as far as the lower border of pons, reaches
Fig. 11.2: Thrombosis of the anterior spinal artery
its posterior aspect between the thin roof of cavity of
fourth ventricle a nd cereb ellum, gives a choroidal
ARTERIES OF BRAIN branch to the choroid plexus of fourth ventricle and
turns downwards on the cerebellum supplying it.
Two vertebral and two internal carotid arteries carry
the total arteria l s uppl y to the brain (refer to BOC App). Anterior Spinal Artery
It is formed by the union of a branch from each vertebral
VERTEBRAL ARTERIES artery on ventral surface of m edulla oblongata close to
The vertebral artery on each side is a branch of first part the pons. It s upplies the med ian p a rt o f m edulla
of subclavian artery. Its course is di vided into four parts: oblonga ta and continues in feriorly throughout the
• 1st part lies fro m its origin to the foramen transver- length of spinal medulla/ cord (Fig. 11.1).
sarium of 6th cervica l vertebra.
Medullary Branches
• 2nd part courses throu gh fora men transversaria of
6th to 1st cervical vertebrae (Fig. 11 .3). As vertebral artery ascends along medulla oblongata,
• 3rd part lies on the pos terior a rch of atlas vertebra in it gives number of brand1es to the medulla oblongata.
the suboccipital triangle. Meningeal Branches
• 4th part of the vertebral arte ry enters the cranium
through fora.men magnum under the free margin of A few meningeal branches are given.
posterior a tlanto-occipital membrane.
It enters the s ubarachnoid space in the upper part of BASILAR ARTERY
vertebral cana l after piercing the dura mater and lt is formed by the union of two vertebral arteries
arachnoid mater. Then it curves round the ventrolateral at the lower border of pons. It lies in the median groove
aspect of the medulla oblongata between the rootlets of pons in cisterna pontis and at the upper border of
of hypoglossal nerve, to unite with its fellow at the lower pons ends by dividing into two posterior cerebral arteries.
border of pons and forms the median basilar artery .
Branches
lntracranlal Branches
1 A nterior inferior cerebellar artery: It arises at the lower
Posterior Spinal Artery border of pons, and passes laterally, supplying the
It is the first intracranial branch. It passes inferiorly on sixth, seventh and eighth cranial nerves. Tt then loops
the spinal m edulla among dorsal roots of spinal nerves over the floccu lus of cer ebellum and s u pplies
(Fig. 11.4). anteroinferior aspect of cerebellum.
BLOOD SUPPLY OF SPINAL CORD AND BRAIN

'"-,.___ _ _-+--_ Anterior inferior


cerebellar

.,r-.- - - - - - - Meningeal
,.,....;__,...____,,AJ.i
~ - - - - - - Vertebral
Fig. 11 .4: Arteries related to brain stem

2 Labyrinthine artery: Tt accompanies the vestibulo- surface of midbrain and then curve posterolateral
cochlear nerve and enters the internal a uditory to midbrain at inferomedia I surface of corresponding
m ea tus to supply the internal ear. It is an end artery. hemisphere supplying it with cortical branches.
3 Pontine branches: Th ese are numerous s lender Branches of posterior cerebral arteries
branches whid1 pierce the pons both in the medial l Posteromedial central branches: These pierce ventral
and late ral parts (Fig. 11.4). surface of base of brain thus forming the posterior
4 Superior cerebellar artery: It arises close to superior perforated substance in the interpeduncular fossa. These
border o f pons. It w inds posteriorly along the supply mid brain and caudal part of diencephalon.
superior border of pons and middle cerebellar 2 Posterior choroidal artery: Arises on the lateral aspect
pedtmcle supplying both. It sends many branches of central branches, supplies choroid plexus of the
to the superior surface of cerebellum. lateral ventricle and the third ventricle.
5 Two tenninal posterior cerebral brmzches diverge at upper 3 Cortical bra11ches, namely temporal branches, parieto-
border of pons: These give rise to number of central occipital branch a nd occipita l branch to cerebral
(posteromedial group) branches into the ventral cortex as shown in Figs 11.Sa and b.

Occipital
~ - r- -Posterior branch
cerebral
artery

r--"~ r\-- Temporal


branch

.....-=----r- Occipital
branch

Central branch - -- - - -- -~
Calcarine
Temporal branch -- - - - - - - - ~ branch
(a) (b)

Figs 11 .5a and b: Posterior cerebral artery on: (a) Inferior surface of left cerebral hemisphere, and (b) medial surface of right cerebral
hemisphere
111111 BRAIN- NEUROANATOMY

CLINICAL ANATOMY ~ - -- -- - - X nuclei and


_ __,_~.,,, nerve
• Thrombosis of posterior cerebral artery results in Sympathetic
homonymous hemianopia on the opposite side. fibres
• Thrombosis of superior cerebellar artery results
in Fig. 11.6. XII nucleus and
a. Cerebellum: Disturbed gait, limb ataxia . emerging nerve
b. Brain stem: Ipsilateral Hom er's synd rome.
V nerve nucleus
Contralateral sensory loss- pa in and tem- and tract
perature (including face).
• Damage to anteri o r in ferior cerebellar artery ~ <--- -- Spinothalamic
results in Fig. 11.7. tract
a. Cerebellum: Ipsilateral limb ataxia.
b Brain stem: Ipsilateral- Hom er's synd rome.
Sensory loss-pain and temperature of face. Fig. 11 .8: Effects due to thrombosis of post erior infe rior
cerebellar artery
Facial weakness and paralysis of lateral gaze.
Contralateral sen sory loss-p ain and tem -
perature of limbs and trunk.
• Thrombosis of posterior inferior cerebellar artery INTERNAL CAROTID ARTERY
ca uses damage as given in fig. 11.8: Each internal carotid artery enters the cran ial cavity
a. Cerebellum: Dysarthria, ipsilateral limb ataxia, after traversing the carotid canal and superior aspect
vertigo and nysta gmus (due to damage to of fora men lacerum . It then courses throug h the
vestibulo-floccular connections).
cavernous sinus, pierces the d ural roof of sinus and
b. Brain stem: Ipsilateral- H orner's syndrome.
Sensory loss-pain and temperature of face. ends immediately lateral to optic chiasma and inferior
Pharyngeal and laryngeal paralysis. to anterior p erfo rated subs tance and d iv ides into
Contralateral sensory loss-p ain and tem- middle and anterior cerebral arteries.
perature of limbs and trunk.
Branches
1 Opht/U1lmic arten; for the contents of orbit (see Chapter 13,
Volume 3).
2 Posterior com111u11icating arten;: It passes posteriorly
across the crus cerebri to join the posterior cerebral
Il l- - + -- -- -+-•"\
nucleus
artery and helps to complete the arterial circle. It
gives branches to the crus cerebri, optic tract,
Red -\-----1:;::--___,.,__
hypophysis and hypothalamus.
nucleus 3 Anterior choroidal artery: It passes posterolaterally,
supplies crus cerebri and turns laterally to the medial
aspect of temporal lobe to supply choroid plexus of
inferior horn of lateral ventricle.
Fig. 11.6: Effects due to thrombosis of superior cerebellar artery 4 Anterior cerebral artery: It is a terminal branch of
internal carotid artery and runs above the optic nerve
to follow the curve of corpus callosurn. Close to its
- - - -- - - VI nucleus
ori gin, th is artery is joined b y a nterio r co m-
Sympathetic municating artery. Deep branches of anterior cerebral
fibres
supply part of internal capsule and the basal nuclei.
VII nucleus and Cortica l branches s upply the med ial surface of
emerging nerve
hemisphere by g iving:
' '-,,_,__ _ V nucleus a. Orbital
and tract b. Frontal
c. Parietal branches (Fig. 11.9).
6'--- -- - Spinothalamic
5 Middle cerebral arten;: lt is the larger terminal bran ch
tract
of internal carotid artery tha t lies in line w ith
the internal carotid artery (Figs 11.l0a and b). It runs
Fig. 11.7: Effects due to damage to anterior inferior cerebellar artery
laterally in the stern of lateral su.lcus. It gives off:
BLOOD SUPPLY OF SPINAL CORD AND BRAIN

Parietal a. Deep or perfora ting branches which s upp ly


Frontal
-=~- - - - - - Area for anterior limb of internal capsule and part of basal
micturition nuclei. The artery then passes out to the lateral
and leg
surface of hemisphere at the insula of the lateral
sulcus. It ends by giving cortical branches.
b. Temporal (Fig. 11.11 )
_ __,,_.......,.-----;.-+-- Corpus
c. Frontal
callosum
d. Pa rietal branches.

CIRCULUS ARTERIOSUS OR CIRCLE OF WILLIS


It is a hexagonal arterial circle, situated at the base of
Orbital brain i.11 the interpeduncu..lar fossa. It is formed by the
anterior cerebral branches of internal carotid, terminal
Fig. 11 .9: Medial surface of right cerebral hemisphere with parts of internal carotid arteries and the poste rior
anterior ce rebral artery cerebral brancl1es of basilar artery (refer to BOC App).

Fronta l - - - - ,
, - - - - - -- - Motor cortex

..-----,-,,..+--- Basal ..----- - Sensory cortex


nuclei
r----:-rr77'- -"r- - - Trunk, upper
limbs, face, lips,
mouth
--,-,.--.-.....-- Parietal
d--\-\--1---\-\-U--I-- Internal
'capsule

.......,,._,__ Temporal
lobe
Middle cerebral artery Middle - _.,.~
cerebral artery
(a) (b)
Figs 11 .10a and b: (a) Deep branches of middle cerebral artery, and (b) cortical branches of middle cerebral artery

Cortical branches - - -- ---,.


of middle cerebral ~ -- - , - -- - Cortical branches
artery in lateral of anterior cerebral artery
sulcus

Segments of
internal
carotid artery:

Fig. 11 .11 : The cortical branches of three cerebral arteries illustrated on the lateral surface of cerebral hemisphere
BRAIN-NEUROANATOMY

The two anterior cerebral arteries are connected by Cortical Branches


anterior communicating artery. The internal carotids These branches arise from all three cerebral arteries, i.e.
and posterior cerebral arteries of sam e side are united anterior cerebral , middle cerebral and posterior cerebral.
by the posterio r communicating artery. Their origin, course, and branches are given in Table 11.1.

FORMATION Cerebral Cortex


Anteriorly: Anterior communicating artery joining the Cerebral cortex is supplied by branches from all three
two anterior cerebral arteries. arteries.
A11terolatemlly: Anterior cerebral arteries. 1. Superolateral surface: This surface is mostly supplied
Laterally: Internal carotid arteries (Figs 11 .12 and by middle cerebral. Areas not supplied by this artery
11.13a, b). are as under:
Posterolaterally: Pos terior communicating arteries i. A strip of about 2 cm wide along the supero-
medial border extending from fron tal pole to the
Posteriorly: Pos terior cerebral arteries
p arietooccipital sulcus is supplied by anterior
The circulus arteriosus attempts to equalize the flow cerebral artery (Fig. 11.14).
of blood to different parts of brain and p rovides a ii. Area of occipital lobe is supplied by posterior
collateral circulation in the even t of obstruction to one
cerebral artery.
of its components. There is hardly any mixing of blood iii. Inferior tem poral gyrus excluding the p art of the
streams on right and left sides of the circulus a rteriosus. temporal po le is also su p plied by p osterior
Middle cerebral artery is not forming the circle of Willis. cerebral artery.
BRANCHES
2. Medial and tentorial sufaces: The main artery here is
the anterior cereb ral. The med ial aspects of the
The bran ch es of the circulus arteriosus a re cortical, occip ital lobe, temporal lobe exce pt area around
central and choroidal. Cortical or external branches run temporal p ole is s upplied by posterior cerebral
on the surface of the cerebrum, anastomose freely and artery. Temporal pole area gets nourished by middle
if these get blocked th ey give rise to small infa rcts. cerebral artery (Fig. 11.15).
The central branches perforate the white matter to 3. Inferior surface: Medial one-third of orbital surface is
supply the thalam us, the corpus s triatum, and the supplied by anterior cerebral, while lateral two-
in ternal capsule. These do no t anastomose and if these thirds, includ ing the temporal pole area and anterior
get blocked, they give rise to large infarcts. most part of tento rial surface is vascularised by
Choroidal branches supply the choroid plexuses of middle cerebral. Rest of the ten torial surface is
the various ventricles. supplied by the posterior cerebral artery (Fig. 11.16).

Fig. 11 .12: Arteries seen on the inferior surface of brain


BLOOD SUPPLY OF SPINAL CORD AND BRAIN

Anterior cerebral artery

~ - - -- Anteromedial group
, - -- - Internal carotid artery
N~--~
Anterior choroidal artery

Anterolateral group

Posterior choro1dal artery I•~ - - - Posterior cerebral artery


~ - - - Posterolateral group

--==-- - - - - - Basilar artery


~ - -- - - - Labyrinthine artery

Fig. 11.13a: Circle of Willis and the branches of arteries supplying the brain

Frontal branch of anterior cerebral artery Central Branches


These arteries a re thin, n umero us end a rteries. These
arise in six groups.
l. Anteromed ial arise as one group from both anterior
cerebral and anterior communicating artery. These
enter the medial most part of anterior perforated sub-
stance.
2. Anterolateral group arise in two groups one from each
middle cerebral a rtery. These divide in two sets:
Mediate striate ascend through lentiform nucleus to
su pply this n ucleus includ ing caudate n ucleus and
internal capsule. The lateral striate arise ascend lateral
to lentiform nucleus, turn medially, pass through the
substance of this nucleus to enter internal capsule. One
of the lateral stria te branch is larger than the others
and is called Charcot's artery of cerebral haemorrhage.
3. The posteromed.ial arise as one group from posterio r
communicating and posterior cerebral a rte ries.
4. Pos terolateral a rise as two groups from the lateral
parts of each posterior cerebral artery. These are also
in two sets.
Choroidal Branches
1. The anterior choroidal is a branch of in ternal ca rotid
Posterior cerebral artery artery. lt supplies blood to choroid plexus of inferior
Basilar artery horn of late ral ventricle.
2. Posterior ch oro ida l artery arises fro m posterior
Fig. 11 .13b: Magnetic resonance angiogram of the cerebral cerebral to give branches for the choroid plexus of
blood vessels rest of lateral ventricle including third ventricle.
BRAIN-NEUROANATOMY

Table 11.1: Important arteries of brain


Artery Origin Course Cortical branches
Middle cerebral Largest and direct branch of ICA In the lateral sulcus and on the insula 1. Orbital
(Figs 11 .1O and 11 . 14) 2. Frontal
3. Parietal
4. Temporal
Anterior cerebral Smaller terminal branch of ICA Coextensive with corpus callosum. Two 1. Orbital
(Figs 11.9 and 11 .15) arteries are connected by the anterior 2. Frontal
communicating artery 3. Parietal, including
paracentral artery
Posterior cerebral Terminal branch of basilar artery Winds round cerebral peduncle to reach 1. Temporal
(Fig. 11 .1 6) the tentorial surface of cerebruma 2. Occipital
3. Parieto-occipital

• AL: Anterolateral; AM: Anteromedial; PM: Posteromedial; PL: Posterolateral

3. Posterior inferior ce rebellar artery supplies the c. Intimately applied to the capillaries there are
choroid plexus of the fourth ventricle. numerous processes of astrocytes and it has been
Important arteries of the brain are shown in Table 11.1.
, - - - - Anterior cerebral artery
ARTERIAL SUPPLY OF DIFFERENT AREAS ~ - - - Middle cerebral
Cerebral Cortex artery

Cerebral cortex is supplied by branches of all three


cerebral arteries. All the three surfaces receive branches
from all three arteries.
Middle cerebral is main artery on superolateral
surface (Fig. 11.14).
Anterior cerebral artery is chief artery on medial
s urface (Fig. 11.15).
Posterior cerebral is principal arte ry on inferior
surface (Fig. 11.16).
Cerebellum '--- -- Posterior cerebral
The little brain is supplied by following arteries: artery
• Superior cerebellar Fig. 11 .14: Arterial supply of superolateral surface of cerebral
• Anterior inferior cerebellar hemisphere
• Posterior inferior cerebellar
Anterior cerebral artery
BLOOD-BRAIN BARRIER
The constituents of CSF are not exactly same as those
of extracellular fluid (ECF) elsewhere in the body. Many
large molecular substances hardly pass from blood to
CSF or interstitial fluids of brain even though these can
pass to ECF of the body thereby reflectin g the existence
of BBB.
The existence of a ' blood-brain barrier' (BBB or
haematoencephalic barrier) is due to the fact that the
endothelial cells of brain capillaries are held to each
other by tight junctions. The BBB is formed by struc-
tures between the blood and nerve cells of brain. The
blood in the lumen of the capillary is separated from
the neurons by:
a. Capillary endothelium. Fig. 11 .15: Arterial supply of medial and tentorial surfaces of
b. Basemen t membrane of endothelium. cerebral hemisphere
BLOOD SUPPLY OF SPINAL CORD AND BRAIN

brain surface. The spaces taper progressively. Although


these are inward extensions in ana tomical sense. The
subarachnoid and perivascular spaces are separated a
Anterior--+-- - - -+ - - - - Middle thin layer of pia mater. The flow of extracellular fluid
cerebral cerebral
artery
is outward into the subarachnoid space.
artery
The perivascular spaces are involv ed in a uto-
regulation of brain arterioles which regulates the blood
------'----J-- Circle supply to tissues.
of Willis Th e chief internal source of autoregulation is the
adjustment of a rterial muscle tone in response to
intraluminal pressure changes. Cerebral blood flow
Posterior remains a t 60-70 ml/100 g / min during systemic blood
cerebral pressure; changes ranging from 80 to 180 mm Hg. This
artery is achieved by a direct myogenic response to distension
produced by rising intraluminal pressure.
The H + ion concentration in the perivascular space
is the chief external sou rce of autoregulation of cerebral
blood vessels. A rising H + (usually following hyper-
Fig. 11 .16: Arterial supply of inferior surface of cerebral capnia-excess plasma CO2) travels along perivascular
hemisphere space from the capillary bed and it inhibits vascular
muscle, perhaps by reducing ionized calcium level. On
estimated that these processes cover about 80% the o ther hand, hypocapnia causes vasoconstriction.
of the capillary surface.
Some areas of brain are devoid of blood-brain
barrier. These include pineal body, hypophysis cerebri, CLINICAL ANATOMY
choroid plexuses and area postrema in fourth ventricle
• Thrombosis of lateral striate branches of middle
of brain. BBB exists in newborn but is more permeable
cerebral artery causes motor and sensory loss
to certain s ubstances than it is in adult.
to most of the opposite side of body except lower
Functions of Blood-Brain Barrier limb.
1 To modu late entry of metabolic substrates notably • Hemiplegia is a common condition. It is an upper
glucose. motor neuron type of paralysis of one-half of
2 lt allows entry of gases, water, electrolytes, amino the body, including the face. It is usually due to
acids and lipid-soluble substances. an internal capsule lesion caused by thrombosis
3 !t restricts entry of macromolecules that is lipid of one of the lenticulostriate branches of middle
msoluble substances and thus blocks entry of toxins cerebral artery (cerebral thrombosis) (Fig. 11.17).
as either these are boLmd to the plasma albumin or One of the lenticulostriate branches is most
their solubilities arc inappropriate. frequently ruptured (cerebral haemorrhage); it is
known as C harcot's artery of cerebral haemo-
4 It blocks entry of transmitters from blood, notably
of epinephrine. rrhage. This lesion also produces hemiplegia with
deep coma, and is ultimately fa tal.
5 The drugs like penicillin, no radrenaline and thio-
pentone cannot cross it. • Thrombosis of Heubner's recurrent branch of the
6 Some drugs like atropine, chloramphenicol, tetra- anterior cerebral artery causes contralateral upper
cycline and sulfas cross the barrier easily. monoplegia.
7 lts other important function is to pump ions- • Occlusion proximal to the anterior communicating
notably potassium into and out of the blood. a rtery is normally well tolerated because of the
cross flow (Fig. 11.18a).
8 Entry of hormones is restricted to certain p laces o nly,
so that normal biological rhythm of the body is Distal occlu sion results in weakness and cortical
m aintained. sensory loss in the contralateral lower limb with
associated incontinence (Fig. 11.18b).
PERIVASCULAR SPACES • Thrombosis of the paracentral artery (terminal
cortica l branch of the anterior cerebral a r tery)
The perivascular spaces (Virchow-Robin) are extensions causes contralateral lower limb monoplegia.
of subarachnoid space around vessels peneh·ating the
BRAIN-NEUROANATOMY

2 Superficial middle cerebral vein: This drains the area


round the posterior ramus of the lateral sulcus. It
terminates in the cavernous sinus, or at times into
the sphenoparietal sinus. Through the superior and
infe rio r anastomotic veins, it communicates wi th
the sup erior sagi ttal and transverse sinu ses. It
also communicates with the deep middle cerebral
vein.
3 Deep middle cerebral vein: This drains the surface of
the insula and terminates in the basal vein.
4 Inferior cerebral veins: These rue several in number.
They are divided into orbital and tentorial veins. The
orbital veins termina te in the superior cerebral veins
or in the s uperior sagittal s inus. The tentorial veins
terminate in the cavernous or any other surrounding
sinus.
Lower limb flexed 5 Anterior cerebral veins: These are small veins which
Fig. 11.17: Posture of hemiplegic person
drain the corpus callosum and the anterior part of
the medial surface of the hemisphere. They terminate
in the basal vein (Fig. 11.20).
Anterior
cerebral artery
Internal Cerebral Veins
There is one vein on each s ide. It is form ed by the union
of the thalamostriate and choroidal veins at th e apex of
the tela choroidea of the third ventricle. The right and
left veins run posteriorly parallel to each other in the
tela choroidea, a nd unite together to form the great
Anterior
cerebral vein below the spleniun1 of the corpus callosum
(a) communicating (b) (Fig. 11.21 ).
artery

Figs 11 .1 Sa and b : Effects of occlusion of anterior cerebral Terminal Veins


artery 1 Great cerebral vein: This is a single median vein. It is
formed by union of the two internal cerebral veins.
It terminates in the straight s inus. Its tributaries
VEINS OF THE CEREBRUM include the basal veins, and veins from the pineal
body, the colliculi, the cerebellum and the adjoining
CHARACTERISTICS OF THE VEINS part of the occipital lobes of the cerebrum.
1 The walls are devoid of muscle. 2 Basal vein: There is on e vein on each side. It is formed
2 The veins have no valves. at the anterior perforated substance by the union of
3 To maintain patency, some of them open into the the deep middle cerebra l vein, the anterior cerebral
cranial venous sinuses against the direction of blood veins, and the striate veins. It runs posteriorly, winds
flow in the sinus, e.g. the superior cerebral veins row1d the cerebral peduncle, a nd terminates by
draining into the superior sagittal sinus. joining the great cerebral vein. Its tributaries include
(apart from the veins forming it) small vei.ns from
GROUPS OF VEINS the cerebra l peduncle, interpeduncular structures,
the tectum of the midbrain, and the parahippocampal
External Cerebral Veins
gyrus.
1 Superior cerebral veins: These a re 6 to 12 in number.
They drain the s uperolateral sLUface of the hemi- Ultimately, all veins drain into th e variou s cranial
sphere. They temunate in the superior sagittal sinus venous sinuses which, in turn, drain into the internal
(Fig. 11.19). jugular vein.
BLOOD SUPPLY OF SPINAL CORD AND BRAIN

Superficial anastomotic vein

Fig. 11 .19: Veins on the superolateral surface of cerebral hemisphere

Fig. 11.20: Veins on the inferior surface of cerebral hemisphere

BLOOD SUPPLY OF THE BRAIN STEM

A'~ - - - - - Choroidal Th e midbrain is supplied by branches from the posterior


vein cerebral arteries, including their central branches, both
l --'--:-'-'-12~,------- - Internal
posteromedial and p osterolateral.
cerebral The pons is supplied b y the pontine branches of
vein
basilar artery.
~~.,:-=:-'-'f!ll--'I:---- Tela choroidea
of third ventricle The medulla is supplied by:
a. The medullary branches of the vertebral artery.
b. Branch es from the pos terior inferior cerebellar
- -- -- - - - - - Great cerebral
artery .
vein The veins of the brain stem drain into neighbouring
Fig. 11 .21 : Internal cerebral veins veno us sinuses.
BRAIN-NEUROANATOMY

CLINICAL ANATOMY • Posterior cerebra] arteries are the terminal branches


of the basilar artery and suppy the visual cortex.
• A nastomo tic and end a rteries: In th e circle o f • Middle cerebral artery is the larger terminal branch
Willis, th e b lood in the th ree communicating
of internal carotid and supplies most of the supero-
arteries is nor mally static. Following occlusion of
lateral surface of the cerebral cortex.
one of the three large arteries contributing to the
circle, the other two compensate more or less • Anterior cerebral artery is the smaller terminal
complete ly, v ia comm unicating a rteries. With branch of the internal carotid artery. It runs along
occlusion of one internal carotid , the other internal th e corpus callosum supply ing maximum area on
carotid may perfuse both anterior cerebral arteries. the medial su rface of the cerebral hemisphere.
With occlusion of basilar, each posterior cerebra l • Two lobes of the cerebellum are supplied by 3 pairs
artery m ay be perfused by the internal carotid of of cerebellar arteries. These are superior cerebellar,
its own side. a nterior inferior cerebellar and posterior inferior
Fur ther an astomosis occurs be tween cortical cerebellar arteries.
branches of cerebral arteries, prior to perforation • Anterior two-thirds of spinal cord is supplied by
of the branches into b rain substance. On ce th e larger anterior spinal artery. Only posterior one-
cortical and central branches perfora te, they third of the cord is supplied by posterior spinal
become end arteries hardly communicating a t arteries.
capilla ry level.
• Cerebra l vascular disease is quite common in old
age and manifest in d ifferent ways.
a. Haemorrh age-cortical or s ubcortical CLINICOANATOMICAL PROBLEMS
b. Thrombosis Case 1
c. Embolism . A 40-year-old obese man comp la ins of nausea,
• H ypertensive enceph alopathy is a manifestation vomiting, hoarseness of voice for 15 days, difficulty in
of s ustained elevation of d iastolic blood pressure walking on the right side, with inability to feel pain,
in the fo rm of m ulti ple di ffuse small lesions ho t a nd cold sensations from the limbs and trunk.
distributed all over, result in a variegated picture
• Where is the lesion?
of the ci rcle of W illis (Berry's aneurysm).
• The ar te ries o f th e brai n ar e supp lied with • Which nuclei and fibres are involved?
sympathetic n erves w hich run on to them from Ans: The symptoms in the p resent case are due to
carotid and vertebral plexuses. Th ey are extremely thrombosis of the largest branch of fourth part of
sensitive to injury and readily react by passing into vertebral artery, the posterior inferior cerebellar
p rolonged spasms. This b y itself may be sufficien t artery. The various nuclei involved are vestibular
to cause dam age to brain tissue since even the least nuclei, inferior cerebellar peduncle, nucleus
sensitive neurons cannot withstand absolute loss of ambiguus and lateral spinoth alamic tract of the
blood s upply fo r a period more than 3-7 minutes. opposi te side.
Case 2
Mnemonics
A hypertensive patient aged 60 years was taking the
treatment very erra tically. One night he felt severe
Cell is Clearly Circulating h eadache and soon paralysis of both his right-sided
limbs.
C - Cortical branches
C - Central branches • Where is the le ion?
C - Choroidal branches • Explain th e genesis of his symptoms.
Ans: The hypertension should have been treated
properly. Since the treatment was not done a long
the right lines, he su ffered from haemorrhage of the
• Posterior inferior cerebellar artery is the largest left late ral striate arteries which supply the internal
branch of vertebral artery . It suppl ies postero- capsule. This leads to paralysis of his right half of
lateral part of medulla oblongata, lower part of the body. This is an u pper motor neuron type of
paralysis with exaggerated reflexes, increased tone
pons, inferior s u rface of ce rebellum including
of the muscles, etc. It is quite a serious condition and
choroidal branches to 4th ventricle.
is called "cerebral stroke".
BLOOD SUPPLY OF SPINAL CORD AND BRAIN

FREQUENTLY ASKED QUESTIONS

1. Describe the intracranical course of vertebral, a. Blood supply of spinal cord


basilar and in ternal carotid arteries including the b. Blood supply of cerebellum
formation of circle of Willis. c. Blood-brain barrier
2. Enumerate the branches of anterior, middle and d. Blood supply of brain stem
posterior cerebra l arteries. e. Name the external cerebral, internal cerebral and
3. Write short notes on: the terminal veins

MULTIPLE CHOICE QUESTIONS

1. Labyrinthine artery is a branch of: 4. Anterior spinal artery is a branch of:


a. Basilar a. Vertebral b. Internal caro tid
b. Vertebral c. Basilar d. Labyrinthine
c. internal carotid 5. Which is the largest di rect branch of internal carotid
d. Posterior inferior cerebellar artery?
2. Vein of Galen or great cerebral vein is formed by a. Middle cerebral b. Anterior cerebral
union of: c. Posterior cerebral d. Posteriorinferiorcerebellar
a. Right a nd left internal cerebral veins 6. What is not true abou t BBB (blood-brain barrier)?
b. Occipital and transve rse s inuses a. Many larger molecular substances hard ly pass
c. Inferior sagittal and straight sin uses from blood to CSF
d. Occipital and petrosal sinuses b. Formed by stru ctu re between blood and nerve
3. Wh ich of the following arteries supp ly v is ual cells of brain
fib res?
c. The constitution of CSF is exactly same as those
a. Anterior and middle cerebral of extracellular fluid elsewhere in body
b. Middle cerebral
d. Pineal bod y, hypoph ysis cer eb ri, ch oroid
c. Middle a nd posterior cerebral plexus, area postrema, TV ventricle are devoid
d. Posterior cerebral of BBB

ANSWERS
1. a 2.a 3. C 4.a 5. a 6. c
CH A P T ER

Investigations of a Neurological
12
Case, Surface and Radiological
Anatomy and Evolution of Head
<J}l u~ u,.;j,u l 11~ey hai>~, "o/'ednl~y om ,,.,.,.
- JP Senn

INTRODUCTION 3 Computerised tomography or CT scan: In this procedure,


A neurological case needs to have a detailed clinical X-ray beam traces an arc at multiple angles around
history, family history, and clinical examination besides a section of the body. The resulting transverse section
is reproduced by the computer on its monitor screen
the investigations.
(Fig. 12.2).
4 Magnetic resonance imaging (MRI) : The body is
INVESTIGATIONS REQUIRED IN A NEUROLOGICAL CASE
exposed to high energy magnetic fi eld , w hich
Study of brain is of importance in localising the lesion. permits protons in tissues to arrange themselves in
Besides detailed history and clinical examination, the relation to the field. Then a p ulse of radiowaves
folJowing investigations may have to be done according 'reads' these ion patterns and a colour-coded image
to the need of each case. is reproduced on the computer screen (Fig. 12.3).
1 X- ray skull: Anteroposte ri or and la teral views 5 Sonography: High frequency sound waves produced
(Fig. 12.1). by wand (held in hand) get reflected off body tissues
2 Lumbar puncture: It is done between third and fourth and are detected by the same instrument. The image,
lumbar spines. This is clinically useful fo r diagnostic the sonogram, is reproduced on the computer screen.
and prognostic purposes. It is also used for giving It is used to diagnose hydrocephaly or anencephaly
spinal anaesthesia. during intrauterine life.

Fig. 12.1: Lateral view of skull and cervical vertebrae Fig. 12.2: Computerised tomography (CT) scan

180
INVESTIGATIONS OF A NEUROLOGICAL CASE, SURFACE AND RADIOLOGICAL ANATOMY

Fig. 12.3: Magnetic resonance imaging (MRI) Fig. 12.4: Angiography

6 Positron emission tomography (PET): Substance b. Electroencephalography (EEG): The pattern of


emitting positrons are injected into the body which electrical activity of brain is analysed by putting
are taken up by tissues. Collision of positrons with electrodes in the scalp at different points and
electrons of body tissues produces gamma rays, recording it in the machine.
detected by gamma cameras, put around the patient. c. Nerve conduction studies done to estimate the rate
Thus, PET scan is seen on computer screen. Activity of conduction through the nerve fibres.
of different areas of brain is visualised. These procedu res may be used according to the
7 A11giography requirement of the patient.
a. MR angiography: This technique employs modi-
fication so that blood vessels can be visualised SURFACE ANATOMY
without injecting the dye. The conventional angio- Borders of Cerebral Hemisphere
graphy is sti ll preferred.
Mark the following points (Fig. 12.5).
b. Angiography: The contrast medium is injected into • Point 1, just superolateral to the inion
the common carotid or vertebral arteries. X-ray • Point 2, just superolateral to the nasion
pic tures taken immediatel y s how the arterial • Point 3, at the zygoma tic process of the fronta l bone
pattern. The capillary and venous pattern is seen just above the eyebrow
after a little time (Fig. 12.4). • Point 4 at the pterion
c. Digital subtraction angiography (DSA): In this • Point 5 at the middle of the upper border of the
procedure, low concentrations of contrast media zygomatic arch.
are used. Bones and muscles are removed with The superomedinl border is marked by joining points
the help of the computer. Ideal method is arterial 1 and 2 by a paramedian line.
DSA wherein d iluted contrast medium is injected The s11perciliary border is marked by first joining
into the artery to see its course, branches and their points 2 and 3 by a line arching upwards just above
diseases. the eyebrow, and then extending this line to point 4.
Becau se of these modern and safe procedures, The inferolateral border is marked by first joining
the older techniques-pneumoencephalograph y, points 4 and 5 by a line convex forwards (temporal
ventriculography and m yelograph y have become pole), and by then joining points 5 and 1 by a line convex
obsolete. up wa rds, passing just above the external acoustic
8 Electrophysiological methods m eatus.
a. Electromyography ( £MG): This is the study of
electrical activity accompanying the muscle Central Sulcus
contraction. It is also used to s tudy the action of • Point 6 is taken 1.2 cm behind the midpoint of a line
various muscles. joining the nasion with the inion.
BRAIN-NEUROANATOMY

• Point 7, 5 cm above the preauricular point. The sulcus Cerebellum


is marked by joining th ese points by a sinuously It is marked behind the a uricle, immediately below the
cur ved line running downward s and forwards marking for the transverse sinus lying between inion
m aking an ang le of 70 degrees with the median and base of mas toid process.
plane
RADIOLOGICAL ANATOMY OF THE BRAIN
Lateral Sulcus
Cerebral Angiography
The following points are used to ma rk the latera1s ulcus
and its posterior ramus. Cerebral angiography is a radiological technique by
• Point 4 at the pterion which cerebral vessels can b e v isualized. The arterial
• Point 8 is taken 2 cm below the parietal eminence. system is v is ualized by carotid an giography, and the
vertebral system by vertebral angiography.
Point 4 (pterion) is also called the sylvinn point. It is
the stem of the lateral sulcus. Dye: About 10 to 12 ml of 30% p yelocil or diodone.
The posterior ramus of the lateral sulcus is about 7 cm Technique: For carotid angiography, the common carotid
long and can be m arked b y joining p oints 4 and 8. artery is located at the carotid tubercle and the dye is
injected percutaneously. A series of skiagrams are taken
rapidly at intervals of 1 second. Within 2 seconds after
Sensory Motor area the commencement of injection, the dye reaches the
area cerebral arteries, and after 2 seconds it is in the veins.
After another two seconds or so, the dye passes into the
Parietal Motor speech intracranial venous sinuses. The skiagrams taken at
area
eminence different intervals provide arteriogram s, venog.rams (or
Auditory area phlebograms) and sinograrns .
Visual Similarly for vertebral an giography, the d y e is
area injected into the vertebral artery and skiagrams are
taken as described above.
Indications: Cerebral angiography is helpful in diagnosis
of intrac.ranial tumoms, haematomas, aneurysms and
angiomas.

Fig. 12.5: Surface marking of borders of cerebral hemisphere EVOLUTION OF THE HEAD
and of lateral sulcus The head forms the fore-end of the body where all the
special sense organs (eyes, ears, n ose and ton gu e) are
Superior Temporal Sulcus concentrated in and around the face. It is at this end of
This is m arked by a line parallel and 1 cm below the the body that the central nervous system shows its
posterior ramus of the lateral suk us. greatest d evelopment lea ding to the formation of the
brain. The various sense organs keep the i.ndiv idual
Functional Areas of Cerebral Cortex informed about the surround ings so that he can better
adjus t and sustain himself. The continuous inflow of
1 The motor area is marked by a strip about 1 cm broad
information collected by the sense organs is processed
in front of the central s ulcus.
and stored in the form of memory which forms the basis
2 Th e sensory area is marked by a strip about 1 cm broad, of all knowledge and experience.
b ehind the central su lcus.
Photosensitivity is one of the fundamental properties
3 The auditory area is marked be tween the superior of p rotoplasm. This h as resulted in evolution of the eyes
temporal sulcu s and the pos terior ramus of the lateral w hich serve to determine the direction of movement
sulcu s, immediately below the lower end of the with reference to ligh t even in prevertebrate forms of
central sulcus. life. In m ost mammals, however, vision appears to be
4 The visual area (the part extending onto the supero- dominated (in importance) by the sen se of smell. In
lateral surface) is m arked immediately in front of the primates, including man, there is a p rogressive
occipital pole. reduction in the importance of the sense of smell, with
5 Motor speech area is marked by an area above and a concomitant increase in the importa nce of v ision
anterior to pterion. It is mostly present in the left associated with the ability to perform s killed acts of a
h emisphere. w ide variety.
INVESTIGATIONS OF A NEUROLOGICAL CASE, SURFACE AND RADIOLOGICAL ANATOMY

Fig. 12.6: Size of the jaws relative to the size of the head during evolution

The e volution of the sense of hearing took place o nly of an erect posture in wh ich the forelimbs a re no longer
when water dwelling species evolved into those with a required to suppor t body weigh t, and are, therefore, free
terrestrial mode of life. This becomes obvious w hen we to pe rform various functions. (This is often referred to,
remember that the prod uction and tra nsm ission of b y a nthropologists as e111ancipatio11 of the forelimbs.)
sound requires air. The sense of hearing grea tly helped Thus, it would appea r that the whole spectrum of
the animal in detecting hostile sounds made by enemies. huma n sensibiJities is acquired by man from his animal
In man, h earing assumed increasing importance in ancestors. In fact man is inferior to m any a nimals (dogs,
receiving sound s of articulate speech . Hom ologous cattle, etc.) in his acuity of the senses of smell, vision and
with the ear there are la teral-line organs found in water hearing. However, the supremacy of man in the animal
d welling vertebrates like fishes and a mphibia. These kingdom is due to the large relative size of his b rain
organs are sensitive to vibration prod uced by wa ter which has given him unlimited powers of thought, of
currents and help their o wners in judging the d ep th reason and of judgement, highly d eveloped speech and
a nd direction of moveme nt of wa ter, a nd also in hands that can achieve perfection at craftsmanship.
de tec ting the presen ce o f o the r a n im als in the The anatomical features of the human face are a result
neighbourhood. o f a series of changes that h ave occ urred d u ring
The sense of smell (olfactory sense) is one of the oldest evolu tion. The man y changes observed are a result of
sensibilities which made its ap pearance first in aqua tic two main factors. These are the progressive reduction
ve rte brates, a nd was the firs t to rece ive cortical in the size of the jaws; and a concomitant increase in
representatio n. Most of the p ri mitive mamma ls a re the size of the cranial cavity in association witl1 the
guid ed prim arily and pred ominantly by their sense of increasing size of the brain. The alterations in the face
smell; the other senses of to uch, hea ring and vision a nd head are by-products of a change in postu re from
being merely accessory to the d omina ting influence of p ronograd e (four-footed), through orthograd e to a
s me ll . Man has fr eely exploited this unca nn y plantigrade (h.vo-footed) one. A p ronograde animal
endowment o f a sharp sense of smell in domesticated (dog, cow) has lar ge jaws and a sma ll head . An
an imals, especially in dogs. orthograde animal (ape or monkey) has smaller jaws
The sense of smell played a significant role in the and a la rger hea d than in p ron ogra d e a nim a ls .
a nimals search for food; and for sex. With the adoption Plantigrade man has the smallest jaws and the largest
of an arborea l (tree dwelling) mode o f life by p rimates head . Thus, the size of the jaws is inversely proportional
(monkeys and apes), the sense of smell became less to that of the head (Fig. 12.6).
important. This m od e o f life fa vou red a hi g h e r Reduction in jaw size is a ttributable to tl1e liber ty of
development of visual, tactile, acoustic, kinaesthetic, movements of the upper limbs, and also to changed
and mo tor functions in associa tion with increasing habit of eating cooked food, both of which have greatly
intelligence. The reduced importance of the sense of re lieved the jaws of their d iverse fu nctions (tactile
smell has been associated with the loss of a p rojecting feeling, holdi ng, sorting, breaking, biting, tea ring,
snout (the region of the mo uth and nose) that is so chewing, piercing, fighting, etc.) seen in lower animals.
typical of lower mammals. However, it is believed that The muscles acting on the jaws have obviously become
the tactile function of the snout is more important than smaller a nd weaker.
its olfactory fLmction . The same is also true of muscles on the back of the
The most important factor in the disappeara nce of the neck. In p ronograd e animals, these muscles support the
snout in primates and man appears to be the adoption weight of the head. In ord e r to perm it freed o m of
IIDII BRAIN- NEUROANATOMY

mobility to the tongue for articular speech in man, the man than in any other primate, and the bony orbits are
alveolar arches are broadened and the chin is pushed decidedly smaller than in the great apes. Further, the
forwards, making the mouth cavity more roomy. With interorbital distance is greater in man than in apes in
recession of the jaws, the oral aperture is reduced in whom the nasal root is greatly constricted.
size, and the lips are supported by a much better The supraorbital margins of man are markedly
developed orbicularis oris. reduced remnants of the highly developed brow ridges
The distinctive external nose, with exuberant growth of other primates. The diminution in man is partly due
of cartilages forming the prominent dorsum, tip and to the receding jaws which relieve the ridges of their
alae is a characteristic human feature, although it function as buttresses, and partly to the development
appears to serve no special function. The eyes are of a prominent forehead because of increase in the size
directed forwar d s and not late r a lly as in lower of the cranial cavity. The forehead protects the eyes
mammals. This change in direction of the eyes enables from above, a similar function being performed by the
stereoscopic vision. The palpebral fissures are larger in brow ridges in apes.

FREQUENTLY ASKED QUESTIONS

1. ame the investiga tions required in a nemological case.


2. Name the functional areas of cerebral cortex and their location.
3. Write an essay on evolution of head.
CHAPTER

13
Autonomic Nervous System

Autonomic nervous system comprises sympathetic and • They relay in the ganglion of the sympathetic trunk,
parasympathetic components. Sympathetic is active postgan gli onic fibres pass via the grey ram i
during fright, flight or fight. During any of these comm unicantes (grc) and get distributed to the blood
activities, the pupils dilate, skin gets pale, blood vessels of skin, sweat gland s and to arrector pili
pressure rises, blood vessels of skele tal muscles, heart, muscles (Figs 13.1 and 13.2).
lungs and brain dilate. There is hardly any activity in • These may pass through the corresponding ganglion
the digestive tract due to w hich the individual does and ascend to a ganglion higher before terminating
not feel hungry. The person is tense and gets tired soon. in the above manner.
Parasympa the tic has the opposite effects of sym- • These may pass through the corresponding ganglia
pathetic. This component is sympathetic (kind) to the and descend to a ganglion lower and then terminate
digestive tract. Jn its activity, digestion and metabolism in the above manner.
of food occurs. Heart beats normally. Person is relaxed • Postganglionic fibres from upper thoracic gan glia
and can do creative work. supply the thoracic viscera.
Autonomic nervous system is controlled by brain • Some p reganglionic fibres pass to corresponding
stem and cerebral hemispheres. These include reticular ganglia and emerge from these (unrelayed ) in the
formation of brain stem, thalamic and hypothalamic from of splanchnic nerves to supply the abdominal
nuclei, limbic lobe and prefrontal cortex including the and pelvic viscera after synapsing in the ganglia
ascending and descending tracts interconnecting these situated in the abdominal cavity.
regions. • Few fibres of splanchnic nerves reach the medulla
of the suprarena1 gland.
Sympathe tic trunks on either side of the body extend
SYMPATHETIC NERVOUS SYSTEM:
from cervical region to the coccygeal region where both
THORACOLUMBAR OUTFLOW
trunks fuse to form a single ganglion impar. Sympathetic
This is the larger of the two components of autonomic trunk has cervical, thoracic, lumbar, sacral and coccygeal
ne rvous system. It consists of two ganglionated trunks, parts. The branches of each part are d iscussed below.
their branches, preverteb ral ganglia, plexuses. It
supplies all the viscera of thorax, abdomen and pelvis, Cervical Part of Sympathetic Trunk
including the blood vessels of head and neck, brain, It extends from base ofskull to neck of 1st rib. it has 3 gang.lia
limbs, skin and the swea t glands as well as arrector namely superior, middle and inferior cervical ganglia.
pilorum muscle of skin. Branches of these ganglia are tabulated in Table 13.l.
The preganglionic fibres are axons of neurons
situated in the lateral horns ofT1-L2 segments of spinal Thora c ic Part of Sympathetic Trunk
cord. They leave spinal cord through their respective There are usually 11 ganglia on the sympathetic trunk
ventral roots, to reach sympathetic ganglia and beginn- of thoracic part. 1st ganglion lies on neck of 1st rib and
ing of ventral rami via white rami communicantes (wrc) is usually fused with inferior cervical ganglion and forms
[singular: ramus communicans]. There a re 14 wrc on stellate ganglion. The lower ones lie on the head of the
each side. These fibres can have following alternative ribs. The sympathetic trunk continues with its abdominal
routes: part by passing behind the medial arcuate ligament.
185
BRAIN- NEUROANATOMY

Dorsal ramus

Soma lie afferent fibres


White ramus

..--,--- Preganglionic fibres


~ - - , .-+1-~ - - -Postganglionic fibres

Fig. 13.1: Components of a typical spinal nerve

The ganglia are connected with the respective spinal Abdominal Port of Sympathetic Trunk
n erves v ia the white ramus conununicans (from the It runs along the medial bord er of psoas major m uscle.
spinal n erve to the ganglion) an d the grey r amus It is continuous with the pelvic part by passing behind
communicans (from the ganglion to the spina l nerve, the common iliac vessels. There are 4 ganglia in the
i.e. ganglion gives grey, ggg). lumbar or abdominal part. Only upper two ganglia
receive white ramus communicans from the ventral
Branches primary rami of first and second lumbar nerves.
1 Grey rami communicantes to all the s pinal nerves of
thorax, i.e. Tl- T12. The postganglionic fibres pass Branches
along the spinal nerves to supply cutaneous blood 1 Grey rami communicantes to the Ll- LS spinal nerves.
vessels, sweat glands and arrector pili muscles. These pass a long the spinal nerves to be distributed
2 White rami communicantes from upper 4-6 ganglia to the sweat glands, cutaneous blood vessels and
a rrector pili muscles (sudomotor, vasomotor and
travel up the cervical part of sympathetic trunk to
pilomotor).
relay in the three cervical ganglia. Fibres from the
2 Postganglionic fibres pass medially to the aortic plexus.
lower thoracic ganglia Tl0- L2 pass down as pre-
ganglionic fibres to relay in the lumbar or sacral 3 Postganglionic fibres pass in front of common iliac
ganglia. vessels to form h ypogastric p lexus, which is also
s upplemented by branches of aortic p lexus.
3 Second to fifth ganglia give postganglionic fibres to
h eart, lungs, aorta and oesophagus. Aortic plexus: This plexus is formed by preganglionic
4 Lower e ight gan glia g ive fibres w hich a re pre-
sympa the tic, postganglionic symp a the tic, pre-
ganglionic (unrelayed) for the supply of abdominal ganglionic parasympathetic and visceral afferent fibres
v iscera. These are called as splan chnic (visceral) around the abd omin al aorta. This p lexus is concentrated
nerves. around the origin of ventral and lateral branch es of
abdominal aorta. These are known as coeliac plexus,
• Ganglia 5- 9 give fibres w hich constitute g reater
supe rior mesenteric plexus, inferior mesente ric p lexus
splan chnic n erve.
and renal p lexus.
• Ganglia 9- 10 give fibres that constitute lesser
splanchnic n erve. Pelvic Port of Sympathetic Trunk
• Gan glion 11 gives fibres tha t constitute lowest Pelvic part runs in front of sacrum , medial to ventral
splanchnic nerve. sacral foramina. Caudally, the two trunks unite and fuse
AUTONOMIC NERVOUS SYSTEM

-
I_11_C_r._N_. _ _ _ _ _ _ _~CKil=iary
1:::~~~~----o Eye

II
,, ---------------
Pterygopalatine
______ ,,--

,' ,,,,------- ----.....


/ ---
-- ,._, _-----~
Lacrimal gland

Mucous membrane of nose


I I --- 4DV
r ,' Submandibular,, - - - __
Submandibular salivary gland
Cr.N. I ,,
IX Cr.N.
Sublingual salivary gland

C1 Oral mucosa

Parotid salivary gland

Heart

"'
-o T1
; ----
-

;'
,, /,. ,,..,,, .,,,..
- ......- - ;
-
. , . : : . 'S -

Larynx
OJ
1a ----
T2 •~ - - - + -tt,fll
,, ,,,, ,, ,, Trachea
~ __ J] - - 1 - - - - - + ,,......tt-t!I ,, ,1 Greater Bronchi
"' __ J..4
-0 splanchnic
C:
: ___1]_ Oesophagus
~ T6
"' ----- Stomach
~ ___u _
Abdominal vessels
0 T9
u -----
~ __ _TjQ Liver and ducts
ro
Ji ___1.11
QI
~
QI
___ui Pancreas

> L1
-0 - - - - - Suprarenal gland
g L2 ··•·+ - - --+,...,.,rt'-t------.
:0 -----
{:. L3
Small intestine
L4
L5
S1
Large intestine
S2
Rectum

Kidney

Bladder

Q Ganglion I/
- - Parasympathetic preganglionic
Sexual organs
- - - Parasympathetic postgangliomc

- - Sympathetic preganglionic External genitalia

- - - Sympathetic postganglionic

Fig. 13.2: Distribution of sympathetic and parasympathetic nervous systems


BRAIN- NEUROANATOMY

Table 13.1 : Branches of superior, middle and inferior cervical ganglia


Superior cervical ganglion Middle cervical ganglion Inferior cervical ganglion
Arterial branches (i) Along internal carotid artery Along inferior thyroid artery Along subclavian and
as internal carotid nerve vertebral arteries
(ii) Along common carotid and
external carotid arteries
Grey rami communicantes Along cervical 1--4 nerves Along 5 and 6 cervical nerves Along 7 and 8 cervical
nerves
Along cranial nerves Along IX, X, XI , XII cranial nerves
Visceral branches Pharynx thyroid, cardiac Cardiac Cardiac

into a single ganglion impar in front of coccyx. There PARASYMPATHETIC NERVOUS SYSTEM
are 4 ganglia in this part of sympathetic trunk. Their
branches are: Craniosacral Outflow
1 Grey ramj communicantes to the sacral and coccy- Preganglionic parasympathetic fibres are present in 4
geal nerves. cranial nerves, e.g. III, Vil, IX, and X cranial nerves and
also along S2, S3, and S4 spinaJI nerves. Four ganglia
2 Branches to the pelvic plexuses.
namely ciliary, pterygopalatine, submru1dibular and
otic are concerned with efferent parasympathetic fibres
Collateral/Prevertebral Ganglia and Plexuses of III, VII and IX nerves. Their pathways are shown in
Coeliac Plexus Appendix, Table A.2, Volume 3.
Coeliac plexus is the largest of the three autonomic 1 Oculomotor parasympathetic fibres arise in midbra.i.n,
plexuses, e.g. coeliac, superior mesenteric and inferior from the Edinger-Westphal n ucleus. Preganglionic
mesenteric plexuses. It is a dense network of nerve fibres pass through the ID nerve and leave as motor
fibres which urute the two coeliac ganglia. The ganglia root along the nerve to inferior oblique muscle to
receive the greater splru1chnic nerves, lesser splanchnic enter the ciliary ganglion. These fibres are relayed in
nerves of both sides including some filaments of vagi the ciliary ganglion, and the postganglionic fibres
and phrenic nerves. pass via the short ciliary nerves to be distributed to
ciliaris and sphincter pupiJlae muscles.
Coeliac ganglia are two irregularly shaped ganglia.
Each ganglion receives greater splanchnic nerve. The 2 Facial nerve contains efferent parasympathetic fibres.
lower part of the ganglion receives lesser splanchnic These are the axons of neurons of superior salivatory
nerve and is also called as aorticorenal ganglion. The nucleus. These fibres leave the brain as nerv us
aorticorenal ganglion gives off the renal plexus which intermedius, and form part of the facial nerve and
accompruues the renal vessels. pass along its chorda tympani branch. Chorda
tympani nerve joins the liingual nerve in the
Secondary plexuses arising from coeliac and infratemporal fossa. These fibres travel with the
aorticorenal plexus are distributed along the branches ling ual nerv e to reach submandibular ganglion.
of the aorta, namely phrenic, s plenic, left gastric, Fibres of chorda tympani nerve relay in this ganglion
hepatic, intermesenteric, suprarenal, renal, gonadal, from where pos tganglionic fibres supply the
superior and inferior mesenteric plexuses. submandibular and sublingual salivary glands.
Greater petrosal branch of facial nerve joins the deep
Superior Hypogastric Plexus
petrosal (sympathetic fibres) to form the nerve of
This plexus lies between the two common iJiac arteries pterygoid canal. Only greater petrosal nerve fibres
and is formed by: (i) aortic plexus, (ii) branches from relay in the pterygopalatine ganglion. These post-
lumbar sympathetic ganglia. It divides into right and ganglionic fibres supply lacrirnal gland, glands of
left inferior hypogastric plexus (pelvic plexus); which nose, pharynx and palate.
rw1S on the medial side of internal iliac artery and is 3 Glossopharyngeal nerve contains the axons of the
supplemented by pelvic splanchnic nerves (para- inferior saLivatory nucleus. They travel through IX
sympathetic nerves). Thus, inferior hypogastric plexus nerve ru1d are given off in its tympanic branch which
contains both sympathetic and parasympathetic nerves. forms ty mpanic plexu s from where the lesser
These are for the supply of the pelvic viscera along the petrosal nerve starts. The lesser petrosal nerve relays
branches of the arteries. in the otic gru1glion. The posttganglionic fibres are
AUTONOMIC NERVOUS SYSTEM

given to the auriculotemporal nerve to reach the Smaller branches of coronary arteries are supplied
parotid salivary gland. by parasympathetic nerves. These nerves are concerned
4 Vagus or X cranial nerve contains efferent parasym- with slowing of the cardiac cycle. The nerves reach the
pathetic fibres. They have their origin in the dorsal heart by two plexuses-superficial and deep ca rdiac
nucleus of vagus and pass along its pulmonary, plexuses.
cardiac, oesophageal, gastric and intestinal branches.
Superficial Cardiac Plexus
Sacral Outflow • Superior cervical cardiac branch of left sympathetic
Pelvic Splanchnlc Nerves trunk.
• Inferior cervical cardiac branch of left vagus nerve.
These a re the preganglionic fibres constituting the sacral
component of the craniosacral outflow of the Deep Cardiac Plexus
parasympathetic nervous system. These arise from
Tt consists of two halves which are interconnected and
lateral horn cell of S2-S4 segments of spinal cord. The
lie anterior to bifurcation of trachea.
axons of these neurons pass along the ventral rami of
S2-S4 nerves to join the inferior hypogastric plexus to Right half Left half
be distributed to the pelvic viscera.
• Superior, middle, inferior Only middle and inferio r
Some of the parasympathetic fib res ascend from cervical cardiac branches of branches of left sympathetic
inferior hypogastri.c plexus to reach superior right sympathetic trunk trunk
hypogastric plexus and finally the inferior mesenteric
• Cardiac branches of T2-T4 Same
plexus. Thereafter, these fibres are distributed along the ganglia of right side
branches of inferior mesenteric artery to supply leftone-
• Th ree cervical cardiac Two cervical cardiac branches
third of transverse colon, descending colon and pelvic
branches of right vagus of left vagus
colon. These preganglionic fibers relay in the neurons
• Two branches of right re- Same, but coming from
situated in the wall of the viscera.
current laryngeal ne rve thoracic region
arising from neck region
NERVE SUPPLY OF THE VISCERA
Heart Branches from the plexus g ive extensive branches to
Preganglionic sympathetic neurons a re located in pulmonary plexuses, right and left coronary plexuses.
lateral horns Tl-TS segments of spinal cord. These Branches from the coronary plexuses su pply both the
fibres pass along the respective ventral roots of thoracic atria and the ven tricles. Left ventricle receives richer
nerves to synapse with the respective ganglia of the nerve supply because of its larger size.
sympathetic trw1k. Afte r relay, the postganglionic fibres
form thoracic branches which intermingle with the Lungs
vagal fibers, to form cardiac plexus. The lw1gs are supplied from the anterior and posterior
Some fibres from Tl-TS segments of spinal cord pulmonary plexuses. The anterior plexus is an extension
reach thei r respective ganglia. These fibres then travel of deep cardiac plexus. The posterior plexus is formed
from branches of vagus and T2-TSsympathetic ganglia.
up the cervical pa rt of the sympathetic chain and relay
Small ganglia are found on these nerves for the relay
in superior, middle and inferior cervical ganglia. After
of parasympathetic (brought via vagus neve) fibres.
relay, the postganglionic fibres form the three cervical
Parasympathetic is bronchoconstrictor (motor) whereas
cardiac nerves. Preganglionic parasym pa the tic neurons
sympathetic is inhibitory. Sympathetic stimulation
for the supply of heart are situated in the dorsal nucleus
causes relaxa tion of smooth muscles of bronchia l tubes
of vagus nerve.
(bronchodilator). The pressure of inspired air also
Sympathetic activity increases the heart rate. Larger causes bronchodilation.
branches of coronary arteries are mainly supplied by
sympathetic. It causes vasod ilation of coronary a rteries. Gastrointestinal Tract
Impulses of pain travel along sympathetic fibres. These
Oesophagus
fibres pass th rough sympathetic trunk and reach the
spinal cord via Tl -TS spinal nerves. Th us, the pain may • Cervical part of oesophagus receives branches from
be referred to the a rea of skin supplied by Tl-TS nerves, recurrent laryngea l nerve and middle cervical
i.e. retrosternal, medial side of the left upper limb. Since ganglion of sympathetic trunk.
one is more conscious of impulses coming from skin • Thoracic part gets branches from vagal trunks and
than the viscera one feels as if the pain is in the skin. oesophageal plexus as well as from sympathetic
Trus is the basis of the referred pain. trunks and greater splanchnic nerves.
BRAIN-NEUROANATOMY

• Abdominal part receives fibres from vagal tnmks (i.e. is received from pelvic splanchnic nerves S2-S4. Pelvic
anterior and posterior gastric nerves), thoracic part splanchnic nerves give fibres to inferior hypogastric
of sympathetic trunks, g reater splanchnic nerves and plexuses to supply rectum and upper half of anal can al.
plexus around left gastric artery. The nerves form a Some of inferio r h ypogastric plexuses pass u p through
plexus called myenteric plexus between tw o layers superior hypogastric plexus and get distrib uted along
of the muscularis extema and another one in the sub- the branches of inferior mesenteric artery to the left third
mucous layer. of transverse colon, descending an d sigmoid colons.

Stomach Rectum and Anal Canal


Sympathetic supply reach es from coeliac plexus along Sympathetic fibres pass along inferior mesenteric and
gastric and gastroepiploic arteries. A few branches also superior rectal arteries and also via superior and inferior
reach from thoracic and lumbar sympathetic trunks. h ypogastric plexuses.
Parasympathetic su pply is derived from vagus nerves. Parasym pa thetic supply is from pelvic splanchnic
The left vagus forms anterior gastric, while right vagus nerves, w hich join inferior h ypogastric p lexus. This
comprises posterior gastric nerve. The anterior gastric s upply is m otor to muscles of rectum and inhibitory to
nerve supplies ca rdiac orifice, anterior surface of body internal sphincter.
as well as fund us of stomach and pylorus. The external anal sphincter is supplied by in fe rio r
Posterior gastric nerve supplies posterior surface of rectal branch of pudenda.I nerve. Afferent impulses of
body and fundus till pyloric antrum. It gives number physiological distension of rectum and sigmoid colon
of coeliac bra nches which form pa rt of the coeliac are carried by parasympathetic, whereas pain impulses
plexus. arc con veyed both b y the sympa thetic and p ara-
Vagus is secretomotor to stomach. Its stimulation sympathetic nerves.
causes secretion which is rich in pepsin . Symp athetic
inhibits peristalsis and is motor to the pyloric sphincter. Pancreas
It also carries pain fibres from stomach . Branches of coeliac plexus pass along the arteries. Effect
of sympathetic is vasomotor. The nerve fib res make
Small Intestine
synap tic contact w ith acinar cells before innervating the
The nerves of this p art of th e gut are derived from isle ts. The pa rasympa thetic ga ngli a lie in sparse
coeliac ganglia formed by posterior gastric ner ve connective tissue of the gland and the islet cells.
(vagus) and splanchnic nerves (sympathetic) and the
plexus around superior mesenteric artery. These nerves Uver
form myenteric plexus and submucous plexus. Para- Nerves of the liver are derived from hepatic p lexus
sympathetic fibres relay in the ganglion cells present wh ich is an offshoot of coeliac plexus. This contains
in these plexuses. Parasympathetic system is secreto- bo th sympathetic and parasympathetic fibres. These
m otor to the intestines and inhibits the sphincters. accompany the blood vessels and bile duct. Both types
Sympathetic fibres inhibits the peristaltic movements of of nerve fibres also reach the liver through various
intestine but stimulates the sphincters. The autonomic peritoneal folds.
nerves in the intestine form enteric nervous system.
Gallbladder
Large Intestine Parasympathetic and sympathetic nerves of gallbladder
Large intestine, excep t the lower half of anaJ canal, is are derived from coeliac plexus, along the hepatic artery
supplied by both components of autonomic nervous (hepatic plexus) and its branches. Fibres from the right
system . The derivatives of midgut, i.e. caecum, vermi- phrenic nerve (C4) thro ugh the communication of
form appendix, ascending colon and right two-thirds coeliac and phrenic plexus also reach gallbladder in the
of tra11sverse colon receive their sympa thetic nerve hepatic plexus. Thus, the reason of pain in the right
supply from coeliac and superior mesenteric ganglia shoulder (from where impulses are carried by lateral
and parasympathetic from vagus nerve. s upraclavicular ner ve C4) in ch o lecystitis is the
Left one-third of transverse colon, descending colon, stimulation of phrenic nerve fibres (C4) d ue to the
sigm oid colon, rectum and upper half of anal canal communication between phrenic plexus and hepatic
(developed from hind gut) receive their sympa thetic plexus via coeliac plexus. Coeliac plexus gets fibres from
nerve supply from lumbar part of sympathetic trunk thoracic 7 ganglia. Thoracic 7 nerve supplies skin over
and superior h yp ogastric plexus through the plexuses inferior angle of scapula. Hepatic plexus, an offshoot
on the branches of inferio r mesenteric artery. Its effect of coelia c plexus supplies gallbladder . So pain of
is chiefly vasomotor. Parasympathetic supply of colon gallbladder is also referred to inferior angle of scapula.
Kidneys
AUTONOMIC NERVOUS SYSTEM

to the muscular coat and inhibitory to the sphincter;


1
.J
The kidneys a re supplied by renal plexus formed from sympa thetic system is chiefly vasomotor. Emptying and
coeliac ganglion, coeliac plexus, lowest thoracic filling of urinary bladder is normally conh·olled by para-
splanchn ic nerve, a nd first lumbar splanchnic nerve. sympathetic system only.
The plexus runs along the branches of renal artery to
Male Reproductive Organs
supply the vessels, renal glomeruli and tubules. These
are chiefly vasomotor in hinction. Testicular plexus accompanies the testicular artery to reach
Ureter is supplied in its upper part from renal and the testis. It is formed by renal and aortic plexus, and
aortic plexus, middle part from supe rior h ypog astric also from superior and inferior hypogastric p lexuses.
plexus and lower part from h ypogastric nerve and This plexus supplies the epididym.is and d uctus deferens.
inferior hypogastric plexus. Prostatic plexus is formed from inferior hypogastric
plexus and branches are distributed to prostate, seminal
Vesical Plexus vesicle, pros ta tic urethra, ejaculatory ducts, erectile
Sympathetic fibres arise from Tl 1-12 segments and tissue of penis, penile part of urethra and bulbourethral
lumbar 1- 2 segments of spinal cord. Parasympathetic g lands. Sympathe tic nerves cause vasoconstriction,
fibres arise from sacral 2, 3, 4 segments of spinal cord, parasympathetic nerves cause vasod ilatation.
which relay in the neurons present in and near the wall Comparison of parasympathetic and sympathetic
of urinary bladder. Parasympathetic system is motor nervous systems is tabulated in Table 13.2.

Table 13.2: Comparison of parasympathetic and sympathetic nervous systems


Parasympathetic Sympathetic
Preganglionic neuron Located in midbrain, pons and medulla oblongata Located in lateral horn of spinal cord from Th 1-
and pass through Ill, VII, IX, X cranial nerves and 12 and L 1- 2 segments
also along S2-S4 segments of spinal cord
Preganglionic fibres Longer (Fig. 13.3b) Shorter (Fig. 13.3a)
Relay of impulses Occurs in neurons close to viscera Occurs in neurons little away from the viscera they
supply
Postganglionic fibres Short Long
Neurotransmitter Both at preganglionic endings and postganglionic At preganglion ic endings, acetylcholine is
endings, acetylcholine is released released. At postganglionic endings, adrenaline is
released, except in cases of sweat glands where
acetylcholine is released .
Number of synapses Preganglionic neuron makes synapses with much Preganglionic neuron makes connection with large
smaller number of neurons. Impu lses are number of postganglionic nerve cells and impulses
localised are widespread.
Postganglionic supply Only the viscera are supplied by postganglionic All the viscera are supplied by post-ganglionic
fibres . These do not supply blood vessels of fibres. The only exception is suprarenal gland
skelelal muscles which is supplied by the preganglionic fibres.
Functions These activities are discrete as well as isolated These activities are mass reactions, widely diffuse
and conserve the body energies in their action. These reactions are catabolic in
nature and are used in fright, flight or fight.
Action of skin Nil Sudomotor, pilomotor and vasomotor
Effect on blood vessels Blood vessels to the glands of gastrointestinal Blood vessels to skeletal muscles (cholinergic),
tract are dilated heart and brain are dilated.
Effect of gastrointestinal Secretory to the glands, motor to the smooth Decreases the secretory activity of glands, including
system muscles and inhibitory to the sphincters of gut the peristalsis of gut. It is motor to the sphincters.
Effect on pupil Pupil is constricted, lens curvature is increased Dilates the pupil.
as in reading
Heart Slows the pulse, maintains normal blood pressure Tachycardia, rise in blood pressure. Dilates the
coronaries
Lungs Increase the secretions of glands of lungs and is Decreases the secretions, is bronch odilator.
bronchoconstrictor Adrenaline-like drugs are given in asthma.
Urinary bladder Both filling and emptying of urinary bladder are Supplies only blood vessels of bladder, sphincter
controlled by parasympathetic vesicae is contracted by sympathetic action during
ejaculation
11111 BRAIN-NEUROANATOMY

Vagus nerves has a large general visceral afferent


.,.__ _ Soma in lateral horn of - - ----'= - compo nent. The superior ganglion is somatic and
grey matter inferior is visceral in nature. Their central processes end
in dorsal nucleus of vagus or tractus sol itarius.
Afferents are reached from pharynx and oesophagus
lj Sympathetic ganglion
near CNS
v ia IX, X cranial nerves wh ich are concerned with
swallowing reflexes. In the thorax, afferent fibres arise
from walls of great vessels, aortic and carotid bodies
and bronchial musculature (for cough reflex). General
visceral afferent fibres from stomach and intestine also
terminate in the dorsal nucleus of vagus which may be
responsible for nausea and hunger.

CLINICAL ANATOMY
Effector Effector
(a) (b) 1 Removal of stella te ganglion improves the blood
supply to the upper limb. But its removal causes
Figs 13.3a and b : (a) Sympathetic nervous system, and (b) para-
Homer's syndrome which is comprised of:
sympathetic system
• Anhidrosis of the same side of face
Female Reproductive Organs • Partial drooping of upper eyelid, i.e. ptosis
The ovary and uterine tube receive their nerve supply • Enophthalmos
from plexus around the ovarian vessels. This plexus is • Constriction of the pupil
derived from renal, aortic plexuses and also from • Loss of ciliospinal reflex
superior and inferior hypogastric plexuses. Sympathetic • Flushing of face
fibres derived from T10- Tll segments of spinal cord 2 Arteries of the upper limb are innervated by
are vasomo tor in nature whereas parasympathetic sympathetic fibres. Pregangl ionic fibres originate
fibre are probably vasodilator in function. from the cell bodies of T2-T5 spinal segm ents.
Fibres ascend in the sympathetic trunk and
Uterus synapse with middle and inferior cervical ganglia.
It is supplied by uterovagina l plexus, formed from the Postganglionic fibres join the nerves which
constitute the brachia! plexus, get distributed to
inferior hypogastric plexus. The sympathetic fibres are
the arteries of the upper limb in each region. These
derived from T12 to L1 segments o f spinal cord.
Parasympathetic fibres arise from S2- S4 segments of fibres may be cut to relieve the symptoms of
Raynaud's disease.
spinal cord. Sympathetic system causes uterine contrac-
ti o n and vasoconstriction, while parasympathetic 3 Thoracic 2-5 ganglia and stellate ganglia may be
nerves produce vasodilatation and uterine inhibition. removed in cases of intractable angina pectoris.
Vagina is supplied by nerves arising from inferior hypo- 4 Arteries of lower Umb are supplied by lower three
gastric plexus to uterovaginal plexus. These supply wall thoracic and upper two lumbar segments of the
of vagina including vestibular glands and clitoris. Para- spinal cord. Femoral artery is supplied by sym-
sympathetic fibres cause vasodi lator effect on the pathetic fibres from femoral and obturator nerves.
erectile tissue. Posterior tibial artery receives the postganglionic
fibres from common peroneal and tibial nerves.
AFFERENT AUTONOMIC FIBRES Buerger' s disease may be trea ted by lumbar
sympathectomy.
Autonomic afferents are periphera l processes of
5 Megacolon: There is absence of ganglion cells and
pseudounipolar cells in some cranial and spinal nerve
ganglia. The terminals of a utonomic nerves may be failure of innervation of the smooth muscle layers
loops, rings, tendril-like endings, a few encapsulated of pelvic colon.
ones in the walls of viscera. Viscera are sensitive to 6 Referred pain: If the somatic nerves from skin and
· stretch, ischaemia and distension. These sensations afferent fibres from viscera enter the same segment
cause pain and reach up to the level of consciousness. of the spinal cord, the phenomenon of referred pain
General visceral afferent fibres are in III, Vil, IX, X occurs. Visceral pain in the appendix is produced
cranial nerves, sacral 2, 3, 4 nerves and in Tl-L2 spinal due to either spasm of its muscle, or distension of
nerves. its lumen. The afferent impu lses ascend through
the superior mesenteric plexus, lesser splanchnic
AUTONOMIC NERVOUS SYSTEM

The nerve fibres originating in the visceroefferent


column (lateral horn) of thoracolumbar segments of
1
--
nerve to reach the spinal cord at Tl Olevel. Jmpulses
from the skin around umbilicus are also carried by spinal cord synapse with neurons of sympa thetic
TlO segment. ganglion at the same level in sympathetic chain or pass
Brain is more conscious of impulses from skin. So through the chain to preaortic or colla teral ganglion.
in early case of appendici tis, though there is The preganglionic fibres ha ve myelin shea th and
stimulation of sympa theti c fibres of appendix, stimulate sympathetic ganglion cells. Passing from
person thinks the impulses are arising from skin spinal nerves to sympathetic ganglion, they form the
of umbilicus. So pain of early appendicitis is white ramus communkans. Since the visceroefferent
referred to the umbilicus. La ter on when parietal column extends from Tl-L2 segments of spinal cord,
peritoneum is inflamed, pain is localised in the white ranu comm unicantes are fow1d only at Tl-L2
right iliac fossa. levels (Fig. 13.3a).
7 Pain fibres from the body of the uterus pass with Axons of sympathetic gan glio n cells are called
sympathetic nerves through the hypogastric plexus postganglionic fibres and have no myelin sheath. They
and the lumbar splanchnic nerves to cells on the pass either to other levels of sympathetic chain or
dorsal roots of the lower thoracic and upper lumbar extend to heart, lungs and intestinal tract.
nerves. Afferents from cervix pass in dorsal roots Other fibres known as grey rami communicantes pass
of upper sacral nerves. Cauterization of cervix does from sympathetic chain to spin a I nerves and from there
not cause pain whereas stretch (dila tation) of cervix to peripheral blood vessels, a rrector pilorum muscles
is painful. and sweat glands. Grey rami communicantes are found
at all levels of spinal cord.
Development Parasympathetic Portion
Sympathefic Portion Pregangl ionic neurons are formed in the brain stem and
Sympa thetic pathways consist of two neurons, i.e. sacral region of spinal cord.
preganglionic and postganglionic. The preganglionic These neurons in the brain stem are located in general
neurons develop in the mantle layer of thoracolumbar visceral efferent column. These give rise to Edinger-
segmen ts of sp inal cord, Tl-L2 segments. These Westphal nucleus, lacrimatory, superior saliva tory and
neurons are located in the genera l visceral efferent inferior salivatory nuclei and dorsal nucleus of vagus.
column or intermediate zone and form the lateral horn Their axons constitute the cranial parasympathetic
of the spinal cord. The axons arising from these neurons outflow (Fig. 13.3b).
are myelinated and pass into ventral nerve roots to enter The sacral preganglionic neurons are derived from
spinal nerves. After a short course, they leave the spinal the mantle layer of sacral part of the spinal cord, their
nerve and pass towards postganglionic neurons. axons constitute the sacral parasympathetic outflow.
Postganglionic neurons develop in the 5th week of Postganglionic neurons of cranial region are derived
intrauterine life; cells originating in the neural crest of from neural crest cells. These neurons form ciliary, otic,
the thoracic region migrate on each side of spinal cord sphenopalatine and submandibular ganglia and also
towards the region immediately behind the dorsal the ganglia associated with various viscera supplied
aorta . H ere they form a bilateral chain of segmentally by vagus nerve. Postganglionic axons arise from these
a rranged sympa the tic gangl ia interconnected by neurons in the ganglia and supply constrictor papillae,
longitudinal nerve fibres. Together they form the lacrimal, salivary glands and various viscera.
sympathetic cha ins located on each side of vertebral According to some investigators, postganglion ic
column. From positions in the thorax, neuroblasts neurons of the brain arise from same region as the
migrate towards cervical and lumbosacral region, thus preganglionic neurons and migrate along the path
extending sympathetic chain to their full length. The followed by postganglion ic fibres.
arrangement is obscured in the cervical region by fusion In the sacral region, the postganglionic neurons
of the ganglia (Fig. 13.1). migrating from the sacral part of the spinal cord supply
Some neuroblasts migrate in front of aorta to form pelvic viscera and distal one-third of transverse colon,
preaortic ganglia like coeliac, mesenteric ganglia. descending colon, pelvic colon, and rectum.
Appendix
.!/l,al lendcu ,,,,. oull11,11,y j,eoj,lr ,rill, u-lwoulln,n/1 ti, ln111i11r,/l,,11
.fhin o/ /1,,, mi11rl i, tl"OlM! //,n11 j,11i11 oj' /1,,. I-Mf,1

Anterior wall: Lamina terminalis, anterior comm issure,


SUMMARY OF THE VENTRICLES OF THE BRAIN
anterior column of fornix (see Fig. 9.1).
LATERAL VENTRICLE Posterior wall: Pineal body and cerebral aqueduct.
The lateral ventricle comprises a cenh·al body and three Floor: Optic chiasma, tube rcineriu m, infu ndibulum,
horns-anterior, posterior and inferior. Their walls are mammillary bod y, posterior perforated substance and
enumerated. tegmentum of m idbrain.
Roof: Ependyma, tela choroidea.
Body or Central Part Lateral wall: Medial surface of thalamus, medial aspect
Roof Trunk of corpus callosum. of hypothala mus, epithala mus a nd interven tricular
Floor:Superior surface of thalamus, thalamostriate vein, foramen.
stria terminalis, body of caudate nucleus. Recesses: lnfundibular recess, optic recess, pineal recess,
suprapineal recess (see Fig. 9.1).
Medial: Septum pellucidwn, body of fomix (see Fig. 9.Sa).
Anterior Horn FOURTH VENTRICLE
Roof: Anterior part of trunk of corpus caUosum. The cavity of fourth ventricle is situated dorsal to pons
and upper part of medulla oblongata and ventral to
Anterior: Genu and rostrum of corpus callosum.
the cerebellum. Its boundaries, recesses, apertures and
Floor: Head of caudate nucle us (see Fig. 9.7a). continuations are men tioned here:
Medial wall: Septum pellucidum and column of fornix. Lateml boundaries: Gracile tubercle, cu neate tubercle
inferior cerebellar ped uncles and superior cerebellar
Posterior Horn peduncles (see Fig. 7.1).
Roof and lateml wall: Tapetum of corpus caJlosum.
Floor
Medial wall: Bulb of posterior horn above and calcar a vis Upper part: Facial colliculus on the dorsal surface of pons
below (see Fig. 9.8). (see Fig. 7.2).
Inferior Horn intermediate part: Vestibular nuclei, medullary striae.
Roof and lateral wall: Tapetum, tail of caudate nucleus, Lower part: Upper part of medulla oblonga ta containing
stria terminalis and amygdaloid nucleus. h ypoglossal an d vagal triangles.
Floor: Pes hippocampus, hippocampus, alveus, fimbria, Roof: Superior medulla ry velum, thin sheet of pia mater
d entate gyrus and collateral emine nce (see Fig. 9.9). and epend y ma with median aperture, inferior
medullary velum (see Fig. 7.2).
THIRD VENTRICLE Recesses in roof: One median dorsal, two lateral dorsal
The third ventricle lies between the two thalami. The and two lateral.
com ponents of its bo undaries and recesses are Apertures: One median - foramen of Magendie, two
enumerated: la te ral - foramina of Lushka (left and right).
194
APPENDIX

Continuity: Above w ith cerebral aqueduct most of anterior two-thirds of tongue and afferents
Below with central ca nal of spinal cord. from glands supplied by it.
Table Al shows arteries of brain. 4 General somatic afferent from part of skin of auricle.

NUCLEAR COMPONENTS OF CRANIAL NERVES CN VIII: VESTIBULOCOCHLEAR


Special somatic afferent column:
CN I: OLFACTORY T1m parts: Vestibular nuclei: Medial, superior, spinal,
Part of forebrain lateral.
CN II: OPTIC Cochlear 1111clei: Dorsal and ventral.
All a t pontomedu llary junction.
Part of forebrai n
CN Ill: OCULOMOTOR CN IX: GLOSSOPHARYNGEAL
1 Gene ral somatic efferent column for 5 extraocular 1 Special visceral efferent for one muscle of pharynx-
muscles at level of superior colliculus. the stylopharyn geus in medulla oblongata.
2 Genera l visceral effe rent co lumn for 2 se ts of 2 General visceral efferent for parotid gla nd (see
intraocular muscles (see Flowchart A.4, Volume 3). Flowchart A.3, Volume 3).
3 General somatic afferent-mesencephalic nucleus o f 3 Special and general visceral afferent (nucleus of b:actus
C V. lt receives proprioceptive im pulses from solitarius) for sensations of taste from posteiior one-
extraocular muscles (see Figs 4.4a and b). third tongue and circumvallate papi llae, also carries
general sensations from posterior one-third tongue,
CN IV: TROCHLEAR tonsil carotid body and carotid sinus.
1 General somatic efferent column for supply of only 4 Genera l somatic afferent for propriocepti ve fibres
superior oblique muscle at level of inferior colliculus. from the muscle.
2 General somatic afferent-mesence phalic nucleus of
CN V. Tt receives p roprioceptive impulses from the CN X + CN XI: VAGUS AND CRANIAL PART OF CN XI
superior oblique muscle. 1 Special visceral effere n t for muscles of larynx,
CN V: TRIGEMINAL pharynx, soft palate in med ulla oblongata.
2 Special and general visceral afferents carry (nucleus
1 Special visceral efferent column for 4 muscles of of tractus solitarius) taste from posteriormost part
mastication and 4 other muscles at upper level of pons. of tongue, epiglottis and afferents from foregut and
2 General soma tic afferent column: midgut derivatives.
a. Spinal nucleus of CN V for pain and temperature 3 Genera l visceral efferent for glands of respiratory
from face. system and gastrointestinal tract till righ t two-thirds
b. Superior sensory nucleus of C V for touch and of transverse colon.
pressu re from face. 4 General som a ti c afferen t from skin of external
c. Mesencephalie nucleus of C l V for proprioceptive auditory meatus.
impulses from extraocular muscles, muscles of
tongue and mastication. CN XI : SPINAL PART OF ACCESSORY NERVE
CN VI: ABDUCENT 1 Special visceral efferent column in Cl-C4 ventral
1 General somatic efferent colum n for late ral rectus at horn cells of spinal cord for stemocleidomastoid and
lower level of pons. trapezius.
2 Genera l soma tic afferent- mesencephal ic nucleus of 2 General somatic afferent-dorsal horns of C2-C4
CN V. lt receives proprioceptive impulses from the segments of spinal cord. These receive propriocep-
lateral rectus muscle. tive impulses from the above two muscles.

CN VII: FACIAL CN XII: HYPOGLOSSAL


1 Special visceral efferent colurnn fo r muscles of facia l 1 General som a tic efferent column for all 4 intrinsic
expression a t lower level of pons. muscles of tongue and three extrinsic muscles:
2 General visceral efferent for lacrimal, nasal, pa latal Styloglossus, genioglossus and hyoglossus in medulla
and submandibular, sublingual glands (see Flowcharts oblongata.
A.1 and A.2, Volume 3). 2 Genera l somatic affcrent-mesencephalic nucleus of
3 Special visceral afferent and general visceral afferen t CN V. It receives proprioceptive im pulses from the
(nucle us of tractus solitarius) for carrying taste from muscles of tongue.
BRAIN- NEUROANATOMY

Table A.1: Arteries of brain


1. Vertebral artery, a branch of 1st part of subclavian artery, is divided into four parts
a. First part: Lies deep in the neck in the vertebral triangle; gives no branches.
b. Second part: Passes in the foramen transversaria of C6-C1 vertebrae; gives spinal branches for supply of meninges and
spinal cord (see Fig. 11.3).
c. Third part: Lies in the suboccipital triangle, on the posterior arch of atlas vertebra and gives branches to muscles of
suboccipital triangle.
d. Fourth part: Enters the cranial cavity through foramen magnum. Joins with the same artery of opposite side to form basilar
artery at the lower border of pons. The fourth part gives:
i. Meningeal branches
ii. Posterior spinal artery
iii. Anterior spinal artery
iv. Posterior inferior cerebellar artery
v. Medullary branches.

2. Right and left vertebral arteries unite at the lower border of the pons to form a median basilar artery, which gives
following branches:
a. Anterior inferior cerebellar (see Fig. 11.4)
b. Pontine branches
C. Labyrinthine branches
d. Superior cerebellar
e. Posterior cerebral

3. Internal carotid artery


a. Cervical part gives no branches.
b. Petrous part gives (i) caroticotympanic for the middle ear, and (ii) pterygoid branch.
c. Cavernous part gives branches to (i) trigeminal ganglion, and (ii) superior and inferior hypophyseal branches.
d. Cerebral part gives following branches:
i. Ophthalmic artery which supplies outer layers of eyeball and retina through central artery of retina which is an end artery
ii. Anterior cerebral (see Fig. 11 .13)
iii. Middle cerebral
iv. Posterior communicating
v. Anterior choroidal

4. Circle of Willis
Circle of Willis is formed by union of (i) anterior cerebral, (ii) terminal part of internal carotid, (iii) posterior communicating
branch of internal carotid, (iv) joining the posterior cerebral branch of vertebral artery on each side (see Fig. 11.1 3). The two
anterior cerebral arteries are joined by anterior communicating artery.
It gives:
a. Central branches: These are long thin, numerus end arteries with supply deeper structures like internal capsule and basal
ganglia.
b. Choroidal branches of internal carotid and posterior cerebral arteries supply choroid plexuses of the ventricles.
c. Cortical branches: These are:
i. Anterior cerebral: Chief artery on the medial surface of cerebral hemisphere till parieto-occipital sulcus. It also supplies
1 cm wide area on the superolateral surface, along the superomedial border. The area includes motor and sensory
areas of lower limb and perineum.
ii. Middle cerebral: Main artery of the superolateral surface supplying major parts of motor and sensory areas. It also
supplies motor speech area, auditory and vestibular areas.
iii. Posterior cerebral: Chief artery of the tentorial surface and occipital lobe. This is the artery of visual cortex.
APPENDIX

EFFERENT PATHWAYS OF CRANIAL PART OF There is no motor weakness and pa tient has
PARASYMPATHETIC NERVOUS SYSTEM normal knee and ankle reflexes.
Medial medullary syndrome: This syndrome
Preganglionic parasympathetic fibres are present in occurs due to thrombosis of anterior spinal artery.
4 cranial nerves, e.g. cranial nerves III, Vll, IX, X and
There is paralysis of muscles of tongue on same side,
along spinal nerves S2, S3, S4. Four ganglia namely
ci liary, pterygopalatine, submandibular and otic are associa ted with hemiplegia and loss of position sense
concerned with efferen t parasympathetic fibres. Their in limbs on the opposite side (see Fig. 5.8).
connections are shown in Flowcharts A. l to A.4 Tabes dorsalis: Tabes dorsalis affects the posterior
(see Volume 3). white column of spinal cord. It leads to bilateral loss
of proprioceptive sensations and tactile discrimination
below the side of lesion. The finger nose test is past
CLINICAL TERMS pointing with eyes closed (see Fig. 3.6).
Brown-Sequard syndrome: The signs and symptoms Lateral me dullary syndrome or WaJlenberg's
are due to injury to one-half of the spinal cord. syndrome: The lateral med ullary syndrome leads to
Following are at the level of injury: symptoms as:
a. Ipsilateral upper motor neuron paralysis. a. On tlte side oflesion: Vertigo, vomiting, nystagmus
b. Ipsilateral loss of conscious proprioception. (vestibu lar nuclei affected) and ataxia of limbs
c. Contralateral loss of pain and temperature. (i nferior cerebellar peduncle). Horner's
syndrome (sympathetic fibres) and dysphagia,
Following are due to injury to various tracts below
hoarseness (nucleus ambiguus).
the level of injury:
b. On the opposite side of lesion: Loss of pain and
a. Ip silateral lower motor neuron paralysis.
temperature from limbs and trunk (see Fig. 5.8).
b. Ipsilateral loss of sensa tion over the cranial
Cerebellopontine angle syndrome: The anato-
dermatome.
mical struchues located in cerebellopontine angle are
These (a), (b) are due to injury to nerve root at the choroid plexus of 4th ventricle, 7th and 8th nerves.
level of injury (see Fig. 3.18). A tumour here gives symptoms: Facial ner ve
Cauda equina s yndrome: It occ urs due to paralysis and 8th nerve paralysis lead ing to deafness
compression of cauda equina in the vertebral canal. and vertigo. Flocculus of cerebellum involved leads
L2- S5 nerve roots are affected. Its fea tures are: to ataxia on the affected side.
a. Loss of knee and ankle jerks. Milla rd-Gubler syndrome: Millard-Gub ]e r
b. Sensory loss in nerve root distribution. syndrome occurs due to lesion in the lower pons
c. Asymmetric areflexic lower motor neuron type affecting pyramidal tract and fibres of 6th and 7th
of paralysis. cranial nerves. The symptoms are:
d . Later involvement of bowel and bladder. a. Ipsilateral medial squint.
Syringomyelia: There are cavi ties around the b. lpsil atera l paralysis of m u scles of fac ial
central canal. There is bilateral loss of sp inothalamic expression.
fibres. Lateral spinothalamic tracts cross at once while c. Contralateral hemiplegia.
anterior spinothalamic first ascend and then cross. Benedikt's syndrome : Benedikt's syndrome
There is loss of pain and temperature at one level and results due to lesion of tegmentum of midbra in
loss of touch and pressure at another level. So it is involving su perior brachium, fibres of 3rd nerve, red
called "d issociated sensory loss" (see Fig. 3.19). nucleus and medial lemniscus (see Fig. 5.17).
Conus medullaris syndrome: It is produced due Weber's syndrome: Weber's syndrome involves
to pressure on con us medullaris of spinal cord from corticospinal tract and 3rd nerve nucleus. There is
w here S2, S3 and 54 nerves arise. The symptoms and lateral squint on same side and hemiplegia on the
signs are: opposite side of body (see Fig. 5.17).
a. Saddle-shaped anaesthesia on the bottom. Parinaud's syndrome: This syndrome occurs due
b. Loss of anal sphi ncteric reflex. to compression of superior colliculi when these get
c. U ri.nary bladder and bowel get affected early. pressed by tumour of pineal gland. There is paraly is
BRAIN-NEUROANATOMY

of upper gaze only. Other eye movements are d. Involuntary movement like tremors, pin rolling
tmaffected (see Fig. 5.17). movements of hand.
Thalamic syndrome: Thalamic syndrome is due e. Bends forwards during walking.
to a vascular lesion . It is characterised by distur- Babinski's sign: In case of lesion of corticospinal
bances of sensations, hemiparesis or hemiplegia with tract there is dorsiflexion of big toe and fanning of
hyperaesthesia and severe spon taneous pain. other toes in response to scratching the skin on the
Pleasant as well as unpleasant sensations are lateral side of sole. This sign is positive in case of
exaggerated. upper motor neuron lesion.
Subarachnoid haemorrhage: Subarachno id When corticospinal tract is damaged, the influence
haemorrhage is th e collection of blood in the of other tracts becomes obvious which ca use
subarachnoid space at the base of brain. These are dorsiflexion of 1st toe and fanning of other toes. In
also called the cisterns. The circle of Willis lies in the infants and children u p to two years Babinski's sign
interpeduncular cistern. Any small branch usually is normally present as the tracts are not full y
due to persistent hypertension may rupture to give myelinated (see Fig. 1.8).
rise to subarachnoid haemorrhage. Poliomyelitis: It is a viral disease which involves
Cerebral stroke: The neurological signs and anterior horn cells leading to flaccid paralysis of
symptoms d ue to lack of blood supply constitute the affected segments. It is lower motor neu ron
the cerebral stroke. It is mostly due to rupture of paralysis (see Fig. 3.6).
any of the a rteries especially central branch of Following is the comparison between upper motor
middle cerebral artery supp lying the internal neuron and lower motor neuron paralysis:
capsule.
Charcot's artery of cerebral haemorrhage: The LMN paralysis UMN paralysis
largest branch of anterolateral central branches Muscle tone abolished Muscle tone increased
of middl e cerebra l ar tery is called Charcot's Leads to flaccid paralysis Leads to spastic paralysis
artery of cerebral haemorrhage. It suppl ies internal Muscles atrophy later No atrophy of muscles
capsule which has motor fibres for one side of Reaction of degeneration Reaction of degeneration
body. Damage to artery causes opposite side seen not seen
hemiplegia.
Tendon reflexes absent Tendon reflexes exag-
Sparing of macula in thrombosis of posterior gerated
cerebral artery: Macttla is represented at the Limited damage Extensive damage
occipital pole. It is supplied by branches of middle
cerebral artery or by anastomosis between middle Cerebral vascular disease: It is quite common in
and posterior cerebral arteries. So thrombosis of old age and manifest in different ways.
posterior cerebral artery does not harm the macula a. Haemorrhage-cortical or subcortical
(see Fig. 4.13). b. Thrombosis
Hydrocephalus: Hydrocephalus is an abnormal c. Embolism.
increase in the volume of CSF within the skull. ft
Hypertensive encephalopathy: This is a mani-
may be due to increased production, blockage in
circulation or decreased absorption of CSF. festation of sustained elevation of diastolic blood
pressure in the form of multiple diffuse small lesions
Hydrocephalus may be "internal" within ventri- distributed all over, result in a variegated picture of
cular system causing increased intracranial pressure the circle of Willis (berry's aneurysm).
and brai n damage. lf CSF accumulates in the
subarachnoid space, the cond ition is calJed external Nerve s upp ly: The ar teries of the brain are
h ydrocephalus (see Fig. 2.7). supplied with sympathetic nerves which run onto
them from carotid and vertebral plexuses.
Parkinsonism: Lesion of corpus stria tum leads to
parkinsonism. It gives rise to: They are extremely sensiti ve to injury and readily
react by passing into prolonged spasms. This by itself
a. Lead pipe rigidity or hypertonicity. may be sufficient to cause damage to brain tissue
b. Movements are slow (see Fig. 8.23). since even the leas t sensitive neurons can not
c. Lo s of automatic associated movements and withstand absolute loss of blood supply for a period
also loss of facial expression. more than 3-7 minutes.
APPENDIX

MULTIPLE CHOICE QUESTIONS

1. Match the structures on the left with their related 2. Special features of the parts of brain:
structures on the right. Left Right
Left Rig/it a. Olivary nucleus 1. Cerebellum
a. General somatic afferent 1. Ves tibulo- b. Dentate n ucleus ii. Midbrain
cochlear nerve
c. Facial collicul us Ill. Pons
b. Special somatic afferent 11. Trigeminal
c. Special v isceral efferent 111. Oculomotor d. Subs tantia nigra iv. Medulla
d. Gen era l somatic efferent 1v. Accessory oblongata

ANSWERS
1. a. - ii, b. - i, c. - iv, d . - iii, 2. a. - iv, b. - i, C. - iii, d. - ii.
FURTHER READING
1 Alexander GE, Dehong MR, Strick PL. Parallel organization of functionally segregated circuits linking basal ganglia and
cortex. A1111 Rev Neurosci 1986; 9:357--82.
2 Bjorklund A, Hokfelt T, Owman C (eds). The peripheral Nervous System. Handbook of Chemical Neuroanatomy. Vol 6
Amsterdam: Elsevier 1988.
3 Broda! P, Bjaalie JG. Organisation of the pontine nuclei Neurosci Res 1992; 13:83-118.
4 Browder J, Kaplan HA. Cerebral Dural Sinuses and their Tributaries Springfield, lllious: Thomas 1976.
5 Crossman AR, Neary D. Neuroanatomy. An Illustra ted Colour Text 2nd edition. Edinburgh Churchill Livingstone 2000.
6 Duvernoy HM, Delon S, Vannson JL. Cortical blood vessels of the human Brain. Brain Res Bull 7:519-79 1981.
7 Garg, Ka ul, Bahl. Textbook of Neuroanatomy, 4th edn., CBS Publishers & Distributors
8 Gebhart Al, Petersen SE, Thach WT. Role of the posterola teral cerebellum in langnage. Ann NY Acnd Sci 2002; 978:
318-33.
9 H ubel DH . Eye, Brai n and Vision Scientific American Library Series No. 22 1988.
10 Jones EG. The Thalamus New York; Plenum Press 1985; 403-11.
11 Kaplan HA, Ford DH. The Brain Vascular Syste m Amsterdam: Elsevier 1966.
12 Leigh RJ, Zee DS. The Neurology of eye movement, 3rd edition Oxford. Oxford University Press 1999.
13 Macchi G, Jones EG. Toward an agreement on terminology of nuclear and subnuclear division of the motor thalamus. J
Ne11ros11rg 1997; 86(4):670-85.
14 Nadal 18. Comparative ana tomy of the cochlea and auditory nerve in mammals Hear Res 1988; 34:253-66.
15 Nieuwenhuys R, Voogd J, Huijzen C Van. The h uman central nervous system. A synopsis and atlas 3rd edition Berlin:
Spring Verlag 1988.
16 Papez JW. A proposed mechanism of emotion Arch eurol Psychiat 1937; 38:725-43.
17 Paulson OB. Blood brain barri r, brain metabolism and cerebral blood flow Eur europsychopharmacol 2002; 12 (6):
495- 501.
18 Penfield W, Rasmussen T. The Cerebral Cortex of man. New York; Macmillan 1950.
19 Penney JB Jr, Yow1g AB. Stria tal inhomogeneities and basa l ganglia func tion. Mov Disord 1986; 1:3-15.
20 Sd1mahmann JD, Sherman JC. The cerebellar cognitive affective syndrome. Brain 1998; 121:561- 79.
21 Schoenen J, Faull RLM. Spinal cord: Cytoarchitectural, dendro architectural and myeloarchitectural organisation. In :
Paxinos G (ed) The Human Nervous system. San Diego, CA: Academic Press: 1990; 19-53.
22 Sperry RW. Consciousn ess, Personal Iden tify and the d ivided brain Neuropsychologia 1984; 17:153-66.
23 Strazielle N, Ghersi-Egea JF. Choroid plexus in the Central Nervous System: Biology and Physiopathology. JNeuropat/10/
Exp Neural 2000; 59(7):561-74.
24 Turnbull IM, Brieg A, Hassler 0. Blood supply of cervical spinal cord in man. A microangiographic cadaver study. J
Neurosu rg 1966;24:951-65.
25 Zeki S. A Vision of the Brain, Oxford : Blackwell Scientific, 1993.
26 Zhang ET, Inman CBE, Weller RO. In terrelationships of the pia mater and the perivascular (Virchow-Robin) spaces in
the Human Cerebrum. J Annt 1990;170:111-23.
SPOTS

l. a. Identify the structure. 6. a . Identify the structure.


b. Where are such structures b. Name the muscles
found? attached to It.
c. What is the nerve supply?

2. a. Name the structure. 7. a. Name the structure.


b . Enumerate Its folds. b. Name its fibres.

3. a . Identify the structure. 8. a . Identify the part.


b. Where does it terminate? b. What is its blood supply?

4. a. Identify the structure. .. 9. a. Identify the structure .


b . What is the effect if its \., / b. Name its branches.
c rossing fibres are
damaged?

5. a. Identify the structure. l 0. a. Identify the structure.


b. Name its functional b. What are its parts?
components.
BRAIN-NEUROANATOMY

ANSWERS OF SPOTS

l . a . Bipolar neuron
b. Retina, nasal mucous membrane, taste buds, cochlear ganglion and vestibular ganglion (special senses)

2. a . Meningeal layer of dura mater


b. Faix cerebri, falx cerebelli, tentorlum cerebelll and dlaphragma sellae

3. a. Lateral corticospinal tract


b . Neurons of anterior horn of spinal cord

4. a. Optic chiasma.
b. Bltemporal hemianopia

5. a. IX or glossopharyngeal nerve
b. SpVE: Special visceral efferent
GVE: General visceral efferent
GVA: General visceral afferent
SpVA: Special visceral afferent
GSA: General somatic afferent

6. a . Ramus of mandible
b. Temporalis, masseter, lateral pterygold and medial pterygoid
c . Mandibular b ra nch of trigeminal nerve

7. a. Middle cerebellar peduncle


b . Corticopontocerebellar fibres

8. a. Occipital lobe
b . Posterior cerebral artery

9. a . Basilar artery
b. Anterior Inferior cerebellar, pontine, labyrinthine, superior cerebellar and posterior cerebral

l 0. a . Corpus callosum
b. Rostrum, genu, body and splenium.
Index

A m ed ia l occip ital 123 Cereb ral h emis phere 121


medial or bital 123 b orders of 122
Accommodation reflex 58 s uperomedial 122 external features of 12 l
Anos mia 55 Brain stem 9 0 insula 124
Arachnoid m a ter 19 Brain lobes of 124
Area. areas blood s upply of 167 m edial surface of 122
acoustic 13 1 orbital s urface of 122
in troduction lo 3
p oles of 123
molor 12 7 parts/divisions 3 s urfaces of 121
motor s peech 129 radiological ana tomy of 182 Chiasma optic 56
of Broca 129 Cistern
of Brodmann 126 C cerebellomedullary 23
of cerebral cortex 126 interpedunc ular 2 3
Caps ule interna l 146
pre molor 127 lu m bar 23
anterior limb of 148 of gr eat cerebral vein 23
s ensory 13 0
vis u a l 13 1 blood s upp ly of 148 of lateral s ulcus 23
Arte rial vasocoron a 42 fi bres in 146 Cisterna
Artery. arteries genu of 148 ambiens 23
parts of 14 6 magn a 23
basilar 168
poslerior limb of 148 p ontins 23
internal carotid 170 Clinical anatomy
cereb ella r 111 relrolentiform pa rt of 148
acou s tic n euroma 77
cerebral I 7 4 su ble ntiform pa rt of 148 ageing 132
a nterior I 70 Cauda equina 29 Alzh eimer 's d isease 13 2
pos terior 169 Centre a n osmia 5 5
middle 170 drinking 140 a n terior lobe lesion of
feeding 139 cerebellum 11 2
B h u nger 139 Argyll Rob ertson pupil 60. 103
thirst 140 a the losls 143
Ba bins ki's s ign 8 b allismus 143
bipola r 4 Cerebellum 105
Bell's palsy 73
multi polar 4 blood s upply of 1 11 b inasal h emlanopia 60
pseudounipolar 4 con n ections of 109 bra in stem les ion 95, 98. 10 I
unipolar 4 functions of 112 cere bello-p ontine angle 9 8
Blood s upply of bra in 167 lobes of 105 Ch arcors a rtery of cereb ral
brain stem 17 7 vallecula o f I 0 5 h aemorhage 149
vermis of 106 c horea 143
cerebellum 111. 174
Ce reb ral h e mis phe re 12 1 corneal blink re flex 58 , 59
medulla 95 d a m age to pyra midal tract 16 2
midbra in 10 1 Cerebrosplnal fluid 25 d eafness 77
p on s 9 8 a bsorption of 25 d ementia 132
spinal cord 42 circu lation o f 25 drooping of shou ld er 85
Bor der s of cerebrum fo rma tion of 2 5 glossoph aryngcal neu ralgia 8 1
in ferola leral 122 functions of 2 5 h omonymous hemianop ia 60
203
204 BRAIN-NEUROANATOMY

hydrocephalus Clinical Terms 197 commissural 145


communicating 25 Colliculus projection 145
non-communicating 25 inferior 100 Foramen, forarnina
injury to vital centres in medulla 96 superior 100 of 4th ventricle
lesions of cerebral cortex 133 Commissures lateral 117
lesions of cranial nerves/branches anterior 145 median 117
eight nerve 74 of fornix 145 of Luschka 11 7
eleventh nerve 84 posterior 145 of Magendie 11 7
fifth nerve 67 Corpus callosum
first nerve 53 bodyof 145 G
fourth nerve 63 genu of 145
ninth nerve 77 Gyrus, gyri
rostrum of 145
optic nerve damage 58 cingulate 125
splenium of 145
optic neuritis 60 frontal
trunk of 145
recurrent laryngeal 83 inferior 124
Corpus striatum
second nerve 56 medial 127
connections of 142
seventh nerve 70 middle 124
functions of 142 superior 124
sixth nerve 65
tenth nerve 81 occipital superior 124
t h ird nerve 61 D occipitotem poral
trigeminal neuralgia 69 Development of lateral 126
twelfth nerve 86 cerebellum 112 medial 126
lesions of hypothalamus 140 cerebral hemisphere 13 orbital 126
lesions of internal capsule 149 Functional components 48 parahippocampal 126
neocerebellar lesion 112 medulla oblongata 96 paraterminal 126
nystagmus 112 midbrain 103 parolfactory 126
optic neuritis 60 neural crest 11 postcentral 125
paralysis of Ill nerve 63 neural tube 11 p recentral 125
parkinsonism 143 pons 99 rectus 126
poliomyelitis 30 spinal nerve roots 15 supramarginal 125
pontine haemorrhage 99 sympathetic and parasympathetic temporal 125
syndromes nervous system 193 middle 125
Benedict 103 Diencephalon 12
superior 125
Dissection of
Brown-Sequards 44
basal nuclei 14 1
cauda equina 30 H
cerebrum 120
cerebellar 112
lateral ventricle 152 Haem orrhage
con us medullaris 30 meninges 19
lateral medu llary 96 pontine 99
spinal cord 28 Head
medial medullary 96 third ventricle 151
Millard -Gubler 99 evolution of 182
white matter of brain 144
Parinaud 103 Human speech 133
Weber 103 Hypothalamus
E bou ndaries of 138
syringomyelia 44
tabes dorsalis 30 Epithalamus 138 connections 139
thrombosis of Evolution of head 182 functions of 139
anterior inferior cerebellar parts of 139
artery 170 F
anterior spinal artery 168 I
Faix cerebelli 20
Heubner's artery 175 Faix cerebri 20 Investigations in a neurological
lateral striate artery 1 75 Fasciculus case 180
paracentral artery 175 cuneatus 41
posterior cerebral artery 170 gracilis 40 L
posterior inferior cerebellar uncinate 144
artery 170 Fibres Lemniscus
superior cerebellar artery 170 arcuate 144 lateral 74
tumours of pons 99 association 144 medial 95
VII nerve palsy in newborn 74 short 144 trigeminal 67
INDEX 205

Ligamentum denticulatum 29 cochlear 74 p


Limbic system 156 dentate 109
Lobule efferent Parkinsonism 143
paracentral 126 somatic 49 Pathway, pathways for
parietal general 49 pain 162
inferior 124 visceral proprioceptive imp ulses 163
superior 124 taste 163
general 50
Locus coerulcus 116 touch 163
special 49
emboliformis 110 Pia mater 2 1
M facial 49
Pineal body
fu n ctions of 138
Midbrain 99 fastigii 110
structure of 138
internal structure of 100 globosus 109
Poles, of cerebral hemisphere
Neocerebellum 106 hypoglossal 49
Nerve, nerves frontal 123
lacrimatory 50
abducent 65 occipit al 123
oculomotor 49
accessory 84 temporal 123
of hypothalamus
cran ia l root of 85 Pons 393
dorsomedial 139
functional components of 84 basilar part of 97
lateral 139
spinal root of 85 tegmen tum of 97
paraventricular 139
cochlear 74
posterior 139
facial 70 R
branches of 71 supraoptic 139
functional components of 70 tuberal 139 Radiation
nuclei of 70 ven tromed ial 139 auditory 148
relations of 71 of seventh cranial nerve 70 optic 148
glossopharyngeal 7 7 of sixth cranial nerve 65 Reflex
branches of 80 of spinal nucleus of trigeminal accommodation 58
distribution of 80 nerve 67, 94
functional components of 78 of thalamus s
laryngeal anterior 135
ext ernal 83 intralaminar 135 Sign , Babinski 8
internal 83 lateral 135 Spinal cord
recurrent 83 medial 135 blood supply of 42
superior 83 midline 135 colu mns
oculomotor 61 a nterior 30
reticular 135
olfactory 53
ventral 135 lateral 30
trigeminal 67
of tractus solitarius 51 posterior 30
trochlear 63
of trigeminal nerve white 30
vagus 81
branches of 82 main sensory 53 enlargement of
functional components of 81 mesencephalic 53 cervical 29
nuclei 81 motor 53 lum bar 29
relations of 8 1 s pinal 53 internal structure of 30
vest ibulocochlear 74 superior 53
Subthalamus 140
of vagus, dorsal 51
Sulcus
N olivary
calcarine 125
inferio r 94
Neuron, neurons central 124
superior 98
bipolar 4 ci n gulate 125
pontine 97
multipolar 4 parolfactory 126
pretectal 10 1
pseudounipolar 4 postcentral 124
unipolar 4 red 102
sal ivatory p recen tral 124
Nucleus, nuclei
somatic inferior 50 suprasplenial 125
general 49 superior 50 temporal
special 53 trochlear 49 inferior 124
visceral 50 vestibular 53 superior 124
206 BRAIN-NEUROANATOMY

Surface, of cerebrum spinothalamic floor 11 5


inferior 122 a nterior 38 part 116
medial 122 lateral 38 recesses of 1 1 8
orbital 122 tectospinal 38 roofof 116
superolateral 121 vestibulospinal 37 la teral 152
tentorial 122 Trunk anterior horn of 154
of corpus callosum 145 central part of 153
T veins cerebral
inferior horn of 155
Thalamus anterior 176
posterior horn of 155
connections 135 deep midd le 176
third 151
functions of 137 external 176
boundaries of 152
Tract, tracts grea t 176
inferior 1 73 commun ications of 151
ascending 37
corticospinal 35 internal 176 recesses of 152
descending 35 superficial middle 176 Vermis of cerebellum 105
olivospi nal 35 superior 176 Vestibulocochlear nerve 74
pyramidal 36 Villi, arachnoid 20
reticulospinal 3 7 V
rubrospinal 37
Ventricle
w
spinocerebellar
anterior 41 fourth 115 White matter 144
posterior 4 1 boundaries lateral 115 Willis, circle of 171

Вам также может понравиться