Oligadendracyte (forms all myelin in CNS; undergoes inflammatory reaction jin multiple sclerosis patients) Central nervous system Peripheral nervous system Collateral branch Schwann cell (forms all myelin jn PNS; undergoes inflammatory reaction in Guillain-Barré syndrome patients) Figure 2-1. Features of a skeletal motor neuron.Anterograde transport is mediated by kinesin. Kinesin Microtubule Retrograde transport is mediated by dynein. Figure 2-3. Mechanisms of axonal transport. (Reproduced with permission from Kierszenbaum, AL. Histology and Cell Biology, Mosby, 2002.)Muscle Spindles / Golgi Tendon Organs 20 4> Author: Medbullets Team ‘Topic updated on 11/02/15 8:53am Muscle Spindle Axons of Fxtafusal — Ymotor muscle fibers neurons Axon of * Function sae © detect muscle length neuron, © allows for dynamic feedback when contraction applied does not shorten the muscle to the desired length * Physiology ¢ in parallel to extrafusal muscle fibers © neuronal circuit ) = ft muscle stretch stimulates 1a afferent ‘Group Tand I afferent axons neurons Intrafusal Nuclear Subcapsular Nuclear Capsule = 1a afferent neurons enters the dorsal ™™<* fe Neo Ceca sie Read a za ereeeiny Be a" Cs Pan ea Rena Seda - Sra) a eT Te Coes SO tee lobe Ts Cory Creed a =< Cruel us Ona so Nea Yin ee is eed Peet oy reorers Cee rey Sica Higher mental Cre eee) . nnCommon brain lesions Thalamus. Hypothalamus — Amygdala Brainstem ippocerip us Spinal cord Mammillary bodies‘A midsagittal view showing the inner boundaries of the lobes of the cerebral cortex (Structures outside of the cerebrum are labeled in italics.) Precentral gyrus Central sulcus. Postcentral gyrus Limbic lobe Frontal lobe Corpus callosum Parieto-occipital sulcus Thalamus Occipital lobe Pineal gland Hypothalamus Corpora quadrigemina aan Aqueduct of the midbrain eee Fourth ventricle Temporal lobe Cerebellum Mamillary body ‘Medulla oblongataFigure |-6, Medial view of the central nervous system.Figure 7-3. T-2 weighted MRI of medial of the CNS showing a calcified craniopharyngioma at (A). B: Hypothalamus. C: Thalamus. D: F: Medulla. G: Fourth ventricle. Hz Vermis of cerebellum. I: J: Basilar artery. K: Anterior cerebral artery. L: Pineal gland.Figure I-7. MRI of the medial view of the central nervous system. A. Corpus callosum (splenium). B: Lingual gyrus. C: Cuneus gyrus. D: Primary motor cortex. E: Primary somatosensory cortex. F: Midbrain. G: Pons. H: Medulla. I: Hypothalamus in wall of third ventricle. J: Poste- rior vermis of cerebellum with intracerebral hemorrhage. K: Pituitary. L: Mammillary body. M: Pineal.‘A 68-year-old man comes to the physician because of progressive aifficuorpus callosum ateral ventricle laustrum isula hird ventricle ypothalamus ituitary glandCaudate nucleus Anterior limb of internal capsule Genu of internal capsule Globus pallidus Putamen Bi Anterior circulation (lenticulostriate branches af middle cerebral artery) Anterior choroidal artery Posterior circulation (thalamoperforate and thalamogeniculate branches of posterior cerebral artery) Figure 8-4. Arterial supply and topographic organization of internal capsule. F: Corticobulbar axons. A and L: Corticospinal axons for con- tralateral (A) Arm and (L) Leg. Somatosensory thalamic projections from f: face, a: arm, and Iz leg.Figure 1-16. The meninges, subarachnoid space, and flow of cerebrospinal fluid.ACA Ophthalmic artery ‘MCA Anterior choroidal artery Lenticulostriate arteries a Xe ye _ ve Paramedian a of ee el artery ES Basilar artery Vertebral en Labyrinthine artery Sr Anterior ve spinal artery artery - Figure I-8. Branches of the anterior and posterior circulations. ACA, anterior cerebral artery; MCA, middle cerebral artery; PCA, posterior cerebral artery; SCA, superior cerebellar artery; AICA, anterior inferior cerebellar artery; PICA, posterior inferior cerebellar artery.Figure 1-10. Carotid arteriogram (anterior-posterior view). A: Left anterior cerebral artery. B: Left internal carotid artery. C: Right middle cerebral artery. D: Left middle cerebral artery. E: Right anterior cerebral artery.Figure I-12. Carotid arteriogram with berry aneurysm. A: Anterior cere- bral artery. B: Middle cerebral artery. C: Internal carotid artery. D: Berry aneurysm at junction of anterior cere- bral artery and anterior communicating artery.C Midbrain Paramedian branches of basilar artery Thalamoperforating Short circumferential artery br of PCA Anterior spinal artery Vertebral artery {i Posterior inferior . ee cerebellar artery i Superior cerebellar artery [i Quacrigeminal artery Anterior inferior cerebellar artery Anterior choroidal artery Figure 4-15. A-C: Arterial supply and common lesion sites (blue areas) of the brainstem. (Repro- duced with permission from Michael-Titus, Revest, and Shortland. The Nervous System, Elsevier, 2007.)Right cerebral cortex Supratentorial Brain $e 2 wy Midbrain rostral Medulla Oblongata (closed) caudal Medulla} (pyramidal decussation) lower cervical spinal cord thoracic spinal cord lumbosacral = ik, a spinal cordMidbrainIll nucleus and nucteus of Eiger ‘Westphal Periaqi 7 | Superior colliculus sray matte | mar and Scena -- ms ‘Mectal lemniscus met ‘Nedial geniculate > Body (rucleus) a= Red nucleus | cerebeat Peduncie Upper midbrain; level of CN til re 4-2. A and B: Upper Midbrain. A: Oculomotor nucleus and nucleus of Edinger-Westphal. B: Oculomotor nerve fibers. C: Spinothalamic tract/descending hypothalamic fibers. D: Medial lermniscus. E: Medial geniculate nucleus. F: Substantia nigra. G: Corticobulbar tract. H: Corticospinal tract. I: Superior colliculus. J: Periaqueductal gray matter. K: Cerebral aqueduct. L: Red nucleus. Inset: Levels of sections in Figures 4-2 to 4-7, (Az Reproduced with permission from Waxman, SG. Neuroanatomy. McGraw-Hill, 2003.)‘vnc 7 “eoticspina tract‘Medial ecu fasciculus Figure 4-5. A and B: Lower Pons. A: Abducens nucleus. B: Motor nucleus of CN VIL C: Superior olivary nuclei. D: Corticospinal/corticobulbar tracts. E: Medial lem- niscus. F. Medial longitudinal fasciculus. G: Facial nerve. H: Spinothalamic tract and descending hypothalamic fibers. Iz Pontine nuclei. : Superior cerebellar peduncle. K: Middle cerebellar peduncle. - onMedulla MedullaA Fourth Medial longitudinal te fasciculus ‘Medial lemniscus—— “Corbcepinal rat) Open medulla Figure 4-6. A and B: Open Medulla. A: Hypoglossal nucleus. B: Dorsal ‘motor nucleus of X. Cs Solitary nucleus and tract (biack dot). Dz Medial ‘estibular nucleus. E: Inferior vestibular nucl G: Nucleus ambiguus. H: Medial lerniscus. I: Spinothalamic tract and descending hypothalami 1X or CN X. L: Inferior cerebellar peduncle. M: Fibers of CNs Vll, IX, or X forming solitary tract. N. Medial longitudinal fasciculus. (A Reproduced with permission from Waxman, SG. Clinical Neuroanatomy. McGraw-Hill, 2003;Conus Medullaris, atte vertebral level 3 inthe adult Cauda Equina from L2 ino the sacral canal FEES Soures Uniebminod Five Spinal Cord Regions ‘And ‘Two Enlargements cervical enlargement lumbo-sacral enlargement The absolute amount of white matter decreases from cervical to coccygeal segments. ‘The amount of ‘gray matter is greater in the enlargements than the uaper cenical and thoracic regions.‘White matter tracts Fascieulus gracilis ‘Sensory (fine touch, proprioception) {rom ipsilateral lower limb. Fasciculus cuneatus Sensory (fine touch, proprioception) {rom ipsilateral upper limb. Proprioception from bs to cerebellum, Lateral corticospinal tract motor to ipsilateral ventral horn mostly im musculature. Spinothalamic tract Pain and temperature from contralateral side of the body. Anterior corticospinal tract Motor to ipsi- and contralateral ventral horn mostly axial musculature. ‘Somatotopic distribution of fibers in white matter tracts Fasciculus gracilis Fasciculus cuneatusSubstantia gelatinosa, Nucleus preprius Dorsal nuciaus (*) | vieresoawa Pr Cental vii canal ‘ Motor neurons. we of the anterior horn Nuclei Discriminative touch and proprioception Sensory fiers will antar the dorsal horn anc then travel in dorsal columns without synapsing| in the posterior hom. Posterolateral fasciculus (Lissauer tract) ‘Sensory bers carrying pain and temperature vill ascend or descend several spinal cord levels here before aynapsing in the dorsal har. Posterior haen Lamina Il of the gray mater: fest modulation for pain and temperature Pain and temperature Fibers enter the doreal horn, may travel up or down 12 segments in the Lissaver tract, then synapse in the nucleus propriue, Fibers then ‘ross the midline in anterior commiseure andtravel inthe spinothalamic tact ‘Anterior hom ‘a-Motor neurons are lacated inthe anterior horn. They exit the spinal cord ‘and travel to their target muscles. Interneuron cicuits inthe anterics hom Fiter descending motor formation and ara part of localized reflex circuits.Spinal cord and associated tracts Dorsal columns 3a 3b Lateral CST Spinothalamic tractPosterior spinal artery: Anterolateral system Anterior spinal artery Figure |-13. Blood supply of the spinal cord.Substantia gelatinosa {lamina II) Corticospinal and rubrospinal tracts Topographic organization of alpha and gamma motor Alpha and gamma neurons in lamina IX Reticulospinal and motor axons from of cervical cord vestibulospinal tracts lamina IX in ventral root e—< Renshaw cells Figure 3-3. Topographic organization of alpha and gamma motor neurons in lamina IX.Motor and descending (efferent) Sensory and ascending * pathways. (red) Pyramidal tracts = Lateral corticospinal tract, «Anterior corticospinal tractsé Pevensie Est Vw Go Toe Wingow te Br serews | Se mus ime wong yo 39, A 23,year-old man nas had progressive weakness end atopy of the intnste muscles of the fet hand Curing the past 3 months. T ‘damage to which of the folowing labeled ses i the css section af he spina cog shown? Del HorsUMN cell bodies in cerebral cortex and brainstem A lesion here results in a spastic weakness that is ipsilateral and below the lesion A lesion here results in. a flaccid weakness that is ipsilateral and at the level of the lesion, Pyramidal decussation Rubrospinal and corticospinal tracts (flexor biased UMN tracts) Reticulospinal and vestibulospinal tracts (extensor biased UMN tracts) Figure 3-5. The course of axons of upper motor neurons in the medulla and spinal cord with repre- sentative cross-sections. Note the different effects of upper versus lower motor neuron lesions. (Re- produced with permission from Waxman, SG. Clinical Neuroanatomy, McGraw-Hill, 2003.)Ipsilateral loss of vibratory sense in lower limb: ipsilateral loss of vibratory —~ sense in upper limb of pain and temperature Figure 3-14, Major spinal cord neural components and clinical anatomy de- picted in myelin-stained section of upper thoracic cord. A: Fasciculus Gracilis. B: Fasciculus cuneatus. C: Corticospinal tract. D: Anterolateral system (spinothalamic tract). E: Dorsal horn. F: Lateral horn (preganglionic sympathetic neurons). Gz Ventral horn (lower motor neurons)ee ’ a - Olfactory bulb ‘ 5 2 (synapse point of cranial nerve 1) _ Optic chiasma Optic nerve (Il) Optic tract Mammillary body Midbrain Pons Spinal cord 2281 Poem Eco eThe Cranial Nerves Someday you may have to learn these names. Olfactory bulb (termination of olfactory nerve, NI) Olfactory tract. Optic nerve (Il) Optic chiasm Optic tract ; ‘Trochlear nerve (IV) Pons ' Trigeminal nerve (V) Oculomotor nerve (II!) Abducens nerve (VI) Facial nerve (Vil) Vestibulocochlear nerve (VIII) Glossopharyngeal nerve (IX) ‘Vagus nerve (X) Accessory nerve (XI) Hypoglossal nerve (XII) Medulla oblongata Cerebellum Spinal cordThalamus Hi bypothatamus Diencephalon Midbrain er Pons Brain stem 1 medulla oblongata 2 — View (b) < Midbrain Diencephaton — spate" Goipova colliculus |_ quadrigemina *inferior | of tectum colliculus Pineal gland + Trochlear nerve (IV) \ * Superior cerebellar peduncle N“ A Pons ); >——+ Middle cerebellar peduncle Medulla oblongata + Inferior cerebellar peduncle Floor of fourth ventricle Facial nerve (VII) Choroid plexus (fourth ventricle) Dorsal median sulcus + Vestibulocochlear nerve (Vill) * Glossopharyngeal nerve (IX) «Vagus nerve (X) + Accessory nerve (Xx!) Dorsal root of first cervical nerve (c) Dorsal view