CRANIAL NERVES & Spinal

Nerve
DR SUGIANTO SPS MKES PHD

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CRANIAL NERVES
INFRATENTORIAL
BRAINSTEM

◦ Midbrain : CN III, IV
◦ Pons: CN V, VI, VII, VIII
◦ Medulla: CN IX, X, XI, XI
◦ Outside the Brainstem : CN I, II

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Cranial nerves

Cranial nerve
Brain stem
Mid brain III.& IV. - fr.MBr.
Crus cerebri
Pons V.,VI, VII. - Pons

Pyramid VIII,IX, X, XI. - Medulla

Olive
Medulla

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Brainstem Components

Front

Rear

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 VENTRAL ASPECT
CN III
Basis Pedunculi
CN IV
Posterior perforated
substance

CN V
pons CN VI
CN VII, VIII
Hypoglossal N

Inferior olive M
Glossopharyngeal N
pyramid
Vagus N

Pyramidal Spinal Accessory N

decussation

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DORSAL ASPECT

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Brainstem Divisions

Midbrain

Pons

Medulla Oblongata

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TrueCranial nerves originate from
Brainstem Brain ( ) median sagittal section
Brain stem(FR.B/L. U/W.) Includes;

Medulla
Pons
Mid brain

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 Brain viewed fr. below
Crainal nerves fr. Br.stem
III.,VI.& XII
In a vertical line occupy more medial
as they come out of the Br.stem

III N.
fr.medial side of crus cerebri
of m.brain
VI N.
- junction b/t Pons & Pyramid of Medulla

XII N. Pyramid
Olive
-b/t. Pyramid & Olive
iv N.
- from M.brain

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 Anterior
Cranial N. fr. Br.Stem
cont…

VII , VIII.N.
-at the Cerebellopontine angle
-b/t Pons & Olive
Olive
Pyramid
IX, X, XI.(cr.roots)
-b/t Olive & Inf.Cerebellar pedun.

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 Brain stem (front view)

Nuclei of Cr.N. III iii.

iv. Mid brain
to XII.are located in
v.
Brain stem vi. Pons

viii. vii.
ix.Glosopharyngeal
Medulla
x. Vagus
xi.Accessory

xii.

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Functional Component carried by The Cranial
Nerves
General Somatic Afferent (GSA)
◦ These fibre carry general sensation ( touch, presure, pain, and temperature)
◦ From cutaneus structure and mucous membrane of the head, and general
proprioception (GP) from somatic structure such as muscle, tendons, and joint of the
head and neck

General Somatic Efferent (GSE)

◦ These fibre provide general motor innervation to skletal muscle

General Visceral Afferent (GVA)

◦ From the viscera is transmitted by the facial, glossopharyngeal, and vagus nerves

General Visceral Efferent (GVE)

◦ These fibre provide visceral motor (parasympathetic) innervation to the viscera.

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Functional Component carried by The Cranial
Nerves
Special Somatic Afferent (SSA)
◦ These fibre carry special sensory input from the eye (retina), for vision, and from the
ear (vestibular apparatus for equilibrium, and the cochlea for hearing)

Special Visceral Afferent (SVA)

◦ These are special sensory fibres from the viscera. These fibres convey the special
sense of smell transmitted by the olfactory nerve and the special sense of taste
transmitted by the facial, glossopharyngeal, and the vagus nerves

Special Visceral Efferent (SVE)

◦ These motor fibres are special because they supply motor innervation to skletal
muscle of brachial arch origin
◦ These fibres are carried by the nerves of the branchial arches, which are the
trigeminal, facial, glossopharyngeal, and vagus nerve

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Modality Cranial Nerve
General somatic afferent (GSA) V, VII, IX,X
General somatic efferent (GSE) III, IV, VI
General visceral afferent (GVA) VII, IX, X
General visceral efferent (GVE) III, VII, IX, X
Special somatic afferent (SSA) II, VII
Special visceral afferent ( SVA ) VII, IX, X
Special visceral efferent ( SVE ) V, VII, IX, X

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 The Cranial Nerves
I. Accessory nerve
II. Olfactory nerve
III. Optic nerve
IV. Oculomotor nerve
V. Trochlear nerve
VI. Trigeminal nerve
VII. Abducens nerve
VIII. Facial nerve
IX. Vestibulocochlear nerve
X. Glossopharyngeal nerve
XI. Vagus nerve
XII. Hypoglossal nerve

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Cranial nerves carrying Motor
only
Extra ocular muscles
III. Oculomotor
(voluntary/striated muscle)
IV. Trochlear
derived from Somites
VI. Abducent
XII. Hypoglossal- muscles of Tongue derived from Somites
XI. Accessory - muscles derived from Branchial arch
Cranial nerves carrying both
Motor & Sensory (Mixed nerves)
V.Trigeminal
VII.Facial
IX.Glossopharyhgeal
X.Vagus
OLFACTORY NERVE
ONLY sensory nerve that has no precortical relay in the thalamus
ANATOMICAL PATHWAY
◦ First –order neurons : olfactory receptor cells, that project to the mitral cells of the olfactory
bulb
◦ Mitral cells project to the lateral olfactory stria via the olfactory tract, to the primary olfactory
cortex, and to the amygdala.
◦ Primary olfactory cortex ( Area 34): Pyriform cortex

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OLFACTORY NERVE
CLINICAL CORRELATION

◦ LESIONS result in ipsilateral anosmia

◦ LESIONS result from trauma, or olfactory grove

meningioma

◦ LESIONS in the parahimppocampal uncus may cause

‘uncal hallucinations’, uncinate fits ( ‘déjà vu’).

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Olfactory Nerve (= CN or N I)

1º function?
Origin?
Destination? _____________(By way of cribiform plate of
ethmoid)
Only CN directly attached to Cerebrum

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OLFACTORY NERVE

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OPTIC NERVE
FUNCTIONS: Subserves vision and pupillary light reflex ( afferent limb )
Visual acuity
Visual field
Funduscopic examination

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OPTIC NERVE
VISUAL PATHWAY

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OPTIC NERVE
VISUAL FIELD

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Cranial Nerves 2 and 3

Pupillary size
Pupillary light reflex
◦ Direct and consensual
Accomodation

Anisocoria – one pupil is larger than the other

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Cranial Nerve 2
Visual acuity
◦ Hold VA chart 4 inches
from patients face
◦ Test and occlude each eye
alternately

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Cranial Nerve 2
Visual field testing
◦ Confrontation test
◦ Stay 1 foot from the patient
◦ Cover one eye
◦ Keep uncovered eye locked
On yours
◦ Slowly bring in your hand
from the periphery until
patient sees it

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Cranial Nerve 2
Using an
ophthalmoscope, observe
the
◦ optic disc
◦ physiological cup
◦ retinal vessels
◦ fovea.

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OCULOMOTOR NERVE
FUNCTION: Moves the eye, constricts the pupil, accomodates and
converges

COURSE: From the interpeduncular fossa of the midbrain, passes

through cavernous sinus, enters the orbit via the superior orbital
fissure.

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OCULOMOTOR NERVE
Innervates the following
◦ Medial rectus muscle ( adducts )
◦ Superior rectus muscle
(elevates, intorts, adducts )
◦ Inferior rectus muscle
(depresses, extorts, adducts )
◦ Inferior oblique ( elevates, extorts, abducts )
◦ Levator papalebrae muscle
(elevates the upper lid)

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Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves FK UKDW 37
CLINICAL
CONSIDERATIONS
Unilateral damage to the oculomotor nerve results in deficits in the
ipsilateral eye.
The following ipsilateral muscles will be paralyzed: the levator palpebrae
superioris, resulting in ptosis (G., “drooping”) of the upper eyelid; the
superior and inferior recti, resulting in an inability to move the eye
vertically; and the medial rectus, resulting in an inability to move the eye
medially.
The eye deviates laterally (due to the unopposed lateral rectus), resulting
in lateral strabismus.
The sphincter pupillae muscle becomes nonfunctional due to interruption
of its parasympathetic innervation. The pupil ipsilateral to the lesion will
remain dilated (mydriasis) and does not respond (constrict) to a flash of
light.

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OCULOMOTOR NERVE
CLINICAL CORRELATION
◦ Oculomotor palsy (ANISOCORIA) in cases of transtentorial
/ uncal herniation
◦ Oculomotor palsy results in diplopia, internal
ophthalmoplegia
◦ Aneurysm of the carotid or the posterior communicating
arteries frequently compress CN III within the cavernous
sinus or the intepeduncular cistern
◦ Diabetic oculomotor palsy damaging the central fibers
and sparing the pupilloconstrictor fibers.

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8. What extraocular muscle is affected in this patient?
What innervates this muscle?
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TROCHLEAR NERVE
Pure Motor Nerve
Innervates the superior oblique muscle, which
depresses, intorts and abducts the eye
ANATOMICAL PATHWAY
◦ Arises from the caudal midbrain,
◦ decussates beneath the superior medullary velum of the midbrain,
◦ exits dorsally, caudal to the superior colliculus
◦ encircle the midbrain within the subarachnoid space
◦ Passes thru the cavernous sinus
◦ Enters the orbit via the superior orbital fissure

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TROCHLEAR NERVE
CLINICAL CORRELATION

◦ Lesion produces extorsion of the eye and weakness of downward gaze

◦ Vertical diplopia
◦ Head tilting
◦ Particularly vulnerable to head trauma due to its course around the midbrain
Since the eyes become misaligned following such a lesion, an individual with
trochlear nerve palsy experiences vertical diplopia (double vision),
accompanied by weakness of downward movement of the eye

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TRIGEMINAL NERVE
Has 3 divisions : ophthalmic, maxillary,
mandibular
Innervates
◦ Muscles of mastication
◦ Temporalis, masseter, lateral and medial pterygoids
◦ Tensor tympani
◦ Veli palatini
◦ Myelohyoid muscle
◦ Anterior belly of the digastric muscle

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TRIGEMINAL NERVE
Provides sensory innervation to the face, mucous membranes of the
nasal and oral cavities and frontal sinus, hard palate, and deep
structures of the head.

Innervates the dura of the anterior and middle cranial fossa (

supratentorial dura)

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 V. Trigeminal nerve
Distributions
Motor (Branchiomotor)
i.Muscles of (1st.pharyngeal arch)
muscles of mastication,
ant.belly of digastric, mylohyoid & tensors palati & tympani
Sensory
i. from Skin of face and scalp( in front of chin-ear vertex line)
ii. from nasal mucosa,paranasal sinus & eye (V.i )
nasal mucosa, max.sinus, palate,upperjaw &teeth (V.ii.)
oral mucosa, ant.2/3 of tongue, lower jaw &teeth (V.iii.)
iii. Dura mater of cranial cavity
 V: Trigeminal (3 nerves in 1!)
V1. Ophthalmic
◦ Exits with eye muscle group (superior orbital fissure, through orbit to superior
orbital notch/foramina)
◦ Sensory to forehead, nasal cavity

V2. Maxillary
◦ Exits foramen rotundum through wall of maxillary sinus to inferior orbital
foramina)
◦ Sensory to cheek, upper lip, teeth, nasal cavity

V3. Mandibular
◦ Exits foramen ovale to mandibular foramen to mental foramen
◦ Motor to jaw muscles--Masseter, temporalis, pterygoids, digastric
◦ Sensory to chin
◦ Sensory to tongue

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves FK UKDW 46

Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves FK UKDW 47
ANATOMICAL PATHWAY

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TRIGEMINAL NERVE
CLINCIAL CORRELATION

◦ Hemianesthesia from the face and mucous membranes of the oral

and nasal cavities
◦ Loss of corneal reflex
◦ Flaccid paralysis of the muscles of mastication
◦ Deviation of the haw to the weak side
◦ Partial deafness to low-pitched sound due to paralysis of the tensor
tympani muscle
◦ Trigeminal Neuralgia, paroxysms of sharp , stabbing pain involving
one or more branches of the nerve

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Trigeminal neuralgia
A common clinical concern regarding the trigeminal nerve is trigeminal
neuralgia.
This condition results from idiopathic etiology (unknown cause) and is
manifested as intense, sudden onset, and recurrent unilateral pain in
the distribution of one of the three divisions of the trigeminal nerve,
most commonly the maxillary division

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Cranial Nerve 5
Facial Sensation
◦ Ophthalmic
◦ Maxillary
◦ Mandibular

Corneal Reflex

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Cranial Nerve 5

Masseter tone
Open mouth against
resistance applied at the
base of the chin

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ABDUCENS NERVE
PURE MOTOR NERVE
Innervates the lateral rectus muscle
ANATOMICAL PATHWAY
◦ Arises in the tegmentum of caudal pons
◦ Exits and pass through the corticospinal tract
◦ Passes through the pontine cistern and cavernous sinus
◦ Enters the orbit via the superior orbital fissure

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Abducens
(CN VI)
Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves FK UKDW 55
ABDUCENS NERVE
CLINICAL CORRELATION

◦ Most common isolated palsy resulting from the long peripheral course of the
nerve..
◦ Convergent (medial) strabismus (esotropia) with inability to abduct the eye
◦ Horizontal diplopia

A lesion involving the abducens nucleus results in medial strabismus,

horizontal diplopia, and lateral gaze paralysis

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Right gaze with impaired abduction of right eye.

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FACIAL NERVE
Mediates facial movement, taste, salivation, lacrimation and general
sensation from external ear
Innervates the taste buds from the anterior two-thirds of the tongue
Innervates the lacrimal, submandibular and sublingual glands.

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VII: Facial Nerve
(exits cranial cavity with VIII--internal auditory meatus)

Facial muscles (five branches fan out over face from stylomastoid
foramen)
◦ Temporal
◦ Zygomatic
◦ Buccal
◦ Mandibular
◦ Cervical

“chorda tympani” (crosses interior ear drum to join V3 )

◦ Taste to anterior 2/3 of tongue
◦ Submandibular, sublingual salivary glands

Lacrimal glands

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Function Facial Nerve
Branchial motor (special visceral efferent)
◦ Supplies the muscles of facial expression; posterior belly of digastric muscle;
stylohyoid, and stapedius

Visceral motor (general visceral efferent)

◦ Parasympathetic innervation of the lcrimal, submandibular, and sublingual
glands, as well as mucous membranes of nasopharynx, hard and soft palate

Special sensory (special afferent)

◦ Taste sensation from the anterior 2/3 of tongue; hard and soft palates

General sensory (general somatic afferent)

◦ General sensation from the skin of the concha of the auricle and from a
small area behind the ear.

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Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves FK UKDW 63
FACIAL NERVE
ANATOMICAL PATHWAY
◦ Geniculate ganglion in the temporal bone
◦ Exits the brainstem in the cerebello pontine angle
◦ Enters the internal auditory meatus and the facial canal
◦ Exits the skull via the stylomastoid foramen

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FACIAL NERVE
CLINICAL CORRELATION
◦ Central Facial Palsy
◦ Bell’s palsy ( peripheral facial palsy )
◦ Loss of corneal reflex (efferent limb)
◦ Loss of taste from the anterior 2/3 of the tongue
◦ Bilateral facial palsy seen in GBS

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Cranial Nerve 7
Inspect the face for any
facial asymmetry
◦ drooping, sagging or
smoothing of normal
facial creases
Raise eyebrows
Close eyes
Smile

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9a. Is this a peripheral or central facial nerve palsy?

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FACIAL NERVE
Central or Peripheral

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9b. Is this a peripheral or central facial nerve palsy?
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VESTIBULO- COCHLEAR NERVE
VESTIBULAR NERVE
◦ Maintains equilibrium

COCHLEAR NERVE
◦ Mediates hearing

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Vestibulocochlear (N VIII)
VESTIBULO- COCHLEAR NERVE
VESTIBULAR NERVE
◦ Associated with the cerebellum, flocullo nodular lobe
◦ Regulates compensatory eye movements
◦ ANATOMICAL PATHWAY
◦ Bipolar neurons in the vestibular ganglion
◦ Projects to the hair cells of the cristae of the semicircular ducts of the
utricle and saccule
◦ Project to the 4 vestibular nuclei of the brainstem and to the
flocculonodular lobe of the cerebellum
◦ Conducts efferent fibers to the hair cells from the brainstem

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VESTIBULO- COCHLEAR NERVE
VESTIBULAR NERVE

◦ CLINICAL CORRELATION

◦ Lesions result in
◦ dysequilibrium
◦ vertigo
◦ nystagmus

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VESTIBULO- COCHLEAR NERVE
COCHLEAR NERVE
◦ ANATOMICAL PATHWAY
◦ Spiral ganglion of the cochlea
◦ Projects its peripheral processes to the hair cells of Organ of Corti
◦ Project its central processes to the dorsal and ventral cohclear nuclei of the brainstem
◦ Conducts efferent fibers to the hair cells from the brainstem

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VESTIBULO- COCHLEAR NERVE
COCHLEAR NERVE

◦ CLINICAL CORRELATION

◦ Lesions result in
◦ Hearing loss (sensorineural deafness )
◦ Tinnitus

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Cranial Nerve 8
Gross hearing test

Weber test
◦ Test for lateralization
◦ Normal – sound is heard in both
ears
◦ Abnormal – sound lateralizes to
the abnormal ear
Rinne test
◦ To differentiate conductive from
sensorineural hearing loss

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Pemeriksaan weber
Garputala di letakan di dahi penderita
Pada keadaan normal kiri dan kanan sama keras
Bila terdapat tuli konduksi di sebelah kiri, misal oleh karena otitis
media, pada tes weber terdengar kiri lebih keras.
Bila terdapat tuli persepsi di sebelah kiri, maka tes weber terdengar
lebih keras di kanan

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Pemeriksaan Rinne
Pada telinga sehat, pendengaran melaui udara di dengar lebih lama dari
pada tulang
Garputala ditempatkan pada planum mastoid sampai penderita tidak
dapat mendengarnya lagi, kemudian garputala dipindahkan ke depan
meatus eksternal. Jika pada posisi yg kedua ini masih terdengar di
katakan tes positif,
PADA ORANG NORMAL ATAU TULI PERSEPSI, TES RINNE POSITIF, PADA
TULI KONDUKTIF TES RINNE NEGATIF

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Pemeriksaan Rinne

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GLOSSOPHARYNGEAL NERVE
SENSORY NERVE

Mediates taste, salivation and swallowing

Mediates inputs from the carotid sinus, which contains

the baroreceptors that monitor arterial blood pressure

Also mediates input from the carotid body which

contains chemoreceptors that monitor O2 and CO2
concentration of blood.

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GLOSSOPHARYNGEAL NERVE
Innervates the external ear and external auditory
meatus

Innervates the taste buds of the posterior one-third of

the tongue

Innervates the mucous membranes of the posterior 1/3

of the tongue, tonsil, upper pharynx, tympanic cavity
and auditory tube

Innervates the parotid gland

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Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves FK UKDW 83
GLOSSOPHARYNGEAL NERVE
ANATOMICAL PATHWAY

◦ It is the nerve of pharyngeal (brachial) arch 3

◦ Exits the medulla ( brainstem ) from the postolivary

sulcus with CN X, XI.

◦ Exits the skull via the jugular foramen with CNX, XI

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GLOSSOPHARYNGEAL NERVE
CLINCIAL CORRELATION

◦ Loss of gag reflex, interruption of the afferent limb

◦ Hypersensitive carotid sinus reflex (syncope)

◦ Loss of taste over the posterior 1/3 of the tongue

◦ Loss of general sensation in the pharynx, tonsils, fauces, back of the

tongue

◦ Glossopharyngel Neuralgia

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 If CN 9 on the right is not
functioning (e.g. in the setting of a
stroke), the uvula will be pulled to
the left. The opposite occurs in the
setting of left CN 9 dysfunction.

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VAGUS NERVE
Mediates phonation, swallowing, elevation of the
palate, taste and cutaneous sensation from the ear.

innervates the viscera of the neck, thorax and

abdomen

ANATOMICAL PATHWAY
◦ Exits the brainstem from the postolivary sulcus
◦ Exits the skull via jugular foramen with CN IX, and CN XI

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Human Anatomy, Frolich, Head/Neck IV: Cranial Nerves FK UKDW 88
VAGUS NERVE
Innervates the pharyngeal arch muscles of the
larynx and pharynx, striated muscle of the upper
esophagus, muscle of the uvula, and the levator
veli palatini and palatoglosus muscles

efferent limb of the gag reflex

Innervates the viscera of the neck and thoracic and

abdominal cavities as far as the left colic flexure

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VAGUS NERVE
CLINCIAL CORRELATION

◦ Ipsilateral paralysis of the soft palate, pharynx, larynx –

dysphonia, hoarseness, dysarthria and dysphagia

◦ Loss of gag reflex

◦ Anesthesia of the pharynx and larynx which leads to

unilateral loss of cough reflex

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CLINICAL
CONSIDERATIONS
Unilateral damage of the vagus nerve near its emergence from the
brainstem results in a number of deficiencies on the ipsilateral side.
Damage to the SVE branchiomotor fibers will cause flaccid paralysis or
weakness of: (i) the pharyngeal muscles and levator veli palatini of the
soft palate, resulting in dysphagia (difficulty swallowing); (ii) the
laryngeal muscles, resulting in dysphonia (hoarseness) and dyspnea
(difficulty breathing); and (iii) loss of the gag reflex (efferent limb).
Damage to the GVA fibers will cause loss of general sensation from the
soft palate, pharynx, larynx, esophagus, and trachea. Damage to the
GVE fibers will cause cardiac arrhythmias.

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FK UKDW 92
SPINAL ACCESSORY
NERVE
Mediates head and shoulder movement and innervates
laryngeal muscles

◦ CRANIAL DIVISION
◦ Arises from the nucleus ambiguus of the medulla
◦ Exits the medulla and join CN X
◦ Innervates the intrinsic muscles of the larynx via the inferior (recurrent) laryngeal
nerve with the exception of the cricothyroid muscle

◦ SPINAL DIVISION
◦ Arises from the ventral horn of cervical segments C1 to C6
◦ Innervates the sternocleidomastoid muscle with the cervical plexus (C2) nd the
trapezius muscle (C3,C4)

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SPINAL ACCESSORY
NERVE
CLINICAL CORRELATION

◦ Paralysis of sternocleidomastoid muscle, with difficulty in

turning the head to the contralateral side

◦ Paralysis of the trapezius muscle resulting to a shoulder

droop and winging of the scapula

◦ Paralysis of the larynx

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Cranial Nerve 11
Look for wasting of the
trapezius muscles
Ask the patient to shrug
their shoulders against
resistance
Ask the patient to turn
their head to the side
against resistance

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FK UKDW 96
 Place your open left hand against
the patient's right cheek and ask
them to turn into your hand while
you provide resistance. Then
repeat on the other side. The right
Sternocleidomasoid muscle (and
thus right CN 11) causes the head
to turn to the left, and vice versa.

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HYPOGLOSSAL NERVE
Mediates tongue movement

Innervates the intrinsic muscles of the tongue

ANATOMICAL PATHWAY

◦ Arises from the hypoglossal nucleus of the medulla

◦ Exits the medulla in the preolivary sulcus
◦ Exits the skull via the hypoglossal canal

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HYPOGLOSSAL NERVE
CLINICAL CORRELATION

◦ HEMIPARALYSIS of the tongue

◦ Protrusion cause the tongue to point toward the weak side because of
the unopposed action of the opposite genioglossus muscle
A lesion in the hypoglossal nucleus or nerve results in flaccid paralysis and subsequent
atrophy of the ipsilateral tongue musculature.
Hemiparalysis of the tongue causes creasing (wrinkling) of the dorsal surface of the
tongue ipsilateral to the lesion

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Cranial Nerve 12
Ask the patient to
protrude tongue
Watch for deviation
◦ Deviates toward the same
side in a peripheral lesion
◦ Deviates toward the
opposite side in a central
lesion

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Organization of Nervous System
Central Nervous System (CNS) = brain and spinal cord

Peripheral Nervous System (PNS) = nerves

CNS PNS
Peripheral Nervous System

skin

muscle

FK UKDW Pg 344 102

 Spinal Nerves (31 pairs)
Each pair of nerves located in particular segment (cervical,
thoracic, lumbar, etc.)
Each nerve pair is numbered for the vertebra sitting above it
(i.e. nerves exit below vertebrae)
◦ 8 pairs of cervical spinal nerves; *C1-C8
◦ 12 pairs of thoracic spinal nerves; T1-T12
◦ 5 pairs of lumbar spinal nerves; L1-L5
◦ 5 pairs of sacral spinal nerves; S1-S5
◦ 1 pair of coccygeal spinal nerves; C0

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Spinal Cord
Segments

Pg 393
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Gross Anatomy of the Spinal Cord

• Features of the Spinal Cord

• 45 cm in length
• Passes through the foramen magnum
• Extends from the brain to L1
• Consists of:
• Cervical region
• Thoracic region
• Lumbar region
• Sacral region
• Coccygeal region
Gross Anatomy of the Spinal Cord

• Features of the Spinal Cord

• Consists of (continued):
• Cervical enlargement
• Lumbosacral enlargement
• Conus medullaris
• Cauda equina
• Filum terminale: becomes a component of the
coccygeal ligament
• Posterior and anterior median sulci

© 2012 Pearson Education, Inc.

Figure 14.1a Gross Anatomy of the Spinal Cord

C1
C2
Cervical spinal C3
nerves C4
C5
C6 Cervical
C7 enlargement
C8
T1
T2
T3
T4
T5
T6
T7

Thoracic T8
spinal Posterior
nerves T9 median sulcus

T10

T11 Lumbosacral
enlargement
T12

Conus
L1 medullaris

L2
Lumbar Inferior
spinal L3 tip of
nerves spinal cord
L4
Cauda equina
L5

S1
Sacral spinal
S2
nerves
S3
S4
S5

Coccygeal Filum terminale

nerve (Co1) (in coccygeal ligament)

Superficial anatomy and orientation of the adult spinal cord. The

numbers to the left identify the spinal nerves and indicate where
the nerve roots leave the vertebral canal. The spinal cord, however,
extends from the brain only to the level of vertebrae L 1–L2.
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Gross Anatomy of the Spinal Cord

• Features of the Spinal Nerves

• Consist of:
• Sensory nerves (afferent nerves): transmit
impulses toward the spinal cord
• Motor nerves (efferent nerves): transmit impulses
away from the spinal cord

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Nerve Plexuses

• The Cervical Plexus (C1–C5)

• Consists of cutaneous and muscular
branches
• Cutaneous branch innervates:
• Head
• Neck
• Chest

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Nerve Plexus

• The Cervical Plexus

• Consists of cutaneous and muscular
branches
• Muscular branch innervates:
• Omohyoid, sternohyoid, geniohyoid, thyrohyoid
• Sternothyroid
• Scalenes
• Sternocleidomastoid
• Levator scapulae
• Trapezius
• Diaphragm (controlled by the phrenic nerve of the
cervical plexus)
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Figure 14.9 The Cervical Plexus

Accessory
nerve (N XI)
Cranial
Hypoglossal
nerves
nerve (N XII)
Great auricular nerve
Lesser occipital
nerve

C1
C2

Nerve roots of C3 Geniohyoid muscle

cervical plexus
Transverse
C4 cervical nerve
C5 Thyrohyoid muscle
Ansa cervicalis

Omohyoid muscle
Supraclavicular Phrenic nerve
nerves
Clavicle Sternohyoid muscle

Sternothyroid muscle

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Table 14.2 The Brachial Plexus

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Nerve Plexus

• The Lumbar and Sacral Plexuses (T12–S4)

• Also called the lumbosacral plexus
• Lumbar plexus nerves
• Genitofemoral nerve
• Lateral femoral cutaneous nerve
• Femoral nerve
• Sacral plexus nerves
• Sciatic nerve (branches to form the common
fibular nerve and the tibial nerve)
• Pudendal nerve

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Figure 14.12a The Lumbar and Sacral Plexuses, Part I

T12

T12 subcostal nerve

L1

Iliohypogastric nerve L2 LUMBAR

PLEXUS
Ilioinguinal nerve
L3
Genitofemoral nerve
Lateral femoral
cutaneous nerve
L4
Branches of
Femoral branch
genitofemoral
nerve Genital branch
L5
Femoral nerve
Obturator nerve Lumbosacral
trunk
The lumbar plexus, anterior view
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Figure 14.12b The Lumbar and Sacral Plexuses, Part I

L5

Lumbosacral trunk

S1
SACRAL
Superior gluteal nerve PLEXUS
S2
Inferior gluteal nerve
S3

S4
Sciatic nerve S5

Posterior femoral Co1

cutaneous nerve
Pudendal nerve

The sacral plexus, anterior view

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Figure 14.12c The Lumbar and Sacral Plexuses, Part I
Subcostal nerve

Iliohypogastric nerve
Ilioinguinal nerve
Genitofemoral nerve
Lateral femoral
cutaneous nerve
Femoral nerve
Superior gluteal nerve
Inferior gluteal nerve

Pudendal nerve
Posterior femoral
cutaneous nerve (cut) Obturator nerve

Sciatic nerve
Saphenous
nerve

Sural
Saphenous nerve nerve
Fibular
nerve

Common fibular
nerve

Superficial fibular Tibial

nerve nerve
Saphenous
Deep fibular Sural nerve
nerve nerve

Saphenous Sural
nerve nerve

The lumbar and sacral Tibial Fibular

nerve nerve
plexuses, anterior view
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Table 14.3 The Lumbar and Sacral Plexuses

© 2012 Pearson Education, Inc.

FK UKDW 118
 4 Kinds of Nerve Fibers
Somatic Sensory – “body senses”
◦ touch, pressure, temperature, vibration of body, muscles
stretching, balance
Visceral Sensory – “organ senses”
◦ Stretch, pain, temperature in organs
◦ (eg) nausea, hunger, cramps
Somatic Motor – “body movement”
◦ Voluntary contraction of skeletal muscles
Visceral Motor – “organ movement”
◦ Contraction of smooth muscle, glands
◦ = Autonomic Nervous System

FK UKDW 119
Types of Nerve Fibers
Sensory = Afferent Nerve fibers = picked up by sensory receptors
throughout body (PNS) and carried TOWARDS spinal cord + brain (CNS)
Motor = Efferent Nerve fibers = carried AWAY from CNS by nerves of
PNS to innervate body’s muscles and glands
Remember: SAME

FK UKDW 120
FK UKDW 121
OCULOMOTOR NERVE
Visceral efferent consists of the pre-ganglionic parasympathetic fibers

◦ Edinger-Westphal nucleus, projects preganglionic parasymphathetic fibers to the ciliary ganglion

of the orbit
◦ Ciliary Ganglion, projects postganglionic parasympathetic fibers to the sphincter muscle of the
iris (miosis) and to the ciliary muscle
(accomodation)

FK UKDW 122