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    Netter de neurologia pdf Netter de neurologia pdf Document Transcript

    • Atlas of Neuroanatomy and NeurophysiologySelections from the Netter Collection of Medical Illustrations Illustrations by Frank H. Netter, MD John A. Craig, MD James Perkins, MS, MFA Text by John T. Hansen, PhD Bruce M. Koeppen, MD, PhD
    • Atlas of Neuroanatomy and NeurophysiologySelections from the Netter Collection of Medical IllustrationsCopyright ©2002 Icon Custom Communications. All rights reserved.The contents of this book may not be reproduced in any form without writtenauthorization from Icon Custom Communications. Requests for permissionshould be addressed to Permissions Department, Icon Custom Communications,295 North St., Teterboro NJ 07608, or can be made at www. Netterart.com.NOTICEEvery effort has been taken to confirm the accuracy of the information presented.Neither the publisher nor the authors can be held responsible for errors or for anyconsequences arising from the use of the information contained herein, and makeno warranty, expressed or implied, with respect to the contents of the publication.Printed in U.S.A.
    • Foreword Frank Netter: The Physician, The Artist, The Art This selection of the art of Dr. Frank H. Netter on neuroanatomy and neurophysiology is drawnfrom the Atlas of Human Anatomy and Netter’s Atlas of Human Physiology. Viewing these picturesagain prompts reflection on Dr. Netter’s work and his roles as physician and artist. Frank H. Netter was born in 1906 in New York City. He pursued his artistic muse at the Sorbonne,the Art Student’s League, and the National Academy of Design before entering medical school atNew York University, where he received his M.D. degree in 1931. During his student years, Dr.Netter’s notebook sketches attracted the attention of the medical faculty and other physicians, allow-ing him to augment his income by illustrating articles and textbooks. He continued illustrating as asideline after establishing a surgical practice in 1933, but ultimately opted to give up his practice infavor of a full-time commitment to art. After service in the United States Army during the SecondWorld War, Dr. Netter began his long collaboration with the CIBA Pharmaceutical Company (nowNovartis Pharmaceuticals). This 45-year partnership resulted in the production of the extraordinarycollection of medical art so familiar to physicians and other medical professionals worldwide. When Dr. Netter’s work is discussed, attention is focused primarily on Netter the artist and onlysecondarily on Netter the physician. As a student of Dr. Netter’s work for more than forty years, I cansay that the true strength of a Netter illustration was always established well before brush was laid topaper. In that respect each plate is more of an intellectual than an artistic or aesthetic exercise. It iseasy to appreciate the aesthetic qualities of Dr. Netter’s work, but to overlook its intellectual quali-ties is to miss the real strength and intent of the art. This intellectual process requires thorough under-standing of the topic, as Dr. Netter wrote: “Strange as it may seem, the hardest part of making a med-ical picture is not the drawing at all. It is the planning, the conception, the determination of point ofview and the approach which will best clarify the subject which takes the most effort.” Years before the inception of “the integrated curriculum,” Netter the physician realized that agood medical illustration can include clinical information and physiologic functions as well as anato-my. In pursuit of this principle Dr. Netter often integrates pertinent basic and clinical science ele-ments in his anatomic interpretations. Although he was chided for this heresy by a prominentEuropean anatomy professor, many generations of students training to be physicians rather thananatomists have appreciated Dr. Netter’s concept. The integration of physiology and clinical medicine with anatomy has led Dr. Netter to another,more subtle, choice in his art. Many texts and atlases published during the period of Dr. Netter’scareer depict anatomy clearly based on cadaver specimens with renderings of shrunken and shriv-eled tissues and organs. Netter the physician chose to render “live” versions of these structures—notshriveled, colorless, formaldehyde-soaked tissues, but plump, robust organs, glowing with color! The value of Dr. Netter’s approach is clearly demonstrated by the plates in this selection.John A. Craig, MDAustin, Texas
    • This volume brings together two distinct but related aspects of the work of FrankH. Netter, MD, and associated artists. Netter is best known as the creator of theAtlas of Human Anatomy, a comprehensive textbook of gross anatomy that hasbecome the standard atlas for students of the subject. But Netter’s work includedfar more than anatomical art. In the pages of Clinical Symposia, a series of mono-graphs published over a period of more than 50 years, and in The Netter Collectionof Medical Illustrations, this premier medical artist created superb illustrations ofbiological and physiological processes, disease pathology, clinical presentations,and medical procedures.As a service to the medical community, Novartis Pharmaceuticals has commis-sioned this special edition of Netter’s work, which includes his beautiful andinstructive illustrations of nervous system anatomy as well as his depictions ofneurophysiological concepts and functions. We hope that readers will find Dr.Netter’s renderings of neurological form and function interesting and useful.
    • Click any title below to link to that plate. Part 1 NeuroanatomyCerebrum—Medial Views . . . . . . . . . . . . . . . . . 2 Oculomotor (III), Trochlear (IV) and Abducent (VI) Nerves: Schema. . . . . . . 27Cerebrum—Inferior View. . . . . . . . . . . . . . . . . . 3 Trigeminal Nerve (V): Schema . . . . . . . . . . . . 28Basal Nuclei (Ganglia). . . . . . . . . . . . . . . . . . . . 4 Facial Nerve (VII): Schema . . . . . . . . . . . . . . . 29Thalamus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Vestibulocochlear Nerve (VIII): Schema. . . . . 30Cerebellum . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Glossopharyngeal Nerve (IX): Schema . . . . . . 31Brainstem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Vagus Nerve (X): Schema . . . . . . . . . . . . . . . . 32Fourth Ventricle and Cerebellum . . . . . . . . . . . 8 Accessory Nerve (XI): Schema . . . . . . . . . . . . 33Accessory Nerve (XI) . . . . . . . . . . . . . . . . . . . . 9 Hypoglossal Nerve (XII): Schema . . . . . . . . . . 34Arteries to Brain and Meninges . . . . . . . . . . . 10 Nerves of Heart . . . . . . . . . . . . . . . . . . . . . . . . 35Arteries to Brain: Schema . . . . . . . . . . . . . . . . 11 Autonomic NervesArteries of Brain: Inferior Views . . . . . . . . . . . 12 and Ganglia of Abdomen. . . . . . . . . . . . . . . 36Cerebral Arterial Circle (Willis) . . . . . . . . . . . 13 Nerves of Stomach and Duodenum . . . . . . . . 37Arteries of Brain: Frontal View and Section . . 14 Nerves of StomachArteries of Brain: and Duodenum (continued) . . . . . . . . . . . . 38 Lateral and Medial Views . . . . . . . . . . . . . . . 15 Nerves of Small Intestine . . . . . . . . . . . . . . . . 39Arteries of Posterior Cranial Fossa . . . . . . . . . 16 Nerves of Large Intestine . . . . . . . . . . . . . . . . 40Veins of Posterior Cranial Fossa . . . . . . . . . . . 17 Nerves of Kidneys,Deep Veins of Brain. . . . . . . . . . . . . . . . . . . . . 18 Ureters and Urinary Bladder . . . . . . . . . . . . 41Subependymal Veins of Brain . . . . . . . . . . . . . 19 Nerves of Pelvic Viscera: Male . . . . . . . . . . . . 42Hypothalamus and Hypophysis . . . . . . . . . . . 20 Nerves of Pelvic Viscera: Female . . . . . . . . . . 43Arteries and Veins Median Nerve . . . . . . . . . . . . . . . . . . . . . . . . . 44 of Hypothalamus and Hypophysis . . . . . . . . 21 Ulnar Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Relation of Spinal Nerve Roots to Vertebrae . . . 22 Radial Nerve in ArmAutonomic Nervous System: and Nerves of Posterior Shoulder . . . . . . . . 46 General Topography. . . . . . . . . . . . . . . . . . . 23 Radial Nerve in Forearm . . . . . . . . . . . . . . . . . 47Spinal Nerve Origin: Cross Sections. . . . . . . . 24 Sciatic Nerve and PosteriorOlfactory Nerve (I): Schema . . . . . . . . . . . . . . 25 Cutaneous Nerve of Thigh . . . . . . . . . . . . . . 48Optic Nerve (II) Tibial Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 (Visual Pathway): Schema . . . . . . . . . . . . . . 26 Common Fibular (Peroneal) Nerve. . . . . . . . . 50
    • NEUROANATOMY Cerebrum: Medial Views Sagittal section of Cingulate gyrus Paracentral sulcus brain in situ Central sulcus (Rolando) Cingulate sulcus Paracentral lobule Medial frontal gyrus Marginal sulcus Sulcus of corpus callosum Corpus callosum Fornix Precuneus Septum pellucidum Superior sagittal sinus Interventricular Choroid plexus foramen (Monro) of 3rd ventricle Interthalamic Stria medullaris adhesion of thalamus Thalamus and Parietooccipital 3rd ventricle sulcus Subcallosal Cuneus (parolfactory) Habenular area commissure Anterior Pineal body commissure Posterior Subcallosal commissure gyrus Calcarine sulcusHypothalamicsulcus Straight sinus in tentoriumLamina cerebelliterminalis Great cerebral veinSupra- (Galen)opticrecess Superior colliculus Optic chiasm Inferior colliculus Tectal (quadrigeminal) plate Tuber cinereum Cerebellum Hypophysis (pituitary gland) Superior medullary velum Mammillary body 4th ventricle and choroid plexus Cerebral peduncle Inferior medullary velum Pons Cerebral aqueduct Medulla oblongata (Sylvius) Medial surface of cerebral Genu hemisphere: brainstem excised Rostrum of Trunk corpus callosum Splenium Cingulate gyrus Mammillothalamic Isthmus of cingulate gyrus fasciculus Parietooccipital sulcus Mammillary body Cuneus Uncus Calcarine sulcus Optic nerve (II) Lingual gyrus Olfactory tract Collateral sulcus Crus Body of fornix Rhinal sulcus Column Medial occipitotemporal gyrus Fimbria of hippocampus Occipitotemporal sulcus Dentate gyrus Lateral occipitotemporal gyrus Parahippocampal gyrus2
    • Cerebrum: Inferior View NEUROANATOMYSectioned brainstem Frontal pole of cerebrum Longitudinal cerebral fissure Straight gyrus Genu of corpus callosum Olfactory sulcus Lamina terminalis Orbital sulci Olfactory bulb Orbital gyri Olfactory tract Optic chiasm Temporal pole Optic nerve (II) (cut) Lateral sulcus (Sylvius) Hypophysis Inferior temporal sulcus (pituitary gland)Inferior temporal gyrus Anterior perforated substance Optic tract Tuber cinereumInferior (infero- Mammillary bodylateral) marginof cerebrum Posterior perforated substance (in interpeduncular Rhinal sulcus fossa) Cerebral crus Uncus Lateral geniculate body Inferior temporal gyrus Substantia nigra Medial geniculateOccipitotemporal bodysulcus Red nucleus Lateral occipito- temporal gyrus Pulvinar of thalamus Superior colliculus (of Collateral sulcus corpora quadrigemina) Cerebral aqueduct Parahippocampal gyrus Splenium of corpus callosum Medial occipitotemporal gyrus Apex of cuneus Calcarine sulcus Occipital pole of cerebrum Longitudinal cerebral fissure Isthmus of cingulate gyrus 3
    • NEUROANATOMY Basal Nuclei (Ganglia) Horizontal sections through cerebrum A B Genu of corpus callosum Head of caudate nucleus Lateral ventricle Anterior limb of internal Genu capsule Septum pellucidum Posterior limb Column of fornix Putamen Lentiform Globus pallidus nucleus Insula (island of Reil) 3rd ventricle Interthalamic adhesion External capsule Thalamus Claustrum Crus of fornix Retrolenticular part of internal capsule Choroid plexus of lateral ventricle Tail of caudate nucleus Splenium of Hippocampus and fimbria corpus callosum Occipital (posterior) horn of lateral ventricle Habenula Organization of basal nuclei (ganglia) A Pineal body B Caudate Putamen Globus nucleus pallidus Cleft for internal capsule Lentiform Striatum nucleus Caudate Body nucleus Head Thalamus Corpus striatum Levels of A A sections above B B Basal nuclei (ganglia) Pulvinar Lentiform nucleus Medial geniculate body (globus pallidus medial to putamen) Lateral geniculate body Amygdaloid body Tail of caudate nucleus Interrelationship of thalamus, lentiform nucleus, caudate nucleus and amygdaloid body (schema): left lateral view4
    • Thalamus NEUROANATOMY Interventricular foramen (Monro) Corpus callosum (cut) Tela choroidea (cut edge) Head of caudate nucleus of 3rd ventricle Septum pellucidum 3rd ventricle Columns of fornix Choroid plexus Anterior tubercle Superior thalamostriate vein Stria terminalis Pes hippocampi Temporal (inferior) horn Interthalamic adhesion of lateral ventricle Lamina affixa Internal cerebral vein Stria medullaris Dentate gyrus Habenular trigone Collateral eminence Pulvinar (retracted) Hippocampus Lateral geniculate body Fimbria of hippocampus Posterior commissure Medial geniculate body Habenular commissure Brachium of superior colliculus Pineal body Brachium of inferior colliculus Collateral trigone Superior colliculus Calcar avis Inferior colliculus Occipital (posterior) horn Cerebellum of lateral ventricle Calcarine sulcus Internal 3rd ventricle medullary Interthalamic lamina adhesion Pulvinar r rio a n te in dia An m Me ial La d na MD Intralaminar Me llar y lami VA LP nuclei edu L D rn al m Inte LP VL M 3rd ventricle VPL VP Reticular nucleus VI CM M VP M L VP VP Thalamic nuclei Pulvinar External Lateral geniculate body medullary CM Centromedian lamina Medial geniculate body LD Lateral dorsal LP Lateral posterior Median nuclei M Medial Schematic representation of thalamus MD Medial dorsal (external medullary lamina and Schematic section VA Ventral anterior reticular nuclei removed) through thalamus VI Ventral intermedial (at level of broken VL Ventral lateral Lateral nuclei line shown in figure VP Ventral posterior at right) Medial nuclei VPL Ventral posterolateral VPM Ventral posteromedial Anterior nuclei 5
    • NEUROANATOMY Cerebellum Superior surface Anterior cerebellar notch Anterior lobe Quadrangular lobule (H IV-V) Central lobule (II & III) Primary fissure Horizontal fissure Culmen (IV & V) Simple lobule (H VI) Superior vermis Declive (VI) Posterior lobe Postlunate fissure Folium (VII A) Superior semilunar (anseriform) lobule (H VII A) Horizontal fissure Inferior semilunar Posterior cerebellar notch (caudal) lobule (H VII B) Central lobule Anterior lobe Inferior surface Superior vermis Wing of central lobule Lingula (I) Superior Superior medullary velum Middle Cerebellar peduncles Inferior Flocculus (H X) Flocculonodular lobe 4th ventricle Posterolateral (dorsolateral) Inferior medullary velum fissure Nodule (X) Retrotonsillar fissure Uvula (IX) Posterior lobe Inferior vermis Tonsil Pyramid (VIII) Biventer lobule (H VIII) Tuber (VII B) Secondary (postpyramidal) fissure Posterior cerebellar notch Horizontal fissure Inferior semilunar (caudal) lobule (H VII B) Cerebral crus Decussation of superior cerebellar peduncles Medial longitudinal fasciculus 4th ventricle Nuclear layer of Superior medullary velum medulla oblongata Fastigial Superior cerebellar peduncle Globose Cerebellar nuclei Lingula (I) Dentate Vermis Emboliform Section in plane of superior cerebellar peduncle6
    • Brainstem NEUROANATOMY Posterolateral view Thalamus (cut surface) Lateral geniculate body Pulvinars of thalami Optic tract Pineal body Medial geniculate body Superior colliculi Brachia of superior and inferior colliculi Inferior colliculi Cerebral crus Trochlear nerve (IV) Pons Superior medullary velum Trigeminal nerve (V) Superior cerebellar peduncle Middle cerebellar peduncle Rhomboid fossa of 4th ventricle Vestibulocochlear nerve (VIII) Glossopharyngeal (IX) and Facial nerve (VII) vagus (X) nerves Inferior cerebellar peduncle Cuneate tubercle Hypoglossal nerve (XII) Gracile tubercle Accessory nerve (XI) Dorsal roots of 1st spinal nerve (C1) Cuneate fasciculus Gracile fasciculus Olfactory tract Anterior view Anterior perforated substance Infundibulum (pituitary stalk) Optic chiasm Mammillary bodies Optic tract Temporal lobe (cut surface) Oculomotor nerve (III) Tuber cinereum Trochlear nerve (IV) Cerebral crus Trigeminal nerve (V) Lateral geniculate body Abducent nerve (VI) Facial nerve (VII) and Posterior perforated substance intermediate nerve Vestibulocochlear nerve (VIII) Pons Flocculus of cerebellum Middle cerebellar peduncle Choroid plexus of 4th ventricle Olive Glossopharyngeal nerve (IX) Pyramid Vagus nerve (X) Ventral roots of 1st spinal nerve (C1) Hypoglossal nerve (XII) Accessory nerve (XI) Decussation of pyramids 7
    • NEUROANATOMY Fourth Ventricle and Cerebellum Posterior view Habenular trigone Medial Geniculate bodies 3rd ventricle Lateral Pulvinar of thalamus Dorsal median sulcus Pineal body Superior cerebellar peduncle Superior colliculus Locus ceruleus Inferior colliculus Medial eminence Trochlear nerve (IV) Facial colliculus Vestibular area Superior medullary velum Dentate nucleus Superior of cerebellumCerebellar peduncles Middle Inferior Striae medullares Lateral recess Tenia of 4th ventricle Superior fovea Cuneate tubercle Sulcus limitans Gracile tubercle Inferior fovea Dorsal median sulcus Trigeminal tubercle Lateral funiculus Hypoglossal trigone Cuneate fasciculus Vagal trigone Gracile fasciculus Obex Interthalamic adhesion Median sagittal section Posterior commissure Body of fornix Habenular commissure Thalamus (in 3rd ventricle) Pineal body Interventricular Splenium of corpus callosum foramen (Monro) Great cerebral vein (Galen) Anterior commissure Lamina terminalis Lingula (I) Hypothalamic sulcus Central lobule (II-III) Vermis of Cerebral peduncle Culmen (IV-V) cerebellum Cerebral aqueduct (Sylvius) Declive (VI) Superior colliculus Folium (VII A) Tectal (quadrigeminal) plate Superior medullary velum Inferior colliculus Pons Inferior medullary velum Medial longitudinal fasciculus Tuber (VII B) 4th ventricle Pyramid (VIII) Vermis of Choroid plexus of 4th ventricle cerebellum Uvula (IX) Medulla oblongata Nodulus (X) Median aperture (foramen of Magendie) Decussation of pyramids Choroid plexus of 4th ventricle Central canal of spinal cord Tonsil of cerebellum8
    • Accessory Nerve (XI): Schema NEUROANATOMY Nucleus ambiguus Cranial root of accessory nerve (joins vagus nerve and via recurrent laryngeal nerve supplies muscles of Vagus nerve (X) larynx, except cricothyroid)* Spinal root of accessory nerve Jugular foramen Foramen magnum Superior ganglion of vagus nerve Accessory nerve (XI)* Inferior ganglion of vagus nerve C1 spinal nerve C2 spinal nerve Accessory nerve (to sternocleidomastoid and trapezius muscles) Sternocleidomastoid muscle (cut) C3 spinal nerve C4 spinal nerve Trapezius muscle Efferent fibers Proprioceptive fibers *Recent evidence suggests that the accessory nerve lacks a cranial root and has no connection to the vagus nerve. Verification of this finding awaits further investigation. 9
    • NEUROANATOMY Arteries to Brain and Meninges Left middle meningeal artery Middle cerebral artery Posterior cerebral artery Anterior cerebral artery Superior cerebellar artery Anterior communicating artery Basilar artery Ophthalmic artery Left labyrinthine (internal acoustic) artery Posterior communicating Mastoid branch of artery left occipital artery Cavernous sinus Anterior inferior cerebellar artery Middle meningeal Posterior meningeal artery branch of left ascending pharyngeal artery Posterior inferior cerebellar artery Left and right Maxillary vertebral arteries artery (intracranial part) Superficial Posterior meningeal temporal branch of vertebral artery artery External Anterior meningeal carotid branch of vertebral artery artery Posterior auricular artery Facial artery Occipital artery Lingual artery Internal carotid artery Ascending pharyngeal artery Carotid sinus Superior laryngeal artery Carotid body Superior thyroid artery Vertebral artery (cervical part) Common carotid arteryTransverse process of C6 Ascending cervical artery (cut)Deep cervical artery Inferior thyroid artery Supreme intercostal artery Thyrocervical trunk Costocervical trunk Brachiocephalic trunk Subclavian artery Internal thoracic artery10
    • Arteries to Brain: Schema NEUROANATOMY Anterior cerebral artery Anterior communicating artery 1 Middle cerebral artery Ophthalmic artery Supraorbital artery Posterior communicating artery Supratrochlear artery Caroticotympanic branch 2 3 3 Lacrimal artery of internal carotid artery 3 1 Dorsal nasal artery Posterior cerebral artery Middle meningeal artery Superior cerebellar artery 3 Angular artery Anterior tympanic artery 1 Superficial temporal artery Middle meningeal artery 1 Posterior auricular artery 4 Maxillary artery Facial artery 5 5 Occipital artery Basilar artery 4 Lingual artery Anterior inferior cerebellar artery 5 5 Ascending pharyngeal artery Posterior inferior 5 Anterior spinal artery cerebellar artery Spinal segmental medullary branches External carotid artery 5 Vertebral artery Internal carotid artery 5 Common carotid artery Superior thyroid artery Deep cervical artery 5 Common carotid artery Transverse cervical artery Suprascapular artery Vertebral artery Supreme intercostal artery Ascending cervical artery Costocervical trunk Inferior thyroid artery Thyrocervical trunk Subclavian artery Subclavian artery Internal thoracic artery Brachiocephalic trunk Anastomoses Arch 1 Right–Left Aorta Descending 2 Carotid–Vertebral Ascending 3 Internal carotid–External carotid 4 Subclavian–Carotid 5 Subclavian–Vertebral 11
    • NEUROANATOMY Arteries of Brain: Inferior Views Medial frontobasal (orbitofrontal) artery Anterior communicating artery Anterior cerebral artery Distal medial striate artery (recurrent artery of Heubner) Internal carotid artery Anterolateral central (lenticulostriate) arteries Middle cerebral artery Lateral frontobasal (orbitofrontal) artery Prefrontal artery Anterior choroidal artery Posterior communicating artery Posterior cerebral artery Superior cerebellar artery Basilar artery Pontine arteries Labyrinthine (internal acoustic) artery Anterior inferior cerebellar artery Vertebral artery Anterior spinal artery Posterior inferior cerebellar artery (PICA) (cut) Posterior spinal artery Cerebral arterial circle (Willis) Distal medial striate artery (broken line) (recurrent artery of Heubner) Anterior communicating artery Anterior cerebral artery Middle cerebral artery Posterior communicating artery Anterior choroidal artery Optic tract Posterior cerebral artery Cerebral crus Lateral geniculate body Posterior medial choroidal artery Posterior lateral choroidal artery Choroid plexus of lateral ventricle Medial geniculate body Pulvinar of thalamus Lateral ventricle12
    • Cerebral Arterial Circle (Willis) NEUROANATOMY Distal medial striate artery Vessels dissected out: inferior view (recurrent artery of Heubner) Anterior cerebral artery Anteromedial central (perforating) (A2 segment) arteries Anterior communicating artery Hypothalamic artery Anterior cerebral artery (A1 segment) Anterolateral central Ophthalmic artery (lenticulostriate) arteries Internal carotid artery Middle cerebral artery Superior hypophyseal artery Posterior communicating artery Inferior hypophyseal artery Anterior choroidal artery Posterior cerebral artery (P2 segment) Thalamotuberal (P1 segment) (premammillary) artery Posteromedial central Superior cerebellar artery (perforating) arteries Basilar artery Thalamoperforating artery Pontine arteries Posteromedial central (paramedian) arteries Anterior inferior cerebellar artery Labyrinthine (internal acoustic) artery Vertebral artery Vessels in situ: inferior view Anterior cerebral artery Anterior communicating artery Optic chiasm Hypothalamic artery Cavernous sinus Internal carotid artery Infundibulum (pituitary stalk) Superior hypophyseal artery and long hypophyseal portal veins Adenohypophysis (anterior Middle cerebral artery lobe of pituitary gland) Inferior hypophyseal artery Neurohypophysis (posterior lobe of pituitary gland) Posterior communicating artery Posteromedial central (perforating) arteries Efferent hypophyseal veins Superior cerebellar artery Posterior cerebral artery Basilar artery 13
    • NEUROANATOMY Arteries of Brain: Frontal View and Section Corpus callosum Paracentral artery Medial frontal branches Anterolateral central (lenticulostriate) arteries Pericallosal artery Lateral frontobasal Callosomarginal artery (orbitofrontal) artery Polar frontal artery Prefrontal artery Anterior cerebralPrecentral (pre-rolandic) arteriesand central (rolandic)sulcal arteries Medial frontobasal (orbitofrontal) artery Anterior parietal (postcentral sulcal) Distal medial striate artery artery (recurrent artery of Heubner) Posterior parietal Internal carotid artery artery Branch to Anterior choroidal angular gyrus artery Temporal branches Posterior cerebral (anterior, middle artery and posterior) Superior cerebellar artery Middle cerebral artery and branches Basilar and pontine arteries (deep in lateral cerebral [sylvian] sulcus) Labyrinthine (internal acoustic) artery Anterior communicating artery Vertebral artery Posterior communicating artery Posterior inferior cerebellar artery Anterior inferior cerebellar artery Anterior spinal artery Posterior spinal artery Falx cerebri Callosomarginal arteries Corpus striatum and (caudate and lentiform nuclei) Pericallosal arteries (branches of anterior Anterolateral central cerebral arteries) (lenticulostriate) arteries Insula (island of Reil) Trunk of corpus callosum Limen of insula Internal capsule Precentral (pre-rolandic), central (rolandic) sulcal Septum pellucidum and parietal arteries Rostrum of corpus callosum Lateral cerebral (sylvian) sulcus Anterior cerebral arteries Temporal branches of middle cerebral artery Distal medial striate artery (recurrent artery of Heubner) Temporal lobe Anterior communicating artery Middle cerebral artery Optic chiasm Internal carotid artery14
    • Arteries of Brain: Lateral and Medial Views NEUROANATOMY Anterior parietal (postcentral sulcal) artery Posterior parietal artery Central (rolandic) sulcal artery Branch to angular gyrus Precentral (pre-rolandic) sulcal artery Terminal branches of posterior Prefrontal sulcal cerebral artery artery Terminal branches of anterior cerebral artery Lateral frontobasal (orbitofrontal) artery Left middle cerebral artery Left anterior cerebral artery Occipitotemporal Anterior communicating artery branches Right anterior cerebral artery Posterior temporal branch Middle temporal branch Left internal carotid artery Superior and inferior terminal branches (trunks) Polar temporal artery Anterior temporal branch Paracentral artery Posterior Pericallosal artery Medial frontal Cingular branches Intermediate branches Right posterior cerebral artery Anterior Precuneal artery Callosomarginal Dorsal branch artery to corpus callosum Parietooccipital branch Polar frontal artery Calcarine branch Right anterior cerebral artery Medial fronto- basal (orbito- frontal) artery Anterior communicating artery (cut) Medial occipital artery Distal medial striate artery Posterior temporal branch (recurrent artery of Heubner) Anterior temporal branch Right internal carotid artery Posterior communicating artery Note: Anterior parietal (postcentral sulcal) artery also occurs as separate anterior parietal and postcentral sulcal arteries 15
    • NEUROANATOMY Arteries of Posterior Cranial Fossa Thalamogeniculate arteries Lateral and medial geniculate bodies of left thalamus Anterior choroidal artery Choroid plexuses of lateral ventricles Crura of fornix Pulvinars of left and right thalami Splenium of corpus callosum Anterolateral central (lenticulostriate) arteries Occipital (posterior) horn of right lateral ventricle Heads of caudate nuclei Right dorsal branch to corpus callosum (posterior pericallosal artery) Septum pellucidum Parietooccipital Branches of Corpus callosum right posterior Calcarine cerebral artery Anterior cerebral arteriesLongitudinalcerebralfissure Superior colliculi Superior vermianOptic nerve (II) branch IVOphthalmic artery III Posterior medial V choroidal artery Anterior cerebral artery to choroid plexus of 3rd ventricle Middle VIII cerebral artery Posterior lateral choroidal artery Posterior VII communicating artery VI Lateral (marginal) branch IX Thalamoperforating arteries X Inferior vermian artery Left internal carotid artery (phantom) XI Basilar artery Choroidal branch to 4th ventricle (phantom) and Pontine arteries Cerebellar tonsillar branch Labyrinthine (internal acoustic) artery of posterior inferior cerebellar artery Posterior cerebral artery Outline of 4th ventricle (broken line) Superior cerebellar artery Posterior meningeal branch of vertebral artery Anterior inferior cerebellar artery Posterior inferior cerebellar artery (PICA) Anterior meningeal branch of vertebral artery Left posterior spinal artery Temporal branches of posterior cerebral artery Left vertebral artery Anterior spinal artery16
    • Veins of Posterior Cranial Fossa NEUROANATOMY Left superior and inferior colliculi Left pulvinar Basal vein (Rosenthal) Right pulvinar Posterior mesencephalic vein Internal cerebral veins Medial geniculate body Splenium of corpus callosum Lateral Great cerebral vein (Galen) mesencephalic vein Dorsal vein of corpus callosum Lateral geniculate body Inferior sagittal sinus Left thalamus Straight sinus (cut surface) Falx cerebri Optic tract Confluence of sinuses TentoriumInferior thalamo- cerebelli (cut) Left transversestriate veins sinus (cut)Deep middlecerebral Superiorvein (cut) sagittal sinusAnteriorcerebralveinOpticnerve (II) C C CL D F L TU Superior vermian N P vein U Inferior vermian veinAnterior ponto- Falx cerebelli (cut)mesencephalic vein T and occipital sinus Inferior cerebellarTrigeminal nerve (V) hemispheric veinsTransverse pontine vein Intraculminate veinPetrosal vein (draining Superior cerebellar vein (inconstant)to superior petrosal sinus) Preculminate vein Lateral pontine vein Precentral cerebellar vein Anteromedian medullary vein Superior retrotonsillar vein (Inferior retrotonsillar) Parts of cerebellum Vein of lateral recess of 4th ventricle vein of cerebellomedullary L Lingula TU Tuber Superior, middle and cistern CL Central lobule P Pyramid inferior cerebellar peduncles Posterior spinal vein C Culmen U Uvula D Declive N Nodule Anterior spinal vein 4th ventricle F Folium T Tonsil 17
    • NEUROANATOMY Deep Veins of Brain Longitudinal cerebral fissure Anterior cerebral veins Rostrum of corpus callosum Septum pellucidum Anterior vein of septum pellucidum Head of caudate nucleus Anterior vein of caudate nucleus Transverse veins of caudate nucleus Interventricular foramen (Monro) Columns of fornix Superior thalamostriate vein Superior choroid vein and choroid plexus of lateral ventricle Thalamus Tela choroidea of 3rd ventricle Lateral direct vein Posterior vein of caudate nucleus Internal cerebral veins Basal vein (Rosenthal) Great cerebral vein (Galen) Inferior sagittal sinus Straight sinus Tentorium cerebelli Transverse sinus Confluence of sinuses Superior sagittal sinus Dissection: superior view Uncal vein Anterior cerebral vein Superficial middle cerebral vein (draining to sphenoparietal sinus) Optic chiasm Deep middle cerebral vein Cerebral crus Basal vein (Rosenthal) Lateral geniculate body Inferior cerebral Medial geniculate body veins Pulvinar of thalamus Splenium of corpus callosum Great cerebral vein (Galen) Inferior anastomotic vein (Labbé) Dissection: inferior view18
    • Subependymal Veins of Brain NEUROANATOMY Posterior veins of septum pellucidum Lateral direct vein Superior thalamic veins Posterior terminal vein of caudate nucleus (posterior part of thalamostriate vein) Superior choroid vein Internal cerebral veins (right and left) Transverse veins of caudate nucleus Medial (atrial) vein of lateral ventricle Superior thalamostriate vein Lateral (atrial) vein of lateral ventricle Lateral ventricle Splenium of corpus callosum Anterior vein of caudate nucleus Great cerebral vein (Galen) Anterior vein of septum pellucidum Dorsal vein of corpus callosum Genu of corpus Inferior sagittal callosum sinus Internal occipital vein Straight sinus Occipital (posterior) horn of lateral ventricle Interventricular foramen (Monro) Anterior commissure Interthalamic adhesion Anterior cerebral vein Optic chiasm Cerebellum 3rd ventricle Deep middle cerebral vein Inferior thalamostriate veins Basal vein (Rosenthal) Temporal (inferior) horn of lateral ventricle Posterior mesencephalic vein Superior vermian vein Hippocampal and inferior ventricular veins Cerebral aqueduct Veins on lateral wall of ventricle 4th ventricle Veins on medial wall and floor of ventricle Lateral and median apertures of 4th ventricle All other veins 19
    • NEUROANATOMY Hypothalamus and Hypophysis Septum pellucidum Thalamus Fornix Hypothalamic sulcus Anterior commissure Paraventricular PosteriorPrincipal Dorsomedialnuclei of Supraoptichypothalamus Ventromedial Arcuate (infundibular) Mammillary Mammillothalamic tract Optic chiasm Dorsal longitudinal Infundibulum (pituitary stalk) fasciculus and other descending pathways Hypophysis (pituitary gland) Lamina terminalis Hypothalamic sulcus Paraventricular hypothalamic nucleus Supraoptic hypothalamic nucleus Supraopticohypophyseal tract Tuberohypophyseal tract Mammillary Hypothalamohypophyseal tract body Infundibulum (pituitary stalk) Arcuate (infundibular) nucleus Pars tuberalis Median eminence of tuber cinereumAdenohypophysis Fibrous trabecula(anterior lobe of Neurohypophysispituitary gland) Pars intermedia Infundibular stem (posterior lobe of pituitary gland) Pars distalis Infundibular process Cleft20
    • Arteries and Veins of Hypothalamus and Hypophysis NEUROANATOMY Hypothalamic vessels Primary plexus of hypophyseal portal system Superior hypophyseal artery Long hypophyseal portal veins Artery of trabecula Short hypophyseal portal veins Trabecula (fibrous tissue)Efferent hypophyseal vein Efferent hypophyseal veinto cavernous sinus to cavernous sinusSecondary plexus Neurohypophysisof hypophyseal (posterior lobe ofportal system pituitary gland) Capillary plexus of infundibular processAdenohypophysis(anterior lobe ofpituitary gland) Efferent hypophyseal vein to cavernous sinus Inferior hypophyseal arteryEfferent hypophysealveins to cavernous sinus 21
    • NEUROANATOMY Relation of Spinal Nerve Roots to Vertebrae L4 C1 C1 spinal nerve exits Base C1 above C1 vertebra of skull C2 L4 C2 C3 Cervical C3 C4 enlargement C4 L5 C5 C5 C6 C8 spinal nerve L5 C6 C7 exits below C7 C7 vertebra C8 (there are 8 cervical T1 nerves but only T1 7 cervical vertebrae) T2 T2 S1 T3 T3 T4 T4 T5 S2 T5 T6 T6 T7 Lumbar disc protrusion does not usually affect T7 nerve exiting above disc. Lateral protrusion T8 at disc level L4–5 affects L5 spinal nerve, not T8 T9 L4 spinal nerve. Protrusion at disc level L5–S1 T9 affects S1 spinal nerve, not L5 spinal nerve T10 T10 T11 Lumbar T11 enlargement T12 L4 T12 L1 Conus medullaris (termination of L1 spinal cord) L4 L2 L2 L5 L3 L5 L3 Cauda equinaInternal terminal L4filum (pial part) L4 L5 S1 L5 Sacrum S2 S1 S3External S2terminal filum(dural part) S3 Termination of S4 S4 dural sac S5 S5 Coccygeal nerve Coccyx Coccygeal nerve Cervical nerves Thoracic nerves Medial protrusion at disc level L4–5 rarely affects Lumbar nerves L4 spinal nerve but may affect L5 spinal nerve Sacral and coccygeal nerves and sometimes S1–4 spinal nerves22
    • Autonomic Nervous System: General Topography NEUROANATOMY Oculomotor nerve (III) Ciliary ganglion Facial nerve (VII) Pterygopalatine ganglion Glossopharyngeal nerve (IX) Otic ganglion Vagus nerve (X) Chorda tympani nerve Internal carotid nerve and plexus Lingual nerve Superior cervical sympathetic ganglion Submandibular ganglion C4 spinal nerve Pharyngeal and superior laryngeal branches of vagus nerve Middle cervical sympathetic ganglion Vertebral ganglion Recurrent laryngeal branch of vagus nerve Cervicothoracic (stellate) ganglion Superior cervical Cardiac branches Inferior cervical of vagus nerve Sympathetic trunk Thoracic Superior Cardiac plexus Cervical (sympathetic) cardiac nerves Middle Anterior Inferior Pulmonary plexuses PosteriorThoracic (sympathetic) cardiac nerves Esophageal plexus 6th intercostal nerve Thoracic aortic plexus (ventral ramus of T6 spinal nerve) Anterior vagal trunk Sympathetic trunk Posterior vagal trunk 6th thoracic sympathetic ganglion Celiac ganglionGray and white rami communicantes Celiac trunk and plexus Greater splanchnic nerve Superior mesenteric ganglion Lesser splanchnic nerve Superior mesenteric artery Least splanchnic nerve and plexus Aorticorenal ganglion Intermesenteric (abdominal aortic) plexus Lumbar splanchnic nerves (sympathetic) Inferior mesenteric ganglion Gray rami communicantes Inferior mesenteric artery Sacral splanchnic nerves (sympathetic) and plexus Pelvic splanchnic nerves Superior hypogastric plexus (sacral parasympathetic outflow) Parasympathetic branch from inferior hypogastric plexus to Sciatic nerve descending colon Inferior hypogastric Hypogastric nerves (pelvic) plexus Rectal plexus Vesical plexus Sympathetic fibers Parasympathetic fibers Prostatic plexus 23
    • NEUROANATOMY Spinal Nerve Origin: Cross Sections Section through thoracic vertebra Aorta Body of vertebra Fat in epidural space Dura mater Sympathetic ganglion Arachnoid mater* Ventral root Subarachnoid space White and gray rami communicantes Pia mater* Recurrent Spinal nerve meningeal Ventral ramus branches of (intercostal nerve) spinal nerve Dorsal ramus Pleura Lung Spinal sensory (dorsal root) ganglion Dorsal root Lateral horn of gray matter of spinal cord Section through lumbar vertebra of dorsal Lateral branch ramus Sympathetic of spinal ganglion Dura mater Medial branch nerve Gray ramus Arachnoid mater Internal vertebral communicans (epidural) venous plexus Ventral root Fat in epidural Spinal nerve space Ventral ramus (contributes to lumbar plexus) Dorsal ramus Dorsal and ventral Spinal sensory (dorsal root) ganglion roots of lumbar and Dorsal root sacral spinal nerves forming cauda equina Conus medullaris *Leptomeninges24
    • Olfactory Nerve (I): Schema NEUROANATOMY Subcallosal (parolfactory) area Septal area and nuclei Olfactory bulb cells: schema Fibers from Contralateral Efferent fibers to Fibers to olfactory bulb olfactory bulb Afferent fibers from bulb Anterior commissure to central connections and contralateral bulb Medial olfactory stria Granule cell (excited by and inhibiting to mitral and tufted cells) Mitral cell Recurrent process Tufted cell Periglomerular cell Glomerulus Olfactory nerve fibers Olfactory cells Olfactory tract Olfactory mucosa Olfactory trigone and olfactory tubercle Olfactory nerves (I) Lateral olfactory stria Uncus Olfactory bulb Lateral olfactory tract nucleus Hippocampal Cribriform plate of ethmoid bone fimbria Anterior perforated substance Anterior olfactory nucleus Amygdaloid body (phantom) Dentate gyrus Piriform lobe Parahippocampal gyrus 25
    • NEUROANATOMY Optic Nerve (II) (Visual Pathway): Schema G Central darker G circle represents macular zone Overlapping Lighter shades A visual fields represent A monocular fields B B Each quadrant H H a different color Projection on R RC C Projection on right retina left retina P P Choroid Choroid Optic nerves (II) Optic chiasm Periphery Macula Structure of retina: schema Projection on right Projection on left A Amacrine cells dorsal lateral dorsal lateral B Bipolar cells geniculate nucleus geniculate nucleus C Cones Optic tracts G Ganglion cells H Horizontal cells P Pigment cells Lateral R Rods geniculate bodies Optic radiation Optic radiation Calcarine sulcus Calcarine sulcus Projection on left Projection on right occipital lobe occipital lobe26
    • Oculomotor (III), Trochlear (IV) and Abducent (VI) Nerves: Schema NEUROANATOMY Long ciliary nerve Ciliary ganglion Short ciliary nerves Posterior ethmoidal nerve Abducent nucleus Anterior ethmoidal nerve Sensory root of ciliary ganglion Trochlear nucleus Superior oblique muscle Sympathetic root of ciliary ganglion Levator palpebrae Oculomotor nucleus superioris muscle Superior division of oculomotor nerve Superior Accessory oculomotor rectus muscle Frontal nerve (cut) (Edinger-Westphal) nucleus (parasympathetic) Lacrimal nerve (cut) Nasociliary nerve Trochlear nerve (IV) Oculomotor nerve (III) Ophthalmic nerve (V1) Infraorbital nerve Abducent nerve (VI) Zygomatic nerve (cut) Pterygopalatine ganglion Mandibular nerve (V3) Inferior oblique muscle Internal carotid artery Ciliary muscle Inferior division of and nerve plexus oculomotor nerve Dilator muscle of pupil Maxillary nerve (V2) Medial rectus muscle Sphincter muscle of pupil Lateral rectus muscle and Inferior rectus muscle abducent nerve (turned back) Efferent fibers Afferent fibers Parasympathetic root Cavernous plexus of ciliary ganglion Sympathetic fibers Common tendinous ring Parasympathetic fibers 27
    • NEUROANATOMY Trigeminal Nerve (V): Schema Trigeminal nerve (V) ganglion and nuclei Ophthalmic nerve (V1) Motor nucleus Efferent fibers Mesencephalic nucleus Afferent fibers Tentorial (meningeal) branch Principal sensory nucleus Proprioceptive fibers Nasociliary nerve Spinal tract and nucleus Parasympathetic fibers Lacrimal nerve Sympathetic fibers Sensory root of ciliary ganglion Frontal nerve Ciliary ganglion Posterior ethmoidal nerve Long ciliary nerve Short ciliary nerves Anterior ethmoidal nerve Supraorbital nerve Supratrochlear nerve Infratrochlear nerve Internal nasal branches and External nasal branches of anterior ethmoidal nerve Maxillary nerve (V2) Meningeal branch Zygomaticotemporal nerve Zygomaticofacial nerve Zygomatic nerve Infraorbital nerve Pterygopalatine ganglion Superior alveolar branches of infraorbital nerve Nasal branches (posterior superior lateral, nasopalatine Facial nerve (VII) and posterior superior medial) Chorda tympani nerve Nerve (vidian) of pterygoid canal (from facial nerve [VII] and carotid plexus) Pharyngeal branch Greater and lesser palatine nerves Deep temporal nerves Superficial (to temporalis muscle) temporal branches Lateral pterygoid Articular branch and masseteric nerves and anterior auricular nerves Tensor veli palatini and medial pterygoid nerves Auriculotemporal nerve Buccal nerve Submandibular Inferior ganglion Parotid branches alveolar nerve Mental nerve Meningeal branch Inferior dental plexus Mylohyoid nerve Otic ganglion Lesser petrosal nerve (from Lingual nerve Mandibular nerve (V3) Tensor tympani nerve glossopharyngeal nerve [IX])28
    • Facial Nerve (VII): Schema NEUROANATOMY Greater petrosal nerve Facial nerve (VII) Internal acoustic meatusDeep petrosal nerve (from internal carotid plexus) Geniculate ganglion Intermediate nerve Lesser petrosal nerve Internal carotid plexus Motor nucleus of facial nerve (on internal carotid artery) Nerve (vidian) of pterygoid canal Superior salivatory nucleus Otic ganglion Solitary tract nucleus Pterygopalatine ganglion Facial muscles Frontal belly (frontalis) of occipitofrontalis Orbicularis oculi Corrugator supercilii Zygomaticus major Zygomaticus minor Temporal bran Procerus Levator labii superioris Levator labii superioris che alaeque nasi s Levator anguli oris Nasalis Zygomatic bra nch es Depressor septi nasi anterior 2⁄3 Occipital Taste: tongue belly of Buccal (occipitalis) of Orbicularis branches oris occipitofrontalis muscle Depressor Occipital h anc anguli oris branch of posterior al br Depressor labii auricular Cer vic inferioris nerve Mentalis Branches to auricular muscles (Risorius) Posterior auricular nerve al (not shown) Margin ular Nerve to stapedius muscle man dib Buccinator branch Stylomastoid foramen Platysma Tympanic plexus Tympanic nerve (Jacobson) Sublingual gland (from glossopharyngeal nerve) Submandibular gland Glossopharyngeal nerve (IX) Efferent fibers Submandibular ganglion Digastric muscle (posterior belly) Afferent fibers Parasympathetic fibers Lingual nerve (from trigeminal nerve) Stylohyoid muscle Sympathetic fibers Chorda tympani nerve Caroticotympanic nerve (from internal carotid plexus) 29
    • NEUROANATOMY Vestibulocochlear Nerve (VIII): Schema Afferent fibers Facial canal Tympanic cavity Geniculum of facial nerve (site of geniculate ganglion) Chorda tympani nerve Greater petrosal nerve Head of malleus Cochlear (spiral) ganglion Incus Vestibular nerve Cochlear nerve Motor root of facial nerve and intermediate nerve Vestibulocochlear nerve (VIII) Medulla oblongata (cross section) Ampulla of lateral semicircular duct Internal Medial acoustic Ampulla of superior meatus semicircular duct Vestibular Superior nuclei Anterior Utricle Cochlear (diagrammatic) Inferior nuclei Posterior Ampulla of posterior Lateral semicircular duct Inferior cerebellar peduncle (to cerebellum) Saccule Superior division Vestibular ganglion of vestibular nerve Inferior division30
    • Glossopharyngeal Nerve (IX): Schema NEUROANATOMY Efferent fibers Spinal tract and spinal nucleus of trigeminal nerve Afferent fibers Solitary tract nucleus Parasympathetic fibers Tympanic nerve (Jacobson) Nucleus ambiguus Tympanic cavity and plexus Inferior salivatory nucleus Stylomastoid foramen Geniculate ganglion of facial nerve Caroticotympanic nerve (from internal carotid plexus) Greater petrosal nerve Deep petrosal nerve Nerve (vidian) of pterygoid canal Lesser petrosal nerve Pterygopalatine ganglion Mandibular nerve (V3) Otic ganglion Auriculotemporal nerve Parotid gland Tubal branch of tympanic plexus Pharyngotympanic (auditory) tube and pharyngeal openingStylopharyngeus muscle (and branch Glossopharyngealfrom glossopharyngeal nerve) nerve (IX) Jugular foramen Communication to auricular branch of vagus nerve Superior and Inferior ganglia of Glossopharyngeal nerve Communication to facial nerve (VII) Taste and somatic Vagus nerve (X) sensation: posterior Superior cervical 1 ⁄3 of tongue sympathetic ganglion Sympathetic trunk Carotid branch of glossopharyngeal nerve Internal carotid artery Pharyngeal plexus Carotid sinus Pharyngeal, tonsillar and lingual branches of glossopharyngeal nerve Carotid body Common carotid artery Pharyngeal branch of vagus nerve External carotid artery 31
    • NEUROANATOMY Vagus Nerve (X): Schema Posterior nucleus of vagus nerve (parasympathetic SEE ALSO PLATE 160 and visceral afferent) Glossopharyngeal nerve (IX) Meningeal branch of vagus nerve Solitary tract nucleus (visceral afferents including taste) Auricular branch of vagus nerve Spinal tract and spinal Pharyngotympanic (auditory) tube nucleus of trigeminal nerve (somatic afferent) Levator veli palatini muscle Nucleus ambiguus (motor to pharyngeal Salpingopharyngeus and laryngeal muscles) muscle Cranial root of accessory nerve* Palatoglossus muscle (see next plate) Palatopharyngeus Vagus nerve (X) muscle Jugular foramen Superior pharyngeal constrictor muscle Superior ganglion of vagus nerve Stylopharyngeus muscle Inferior ganglion of vagus nerve Middle pharyngeal constrictor muscle Pharyngeal branch of vagus nerve (motor to muscles of palate and lower pharynx; sensory to lower pharynx) Inferior pharyngeal constrictor muscle Communicating branch of vagus nerve to Cricothyroid muscle carotid branch of glossopharyngeal nerve Trachea Pharyngeal plexus Esophagus Superior laryngeal nerve: Internal branch (sensory and parasympathetic) Right subclavian artery External branch (motor to cricothyroid muscle) Right recurrent laryngeal nerve Superior cervical cardiac branch of vagus nerve Heart Inferior cervical cardiac branch of vagus nerve Hepatic branch of anterior Thoracic cardiac branch of vagus nerve vagal trunk (in lesser omentum) Left recurrent laryngeal nerve (motor to muscles of larynx Celiac branches from anterior except cricothyroid; sensory and parasympathetic to and posterior vagal trunks larynx below vocal folds; parasympathetic, efferent and to celiac plexus afferent to upper esophagus and trachea)Celiac and superior mesenteric Pulmonary plexusganglia and celiac plexus Cardiac plexus Hepatic plexus Esophageal plexus Gallbladder and bile ducts Anterior vagal trunk Liver Gastric branches of anterior vagal trunk (branches from posterior trunk behind stomach) Pyloric branch from hepatic plexus Vagal branches (parasympathetic motor, secretomotor and afferent fibers) accompany Pancreas superior mesenteric artery and its branches usually as far as left colic (splenic) flexure Duodenum Small intestine Ascending colon Efferent fibers Cecum Afferent fibers Appendix Parasympathetic fibers32
    • Accessory Nerve (XI): Schema NEUROANATOMY SEE ALSO PLATE 28 Nucleus ambiguus Cranial root of accessory nerve (joins vagus nerve and via recurrent laryngeal nerve supplies muscles of Vagus nerve (X) larynx, except cricothyroid)* Spinal root of accessory nerve Jugular foramen Foramen magnum Superior ganglion of vagus nerve Accessory nerve (XI)* Inferior ganglion of vagus nerve C1 spinal nerve C2 spinal nerve Accessory nerve (to sternocleidomastoid and trapezius muscles) Sternocleidomastoid muscle (cut) C3 spinal nerve C4 spinal nerve Trapezius muscle Efferent fibers Proprioceptive fibers *Recent evidence suggests that the accessory nerve lacks a cranial root and has no connection to the vagus nerve. Verification of this finding awaits further investigation. 33
    • NEUROANATOMY Hypoglossal Nerve (XII): Schema Hypoglossal nerve (XII) Meningeal branch (in hypoglossal canal) Hypoglossal nucleus Superior longitudinal Intrinsic muscles Transverse of tongue and vertical Styloglossus Inferior muscle longitudinal Occipital condyle Inferior ganglion of vagus nerve Ventral rami of C1, 2, 3 form ansa cervicalis of cervical plexus Superior cervical sympathetic ganglion Superior root of Genioglossus ansa cervicalis muscle Internal carotid artery Geniohyoid muscle Hyoglossus muscle Inferior root of ansa cervicalis Thyrohyoid muscle Ansa cervicalis Omohyoid muscle Internal jugular vein (superior belly) Sternohyoid muscle Common carotid artery Sternothyroid muscle Omohyoid muscle (inferior belly) Efferent fibers Afferent fibers34
    • Nerves of Heart NEUROANATOMY Superior cervical Superior cervical sympathetic ganglion sympathetic ganglion Vagus nerve (X) Vagus nerve (X) (Conjoined sympathetic and Superior cervical vagal) superior cervical cardiac nerves (sympathetic) cardiac nerve Middle cervical Superior cervical sympathetic ganglion (vagal) cardiac nerve Middle cervical Middle cervical (sympathetic) cardiac nerve sympathetic ganglion Phrenic nerve Phrenic nerve Inferior cervical Middle cervical (vagal) cardiac nerve (sympathetic) cardiac nerve Inferior cervical Vertebral ganglion (vagal) cardiac nerve Inferior thyroid artery Vertebral ganglion Vertebral artery Cervicothoracic (stellate) ganglion Cervicothoracic (stellate) ganglion Inferior cervical sympathetic Ansa subclavia cardiac nerves Recurrent laryngeal nerve Inferior cervical 3rd thoracic (sympathetic) cardiac nerves sympathetic ganglion Thoracic cardiac branch Thoracic (sympathetic) of vagus nerve cardiac branches 4th thoracic Thoracic cardiac sympathetic ganglion branch of vagus nerve Thoracic (sympathetic) cardiac branches Recurrent laryngeal Cardiac plexus nerve Phrenic nerve (cut) 35
    • NEUROANATOMY Autonomic Nerves and Ganglia of AbdomenRight sympathetic trunk Anterior, PosteriorThoracic duct vagal trunksRight greater Left gastric arteryand lesser and plexussplanchnicnerves Celiac gangliaRight phrenic nerve Left greater splanchnic nerveInferior phrenic Left lesserarteries and plexuses splanchnic nerveRight greater Splenic arteryand lesser and plexussplanchnicnerves Common hepatic artery and plexusRight suprarenalplexus Superior mesenteric ganglion and plexusRight aortico- Left aorticorenalrenal ganglion ganglionRight least Left sympatheticsplanchnic nerve trunkRight renal Intermesentericartery and plexus (aortic) plexusRight Inferior mesentericsympathetic trunk ganglionWhite and gray Left colic arteryrami communicantes and plexus Inferior mesentericCisterna chyli artery and plexusGray ramus communicans Left common iliac artery and plexus3rd lumbar ganglionof sympathetic trunk Superior rectal artery and plexus2nd and 3rd lumbarsplanchnic nerves Superior hypogastric plexusRight ureter and plexus Internal and external iliac arteries andRight testicular (ovarian) plexusesartery and plexus Right and left4th lumbar splanchnic nerve hypogastric nerves to inferior hypo-1st sacral ganglion gastric (pelvic) plexusof sympathetic trunkGray rami communicantes Left sacral plexus Pelvic splanchnic nerves36
    • Nerves of Stomach and Duodenum NEUROANATOMY Right and left inferior phrenic arteries and plexuses Hepatic branch of anterior vagal trunk Anterior and posterior layers of lesser omentum Anterior vagal trunk Branch from hepatic plexus to Celiac branch of posterior vagal trunk cardia via lesser omentum Celiac branch of anterior vagal trunk Right greater splanchnic nerve Left gastric artery and plexus Vagal branch from hepatic plexus to pyloric part of stomach Hepatic plexus Right gastric artery and plexus Anterior gastric branch of anterior vagal trunk Left greater splanchnic nerve Left lesser splanchnic nerve Splenic artery and plexus Celiac ganglia and plexus Plexus on gastro-omental (gastroepiploic) arteries Superior mesenteric artery and plexus Plexus on inferior pancreaticoduodenal artery Plexus on first jejunal artery Plexus on anterior superior and anterior inferior pancreaticoduodenal arteries (posterior pancreaticoduodenal arteries and plexuses not visible in this view) 37
    • NEUROANATOMY Nerves of Stomach and Duodenum (continued) Plexus on gastro-omental Posterior gastric branch of posterior vagal trunk (gastroepiploic) arteries Hepatic branch of anterior vagal trunk via lesser omentum Hepatic plexus Branch from hepatic plexus to cardia via lesser omentum Right gastric artery and Right inferior phrenic artery and plexus plexus Posterior vagal trunk Celiac branch of posterior vagal trunk Celiac branch of anterior vagal trunk Left gastric artery and plexus Left inferior phrenic artery and plexus Celiac ganglia and plexus Greater, lesser and least splanchnic nerves Aorticorenal ganglia Splenic artery and plexus Right phrenic nerve Greater, Phrenic ganglion Lesser, Branch from right inferior phrenic Least plexus to cardia of stomach splanchnic nerves Right and left inferior phrenic arteries and plexuses Anterior vagal trunk Posterior vagal trunk View with stomach reflected cephalad Plexus on anterior superior and anterior inferior pancreatico- Celiac branches duodenal arteries of anterior Right greater, lesser and posterior Plexus on gastroduodenal artery vagal trunks and least Plexus on posterior superior splanchnic nerves and posterior inferior Left gastric pancreaticoduodenal arteries Celiac ganglia artery and plexus Left greater, Superior mesenteric ganglion and plexus Right aortico- lesser and least renal ganglion splanchnic nerves Superior mesenteric ganglion and plexus Left aorticorenal ganglion38
    • Nerves of Small Intestine NEUROANATOMY Recurrent branch of left inferior phrenic artery and plexus to esophagus Anterior vagal trunk Posterior vagal trunk Hepatic branch of anterior vagal trunk (courses in lesser omentum, removed here) Celiac branches of anterior and posterior vagal trunks Inferior phrenic arteries and plexuses Left gastric artery and plexus Hepatic plexus Greater splanchnic nerves Right gastric artery and plexus (cut) Celiac ganglia and plexus Gastroduodenal artery and plexus Lesser splanchnic nerves Least splanchnic nerves Aorticorenal ganglia Superior mesenteric ganglion Intermesenteric (aortic) plexus Inferior pancreaticoduodenal arteries and plexuses Superior mesenteric artery and plexus Middle colic artery and plexus (cut) Right colic artery and plexus Ileocolic artery and plexus Superior mesenteric artery and plexus Peritoneum (cut edge) Mesenteric branches Mesoappendix (contains appendicular artery and nerve plexus) 39
    • NEUROANATOMY Nerves of Large Intestine Anterior vagal trunk and hepatic branch Marginal artery and plexus Posterior vagal trunk Esophagus Celiac branches of anterior Left inferior phrenic and posterior vagal trunks artery and plexusRight inferior phrenic artery and plexus Left gastric artery and plexus Right greater splanchnic nerve Left greater splanchnicCeliac ganglia and plexus nerveRight lesser and Left suprarenalleast splanchnic plexusnerves Left lesser andRight aortico- least splanchnicrenal ganglion nervesSuperior Left aorticorenalmesenteric ganglionganglion Left renal artery and plexusMiddle colicartery 1st left lumbarand plexus splanchnic nerveInferior Left lumbarpancreatico- sympathetic trunkduodenalarteries Intermesentericand plexuses (aortic) plexusRight colic Left colic arteryartery and plexusand plexus InferiorIleocolic mesentericartery ganglion, arteryand plexus and plexusCecal and Sigmoidappendicular arteriesarteries and plexusesand plexuses SuperiorRight internal hypogastriciliac artery plexusand plexus (cut) SuperiorSacral sympathetic trunk rectal artery Right sacral plexus and plexus Pelvic splanchnic nerves Right and left hypogastricMiddle rectal artery and plexus nerves Right inferior hypogastric Rectosigmoid (pelvic) plexus artery and plexus Vesical plexus Nerves from inferior hypogastric (pelvic) Rectal plexus plexuses to sigmoid colon, descending colon and left colic (splenic) flexure Urinary bladder40
    • Nerves of Kidneys, Ureters and Urinary Bladder NEUROANATOMY Anterior vagal trunk Posterior vagal trunk Greater splanchnic nerve Celiac ganglia and plexus Lesser splanchnic nerve Superior mesenteric ganglion Least splanchnic nerve Aorticorenal ganglion Renal plexus and ganglion 2nd lumbar splanchnic nerve Renal and upper ureteric branches from intermesenteric plexus Intermesenteric (aortic) plexus Testicular (ovarian) artery and plexus Inferior mesenteric ganglion Sympathetic trunk and ganglion Middle ureteric branch Superior hypogastric plexus Sacral splanchnic nerves (branches from upper sacral sympathetic ganglia to hypogastric plexus) Gray ramus communicans Hypogastric nerves Sacral plexus Pudendal nerve Pelvic splanchnic nerves Inferior hypogastric (pelvic) plexus with periureteric loops and branches to lower ureter Rectal plexus Vesical plexus Prostatic plexus 41
    • NEUROANATOMY Nerves of Pelvic Viscera: Male Anterior vagal trunk T10 spinal nerve (anterior ramus) Posterior vagal trunk White and gray rami communicantes and Celiac branch Greater Lesser Splanchnic Inferior phrenic arteries and plexuses nerves Least Left gastric artery and gastric plexus Diaphragm Celiac ganglia, plexus and trunk Left renal artery Left aorticorenal ganglion and plexus Superior mesenteric ganglion L1 spinal nerve (anterior ramus) Superior mesenteric artery and plexus Gray Rami Intermesenteric (aortic) plexus White communicantes Inferior mesenteric ganglion, 1st, 2nd, 3rd lumbar splanchnic nerves artery and plexus Gray rami communicantes Ureter and ureteric plexus Sympathetic trunk and ganglia Superior hypogastric plexus 5th lumbar splanchnic nerve Superior rectal artery and plexus L5 spinal nerve (anterior ramus) Hypogastric nerves Lumbosacral trunk Nerve from inferior hypogastric plexus Gray rami communicantes to sigmoid and descending colon (parasympathetic) S1 spinal nerve (anterior ramus)Sacral splanchnic nerves(sympathetic) Pelvic splanchnic nervesInferior hypogastric (parasympathetic)(pelvic) plexus Obturator nerve Sacral plexus and artery Piriformis muscle Ductus deferens and plexus Gluteus maximus muscle and sacro - Vesical plexus tuberous ligament Rectal plexus (Ischio-)coccygeus muscle and Prostatic plexus sacrospinous ligament Cavernous nerves Pudendal nerve of penis Levator ani muscle Inferior anal (rectal) nerve Perineal nerve Dorsal nerve of penis Posterior scrotal nerves42
    • Nerves of Pelvic Viscera: Female NEUROANATOMYSympathetic trunk Abdominal aorta Peritoneumand L2 ganglion Inferior vena cava ExtraperitonealWhite and (subserous)gray rami fasciacommunicantes Common iliac vessels and plexusLumbarsplanchnic Ureternerves Intermesenteric (aortic) plexus Ovarian arteryGray rami and plexuscommunicantes Superior hypogastric plexusL5 spinalnerve Sacral promontory SuperiorRight hypogastrichypogastric plexusnerve (cut) Common iliac artery and plexusRight andleft sacral Uretersympathetictrunks and Internalganglia iliac artery and plexus Sigmoid colon ExternalPiriformis S1 iliac artery Right and leftmuscle and plexus hypogastric nerves S2 Uterus Right sympathetic trunkSacral S3splanchnicnerves S4 Left hypogastric nerve(sympathetic) Inferior hypogastric (pelvic) plexus S5Pudendal Uterine (fallopian) tubenerve OvaryPelvic Symphyseal surface of pubissplanchnicnerves Urinary bladder(parasympathetic) Vesical plexus(Ischio-)coccygeus muscle Uterovaginal plexus Uterus (retracted) Rectal plexus Rectum (retracted) 43
    • NEUROANATOMY Median NerveAnterior view Note: Only muscles innervated by median nerve shown Musculocutaneous nerve Median nerve (C5, 6, 7, 8, T1) Medial Cords of Inconstant contribution Posterior brachial Lateral plexus Pronator teres muscle (humeral head) Medial cutaneous nerve of arm Articular branch Medial cutaneous nerve of forearm Flexor carpi radialis muscle Axillary nerve Palmaris longus muscle Radial nerve Pronator teres muscle (ulnar head) Ulnar nerve Flexor digitorum superficialis muscle (turned up) Flexor digitorum profundus muscle (lateral part supplied by median [anterior interosseous] nerve; medial part supplied by ulnar nerve) Anterior interosseous nerve Flexor pollicis longus muscle Pronator quadratus muscle Palmar branch of median nerve Cutaneous innervation Abductor pollicis brevis Opponens pollicisThenar Superficial head ofmuscles flexor pollicis brevis (deep head supplied by ulnar nerve) Palmar view Communicating branch of median nerve with 1st and 2nd ulnar nerve lumbrical muscles Common palmar digital nerves Proper palmar digital nerves Dorsal branches to dorsum of middle and distal phalanges Posterior (dorsal) view44
    • Ulnar Nerve NEUROANATOMY Anterior view Note: Only muscles innervated by ulnar nerve shown Ulnar nerve (C7, 8, T1) (no branches above elbow) Inconstant contribution Medial epicondyle Articular branch (behind condyle) Cutaneous innervation Flexor digitorum profundus muscle (medial part only; lateral part supplied by anterior interosseous branch of median nerve) Palmar view Flexor carpi ulnaris muscle (drawn aside) Dorsal branch of ulnar nerve Posterior (dorsal) view Palmar branch Flexor pollicis brevis muscle (deep head only; superficial Superficial branch head and other thenar muscles supplied by median nerve) Deep branch Palmaris brevis Adductor pollicis muscle Abductor digiti minimi Flexor digiti minimi brevis Hypothenar muscles Opponens digiti minimi Common palmar digital nerve Communicating branch of median nerve with ulnar nerve Palmar and dorsal interosseous muscles 3rd and 4th lumbrical muscles (turned down) Proper palmar digital nerves (dorsal digital nerves are from dorsal branch) Dorsal branches to dorsum of middle and distal phalanges 45
    • NEUROANATOMY Radial Nerve in Arm and Nerves of Posterior Shoulder Dorsal scapular nerve (C5) Posterior view Supraspinatus muscle Suprascapular nerve (C5, 6) Levator scapulae muscle (supplied Deltoid muscle also by branches from C3 and C4) Teres minor muscle Axillary nerve (C5, 6) Rhomboid Superior lateral minor muscle cutaneous nerve of arm Radial nerve (C5, 6, 7, 8, T1) Inconstant contribution Rhomboid major muscle Inferior lateral cutaneous nerve of arm Posterior cutaneous nerve of forearm Infraspinatus muscle Teres major muscle Lateral intermuscular septum Lower subscapular nerve (C5, 6) Posterior cutaneous nerve of arm (branch of radial nerve in axilla) Brachialis muscle (lateral part; remainder of muscle supplied by musculo- Long head cutaneous nerve) Triceps brachii muscle Lateral head Medial head Brachioradialis muscle Triceps brachii tendon Medial epicondyle Extensor carpi radialis longus muscle Olecranon Extensor carpi Anconeus muscle radialis brevis muscle Extensor digitorum muscle Extensor carpi ulnaris muscle46
    • Radial Nerve in Forearm NEUROANATOMY Radial nerve (C5, 6, 7, 8, T1) Inconstant contribution Superficial (terminal) branch Deep (terminal) branch Posterior view Lateral epicondyle Anconeus muscle Brachioradialis muscle Extensor carpi radialis longus muscle Supinator muscle Extensor carpi radialis brevis muscle Extensor carpi ulnaris muscle Extensor- supinator group of muscles Extensor digitorum muscle and extensor digiti minimi muscle Extensor indicis muscle Extensor pollicis longus muscle Abductor pollicis longus muscle Extensor pollicis brevis muscle Posterior interosseous nerve (continuation of deep branch of radial nerve distal to supinator muscle) Superficial branch of radial nerve Superior lateral From axillary nerve cutaneous nerve of arm Inferior lateral cutaneous nerve of arm Posterior cutaneous nerve of arm From radial nerve Posterior cutaneous nerve of forearm Superficial branch of radial nerve and dorsal digital branches Dorsal digital nerves Cutaneous innervation from radial and axillary nerves 47
    • NEUROANATOMY Sciatic Nerve and Posterior Cutaneous Nerve of Thigh Posterior cutaneous nerve of thigh (S1, 2, 3) Greater sciatic foramen Inferior cluneal nerves Sciatic nerve (L4, 5, S1, 2, 3) Perineal branches Tibial division Common fibular (peroneal) of sciatic nerve division of sciatic nerve Long head (cut) of Short head of biceps femoris muscle biceps femoris muscle Cutaneous innervation Adductor magnus muscle (also partially supplied Long head (cut) by obturator nerve) of biceps femoris muscle Semitendinosus muscle Common fibular Semimembranosus muscle (peroneal) nerve Tibial nerve Articular branch Posterior cutaneous nerve Articular branch of thigh Lateral sural Plantaris muscle cutaneous nerve Medial sural cutaneous nerve Sural communicating branch Common fibular Gastrocnemius muscle (peroneal) nerve via lateral sural cutaneous nerve Sural nerve Medial sural cutaneous nerve Soleus muscle From sciatic nerve Superficial fibular (peroneal) nerve Tibial nerve Sural nerve Lateral calcaneal Tibial nerve Medial branches via medial calcaneal branches calcaneal branches Lateral dorsal Medial and lateral cutaneous nerve plantar nerves48
    • Tibial Nerve NEUROANATOMY Common fibular (peroneal) nerve Tibial nerve (L4, 5, S1, 2, 3) Articular branch Lateral sural cutaneous nerve (cut)Medial suralcutaneous nerve (cut) Medial calcaneal branches (S1, 2) Articular branches Medial From tibial nerve plantar nerve (L4, 5) Plantaris muscle Lateral plantar nerve (S1, 2) Gastrocnemius muscle (cut) Saphenous nerve (L3, 4) Sural nerveNerve to popliteus muscle (S1, 2) via lateral calcaneal and lateral dorsal Popliteus muscle cutaneous branches Interosseous nerve of leg Cutaneous innervation of sole Flexor Soleus muscle (cut and Lateral calcaneal retinaculum partly retracted) branch of sural nerve (cut) Tibial Lateral plantar nerve nerve Flexor digitorum Nerve to abductor longus muscle Medial calcaneal digiti minimi muscle branch Quadratus plantae Medial plantar muscle and nerve Tibialis posterior muscle nerve Abductor digiti Flexor digitorum minimi muscle brevis muscle Deep branch to Flexor hallucis and nerve longus muscle interosseous Abductor hallucis muscles, muscle and nerve 2nd, 3rd and 4th Flexor hallucis lumbrical muscles Sural nerve (cut) and brevis muscle and nerve Adductor hallucis muscleLateral calcaneal branch 1st lumbrical muscle and Superficial nerve branch to 4th interosseous Medial Common muscle calcaneal branch plantar and digital Flexor digiti minimi nerves brevis muscle Proper Common andFlexor retinaculum (cut) plantar Proper plantar digital digital nerves nerves Lateral dorsal cutaneous nerve Note: Articular branches not shown 49
    • NEUROANATOMY Common Fibular (Peroneal) Nerve Lateral sural cutaneous nerve (phantom) Common fibular (peroneal) nerve (phantom) Articular branches Biceps femoris tendon Recurrent articular nerve Common fibular (peroneal) nerve (L4, 5, S1, 2) Extensor digitorum longus muscle (cut) Head of fibula Deep fibular (peroneal) nerve Fibularis (peroneus) longus muscle (cut) Tibialis anterior muscle Superficial fibular Cutaneous innervation (peroneal) nerve Branches of lateral Extensor digitorum sural cutaneous nerve longus muscle Fibularis (peroneus) longus muscle Extensor hallucis longus muscle Fibularis (peroneus) brevis muscle Lateral sural cutaneous nerve Medial dorsal cutaneous nerve Superficial fibular (peroneal) nerve Intermediate dorsal Lateral branch of cutaneous nerve deep fibular (peroneal) nerve to Extensor hallucis brevis and Inferior extensor Extensor digitorum brevis muscles Deep retinaculum (partially cut) fibular (peroneal) Medial branch of nerve deep fibular Lateral dorsal cutaneous nerve (peroneal) nerve (branch of sural nerve) Sural nerve via lateral dorsal Dorsal digital nerves cutaneous branch50
    • Click any title below to link to that plate. Part 2 NeurophysiologyOrganization of the Brain: Cerebrum. . . . . . . 52 The Cerebral Cortex . . . . . . . . . . . . . . . . . . . . 70Organization of the Brain: Cell Types. . . . . . . 53 Descending Motor Pathways . . . . . . . . . . . . . 71Blood-Brain Barrier . . . . . . . . . . . . . . . . . . . . . 54 Cerebellum: Afferent Pathways. . . . . . . . . . . . 72Synaptic Transmission: Cerebellum: Efferent Pathways . . . . . . . . . . . . 73 Morphology of Synapses . . . . . . . . . . . . . . . 55 Cutaneous Sensory Receptors . . . . . . . . . . . . . 74Synaptic Transmission: Neuromuscular Junction . . . . . . . . . . . . . . . 56 Cutaneous Receptors: Pacinian Corpuscle. . . . . . . . . . . . . . . . . . . . 75Synaptic Transmission: Visceral Efferent Endings . . . . . . . . . . . . . . . 57 Proprioception and Reflex Pathways: I . . . . . . 76Synaptic Transmission: Proprioception and Reflex Pathways: II . . . . . 77 Inhibitory Mechanisms . . . . . . . . . . . . . . . . 58 Proprioception and Reflex Pathways: III . . . . 78Synaptic Transmission: Proprioception and Reflex Pathways: IV. . . . . 79 Chemical Synaptic Transmission . . . . . . . . . 59 Sensory Pathways: I . . . . . . . . . . . . . . . . . . . . . 80Synaptic Transmission: Temporal and Spatial Summation . . . . . . . . 60 Sensory Pathways: II . . . . . . . . . . . . . . . . . . . . 81Cerebrospinal Fluid (CSF): Sensory Pathways: III. . . . . . . . . . . . . . . . . . . . 82 Brain Ventricles and CSF Composition . . . . 61 Visual System: Receptors. . . . . . . . . . . . . . . . . 83Cerebrospinal Fluid (CSF): Visual System: Visual Pathway . . . . . . . . . . . . 84 Circulation of CSF . . . . . . . . . . . . . . . . . . . . 62 Auditory System: Cochlea . . . . . . . . . . . . . . . . 85Spinal Cord: Ventral Rami. . . . . . . . . . . . . . . . 63 Auditory System: Pathways . . . . . . . . . . . . . . . 86Spinal Cord: Membranes and Nerve Roots . . 64 Vestibular System: Receptors . . . . . . . . . . . . . 87Peripheral Nervous System . . . . . . . . . . . . . . . 65 Vestibular System: Vestibulospinal Tracts. . . . 88Autonomic Nervous System: Schema . . . . . . . 66 Gustatory (Taste) System: Receptors . . . . . . . 89Autonomic Nervous System: Cholinergic and Adrenergic Synapses . . . . . 67 Gustatory (Taste) System: Pathways . . . . . . . . 90Hypothalamus . . . . . . . . . . . . . . . . . . . . . . . . . 68 Olfactory System: Receptors . . . . . . . . . . . . . . 91Limbic System . . . . . . . . . . . . . . . . . . . . . . . . . 69 Olfactory System: Pathway . . . . . . . . . . . . . . . 92
    • NEUROPHYSIOLOGY Organization of the Brain: Cerebrum Central sulcus (Rolando) Postcentral gyrus Precentral gyrus Postcentral sulcus Precentral sulcus Superior parietal lobule Inferior parietal lobule Supramarginal gyrus Angular gyrus Parietooccipital sulcus Occipital pole Frontal pole Calcarine sulcus Lateral sulcus (Sylvius) Temporal pole Superior temporal gyrus Inferior temporal gyrus Middle temporal gyrus Frontal lobeParietal lobe Temporal lobe Occipital lobe Insula (island of Reil) ©FIGURE 2.1 ORGANIZATION OF THE BRAIN: CEREBRUM•The cerebral cortex represents the highest center for sensory and coordinates smooth motor activities and processes muscle position.motor processing. In general, the frontal lobe processes motor, The brainstem (medulla, pons, midbrain) conveys motor and sensoryvisual, speech, and personality modalities. The parietal lobe information and mediates important autonomic functions. The spinalprocesses sensory information; the temporal lobe, auditory and cord receives sensory input from the body and conveys somatic andmemory modalities; and the occipital lobe, vision. The cerebellum autonomic motor information to peripheral targets (muscles, viscera).52
    • Organization of the Brain: Cell Types NEUROPHYSIOLOGY Multipolar (pyramidal) Bipolar cell of cranial n. cell of cerebral Unipolar cell of motor cortex sensory ganglia of cranial nn. Satellite cells Astrocyte Schwann cell Striated Interneurons (somatic) Blood vessel Free nerve endings muscle (unmyelinated fibers) Encapsulated ending Motor endplate Specialized ending Multipolar somatic Muscle spindle motor cell of nuclei Unipolar sensory cell of cranial nn. of dorsal spinal Multipolar cell root ganglion of lower brain Interneuron Satellite cells motor centers Oligodendrocyte Astrocyte Myelinated afferent Corticospinal fiber of spinal nerve (pyramidal) fiber Multipolar visceral Axodendritic ending motor (autonomic) cell of spinal cord Axosomatic ending Myelin sheath Axoaxonic ending Autonomic preganglionic Multipolar somatic (sympathetic or para- Red: Motor neuron motor cell of sympathetic) nerve fiber Blue: Sensory neuron anterior horn Myelin sheath Purple: Interneuron of spinal cord Gray: Glial and Autonomic postganglionic neurilemmal cells Collateral neuron of sympathetic or and myelin parasympathetic ganglion Renshaw interneuron Note: Cerebellar cells Satellite cells not shown here (feedback) Unmyelinated nerve fiber Myelinated somatic motor Schwann cells fiber of spinal nerve Myelin sheath Schwann cells Motor endplate with Endings on Unmyelinated fibers Schwann cell cap cardiac muscle or nodal cells Striated Free nerve endings (voluntary) Beaded muscle varicosities and endings on Encapsulated ending smooth muscle and gland cells Muscle spindle ©FIGURE 2.2 ORGANIZATION OF THE BRAIN: CELL TYPES•Neurons form the functional cellular units responsible for (e.g., astrocytes, oligodendrocytes), satellite cells, and other spe-communication, and throughout the nervous system, they are cialized cells that optimize neuronal function, provide mainte-characterized by their distinctive size and shapes (e.g., bipolar, nance functions, or protect the nervous system.unipolar, multipolar). Supporting cells include the neuroglia 53
    • NEUROPHYSIOLOGY Blood-Brain Barrier Cell membrane Basement Tight membrane junction proteins Cytoplasm Red blood cell Astrocyte Capillary foot processes lumen Tight Capillary junction endothelial cell Astrocyte ©FIGURE 2.3 BLOOD-BRAIN BARRIER•The blood-brain barrier (BBB) is the cellular interface between the other substances (including many drugs) from the blood to theblood and the central nervous system (CNS; brain and spinal cord). interstitial space of the CNS is restricted by the BBB. CNS endothe-It serves to maintain the interstitial fluid environment to ensure lial cells also exhibit a low level of pinocytotic activity across theoptimal functionality of the neurons. This barrier consists of the cell, so specific carrier systems for the transport of essential sub-capillary endothelial cells with an elaborate network of tight junc- strates of energy and amino acid metabolism are characteristic oftions and astrocytic foot processes that abut the endothelium and these cells. The astrocytes help transfer important metabolites fromits basement membrane. The movement of large molecules and the blood to the neurons and also remove excess K and neuro- transmitters from the interstitial fluid.54
    • Synaptic Transmission: Morphology of Synapses NEUROPHYSIOLOGY Dendrite Node Axon Dendrites Myelin sheath Numerous boutons (synaptic knobs) of presynaptic neurons terminating on a motor neuron and its dendrites Enlarged section of bouton Axon (axoplasm) Axolemma Mitochondria Glial process Synaptic vesicles Synaptic cleft Presynaptic membrane (densely staining) Postsynaptic membrane (densely staining) Postsynaptic cell ©FIGURE 2.4 MORPHOLOGY OF SYNAPSES•Neurons communicate with each other and with effector targets at lower figure shows an enlargement of one such synaptic bouton.specialized regions called synapses. The top figure shows a typical Chemical neurotransmitters are contained in synaptic vesicles,motor neuron that receives numerous synaptic contacts on its cell which can fuse with the presynaptic membrane, release the trans-body and associated dendrites. Incoming axons lose their myelin mitters into the synaptic cleft, and then bind to receptors situatedsheaths, exhibit extensive branching, and terminate as synaptic in the postsynaptic membrane. This synaptic transmission results inboutons (synaptic terminals or knobs) on the motor neuron. The excitatory, inhibitory, or modulatory effects on the target cell. 55
    • NEUROPHYSIOLOGY Synaptic Transmission: Neuromuscular JunctionStructure of Neuromuscular Junction Active zone Myelin sheath Schwann cell process Neurilemma Axoplasm Acetylcholine Schwann cell receptor sites Mitochondria Basement membrane Nucleus of Schwann cell Presynaptic membrane Active zone Synaptic vesicles Synaptic trough Basement membrane Sarcolemma Nucleus of muscle cellMyofibrils Synaptic cleft Postsynaptic membrane Junctional fold Sarcoplasm Acetylcholine receptor sites ©FIGURE 2.5 STRUCTURE OF THE NEUROMUSCULAR JUNCTION•Motor axons that synapse on skeletal muscle form expanded termi- ately stimulated, release their neurotransmitter into the synapticnals called neuromuscular junctions (motor endplates). The motor cleft. The transmitter then binds to receptors that mediate depolar-axon loses its myelin sheath and expands into a Schwann ization of the muscle sarcolemma and initiate a muscle actioncell–invested synaptic terminal that resides within a trough in the potential. A single muscle fiber has only one neuromuscular junc-muscle fiber. Acetylcholine-containing synaptic vesicles accumu- tion, but a motor axon can innervate multiple muscle fibers.late adjacent to the presynaptic membrane and, when appropri-56
    • Synaptic Transmission: Visceral Efferent Endings NEUROPHYSIOLOGY Visceral Efferent Endings               A. Smooth muscle B. Gland (submandibular) C. Neurosecretory (posterior pituitary) Sympathetic terminal ending Pituicyte processes Mucous cellsSmooth muscle cells (cut) Varicosity Axon Axon Schwann cell cap enclosing Schwann Schwann cell cap enclosing nerve axons cell cap nerve axons Fibroblast Schwann cell cap Capillary Schwann cell Neurosecretory Smooth muscle cells Serous cells cap enclosing vesicles Endothelium Varicosities Parasympathetic nerve axons terminal ending Collagen space Terminal endings Mast cell Varicosity Basement membrane ©FIGURE 2.6 VISCERAL EFFERENT ENDINGS•Neuronal efferent endings on smooth muscle (A) and glands (B rosecretion) from expanded nerve terminal endings. This arrange-and C) exhibit unique endings unlike the presynaptic and postsy- ment allows for the stimulation of numerous target cells over anaptic terminals observed in neuronal and neuromuscular junc- wide area. Not all smooth muscle cells are innervated. They aretion synapses. Rather, neurotransmitter substances are released connected to adjacent cells by gap junctions and can thereforeinto interstitial spaces (A and B) or into the bloodstream (C, neu- contract together with the innervated cells. 57
    • NEUROPHYSIOLOGY Synaptic Transmission: Inhibitory Mechanisms I E E (Inhibitory (Excitatory (Excitatory fiber) fiber) fiber) Motor neuron Motor neuron I Axon (Inhibitory Axon fiber) mV 20 mV A. Only E fires 90-mV spike 90 mV A′. Only E fires in E terminal 70 EPSP in 60 motor 60 EPSP in neuron motor neuron 70 70 B. Only I fires B′. Only I fires Long-lasting partial Motor 60 depolarization 70 neuron in E terminal hyper- 70 No response in polarized motor neuron 80 70 C. I fires before E C′. I fires before E Partial 60 depolarization Depolariza- 20 of E terminal tion of motor 70 reduces spike neuron less to 80 mV, thus 80 mV than if only 80 releasing less E fires transmitter 70 substance 60 Smaller EPSP in motor neuron 70 ©FIGURE 2.7 SYNAPTIC INHIBITORY MECHANISMS•Inhibitory synapses modulate neuronal activity. Illustrated here is presynaptic inhibition (left panel) and postsynaptic inhibition (rightpanel) at a motor neuron.58
    • Synaptic Transmission: Chemical Synaptic Transmission NEUROPHYSIOLOGY               Excitatory Inhibitory Synaptic vesicles in synaptic bouton Presynaptic membrane Transmitter Na substances Synaptic cleft Cl K Postsynaptic membrane When impulse reaches excitatory synaptic At inhibitory synapse, transmitter substance re- bouton, it causes release of a transmitter leased by an impulse increases permeability of substance into synaptic cleft. This increases the postsynaptic membrane to Cl . K moves permeability of postsynaptic membrane to out of post-synaptic cell but no net flow of Cl Na and K . More Na moves into postsy- occurs at resting membrane potential naptic cell than K moves out, due to great- er electrochemical gradient Synaptic bouton Resultant net ionic current flow is in a direc- Resultant ionic current flow is in direction that tends to tion that tends to depolarize postsynaptic cell. hyperpolarize postsynaptic cell. This makes depolariza- If depolarization reaches firing threshold, an tion by excitatory synapses more difficult—more depolari- impulse is generated in postsynaptic cell zation is required to reach threshold msec Current 0 4 8 12 16 70 Potential (mV) Potential (mV) 65 Potential Potential 75 Current 70 0 4 8 12 16 msec Current flow and potential change Current flow and potential change ©FIGURE 2.8 CHEMICAL SYNAPTIC TRANSMISSION•Chemical synaptic transmission between neurons may be excita- threshold for an action potential. During inhibition (right column),tory or inhibitory. During excitation (left column), a net increase in the opening of K and Cl channels drives the membrane potentialthe inward flow of Na compared with the outward flow of K away from threshold (hyperpolarization) and decreases the proba-results in a depolarizing potential change (excitatory postsynaptic bility that the neuron will reach threshold (inhibitory postsynapticpotential [EPSP]) that drives the postsynaptic cell closer to its potential [IPSP]) for an action potential. 59
    • NEUROPHYSIOLOGY Synaptic Transmission: Temporal and Spatial Summation Temporal and Spatial Summation of Excitation and Inhibition Excitatory fibers mV Excitatory fibers mV –70 –70 Axon Axon Inhibitory fibers Inhibitory fibers A. Resting state: motor nerve cell shown with synaptic boutons of B. Partial depolarization: impulse from one excitatory fiber has excitatory and inhibitory nerve fibers ending close to it caused partial (below firing threshold) depolarization of motor neuron Excitatory fibers mV Excitatory fibers mV –70 –70 Axon Axon Inhibitory fibers Inhibitory fibers C. Temporal excitatory summation: a series of impulses in one D. Spatial excitatory summation: impulses in two excitatory fibers excitatory fiber together produce a suprathreshold depolarization cause two synaptic depolarizations that together reach firing that triggers an action potential threshold triggering an action potential Excitatory fibers mV Excitatory fibers mV –70 –70 Axon Axon Inhibitory fibers Inhibitory fibers E. Spatial excitatory summation with inhibition: impulses from E. (continued): motor neuron now receives additional excitatory two excitatory fibers reach motor neuron but impulses from impulses and reaches firing threshold despite a simultaneous inhibitory fiber prevent depolarization from reaching threshold inhibitory impulse; additional inhibitory impulses might still prevent firing ©CHART 2.1 SUMMARY OF SOME NEUROTRANSMITTERS AND WHERE WITHIN THE CENTRAL AND PERIPHERAL NERVOUS SYSTEM THEY ARE FOUND Transmitter Location Transmitter Location Acetylcholine Neuromuscular junction, autonomic end- Gas ings and ganglia, CNS Nitric oxide CNS, GI tract Biogenic amines Peptides Norepinephrine Sympathetic endings, CNS -Endorphins CNS, GI tract Dopamine CNS Enkephalins CNS Serotonin CNS, GI tract Antidiuretic CNS (hypothalamus/posterior Amino acids hormone pituitary) -Aminobutyric CNS Pituitary-releasing CNS (hypothalamus/anterior acid (GABA) hormones pituitary) Glutamate CNS Somatostatin CNS, GI tract Purines Neuropeptide Y CNS Adenosine CNS Vasoactive Adenosine CNS intestinal peptide CNS, GI tract triphosphate (ATP)CNS, Central nervous system; GI, gastrointestinal.FIGURE 2.9 TEMPORAL AND SPATIAL SUMMATION •Neurons receive multiple excitatory and inhibitory inputs. Tempo- tial (panel D). Both temporal and spatial summation can be modu-ral summation occurs when a series of subthreshold impulses in lated by simultaneous inhibitory input (panel E). Inhibitory andone excitatory fiber produces an action potential in the postsynap- excitatory neurons use a wide variety of neurotransmitters, some oftic cell (panel C). Spatial summation occurs when subthreshold which are summarized here.impulses from two or more different fibers trigger an action poten-60
    • Cerebrospinal Fluid (CSF): Brain Ventricles and CSF Composition NEUROPHYSIOLOGY Left lateral phantom view Right lateral ventricle Frontal (anterior) horn Central part Left lateral Temporal (inferior) horn ventricle Occipital (posterior) horn Cerebral aqueduct (Sylvius) 4th ventricle Left lateral aperture (foramen of Luschka) Left lateral recess Left interventricular foramen (Monro) Median aperture (foramen of Magendie) 3rd ventricle Central canal of spinal cord © CHART 2.2 CSF COMPOSITION CSF Blood Plasma Na (mEq/L) 140–145 135–147 K (mEq/L) 3 3.5–5.0 Cl− (mEq/L) 115–120 95–105 HCO3− (mEq/L) 20 22–28 Glucose (mg/dL) 50–75 70–110 Protein (g/dL) 0.05–0.07 6.0–7.8 pH 7.3 7.35–7.45FIGURE 2.10 BRAIN VENTRICLES AND CSF COMPOSITION•CSF circulates through the four brain ventricles (two lateral ventri- secretes the CSF. Importantly, the CSF has a lower [HCO3 ] thancles and a third and fourth ventricle) and in the subarachnoid plasma and therefore a lower pH. This allows small changes inspace surrounding the brain and spinal cord. The electrolyte com- blood PCO2 to cause changes in CSF pH, which in turn regulatesposition of the CSF is regulated by the choroid plexus, which the rate of respiration (see Chapter 5). 61
    • NEUROPHYSIOLOGY Cerebrospinal Fluid (CSF): Circulation of CSF Choroid plexus of lateral ventricle (phantom) Superior sagittal sinus Cistern of corpus callosum Subarachnoid space Arachnoid granulations Dura mater Arachnoid Interventricular foramen (Monro) Choroid plexus of 3rd ventricle Cerebral aqueduct (Sylvius) Lateral aperture (foramen of Luschka) Choroid plexus of 4th ventricle Median aperture (foramen of Magendie) Dura mater Arachnoid Subarachnoid space Central canal of spinal cord ©FIGURE 2.11 CIRCULATION OF CEREBROSPINAL FLUID•CSF circulates through the four brain ventricles (two lateral ventri- reabsorbed into the venous system through the arachnoid granula-cles and a third and fourth ventricle) and in the subarachnoid tions and through the walls of the capillaries of the central nervousspace surrounding the brain and spinal cord. Most of the CSF is system and pia mater.62
    • Spinal Cord: Ventral Rami NEUROPHYSIOLOGY Base of skull C1 vertebra (atlas) C1 spinal nerve Cervical plexus C8 spinal nerve Brachial plexus T1 spinal nerve Spinal dura mater 1st rib Filaments of spinal nerve roots Intercostal (T7 and T8) nerves T12 spinal nerve L1 12th rib vertebra Conus medullaris Lumbar plexus L1 spinal nerve L5 vertebra Cauda equina S1 spinal nerve Sacral plexus Sacrum (cut away) Termination of dural sac Sciatic nerve Coccygeal nerve Coccyx ©FIGURE 2.12 SPINAL CORD AND VENTRAL RAMI IN SITU•The spinal cord gives rise to 31 pairs of spinal nerves that distribute fibers of these spinal nerves innervate skeletal muscle, and sensorysegmentally to the body. These nerves are organized into plexuses fibers convey information back to the central nervous system fromthat distribute to the neck (cervical plexus), upper limb (brachial the skin, skeletal muscles, and joints.plexus), and pelvis and lower limb (lumbosacral plexus). Motor 63
    • NEUROPHYSIOLOGY Spinal Cord: Membranes and Nerve Roots Posterior view Ventral root of spinal nerve Dorsal root of spinal nerve Spinal sensory (dorsal root) ganglion Ventral ramus of spinal nerve Dorsal ramus of spinal nerve Dura mater Arachnoid mater Subarachnoid space Pia mater overlying spinal cord Filaments of dorsal root Membranes removed: anterior view (greatly magnified) Gray matter White matter Filaments of dorsal root Dorsal root of spinal nerve Filaments of ventral root Spinal sensory (dorsal root) ganglion Dorsal ramus of spinal nerve Ventral ramus of spinal nerve Ventral root of spinal nerve Spinal nerve Gray and white rami communicantes ©FIGURE 2.13 SPINAL MEMBRANES AND NERVE ROOTS•The spinal cord gives rise to 31 pairs of spinal nerves that distribute The spinal cord is ensheathed in three meningeal coverings: thesegmentally to the body. Motor fibers of these spinal nerves inner- outer, tough dura mater; the arachnoid mater; and the pia mater,vate skeletal muscle, and sensory fibers convey information back which intimately ensheaths the cord itself. CSF bathes the cord andto the central nervous system from the skin, skeletal muscles, and is found in the subarachnoid space.joints.64
    • Peripheral Nervous System NEUROPHYSIOLOGY Posterior horn Dorsal root ganglion Sensory neuron cell body Dorsal root Anterior horn Motor neuron cell body Ventral root Peripheral nerve Axon Myelin sheath Motor neuron Sensory neuron Neuromuscular junction Skin Muscle with ©FIGURE 2.14 PERIPHERAL NERVOUS SYSTEM•The peripheral nervous system (PNS) consists of all of the neural shown here (see Figure 2.15 for the autonomic nervous system).elements outside of the CNS (brain and spinal cord) and provides The somatic component of the peripheral nerves contains boththe connections between the CNS and all other body organ sys- motor and sensory axons. Cell bodies of the motor neurons aretems. The PNS consists of somatic and autonomic components. The found in the anterior horn gray matter, whereas the cell bodies ofsomatic component innervates skeletal muscle and skin and is sensory neurons are located in the dorsal root ganglia. 65
    • NEUROPHYSIOLOGY Autonomic Nervous System: Schema Oculomotor nerve (III) Intracranial vessels Facial nerve (VII) Ciliary ganglion Glossopharyngeal nerve (IX) Eye Pterygopalatine ganglion Medulla oblongata Lacrimal glands Vagus nerve (X) Otic ganglion Parotid glands C1 Gray ra ntes Submandibular ganglion Sublingual and mi C2 ica submandibular glands ommun C3 C4 Peripheral cranial and facial vessels C5 c C6 Larynx C7 Trachea C8 Bronchi Lungs Sweat T1 gland T2 Pulmonary plexus T3 tes Heart Cardiac plexus Gray and white rami communican T4 Greater  Splanchnic Peripheral T5 Lesser  nerves blood vessel Celiac ganglion T6 Least  Stomach T7 Aorticorenal ganglion Liver T8 Gallbladder Bile ducts T9 Lumbar Pancreas T10 splanchnic Superior mesenteric nerves ganglion Suprarenal glands T11 Arrector (smooth) Kidneys T12 Inferior mesenteric muscle of hair follicle ganglion Note: Above three L1 structures are shown at L2 Intestines only one level but Superior hypogastric occur at all levels L3 plexus cantes L4 Descending colon L5 Sigmoid colon m uni Note: Blue-shaded S1 Rectum Inferior co m areas indicate zones of hypogastric parasympathetic S2 Urinary bladder plexus a mi outflow from CNS S3 ay r S4 Pelvic S5 splanchnic Prostate Gr Coccygeal nerves External genitalia © Presynaptic Presynaptic Sympathetic Parasympathetic Antidromic fibers Postsynaptic fibers Postsynaptic conductionFIGURE 2.15 AUTONOMIC NERVOUS SYSTEM: SCHEMA•The autonomic nervous system is composed of two divisions: the a peripheral autonomic ganglion. Postganglionic axons of the auto-parasympathetic division derived from four of the cranial nerves nomic nervous system innervate smooth muscle, cardiac muscle, and(CN III, VII, IX, and X) and the S2-S4 sacral spinal cord levels, and the glands. Basically, the sympathetic division mobilizes our body (“fightsympathetic division associated with the thoracic and upper lumbar or flight”) while the parasympathetic division regulates digestive andspinal cord levels (T1-L2). The autonomic nervous system is a two- homeostatic functions. Normally, both divisions work in concert toneuron chain, with the preganglionic neuron arising from the central regulate visceral activity (respiration, cardiovascular function, diges-nervous system and synapsing on a postganglionic neuron located in tion, and associated glandular activity).66
    • Autonomic Nervous System: Cholinergic and Adrenergic Synapses NEUROPHYSIOLOGY Parotid Glossopharyngeal gland nerve (IX) Larynx Medulla Internal carotid nerve Trachea oblongata Bronchi Lungs Vagus nerve (X) Heart Cervical sympathetic ganglia Striated muscle Sweat glands White ramus Hair follicles Thoracic Gray ramus communicans part of communicans Celiac spinal cord ganglion Peripheral arteries Superior mesenteric Visceral Upper ganglion arteries lumbar part of Gastrointestinal spinal cord tract (L1-2 [3]) Suprarenal gland Inferior mesenteric ganglion Sacral Pelvic splanchnic nerves part of Urinary bladder spinal cord C Cholinergic synapses Urethra Prostate A Adrenergic synapses Presynaptic Presynaptic Sympathetic Parasympathetic fibers Postsynaptic fibers Postsynaptic Somatic fibers Antidromic conduction ©FIGURE 2.16 CHOLINERGIC AND ADRENERGIC SYNAPSES: SCHEMA•The autonomic nervous system (ANS) is a two-neuron chain, with aline (norepinephrine) at its postganglionic synapses, causingthe preganglionic neuron arising from the central nervous system adrenergic (A) effects (except on sweat glands, where acetylcholineand synapsing on a postganglionic neuron located in a peripheral is released). Although acetylcholine and noradrenaline are theautonomic ganglion. Acetylcholine is the neurotransmitter in both chief transmitter substances, other neuroactive peptides often arethe sympathetic and parasympathetic ganglia. The parasympathetic colocalized with them and include such substances as gamma-division of the ANS releases acetylcholine at its postganglionic aminobutyric acid (GABA), substance P, enkephalins, histamine,synapses and is characterized as having cholinergic (C) effects, glutamic acid, neuropeptide Y, and others.whereas the sympathetic division releases predominantly noradren- 67
    • NEUROPHYSIOLOGY Hypothalamus Corpus callosum Septum Fornix pellucidum Lateral ventricle From Thalamus hippocampal formation Interthalamic Lateral adhesion hypothalamic area Paraventricular nucleus Medial Anterior Anterior hypothalamic area forebrain commissure Dorsal hypothalamic area bundle Dorsomedial nucleus Mamillothalamic tract Posterior area Lateral Periventricular preoptic Medial nucleus nucleus preoptic Nucleus nucleus intercalatus Olfactory tract Fornix Cerebral Red nucleus peduncle Ventromedial nucleus Mamillary Optic (II) complex nerve Tuberohypophyseal tract Dorsal Optic chiasm longitudinal Oculomotor (III) nerve fasciculus Supraoptic nucleus Descending hypothalamic Supraopticohypophyseal connections tract Pons Posterior lobe of pituitary Anterior Reticular lobe of formation pituitary ©CHART 2.3 MAJOR FUNCTIONS OF THE HYPOTHALAMUS Hypothalamic Area Major Functions* Preoptic and anterior Heat loss center: cutaneous vasodilation and sweating Posterior Heat conservation center: cutaneous vasoconstriction and shivering Lateral Feeding center: eating behavior Ventromedial Satiety center: inhibits eating behavior Supraoptic (subfornical organ and organum vasculosum) ADH and oxytocin secretion (sensation of thirst) Paraventricular ADH and oxytocin secretion Periventricular Releasing hormones for the anterior pituitary*Stimulation of the center causes the responses listed.FIGURE 2.17 SCHEMATIC RECONSTRUCTION OF THE HYPOTHALAMUS•The hypothalamus, part of the diencephalon, controls a number of information), the thalamus (pain), the limbic system (emotion, fear,important homeostatic systems within the body, including tempera- anger, smell), the medulla oblongata (blood pressure and heartture regulation, food intake, water intake, many of the endocrine rate), and the optic system, and it integrates these inputs for regula-systems (see Chapter 8), motivation, and emotional behavior. It tion of the functions listed.receives inputs from the reticular formation (sleep/wake cycle68
    • Limbic System NEUROPHYSIOLOGY Genu of corpus callosum Head of caudate nucleus Columns of fornix Body of fornix Thalamus Uncus Crura of fornix Fimbria of hippocampus Hippocampus Commissure of fornix Splenium of corpus callosum Lateral ventricle Body of fornix Columns of fornix Commissure of fornix Crura of fornix Mamillary bodies Hippocampus Amygdaloid bodies with fimbria ©FIGURE 2.18 HIPPOCAMPUS AND FORNIX•The limbic system includes the hypothalamus and a collection of pocampal formation. The limbic system functions in linking emo-interconnected structures in the telencephalon (cingulate, parahip- tion and motivation (amygdala), learning and memory (hippocam-pocampal, and subcallosal gyri), as well as the amygdala and hip- pal formation), and sexual behavior (hypothalamus). 69
    • NEUROPHYSIOLOGY The Cerebral Cortex Ms I Sm I Motor Sensory Premotor; orientation; Ms II Sm II eye and head Sensory movements analysis Prefrontal; inhibitory control of behavior; higher intelligence Visual III Visual II Visual I Motor control Language; of speech reading; speech Auditory I Auditory II Ms I Sm I Motor Sensory Ms II Sm III Premotor ? Prefrontal; inhibitory control of behavior; higher intelligence Visual III Visual II Visual I Cingulate gyrus © (emotional behavior) Corpus callosum and cingulum Hippocampal commissure Olfactory Anterior commissureFIGURE 2.19 CEREBRAL CORTEX: LOCALIZATION OF FUNCTION AND ASSOCIATION PATHWAYS•The cerebral cortex is organized into functional regions. In addi- including aspects of memory storage and recall, language, highertion to specific areas devoted to sensory and motor functions, there cognitive functions, conscious perception, sensory integration, andare areas that integrate information from multiple sources. The planning/execution of complex motor activity. General corticalcerebral cortex participates in advanced intellectual functions, areas associated with these functions are illustrated.70
    • Descending Motor Pathways NEUROPHYSIOLOGY Motor Hip Trunk Shoulder Elbow cortex Fin rist Knee W rs Ankle ge b um Internal Toes Th eck capsule N Browd Eyeli Nares Lateral aspect of Lips cerebral cortex to show Tongue Larynx topographic projection of motor centers on precentral gyrus Midbrain Motor system Basis pedunculi Fibers originate in motor cortex and descend via posterior limb of internal capsule to basis pedunculi of midbrain Pons Longitudinal bundles branch upon entering basis pontis and rejoin to Basis enter pyramids of medulla pontis At lower medulla, bulk of fibers cross median plane to form lateral corticospinal tract; some fibers Medulla continue downward in ipsilateral lateral corticospinal tract; others descending ipsilateral anterior Pyramids corticospinal tract Synapse occurs at spinal level: Lateral corticospinal fibers synapse on ipsilateral anterior horn cells; anterior Medulla corticospinal fibers synapse on contralateral anterior horn cells Decussation of pyramids Above mid- thoracic level Motor endplate Spinal Anterior corticospinal tract cord Below mid- thoracic Lateral corticospinal tract level Motor endplate ©FIGURE 2.20 CORTICOSPINAL TRACTS•The corticospinal, or pyramidal, tract is the major motor tract that cord constitute the upper portion of the system (upper motor neu-controls voluntary movement of the skeletal muscles, especially ron). The anterior horn cells and their associated axons constituteskilled movements of distal muscles of the limbs. All structures the lower portion of the system (lower motor neuron).from the cerebral cortex to the anterior horn cells in the spinal 71
    • NEUROPHYSIOLOGY Cerebellum: Afferent Pathways Superior cerebellar peduncle Middle cerebellar peduncle To contralateral cerebellar cortexCortical input LegNucleus Armreticularis Fac Primary fissuretegmenti epontisPontine nuclei(contralateral)Spinal inputInferior oliveUpper partof medulla To nodule and flocculusoblongata Vestibular Inferior cerebellar peduncleSpinal input nuclei Functional Subdivisions of Cerebellum Hemisphere Vermis Reticulocerebellar Inter- tract Lateral mediateVestibular nerve Cuneocerebellar part partand ganglion Anterior lobe tract Leg zone PrimaryLower part Gracile nucleus Arm zone fissureof medulla Face zone Main cuneateoblongata nucleus (relay MiddleCortical input for cutaneous (posterior) 2nd spinal information) lobeLateral reticular projectionnucleus External cuneate nucleus area (gracile (relay for proprioceptive lobule) PosterolateralSpinal input information) fissure Archi-Cervical part From skin (touch Lingula cerebellum Flocculo-of spinal cord and pressure) Flocculus (vestibulo- nodular lobeMotor interneuron From muscle (spindles cerebellum) NoduleRostral and Golgi tendon organs) Paleocerebellum Uvulaspinocerebellar From skin and (spinocerebellum) Pyramid Vermistract deep tissues Neocerebellum Middle vermis (pain and GolgiSpinal border cells (pontocerebellum) Hemisphere tendon organs) Schema ofMotor interneuron From skin (touch theoreticalLumbar part and pressure) “unfolding”of spinal cord and from muscle of cerebellar (spindles and surface inClarke’s column Golgi tendon derivation ofVentral spino- organs) above diagramcerebellar tract Dorsal spinocerebellar tract © FIGURE 2.21 CEREBELLAR AFFERENT PATHWAYS• The cerebellum plays an important role in coordinating movement. It bellum primarily controls movement of the proximal portions of the receives sensory information and then influences descending motor limbs. It receives sensory information on limb position and muscle pathways to produce fine, smooth, and coordinated motion. The tone and then modifies and coordinates these movements through cerebellum is divided into three general areas: archicerebellum (also efferent pathways to the appropriate descending motor pathways. The called vestibulocerebellum) paleocerebellum (also called spinocere- neocerebellum is the largest portion of the cerebellum, and it coordi- bellum) and the neocerebellum (also called the cerebrocerebellum). nates the movement of the distal portions of the limbs. It receives The archicerebellum is primarily involved in controlling posture and input from the cerebral cortex and thus helps in the planning of balance, as well as the movement of the head and eyes. It receives motor activity (e.g., seeing a pencil and then planning and executing afferent signals from the vestibular apparatus and then sends efferent the movement of the arm and hand to pick it up). fibers to the appropriate descending motor pathways. The paleocere-72
    • Cerebellum: Efferent Pathways NEUROPHYSIOLOGY Excitatory endings Motor and Inhibitory premotor endings of cerebral Purkinje cortex cells Ventral anterior and Internal capsule ventral lateral nuclei of thalamus Cerebral peduncle Mesencephalic reticular formation Decussation of superior cerebellar peduncles Red nucleus Descending fibers from Fastigial nucleus superior cerebellar peduncles Globose nuclei Hook bundle of Russell Emboliform nucleus Dentate nucleus Section A–B Cerebellar viewed cortex from below Section B–C viewed from above Vestibular nuclei Inferior cerebellar peduncle A Planes of Inferior olive section: B Lateral reticular nucleus red arrows Medulla oblongata indicate C direction Pontomedullary reticular formation of view ©FIGURE 2.22 CEREBELLAR EFFERENT PATHWAYS•The cerebellum plays an important role in coordinating movement. the proximal portions of the limbs. It modifies and coordinatesIt influences descending motor pathways to produce fine, smooth, these movements through efferent pathways to the appropriateand coordinated motion. The archicerebellum is primarily involved descending motor pathways. The neocerebellum coordinates thein controlling posture and balance and movement of the head and movement of the distal portions of the limbs. It helps in the plan-eyes. It sends efferent fibers to the appropriate descending motor ning of motor activity (e.g., seeing a pencil and then planning andpathways. The paleocerebellum primarily controls movement of executing the movement of the arm and hand to pick it up). 73
    • NEUROPHYSIOLOGY Cutaneous Sensory Receptors Free nerve endings Meissner’s corpuscle Stratum corneum Hair shaft Pore of sweat gland Stratum lucidum Stratum Melanocyte Epidermis granulosum Arrector muscle of hair Sebaceous gland Stratum Cuticle spinosum Stratum Internal sheath basale Hair follicle External sheath Glassy Dermal membrane papilla (of papillary Connective layer) Dermis tissue layer Reticular layer Hair cuticle Sweat gland Subcutaneous tissue Hair matrix Papilla of hair follicle Pacinian corpuscle Artery Subcutaneous Vein artery and vein Sensory nerves Basement membrane Elastic fibers Axon terminal Cutaneous Mitochondrion Detail of Merkel’s disc Skin ligaments nerve Schwann cell (retinacula cutis) Motor (autonomic)Basal nerveepithelial Desmosomes Cross sectioncells MerkelCytoplasmic cellprotrusion LobulatedMitochondria nucleus GranulatedExpanded vesicles Axon ©axon terminal Schwann cells Schwann cell Detail of free nerve ending FIGURE 2.23 SKIN AND CUTANEOUS RECEPTORS• Cutaneous receptors respond to touch (mechanoreceptors), pain respond best to high-frequency stimulation (i.e., vibration). (nociceptors), and temperature (thermoreceptors). Several different Merkel’s discs have small receptive fields and respond to touch and types of receptors are present in skin. Meissner’s corpuscles have pressure (i.e., indenting the skin). Ruffini’s corpuscles have large small receptive fields and respond best to stimuli that are applied receptive fields, and they also respond to touch and pressure. Free at low frequency (i.e., flutter). The pacinian corpuscles are located nerve endings respond to pain and temperature. in the subcutaneous tissue and have large receptive fields. They 74
    • Cutaneous Receptors: Pacinian Corpuscle NEUROPHYSIOLOGY Pacinian Corpuscle as Pressure Transducer Pressure To amplifier Generator potential Action potential 1st node A. Sharp “on and off” changes in pressure at start and end of pulse applied to lamellated capsule are transmitted to Myelin sheath central axon and provoke generator potentials, which in Lamellated capsule turn may trigger action potentials; there is no response to a slow change in pressure gradient. Pressure at central core Central core and, accordingly, generator potentials are rapidly dissipated by viscoelastic properties of capsule (Action potentials may Unmyelinated axon terminal be blocked by pressure at a node or by drugs) Pressure To amplifier Generator potential B. In absence of capsule, axon responds to slow as well as to rapid changes in pressure. Generator potential Action potential dissipates slowly, and there is no “off” response Pressure Na+ Pressure applied to axon terminal directly or via capsule causes increased permeability of membrane to Na+, thus setting up ionic generator current through 1st node If resultant depolarization at 1st node is great enough to reach threshold, an action potential appears which is propagated along nerve fiber ©FIGURE 2.24 PACINIAN CORPUSCLE•Pacinian corpuscles are mechanoreceptors that transduce mechani- producing a “generator potential.” As demonstrated in the figure,cal forces (displacement, pressure, vibration) into action potentials pacinian corpuscles respond to the beginning and end of athat are conveyed centrally by afferent nerve fibers. As the vis- mechanical force while the concentric lamellae dissipate slowcoelastic lamellae are displaced, the unmyelinated axon terminal changes in pressure. In the absence of the capsule, the generatormembrane’s ionic permeability is increased until it is capable of potential decays slowly and yields only a single action potential. 75
    • NEUROPHYSIOLOGY Proprioception and Reflex Pathways: I Spinal Effector Mechanisms Dorsal horn interneuron From motor neuron From Proprioceptive fibers cutaneous Dorsal horn interneuron receptor From muscle spindle Dorsal root ganglion Flexor reflex interneuron To motor neuron Ventral root Dorsal horn interneuron To motor neuron motor axon Schematic representation of motor neurons In cervical enlargement of spinal cord In lumbar Flex enlargement rs o rs of spinal cord Fl e x o rs r s n so so E xt e n Ext e ©FIGURE 2.25 PROPRIOCEPTION: SPINAL EFFECTOR MECHANISM•Position sense or proprioception involves input from cutaneous panel) initiate muscle contraction reflexes. The lower panel showsmechanoreceptors, Golgi tendon organs, and muscle spindles the somatotopic distribution of the motor neuron cell bodies in the(middle figure of upper panel). Both monosynaptic reflex pathways ventral horn of the spinal cord that innervate limb muscles (flexor(middle figure of upper panel) and polysynaptic pathways involv- and extensor muscles of upper and lower limbs).ing several spinal cord segments (top and bottom figures of upper76
    • Proprioception and Reflex Pathways: II NEUROPHYSIOLOGY Alpha motor neurons to extrafusal striated muscle end plates Gamma motor neurons to intrafusal striated muscle end plates Ia (A ) fibers from annulospiral endings (proprioception) II (A ) fibers from flower spray endings (proprioception); from paciniform corpuscles (pressure) and pacinian corpuscles (pressure) III (A ) fibers from free nerve endings and from some specialized endings (pain and some pressure) IV (unmyelinated) fibers from free nerve endings (pain) Ib (A ) fibers from Golgi tendon organs (proprioception) A fibers from Golgi-type endings A fibers from paciniform corpuscles and Ruffini terminals A and C fibers from free nerve endings Alpha motor neuron to extrafusal muscle fiber end plates Gamma motor neuron to intrafusal muscle fiber and plates II (A ) fiber from flower spray endings Extrafusal Ia (A ) fiber from annulospiral endings muscle fiber Intrafusal muscle fibers Sheath Lymph space Nuclear bag fiber Nuclear chain fiber © Detail of Efferent fibers muscle spindle Afferent fibersFIGURE 2.26 MUSCLE AND JOINT RECEPTORS•Muscle spindles and Golgi tendon organs send afferent signals to forces, whereas the nuclear chain fibers respond to static forces.the brain to convey the position of limbs and help coordinate mus- Intrafusal fibers maintain appropriate tension on the nuclear bagcle movement. Muscle spindles convey information on muscle ten- and nuclear chain fibers. If the muscle tension is too great (e.g.,sion and contraction (dynamic forces) and muscle length (static overstretching of muscle or too heavy a load), activation of theforces). The nuclear bag fibers respond to both dynamic and static Golgi tendon organ causes a reflex relaxation of the muscle. 77
    • NEUROPHYSIOLOGY Proprioception and Reflex Pathways: III Ib fibers Ia fibers Extrafusal muscle fiber Intrafusal muscle fiber Alpha motor neurons Gamma motor neurons A. Passive stretch. Both intrafusal and extrafusal muscle fibers stretched; Golgi spindles activated. Reflex via Ia fibers and alpha motor neurons causes tendon secondary contraction (basis of stretch reflexes, such as knee jerk). organ Stretch is too weak to activate Golgi tendon organs Ib fibers Alpha activation from brain Ia fibers Extrafusal muscle fiber Intrafusal muscle fiber Inhibitory interneuron Alpha motor neurons Gamma motor neurons B. Active contraction. Central excitation of alpha motor neurons only causes contraction of extrafusal muscle fibers with consequent relaxation of intrafusal fibers; spindles not activated. Tension is low; Golgi does not adjust to increased resistance. Tendon organ activated, tendon causing relaxation organ Alpha and Ib fibers gamma activation from brain Ia fibers Extrafusal muscle fiber Intrafusal muscle fiber Alpha motor neurons Gamma motor neurons C. Active contraction with gamma coactivation. Intrafusal as well as Golgi extrafusal fibers contract; spindles activated, reinforcing contraction tendon stimulus via Ia fibers in accord with resistance. Tendon organ organ activated, causing relaxation if load is too great ©FIGURE 2.27 PROPRIOCEPTIVE REFLEX CONTROL OF MUSCLE TENSION•Interaction of the muscle spindle and Golgi tendon organ during passive stretch of a muscle (panel A) and during a contraction (panels Band C).78
    • Proprioception and Reflex Pathways: IV NEUROPHYSIOLOGY B. Stretch reflex A. Afferent inhibition (reciprocal inhibition) From extensor spindle receptor (Ia, II fibers) From extensor spindle receptor (Ia, II fibers) From flexor spindle (Ia, II fibers) Axosomatic or axodendritic inhibitory synapse Axoaxonic presynaptic inhibitory synapse Excitatory synapse To extensors To extensors To flexors C. Recurrent inhibition D. Tendon organ reflex From extensor tendon organ (Ib fibers) Inhibitory synapse Renshaw cells Excitatory synapse Collaterals To extensors To synergistic muscles To flexors E. Flexor withdrawal reflex Nociceptive fibers Ipsilateral Contralateral flexion extension Inhibitory synapse Excitatory synapse Excitatory synapse Inhibitory synapse To extensors To extensors To flexors To flexors ©FIGURE 2.28 SPINAL REFLEX PATHWAYS•Summary of the spinal reflex pathways. 79
    • NEUROPHYSIOLOGY Sensory Pathways: I Cerebral cortex: postcentral gyrus Posterior limb of internal capsule Ventral posterolateral (VPL) nucleus of thalamus Mesencephalon (cerebral peduncles) Medial lemniscus Gracile nucleus Spinothalamic tract Cuneate nucleus Lower part of medulla oblongata Fasciculus gracilis Fasciculus cuneatus Reticular formation Dorsal (posterior) spinal root ganglion Proprioception, position Large Cervical part Touch, myelinated of spinal cord pressure, fibers vibration Small Lateral Pain, myelinated spinothalamic tract: temperature and unmyelin- pain, temperature ated fibers Lateral cervical nucleus Ventral (anterior) spinothalamic tract: Spinocervical tract touch, pressure Lumbar part of spinal cord ©FIGURE 2.29 SOMESTHETIC SYSTEM OF THE BODY•Pain, temperature, and pressure sensations below the head ulti- sations to the thalamus (ventral posterolateral nucleus), whereasmately are conveyed to the primary somatosensory cortex (post- the lateral cervical system mediates some touch, vibratory, andcentral gyrus) by the anterolateral system (spinothalamic and spin- proprioceptive sensations (blue and purple lines show these dualoreticular tracts). The fasciculus gracilis and cuneatus of the spinal pathways). Ultimately, these fibers ascend as parallel pathways tolemniscal system convey proprioceptive, vibratory, and tactile sen- the thalamus, synapse, and ascend to the cortex.80
    • Sensory Pathways: II NEUROPHYSIOLOGY Cerebral cortex: postcentral gyrus Ventral posteromedial (VPM) nucleus of thalamus Internal capsule Midbrain (cerebral Dorsal trigeminal lemniscus peduncles) Trigeminal mesencephalic nucleus Ventral Trigeminal motor nucleus trigeminal Principal sensory trigeminal nucleus lemniscus Touch, pressure Pontine Pain, temperature reticular formation Proprioception Trigeminal (semilunar) ganglion Ophthalmic n. Maxillary n. Pons Sensory root and Motor root of mandibular n. Medullary reticular formation Spinal trigeminal tract Spinal trigeminal nucleus Cervical part of spinal Facial (VII) n. cord Vagus (X) n. Dorsolateral fasciculus (of Lissauer) Substantia gelatinosa (Iamina II) ©FIGURE 2.30 SOMESTHETIC SYSTEM OF THE HEAD•Nerve cells bodies for touch, pressure, pain, and temperature in of CN V (purple fibers). Most relay neurons project to the con-the head are in the trigeminal (semilunar) ganglion of the trigemi- tralateral VPM nucleus of the thalamus and thence to the postcen-nal (CN V) nerve (blue and red lines in figure). Neuronal cell bod- tral gyrus of the cerebral cortex, where they are somatotopicallyies mediating proprioception reside in the mesencephalic nucleus represented. 81
    • NEUROPHYSIOLOGY Sensory Pathways: III Schematic demarcation of dermatomes shown as distinct C2 segments. There is actually considerable overlap between C3 C2 any two adjacent dermatomes C4 C5 C3 C6 C4 C5 C7 C8 T1 T1 T2 T2 T3 T3 T4 T4 C6 C6 T5 T6 T5 T1 T7 T6 T8 T9 T7 C5 T10 T8 C8 T11 T9 C7 T12 L1 T10 L2 L3 T11 L4 C6 L5 T12 S1 L1 C8 C7 C8 S2 C7 S2, 3 L2 S3 S4 L3 S5 S1 S2 L4 L5 L1 L2 L3 L5 S1 S2 L4 S1 S1 L5 L5 L4 L4 Levels of principal dermatomes T10 Level of umbilicus C5 Clavicles T12 Inguinal or groin regions C5, 6, 7 Lateral parts of upper limbs L1, 2, 3, 4 Anterior and inner surfaces of lower limbs C8, T1 Medial sides of upper limbs L4, 5, S1 Foot C6 Thumb L4 Medial side of great toe C6, 7, 8 Hand S1, 2, L5 Posterior and outer surfaces of lower limbs C8 Ring and little fingers S1 Lateral margin of foot and little toe T4 Level of nipples S2, 3, 4 Perineum ©FIGURE 2.31 DERMATOMES•Sensory information below the head is localized to specific areas dorsal root is called a dermatome. This figure shows the der-of the body, which reflect the distribution of peripheral sensory matome segments and lists key dermatome levels used by clini-fibers that convey sensations to the spinal cord through the dorsal cians. Variability and overlap occur, so all dermatome segmentsroots (sensory nerve cell bodies reside in the corresponding dorsal are only approximations.root ganglion). The area of skin subserved by afferent fibers of one82
    • Visual System: Receptors NEUROPHYSIOLOGY A. Eyeball B. Section Inner limiting through retina membrane Axons at surface Lens of retina passing Iris Cornea via optic nerve, Suspensory chiasm, and tract ligament Ciliary body to lateral geniculate body Ganglion cell Anterior Posterior chamber chamber Müller cell (supporting glial Ora containing cell) serrata aqueous humor Amacrine cell Bipolar cell Vitreous humor Horizontal cell Rod Retina Cone Choroid Pigment cells Sclera of choroid Fovea Optic nerve Synaptic Synaptic ending ending fully depolarized polarized Synaptic bar C. Rod in dark D. Rod in light Photons Nucleus of light Rhodopsin Lumirhodopsin Metabolic energy Metarhodopsin Centriole Current Retinene Retinene (basal body) flow + + Opsin Opsin Na+ Na+ Vitamin A permeability permeability Vitamin A decreased increased Circulation ©FIGURE 2.32 VISUAL RECEPTORS•The rods and cones of the retina transduce light into electrical sig- dark the cell is depolarized, but it is hyperpolarized in the light.nals. As illustrated for the rod, light is absorbed by rhodopsin, and This electrical response to light is distinct from other receptorthrough the second messenger cGMP (not shown), Na channels responses, in which the response to a stimulus results in a depolar-in the membrane close and the cell hyperpolarizes. Thus, in the ization of the receptor cell membrane. 83
    • NEUROPHYSIOLOGY Visual System: Visual Pathway Central darker circle represents G macular G zone Overlapping visual fields Lightest A shades A represent B B monocular H H fields Each quadrant a different color Projection on Projection on R RC C left retina right retina P P Optic Choroid Choroid (II) nerves Optic chiasm Periphery Macula Structure of retina (schematic): Projection on left Projection on right A Amacrine cells dorsal lateral dorsal lateral B Bipolar cells geniculate nucleus Optic tracts geniculate nucleus C Cones G Ganglion cells Lateral H Horizontal cells geniculate P Pigment cells bodies R Rods Calcarine fissure Projection Projection on left on right occipital lobe occipital lobe ©FIGURE 2.33 RETINOGENICULOSTRIATE VISUAL PATHWAY•The retina has two types of photoreceptors: cones that mediate optic chiasm while information from the temporal retina remains incolor vision and rods that mediate light perception but with low the ipsilateral optic tract. Fibers synapse in the lateral geniculateacuity. The greatest acuity is found in the region of the macula of nucleus (visual field is topographically represented here andthe retina, where only cones are found (upper left panel). Visual inverted), and signals are conveyed to the visual cortex on thesignals are conveyed by the ganglion cells whose axons course in medial surface of the occipital lobe.the optic nerves. Visual signals from the nasal retina cross in the84
    • Auditory System: Cochlea NEUROPHYSIOLOGY Cochlear nerve A. Membranous Semicircular Utricle labyrinth within canals bony labyrinth Saccule (path of sound waves) Scala vestibuli Cochlear duct (scala media) Scala tympani Round window Oval window and stapes B. Section through turn Vestibular (Reissner’s) of cochlea Scala vestibuli membrane (perilymph); weakly Cochlear duct (scala media; positive +80 mV endolymph) Efferent nerve fibers Tectorial membrane Spiral ligament Bone Afferent Scala tympani Outer hair cells; 60 mV nerve fibers (perilymph); 0 mV Basilar membrane Spiral ganglion Inner hair cell; 60 mV C. Spiral organ of Corti Hair cells Tectorial membrane Inner Outer Stereocilia Rods and tunnel of Corti Basilar membrane Supporting cells Spiral lamina Afferent nerve fibers Spiral ganglion Efferent nerve fibers As basilar membrane moves up, hairs are deflected outward, causing depolarization of hair cells and increased firing of afferent nerve fibers ©FIGURE 2.34 COCHLEAR RECEPTORS•The cochlea transduces sound into electrical signals. This is response to pressure changes imparted on the oval window of theaccomplished by the hair cells, which depolarize in response to cochlea in response to vibrations of the tympanic membrane.vibration of the basilar membrane. The basilar membrane moves in 85
    • NEUROPHYSIOLOGY Auditory System: Pathways Acoustic area of temporal lobe cortex Medial geniculate body Brachium of inferior colliculus Inferior colliculus Midbrain Correspondence between cochlea and acoustic area of cortex: Lateral Low tones lemnisci Middle tones Nuclei of High tones Medulla lateral oblongata lemnisci Dorsal cochlear nucleus Inferior cerebellar peduncle Ventral cochlear nucleus Cochlear division of vestibulocochlear nerve Dorsal acoustic stria Reticular formation Inner Outer Trapezoid body Spiral ganglion Hair cells Intermediate acoustic stria Superior olivary complex ©FIGURE 2.35 AUDITORY PATHWAYS•The cochlea transduces sound into electrical signals. Axons convey geniculate bodies) and then the acoustic cortex in the transversethese signals to the dorsal and ventral cochlear nuclei, where it is gyrus of the temporal lobe, where information is tonotopically rep-tonotopically organized. Following a series of integrated relay resented (low, middle, and high tones).pathways, the ascending pathway projects to the thalamus (medial86
    • Vestibular System: Receptors NEUROPHYSIOLOGY A. Membranous labyrinth Superior semi- Vestibular ganglion circular canal Vestibular and cochlear Cristae within divisions of ampullae vestibulocochlear n. Horizontal semi- Maculae circular canal Saccule Posterior semi- Utricle circular canal Cochlear duct (scala media) B. Section of crista Opposite wall of ampulla Gelatinous cupula C. Section of macula Hair tufts Otoconia Hair cells Gelatinous otolithic Nerve fibers membrane Basement Hair tuft membrane Hair cells Supporting cells Basement membrane Nerve fibers D. Structure and innervation Excitation of hair cells Inhibition Kinocilium Kinocilium Stereocilia Basal body Stereocilia Cuticle Cuticle Basal body Hair cell (type I) Hair cell (type II) Supporting cells Supporting cell Afferent nerve Efferent nerve calyx endings Efferent nerve Afferent nerve ending endings Basement Myelin sheath membrane Myelin sheath ©FIGURE 2.36 VESTIBULAR RECEPTORS•The vestibular apparatus detects movement of the head in the form such as the pull of gravity. The three semicircular canals areof linear and angular acceleration. This information is important for aligned so that the angular movement of the head can be sensed inthe control of eye movements so that the retina can be provided all planes. The sensory hair cells are located in the maculae of thewith a stable visual image. It is also important for the control of utricle and saccule and in the cristae within each ampullae.posture. The utricle and saccule respond to linear acceleration, 87
    • NEUROPHYSIOLOGY Vestibular System: Vestibulospinal Tracts Excitatory endings Superior Inhibitory Medial endings Vestibular nuclei Lateral Inferior Ascending fibers in medial Rostral longitudinal fasciculi Upper limb Trunk Ventral Dorsal To Lower cerebellum limb Caudal Somatotopical pattern in lateral vestibular nucleus Vestibular ganglion and nerve Motor neuron (controlling neck muscles) Medial vestibulo- Fibers from cristae Lateral (rotational stimuli) spinal fibers in medial vestibulospinal longitudinal fasciculi tract Excitatory Excitatory endings interneuron to back Inhibitory muscles ? ? interneuron Fibers from maculae (gravitational stimuli) Lower part of To flexor muscles cervical To extensor muscles spinal cord ? Inhibitory ending ? To axial To axial muscles muscles Inhibitory Excitatory ending ending Lumbar part of Lateral vestibulospinal tract spinal cord Inhibitory interneuron Excitatory synapse To flexor muscles To extensor muscles ©FIGURE 2.37 VESTIBULOSPINAL TRACTS•Sensory input from the vestibular apparatus is used to maintain sta- cord (muscle control), cerebellum (vermis), reticular formationbility of the head and to maintain balance and posture. Axons con- (vomiting center), extraocular muscles, and cortex (conscious per-vey vestibular information to the vestibular nuclei in the pons, and ception). This figure shows only the spinal cord pathways.then secondary axons distribute this information to five sites: spinal88
    • Gustatory (Taste) System: Receptors NEUROPHYSIOLOGY A. Tongue B. Section through Foliate vallate papillae papilla Taste buds Duct of gustatory (Ebner’s) gland C. Taste bud Epithelium Fungiform Vallate papillae Basement membrane papillae Nerve plexus Microvilli Nerve fibers Taste pore emerging from taste buds Taste cells Desmosomes Large nerve fiber Basement membrane Fibroblast Epithelium Granules Small nerve fiber Schwann cell Microvilli Intercellular space Large nerve fiber Collagen D. Detail of taste pore E. Detail of base of receptor cells ©FIGURE 2.38 TASTE RECEPTORS•Taste buds on the tongue respond to various chemical stimuli. Taste larize neurons connected to the taste cells. A single taste bud cancells, like neurons, normally have a net negative charge internally respond to more than one stimulus. The four traditional taste qualitiesand are depolarized by stimuli, thus releasing transmitters that depo- that are sensed are sweet, salty, sour, and bitter. 89
    • NEUROPHYSIOLOGY Gustatory (Taste) System: Pathways Ventral posteromedial (VPM) nucleus of thalamus Sensory cortex (just below face area) Lateral hypothalamic area Amygdala Mesencephalic Pontine taste area nucleus and Trigeminal (V) n. Motor nucleus of trigeminal n. Maxillary n. Mandibular n. Pons Pterygo- palatine Greater petrosal n. ganglion Geniculate ganglion Facial (VII) n. Otic and ganglion Lingual n. Nervus inermedius Rostral part of nucleus Chorda of solitary tract tympani Glossopharyngeal (IX) n. Fungiform papillae Lower Foliate papillae part of Valiate papillae medulla oblongata Petrosal (inferior) ganglion of Epiglottis glossopharyngeal n. Larynx Nodose (inferior) ganglion of vagus n. Vagus (X) n. Superior laryngeal n. ©FIGURE 2.39 TASTE PATHWAYS•Depicted here are the afferent pathways leading from the taste receptors to the brainstem and, ultimately, to the sensory cortex in thepostcentral gyrus.90
    • Olfactory System: Receptors NEUROPHYSIOLOGY Olfactory A. Distribution Cribriform plate bulb of olfactory of ethmoid bone epithelium (blue area) Lateral nasal wall Septum B. Schema of section through olfactory mucosa Cribriform plate Schwann cell Olfactory gland Unmyelinated olfactory axons Basement membrane Sustentacular cells Endoplasmic reticulum Nucleus Olfactory cells Dendrites Terminal bars (desmosomes) Olfactory rod (vesicle) Villi Cilia Mucus ©FIGURE 2.40 OLFACTORY RECEPTORS•The sensory cells that make up the olfactory epithelium respond to qualities that can be sensed: floral, ethereal (e.g., pears), musky,odorants by depolarizing. Like taste buds, an olfactory cell can camphor (e.g., eucalyptus), putrid, and pungent (e.g., vinegar, pep-respond to more than one odorant. There are six general odor permint). 91
    • NEUROPHYSIOLOGY Olfactory System: Pathway Efferent fibers Afferent fibers Granule cell (excited by Fibers from contralateral olfactory bulb and inhibiting to mitral and tufted cells) Fibers to contralateral olfactory bulb Mitral cell Anterior commissure Recurrent process Tufted cell Medial olfactory stria Periglom- Olfactory trigone and erular cell olfactory tubercle Glomerulus Anterior perforated Olfactory substance nerve fibers Lateral olfactory stria Lateral olfactory tract nucleus Piriform lobe Uncus Amygdala (in phantom) Entorhinal areaOlfactory epithelium Olfactory tract Olfactory nerves Anterior olfactory nucleus Olfactory bulb Cribriform plate of ethmoid bone ©FIGURE 2.41 OLFACTORY PATHWAY•Olfactory stimuli are detected by the nerve fibers of the olfactory sure (some efferent projections course to the contralateral olfactoryepithelium and conveyed to the olfactory bulb (detailed local cir- bulb, blue lines) or terminate in the ipsilateral olfactory trigonecuitry shown in upper left panel). Integrated signals pass along the (olfactory tubercle). Axons then project to the primary olfactoryolfactory tract and centrally diverge to pass to the anterior commis- cortex (piriform cortex), entorhinal cortex, and amygdala.92
    • Installing Adobe Acrobat Reader 5.0The images and text included in this atlas are contained in a Portable DocumentFormat (pdf) file and can be viewed with Adobe Acrobat Reader. A copy ofAcrobat Reader 5.0 is included on this CD. You will need to install or upgrade toAcrobat Reader 5.0 in order to have full functionality.Please follow these instructions:1. Choose Run from the Start menu and then click Browse.2. Double-click the InstallAcrobat.exe file to open the Reader Installer.3. Follow the onscreen instructions. Running the Atlas of Neuroanatomy and NeurophysiologyWindows1. Insert the CD into the CD-ROM drive.2. If Acrobat Reader 5.0 is not already installed on your computer, follow theinstallation instructions above.3. Choose Run from the Start menu and type x: (where x is the letter of your CD-ROM drive).4. Under Files of Type, click All Files.5. Double-click the Neuro Atlas.pdf file to open the program.6. For best viewing results, use the Edit menu to access the Preferences. SelectGeneral and open the Display preferences to activate the Smooth Line Art option.Macintosh1. Insert the CD into the CD-ROM drive.2. If Acrobat Reader 5.0 is not already installed on your computer, follow theinstallation instructions above.3. Double-click the Neuro Atlas.pdf file to open the program.4. For best viewing results, use the Edit menu to access the Preferences. SelectGeneral and open the Display preferences to activate the Smooth Line Art option.All rights reserved. No material on this CD-ROM may be reproduced in any elec-tronic format, including information storage and retrieval systems, without permis-sion in writing from the publisher. Send requests for permissions to PermissionsEditor, Icon Custom Communications, 295 North St., Teterboro NJ 07608, or visitwww.netterart.com/request.cfm.