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Neuroanatomy

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  • 1. Neuroanatomy MCEM Revision
  • 2. Objectives  Review the BASICS of neuroanatomy  Revise the clinical presentation of stroke disease  Understand the Munro-Kelly Doctrine.  Revise the effects of certain cranial nerve defects  Touch upon spinal anatomy
  • 3. Curriculum contents  Huge topic  General: Structural arrangement of the brain and spinal cord.  Divided into – Lobar anatomy – Neurovascular anatomy – Cranial Nerves & Nuclei – Spinal Anatomy
  • 4. Clinical Considerations  Stroke disease  Subarachnoid Haemorrhage  Intracranial Pathology  Cranial Nerve defects  Spinal lesions
  • 5. Considering the Neocortex  Complex visual functions are processed within the occipital lobe  The motor homunculus lies posterior to the central sulcus  Division of the cortical tracts within the corpus callosum prevents processing of speech  Infacrtion of Broca’s area will cause receptive dysphasia
  • 6. Considering the Neocortex  Complex visual functions are processed within the occipital lobe  The motor homunculus lies posterior to the central sulcus  Division of the cortical tracts within the corpus callosum prevents processing of speech  Infacrtion of Broca’s area will cause receptive dysphasia T F F F
  • 7. The Neocortex - Cerebral Hemispheres  Frontal lobe: anterior to central sulcus – Motor strip, eye control, speech motor function  Parietal lobe: behind central sulcus – Sensory strip, motor and sensory projections, interpretations of motor input  Occipital Lobe: complex visual functions  Temporal Lobe: – Auditory projection, memory, smell(medial)
  • 8. Cortical Links  The cortices are linked by the Corpus Callosum – Division leaves both cortices capable of memory and emotional responses  Cortical connections to the body – Motor, including links to cerebellum – Sensory – Special sensory  Intra cortical connections – Integration of sensory inputs with memory areas
  • 9. Motor tracts Sensory Tracts
  • 10. In relation to neurovascular anatomy  The circle of Willis is an anastamosis of the vertebral and external carotid end arteries  The middle cerebral artery supplies all of the parietal lobe  Occlusion of the anterior cerebral artery causes leg weakness  10% of Berry Aneurysms arise from congenital defects
  • 11. In relation to neurovascular anatomy  The circle of Willis is an anastamosis of the vertebral and external carotid end arteries  The middle cerebral artery supplies all of the parietal lobe  Occlusion of the anterior cerebral artery causes leg weakness  10% of Berry Aneurysms arise from congenital defects F F T F
  • 12. Cerebrovascular Anatomy
  • 13. Neurovascular Anatomy  4 Arteries supply the brain and it’s extensions – 2 Internal Carotid Arteries – 2 Vertebral Arteries – Connect together to form the Circle of Willis.  Branches of the External Carotid Arteries supply the Meninges and Skull.  Venous drainage via dural sinuses into the IJV. – Communicate with the diplopic veins of the skull into the facial venous circulation.
  • 14. Circle of Willis
  • 15. Internal Carotid Branches  Anterior Cerebral Artery  Middle Cerebral Artery – Divides at the trifurcation to form penetrating branches to the basal ganglia
  • 16. Vertebral Artery Branches  2 vertebrals merge to form Basilar – Basilar supplies cerebellum and brain stem structures  Basilar ends in formation of Posterior Cerebral
  • 17. Cortical Supply Sensory Homunculus Motor Homunculus
  • 18. Stroke Patterns  TACI Total Anterior circulatory infarct  PACI Partial Anterior circulatory infarct  POCI Posterior circulation infarct  LACI Lacunar infarct
  • 19. Stroke Patterns  Anterior Cerebral Artery – Leg weakness  Middle Cerebral Artery – Upper limb and face – Perforators cause lacunar stroke (20% of all)  Posterior Cerebral Artery – Short term memory – Smell & Visual defects
  • 20. Lacunar Stroke  Localised lesion within the internal capsule and basal ganglia – Pure motor (50-60%) – Pure sensory (6-7%) – Sensory-motor (20%) – Ataxic Hemiparesis  Lower limb weakness, and loss of co-ordination
  • 21. Sub Arachnoid Haemorrhage  Berry Aneurysm – 1% congenital defect  Found at the branch points of arteries – Posterior Communicating – Anterior Communicating – Middle Cerebral – Basilar