Professional Documents
Culture Documents
HUMAN NEUROANATOMY
(Clinically Oriented)
Easy and Interesting Approach to
HUMAN NEUROANATOMY
(Clinically Oriented)
SAMAR DEB MS
Professor of Anatomy
Agartala Government Medical College
Agartala, Tripura
India
Formerly
Academic Director and Professor of Anatomy
Katihar Medical College, Katihar
Bihar, India
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
2014, Jaypee Brothers Medical Publishers
All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational
purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specifically disclaim any damage,
liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures
and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug
or device.
ISBN 9789350909409
Printed at ? ? ?
Dedicated to
My parents
who trained me to face and to overcome
all kinds of hardship in life
and
My teachers
who gave me the direction to achieve
the success in life.
PREFACE
Just to Justify the Birth of First Edition
During the long journey of my teaching experience for more than 40 years, I had the opportunity to notice the
metamorphosis of my subject, Anatomy. I still remember my memorable days as a student of 1st professional
MBBS (1st MBBS) course, when my esteemed and respected teachers, as stalwarts in the field of anatomy,
used to be satisfied only after getting answers of the questions like, what are the structures passing through
canaliculus innominatus (not foramen ovale!) or what are the structure punctured, in order from superficial
to deep, if a deep pin-prick is made at the apex of femoral triangle. I have experienced that while asked
in examination, marks were divided for enumeration of the structures related to lateral aspect of palatine
tonsil starting from paratonsillar vein (of great clinical significance) up to ramus of mandible(!). My learned
renowned teachers had been very caring to teach all these details to us. But it was the time when Anatomy
used be taught as only Anatomy.
Since the beginning of my teaching profession, as time rolled on, I observed revolution in the subject of
anatomy. Gradually, the subject became more and more delicious when we achieved the techniques to bite
through the dry and hard cortex to enjoy the taste of juicy marrow of the subject through its more horizontal as
well as vertical integration and clinical orientation, of course, with omission of unnecessary details. I believe,
all anatomists like me, are thankful and grateful to Medical Council of India and Anatomical Society of India
who have been pioneer to bring this revolution.
My present submission, Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented),
is an attempt to follow the revolutionary path. Avoiding further details, I can only say, the title of the book,
through its every word, of speaks of its aims and objectives.
About the subject Neuroanatomy, it is well-known to all that, this branch of anatomy is characterized
by various negative adjectives such as, rough and tough, difficult, less important, not much required at
undergraduate level, etc. Undergraduate students are usually in a habit of ignoring or being away from it
as very often they are scared of. But they must know that this branch of anatomy can never be avoided in
professional life. Because Neuroanatomy deals with the study of nervous system which, being the master
system, regulates bodily functions performed by all other systems of body.
An effort has been made to deliver this subject through this book to the doorstep of readers of all levels in
easiest, simplest, and most interesting form.
It is not only the appreciation, if any, but also comments and criticisms are expected from anybody, anytime,
anywhere, its next edition.
Samar Deb
ACKNOWLEGDMENTS
Chapter 1.
Introduction to Human Neuroanatomy 1
Principles of Functions of Nervous System 1
Chapter 2.
Nervous System in Brief 20
Central Nervous System 20
Brainstem26
Cerebellum28
Peripheral Nervous System 35
Chapter 3.
Peripheral End Organs 44
Receptors44
Receptors Other Ways of Classification 51
Motor End Organs (Effectors) 51
Motor Unit 53
Nerve Ending Related to Exocrine Gland Acini 56
Chapter 4.
Spinal Cord 57
Definition and Situation 57
Role of Spinal Cord as a Part of Central Nervous System 57
Extent57
Important Notes in Connection with Termination 57
Parameters of Spinal Cord 57
Regional Classification of Spinal Cord Segments 58
Exit of Spinal Nerves from Vertebral Foramen 59
Correlation of Spinal Cord Segments with Vertebral Level 60
Enlargement60
Surface Features 60
Coverings (Meninges) and Spaces Around the Spinal Cord 61
Internal Structure of Spinal Cord 63
Formation of Different Zones of Spinal Cord 64
Formation of Different Functional Cell Groups 65
Peripheral Outflow of Spinal Cord 66
Internal Structure of Spinal Cord 66
Internal Structure of Spinal Gray Matter 69
Various Cell Groups of Spinal Gray Matter 69
Cell Groups in Posterior Gray Column 69
Cell Groups in Intermediate Area of Spinal Gray Matter 70
Cell Groups in Anterior Gray Column 70
Cell Groups Around Central Canal 71
Rexeds Lamination of Spinal Gray Matter 71
Internal Structure of Spinal White Matter 72
Rubrospinal Tract 80
Tectospinal Tract 81
Vestibulospinal Tracts 82
Reticulospinal Tract 83
Olivospinal Tract 83
Hypothalamospinal Tract 83
Solitariospinal Tract 83
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Chapter 5.
Brainstem 94
Medulla Oblongata 124
Pons125
Midbrain126
Traumatic Lesion 126
Chapter 6.
Cerebellum 128
Introduction128
Position and Relations 128
Principle of Functions 129
Gross Anatomy 129
Primary Fissure and Lobes of Cerebellum 130
Phylogenetic Classification of Cerebellum 131
Internal Structure of Cerebellum 132
Structural detail of Cerebellar Cortex 134
Mechanism of Cerebellar Cortical Circuit 134
White Matter of Cerebellum 135
Nuclei of Cerebellum 135
Relationship Between Cerebellar Nuclei and Mediolateral Subdivisions of Cerebellar Cortex 136
Cerebellar Peduncles 136
Impaired Function of Paleocerebellum 138
Impaired Function of Neocerebellum 138
Chapter 7.
Fourth Ventricle of Brain 139
Chapter 8.
CerebrumCortical Gray Matter 144
Introduction144
Cerebral Hemispheres 145
Medial Surface 153
Tentorial Surface 155
Orbital Surface 155
Some Important Points about Cerebral Cortex 155
Types of Neurons in Cerebral Cortex 155
Layer of Cerebral Cortex 156
Functional Areas of Cerebral Cortex 157
Functional Areas in Frontal Lobe 157
Functional Areas in Parietal Lobe 160
Functional Areas in Occipital Lobe 161
Functional Areas in Temporal Lobe 162
Chapter 9.
Cerebrum White Matter 163
Classification 163
Internal Capsule 172
Chapter 10.
Basal Ganglia 176
Chorea183
Ballismus183
Athetosis183
Parkinson Disease 183
xii
Contents
Chapter 11.
Lateral Ventricle of Brain 185
Chapter 12.
Diencephalon 192
Thalamus193
Metathalamus198
Epithalamus200
Paraventricular Nuclei of Epithalamus 202
Habenular Nucleus and Habenular Commissure
(Consult Figures of Commissure in Chapter of White Matter of Brain) 202
Subthalamus203
Chapter 13.
Third Ventricle of Brain 211
Tela Choroidea and Choroid Plexus 214
Chapter 14.
Meninges of Brain and Cerebrospinal Fluid 215
Dura Mater 215
Arachnoid Mater 221
Pia Mater 223
Cerebrospinal Fluid 224
Chapter 15.
Blood Supply of Brain and Spinal Cord 228
Blood Supply of Brain 228
Variations of Circle of Willis 232
Cortical Branches Supplying Different Surfaces of Cerebral Hemisphere 234
Venous Drainage of Brain 236
Blood Supply of Spinal Cord 237
Venous Drainage of Spinal Cord 239
Blood-brain Barrier 240
Chapter 16.
Reticular Formation 245
Chapter 17.
Limbic System 253
Chapter 18.
Autonomic Nervous System 260
A component Parallel to Somatic Nervous System 260
Autonomic Nervous System and Endocrine system Jointly Maintain Internal Environment of body 260
Composition of Autonomic Nervous System 260
Subdivision of Autonomic Nervous System Sympathetic and Parasympathetic 261
Sympathetic Part of Autonomic Nervous System 264
Parasympathetic Part of Autonomic Nervous System 274
Injuries to Autonomic Nervous System 282
Diseases Involving Autonomic Nervous System 283
Combined Sympathetic and Parasympathetic Lesion Causing Urinary Bladder Dysfunction in Spinal Cord Injury 284
Disrupted Motor Functions of Bladder 284
Visceral Pain 285
Stomach Pain 286
Appendicular Pain 286
Renal Pain 286
Ureteric Pain 287
xiii
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Chapter 19.
Cranial Nerves 288
Olfactory Nerve and Olfactory Pathway 288
Optic Nerve and Visual Pathway 291
Optic Nerve 293
Optic Chiasma 293
Optic Tract 293
Lateral Geniculate Body (Third of Neurons) 294
Macular Vision 294
Clinical Examination of Retina 296
Detachment of Retina 297
Various Kinds of Loss of Visual Field 297
Argyll Robertson Pupil 298
Cranial Nerves Arising From Brainstem 299
Oculomotor Nerve 299
Postganglionic Branches of Ciliary Ganglion 302
Roots of Communication to Ciliary Ganglion 303
Trochlear Nerve 304
Trigeminal Nerve 305
Ophthalmic Nerve 308
Maxillary Nerve 311
Sphenopalatine Ganglion 312
Mandibular Nerve 313
Lingual Nerve 315
Inferior Alveolar Nerve 315
Auriculotemporal Nerve 316
Abducent Nerve 317
Facial Nerve 319
Vestibulocochlear Nerve 326
Vestibular Pathways 326
Cochlear Component of Vestibulocochlear Nerve 330
Last Four Cranial Nerves 334
Glossopharyngeal Nerve 334
Vagus Nerve 337
Accessory Nerve 343
Hypoglossal Nerve 347
Index 349
xiv
Introduction to Human Neuroanatomy
1
Human Neuroanatomy is the division of Human Anat- The exocrine glands influenced by the activity of
omy which deals with of Human Nervous System. the nervous system may be single and solitary like
The Nervous System is defined as the Master of all any salivary gland or the lacrimal gland, or it may be
Systems or the Master System of the body, because multiple and minute, like the mucous glands of the
it controls or regulates all bodily functions performed wall of GI tract, or respiratory tract.
by other systems of the body, for example locomotor So result of functions of nervous system may be
summarized as follows
system, gastrointestinal system, respiratory system.
1. Contraction of voluntary muscle(s): Resulting
movement of a joint. It may result movement of
PRINCIPLES OF FUNCTIONS OF NERVOUS some organs, like tongue, eyeball.
SYSTEM (FIG. 1.1) 2. Contraction of involuntary muscle(s) present in:
a) Viscera: It is called visceral muscle.
When nervous system exerts its action over the other b) Wall of the cardiovascular system: Myocardium
systems of body, most simplified form of its action is of heart or smooth muscle in the wall of the
manifested basically as blood vessels.
1. Contraction of muscles. c) Dermis of skin called Arrectores pili: It is
2. Secretion of exocrine glands. attached to the root of hair follicle.
It may be noted here that the secretion of endocrine 3. Secretion of exocrine glands like:
glands is mostly under the hormonal control. a) Salivary glands or lacrimal gland: Large and
The muscles, whose contraction is regulated by solitary.
nervous system, may be voluntary (striated or skeletal) b) Mucous secreting glands: In the wall of GI tract
or involuntary (nonstriated or smooth). Contraction of or respiratory tractmany and minute.
the voluntary muscles results in movement of a joint. But it is to be noticed that the functions of nervous
The involuntary muscles may be in the wall or in the system do not mean only the effects as mentioned
substance of viscera, which are specifically called above, but, in gist it also performs the followings:
(Fig. 1.1).
Visceral muscle, e.g. in the wall of the gastrointestinal
1. It receives and carries different information from
tract, or tracheobronchial tree or in the substance of
its periphery to center, which are related to change
any solid viscera. Again, the involuntary muscle may in external and/or internal environment.
be in the wall of the cardiovascular channel, e.g. in the 2. It perceives or acknowledges the informations at
wall of the heart (myocardium) or in the wall of blood its center.
vessel (tunica media). It may be also in the dermis of 3. It analyzes, integrates and coordinates the infor-
the skin named the Arrectores pili. mations or inputs.
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
4. It commands for some effect after reception and, classified regionally as Cervical-8, Thoracic-12,
integration or coordination of informations. Lumbar-5,Sacral-5 and Coccygeal-1.
5. It stores the informations for the memory, intelli- 2. Peripheral: This is known as Peripheral Nervous
gence, learning and emotion of an individual. System. This is peripheral outflow or peripheral
extensions from Central Nervous System in the
form of peripheral nerves. The peripheral nerves
SUBDIVISIONS OF NERVOUS SYSTEM (FIGS 1.2 AND 1.3) are divided into two groups as
a) Proximal (Cranial): Cranial nerves, 12 pairs
A. Topographical Subdivision arising as outflow from brain.
1. Central: Part situated in the central axis of the b) Distal (Caudal): Spinal nerves, 31 pairs, each
body, known as Central Nervous System. These pair arising from each segment of spinal cord.
are Brain and Spinal cord. Brain is the proximal Central Nervous System may be compared as the
expanded part situated inside the cranial cavity. Director of an office, and Peripheral Nervous System
Distal, narrow, tubular and elongated part is the as the Field Staff. Like the Director, Central Nervous
spinal cord which is lodged in the upper two-third System gathers information from and gives direction
of the vertebral canal. Grossly brain is divided into to the Peripheral Nervous System, whose duty is to
three partsForebrain, Midbrain and Hindbrain. convey information and also to carry out the order from
Spinal cord is divided into 31 segments, which are its Director, i.e. Central Nervous System, for action.
Stored for
Memory
Intelligence
Learning
Emotions
Sensory information
Carried from undermentioned
receptors Motor effect
Due to change in Produced in the
external/internal environment form of
Cerebrum
Brain
Midbrain
Brain Cerebellum
Brainstem Pons
Medulla oblongata
Spinal nerves
Spinal
cord
Lower spinal
nerve forming
cauda equina
Filum terminale
n Fundamental difference between the Cranial i. Contractions of voluntary muscles to move the
and Spinal nerves: joints or to move some organs like tongue, eyeball.
All the spinal nerves contain sensory (incoming) fibers ii. Contractions of involuntary muscles like
carrying impulse (information) towards the central a) Visceral muscles.
nervous system and motor fibers (outgoing) carrying b) Smooth muscles in the wall of cardiovascular
impulse (directions) away from the central nervous channel.
system to the effector organ, that is why all the spinal c) Smooth muscles in the root of hair follicle of
nerves are mixed nerves. But some cranial nerves are skin, known as Arrectores pili.
mixed like spinal nerves and some are either purely iii. Secretions of exocrine glands which may be either
motor or purely sensory. single, large, solitary, e.g. Salivary glands or
tiny innumerable, for examplemucous glands of
B. Functional Subdivision gastrointestinal and respiratory tract.
Out of these different functionsThe contractions
It is already understood that nervous system controls of voluntary muscles is controlled or regulated as per
various bodily functions. The simplified form of fun- ones own desire and is known as voluntary function,
ctions controlled by nervous system are the follow- whereas others are not under ones own control, called
ings: involuntary function.
3
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
S
P
I Sensory fibers of cranial
N nerve carry sensory
Each of the 31 pairs of spinal A information
nerves L
is
mixed*
C Motor fibers of spinal nerve
O carry out command or effects
R
D
With the help of this background knowledge, it is Two parallel components of autonomic nervous
to be noted that functionally the nervous system is system:
classified as Somatic and Autonomic (Figs 1.4A They are called sympathetic and parasympathetic
and B). nervous system. These two systems have anta-gonistic
A. Somatic Nervous System: It is that division actions on the same target organ, e.g. Parasympathetic
of nervous system which controls or regulates the nervous system contracts the muscles in wall of
voluntary functions, i.e. functions which can be perfo-
hollow viscera like GI tract (peristaltic movements),
rmed as well as controlled as per ones own desire. It
but relaxes the sphincters; whereas the sympathetic
is contraction of voluntary or skeletal muscles.
B. Autonomic Nervous System: It is that division nervous system causes the opposite action on the same
of nervous system which controls or regulates invol- target organ. Again in some cases either of them has
untary functions, e.g. functions which can neither the influence, e.g. mucous glands of respiratory or
be preformed nor can be regulated as per ones own alimentary tract are under control of parasympathetic
desire. These are contraction of involuntary or smooth nervous system, whereas secretion of sweat glands are
muscles and secretion of exocrine glands. controlled by sympathetic system.
4
Introduction to Human Neuroanatomy
Somatic
peripheral
outflow
Motor fibers
To the effector organ, i.e. the
voluntary muscles
Fig. 1.4A Schematic representation of somatic nervous system (centers and outflow)
Autonomic
peripheral
outflow
Centers:
Sympathetic motor
Sympathetic
T1 L2 (L3) segments of spinal
cord
G
Parasympathetic
Nuclei of 3rd, 7th, 9th, 10th
cranial nerves
C Para-
sympathetic
S24 segments of spinal cord motor
Fig. 1.4B Schematic representation of autonomic nervous system (centers and outflow) [G Autonomic ganglia Synaptic junction
between preganglionic and postganglionic neurons]
5
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Dendrites
Axonhillock
Nissl bodies
Nucleus
Neurofibrils
Axon
terminal
Axon
Axodendritic
Junction
(Synapse)
Target organ
(Skeletal muscle)
Fig. 1.6 Chain of neurons transmitting impulse (excited state of neurons) to target organ (e.g. skeletal muscle)
7
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
d d
d
C
d d d D
2. Basal end is conicalknown as axon-hillock. transport (Fig. 1.8A). These chemical substances
3. Wider in breadth. are either concerned with the nerve conduction,
4. It has no terminal branching, but from the middle when these pass through the interneuronal junction
of the axon branching at right-angle may takes (synapse) or these may be concerned with desired
place known as Collaterals. function of nerve impulse when these reach the
5. Terminal end is expanded known as Telodendria effector organ. Sometimes chemical substances (may
showing knob-like or button-like endings called be neurotoxins) liberated at the tissue level, absorbed
axon terminals or Terminal buttons. by axon terminals, are carried back towards the cell
6. Number of axon in neuron is always constantly body of the neuron. This is known as Retrograde
one. transport (Fig. 1.8B).
It is important to notice that dendrites and axons
cannot be differentiated by their relative length. Some Classification of Neurons
neurons may have long axon. Again some may have long 1. According to number of processes (polarity)
dendrite. Fibers of median or ulnar nerve supplying (Figs 1.9A and B)
small muscles of hand are example of long axon. Wher-
It is to be noted that, at one initial phase of
eas fibers of saphenous nerve carrying sensation from
development, neurons used to have no process. How-
skin of foot are the example of very long dendrite. In
ever, this phase is followed by gradual appearance of
both the cases cell bodies are located in or very close to
number of processes which will classify the neurons
spinal cord.
as follows:
Neuronal (Axonal) Transport a. Unipolar neurons
Chemical substances synthesized in the neuronal These are developmentally primitive variety of neu-
cell body are required to be transported through the rons with single process which is the axon. It is devoid
axon at its distal end. This is known as Orthograde of any dendrites.
8
Introduction to Human Neuroanatomy
Dendrite
Axon
Neurotransmitter
Toxin
Fig. 1.8B Retrograde transport, toxins liberated in tissue pass in opposite direction through axon toward cell body
Flask-shaped
Pyramidal (cerebrum) Polygonal (spinal cord) (cerebellum)
Brain
Upper motor
neuron
(Golgi type I)
with long
axon Long
axon
Interneurons
of spinal cord
Spinal cord
Lower motor
neuron (Golgi type I)
with long axon
Figs 1.10A and B A. Golgi type I neuron (with long axon), B. Golgi type II neuron (with short axon)
10
Introduction to Human Neuroanatomy
Cerebrum
(Brain)
Tertiary sensory neurons
Thalamus (Brain)
neurons are stellate cells of cerebellar cortex, which the central nervous system. Their cell bodies are
have short axon and multiple short dendrites giving a situated outside the central nervous system. Only
star-shaped appearance. It forms synaptic connection exception is the cell group of mesencephalic nucleus of
with too many neurons. trigeminal nerve, whose cell bodies lie inside central
It is important to note that some of the neurons nervous system.
may have single long dendrite. For example, fibers
n Secondary sensory (Second order) neu-rons:
present in the sensory nerves carrying sensory imp-
ulse from the periphery are the long dendrites of They are situated at the level of spinal cord which
sensory neurons present in the posterior root ganglia receive impulse from 1st order of neurons.
of spinal nerve. n Tertiary sensory (Third order) neurons: They
relay the sensation from the secondary neurons to the
3. According to function of neuron final target, i.e. cerebral cortex. First group of these
neurons are situated in the thalamus. The second or
a. Sensory neuron (Fig. 1.11) final group is situated in the sensory area of cerebral
These neurons carry sensory impulse from a receptor cortex.
(sensory end organ) through the dendrite towards
the center of nervous system finally through axon. b. Motor neuron (Fig. 1.10A)
From the sensory end organ or receptor situated
These neurons carry outgoing motor impulse from
at the periphery of the body, the sensory nerve
impulse needs to pass through a chain of neurons central nervous system to the peripherally situated
as the relay system to reach the center of nervous effector organs which are either muscles or glands.
system. The participating neurons in this chain l Types of motor neuron:
are classified as primary, secondary and tertiary In somatic nervous systemUpper motor neuron and
neurons (Fig. 1.11). Lower motor neuron.
n Primary sensory (First order) neurons: They i. Upper motor neuron: These motor neurons are
start from the receptor or sensory end organ to enter situated in motor areas of brain above the level
11
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
of spinal cord and brainstem (Midbrain, Pons external or internal, impulse or action potential is
and Medulla). generated.But activity of nervous system depends on
ii. Lower motor neuron: These motor neurons are transmission or conduction of nerve impulse or action
situated in spinal cord. potential through a chain of neurons. In the chain
neurons are approximated or apposed closely to each
4. Classification of neurons in relation to neuronal other. This site of apposition or contact between two
junction(synapse) (Fig. 1.12) neurons is known as synapse. Though, it is simple to
Functions of a neuron depends upon the transmission understand, but in 1891, neuronal theory of Waldeyer
of impulse through a chain of successive neurons. The first established that at the synapse or neuronal
junction of neuronal chain is known as Synapse or junction of two successive neurons are contiguous, but
Ganglion (pl. Ganglia).When related to a particular not continuous to each other. It was then detected that
synapse, the neurons are classified as some chemical substances called Neurotransmitters
a) Presynaptic (Preganglionic) neuron: Proximal jump across the synaptic junction to carry the nerve
to a synapse impulse or action potential of the neuronal chain.
b) Postsynaptic (Postganglionic) neuron: Distal to Fundamental points to remember regarding the
the synapse. synapse:
In somatic nervous system, both the pre and post-
1. Two successive neurons are contiguous in the syn-
ganglionic neurons are situated inside the central
nervous system except the first order of sensory apse but not continuous.
neuron which lies outside of central nervous system, 2. Chemical substance released in the proximal
e.g. Posterior root ganglia cells of spinal nerve. But in neuron (presynaptic neuron) passes to distal or
autonomic nervous system the preganglionic neuron postsynaptic neuron, through which impulse is
is situated inside the central nervous system and transmitted.
postganglionic neuron is situated outside the central 3. Impulse under physiological condition travels thr-
nervous system. ough the synapse in one direction only.
4. Single end of an axon, known as axon terminal
NEURONAL JUNCTION (SYNAPSE) (FIG. 1.12) will form synapse with single dendritic spine.
5. Multiple end button of one presynaptic neuron
It has already been noticed that, when a neuron may form synapse with dendrites of multiple
is stimulated due to change in the environment, neurons or multiple dendrites of single neuron.
Presynaptic neuron Postsynaptic neuron
A. Axodendritic synapse
B. Axosomatic synapse
C. Axoaxonic synapse
Neurofibrils
Axoplasm
Mitochondria
Axon terminal
Presynaptic vesicle containing
Neurotransmitter
Presynaptic membrane
Types of Synapse (Fig. 1.12) Beneath this membrane the axoplasm shows some
specialized features. The cytoplasm is condensed with
So far, it is already understood that axon of presy-
naptic neuron forms synapse with the dendrons of presence of number of mitochondria. It also contains
postsynaptic neuron. But truly speaking axon of a many membrane bound vesicles which contain ch-
neuron may form synapse with any component of emical substances known as neurotransmitter.
another neuron, e.g. dendrite, cell body, even the axon The vesicles are very tiny, 4050 nm (nanometer)
also. So, the synapses are grossly classified as in diameter. One mm (micrometer) is 1/1000 of a
1. Axodendritic: Synapse between axon of presynaptic millimeter and one nm (nanometer) is 1/1000 of a mm
and dendron of postsynaptic neuron. (micrometer). During transmission of nerve impulse,
2. Axosomatic: Synapse between axon of presynaptic neurotransmitter is released from presynaptic vesic-
and cell body or soma of postsynaptic neuron.
les into synaptic cleft by exocytosis to stimulate
3. Axoaxonic: It is considered as a lateral synapse.
In this type, axon of lateral neuron form synaptic postsynaptic membrane of the distal neuron.
connection with axon of another neuron which is
lying in the regular neuronal chain. Synaptic Cleft
Besides the above mentioned commoner types of It is the gap measuring 2030 nm between pre and
synapses, other types are somatodendritic, somato-
postsynaptic membranes. It contains interstitial
somatic and dendrodendritic.
fluid rich in polysaccharides. Through the process of
Structure of a typical axodendritic synapse exocytosis neurotransmitters are released across the
(Fig. 1.13) presynaptic membrane into synaptic cleft.
A typical axodendritic synapse is composed of follo-
wing three parts. These are Postsynaptic Membrane
i. Presynaptic membrane of axon of proximal neuron. This is the thickened plasma membrane of dendrite
ii. Synaptic cleft between axon and dendrite. spine at the site of synapse. This membrane sho-
iii. Postsynaptic membrane of dendrite of distal neu- ws specialization known as receptors which are to
ron. uptake neurotransmitters passing across the syn-
aptic cleft. The dense cytoplasm beneath postsy-
Presynaptic Membrane
naptic membrane is segmented and known as syn-
Thickened cell membrane of the axon terminal at aptic web which contains a network of filame-ntous
the site of synapse is called presynaptic membrane. structure.
13
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Impulse Transmitted Across the Synapse Size of neuroglia is much smaller than neurons,
but their number is far more proportionately, may be
Nerve impulse transmitted through presynaptic neu- as many as 50 times the number of neurons. When the
ron causes release of neurotransmitter from pres- number of neurons are fixed after birth, the neuroglia
ynaptic vesicles. Neurotransmitter passing across the can multiply throughout life. In case of injury or
synaptic cleft act as chemical impulse to stimulate disease of nervous tissue, area of damaged or dead
receptors of postsynaptics membrane. Chemical imp- neurons, are occupied by multiplying neuroglia. This
ulse reaching synaptic web beneath postsynaptic process is known as replacement gliosis.
membrane is again converted into nerve impulse to
stimulate postsynaptic neuron. Types of Neuroglia
In central nervous system
Neurotransmitters 1. Ependymal cell
There are varieties of chemical substances acting as 2. Macroglia a) Astrocytes b) Oligodendrocytes
neurotransmitter. Mostly found neurotransmitters 3. Microglia.
are Acetylcholine and Norepinephrine. Acetylcholine In peripheral nervous system
is liberated as neurotransmitter in many synapses of 1. Schwann cells.
central and peripheral nervous system including those 2. Satellite cells.
of parasympathetic nervous system. Norepinephrine
is released in most of the synapses of sympathetic Ependymal cell (Fig. 1.14A)
nervous system. Glycine is the neurotransmitter These are single-layered cubical or columnar cells
discharged in the synapses of spinal cord. Dopamine is lining the cavities (ventricles and central canal) of
the transmitter found in basal ganglia and substantia central nervous system (brain and spinal cord). They
nigra. Serotonin and Gumma-amino-butyric acid represent the original cells lining the neural tube of
(GABA) are other examples of commonly known embryonic life. The free surface of the cells present
neurotransmitters. ultramicroscopic finger-like prolongations which are
nonmotile in nature. These are known as stereocilia.
Deactivation or cessation of action of neurotransmitters n Functions:
After desired effect, influence of neurotransmitters 1. Stereocilia of free surface of ependymal cells
is withdrawn in either of two different ways. In case increase surface area, so help in absorption of
of Acetylcholine, it is broken down by the enzyme cerebrospinal fluid circulated in cavity of central
Acetylcholinesterase at synaptic cleft. But in case nervous system.
of transmitters like norepinephrine, its effect is 2. Specialized area of ependymal lining of ventricles
restricted by its reuptake back through presynaptic is also concerned with formation of cerebrospinal
membrane. fluid (CSF).
Neuromodulators Astrocytes
These are the chemical substances which enhance, These cells are so-called because they are star-shaped
prolong, restrict or inhibit the effect of the neuro- with radiating cytoplasmic processes. Astrocytes are
transmitter on postsynaptic membrane. They are of following two types.
stored in separate presynaptic vesicles.
Protoplasmic astrocytes (Fig. 1.14B)
NEUROGLIA The radiating processes of these types of astrocytes are
thicker containing more amount of cytoplasm inside.
Broadly, the neuroglia can be defined as group of
cells of nervous system which are other than the
neurons. So the cells of this family do not posses two
basic characteristics of neurons, i.e. irritability and
conductivity. That is why none of them can generate
and conduct the nerve impulse. Both in central as well
as peripheral nervous system fundamentally they act
Stereocilia
as intercellular (interneuronal) supportive material. (Nonmotile microvilli)
In addition, each type of neuroglia is characterized by
its independent specific function. Fig. 1.14A Ependymal cells
14
Introduction to Human Neuroanatomy
Neuron
Capillary Protoplasmic astrocyte
found in gray matter
They are related in relation to cell bodies of neuron 2. Astrocytes transport nutritive materials from blo-
(in gray matter of central nervous system). Terminal od capillaries to neurons.
ends of the processes present foot-like expansions 3. It forms the blood brain barrier.
known as end-feet. These types of astrocytes are
intermediate in position between cell bodies of neuron Oligodendrocytes (Fig. 1.15A)
and blood capillary. End-feet come in contact in one
side with neuronal cell body and in another side with These are smaller round or spherical cells with lesser
wall of capillary, thus helping in selective transport of number of processes. They are found in white matter
substance like nutritive substance or metabolites from of central nervous system where expanded end of their
blood capillary to neuron. This media may prevent processes wrap around the length of nerve fibers. This
transport of some unwanted or toxic materials, for
wrapping (ensheathment) or insulation of nerve fibers
which it is known as blood brain barrier, some drugs
having action on central nervous system posses the is known as Myelination. The myelination prevent the
ability to cross this blood brain barrier. nerve impulse to be dissociated to the surrounding
tissue and thus facilitate the full conduction of impulse
Fibrous astrocytes (Fig. 1.14C ) towards the destination.
The cell bodies of these types of astrocytes are n Functions:
smaller with thinner and more branching processes.
They are predominantly distributed inbetween 1. Oligodendrocytes primarily provide supportive
pro-cesses of nerve cells (in white matter of central functions around neurons of central nervous sys-
nervous system). tem.
n Functions: 2. They form myelin sheath around nerve fibers
1. Astrocytes posses supportive function acting as (processes of neurons) inside central nervous sys-
packing material of central nervous system. tem.
Fibrous astrocytes
Nerve fibers of CNS forming white matter
Nerve
fiber
Cell body of
oligodendrocyte
Fig. 1.15A Multiple processes of one oligodendrocyte form myelin sheath (for insulation) of many nerve fibers in central nervous system
Mesoaxon
Schwann cells
Nerve fiber
Nerve fiber
B
Fig. 1.17 Capsular or satellite cells surrounding cell body of posterior root ganglion neuron
A
Myelin sheath Layers of plasma membrane of
Nucleus of Schwann cell Internode Schwann cell made up of lipid-protein
Nerve fiber
Nerve fiber
B Node of Ranvier
19
Nervous System in Brief*
2
*(This chapter should not be ignored but is to be read thoroughly. If the reader goes thoroughly, all the subsequent chapters will
be better understood)
CENTRAL NERVOUS SYSTEM onents which are further subdivided. Each of these
parts is having Latin names which are of clinical
Central Nervous System is made up of (Fig. 2.1) significance.
1. Brain: Proximal expanded part situated inside the
cranial cavity. Forebrain (prosencephalon)
2. Spinal cord: Distal, narrow, tubular and elongated
part situated in upper two-third of vertebral canal. It is most expanded part having
i. Diencephalon: Central midline part having rig-
Fundamental Subdivisions of Brain (Fig. 2.1) ht and left identical halvesIt forms different
Morphologically, the brain is composed of three comp- components of thalamus.
Cerebrum
Brain Midbrain
Pons Cerebellum
Brainstem
Medulla
oblongata
Filum terminale
Tree
Stem
Brainstem
}
cerebrum. 2. Pons
3. Medulla Two ventral components of hindbrain
Midbrain (mesencephalon) oblongata
It is shortest and simplest out of the three comp- Long-axis of brainstem is oblique vertical directed
onents of brain. downwards and backwards (Fig. 2.3). 3 components
of brainstem namely midbrain, pons and medulla
Hindbrain (rhombencephalon) oblongata are connected to cerebellum by 3 pairs of
It is subdivided into as many as 3 parts. compact bundles of white matter known as cerebellar
l Proximal(Metencephalon): Which is further subd- peduncles (Fig. 2.4)
ivided into two parts: l Superior cerebellar peduncle: Connecting midb-
1. Ventral Pons 2. Dorsal Cerebellum rain.
l Distal (Myelencephalon) 3. Medulla oblongata: l Middle cerebellar peduncle: Connecting pons.
Which is distal most cylindrical part of brain. It is l Inferior cerebellar peduncle: Connecting medulla
continuous with the spinal cord below. oblongata.
Cerebral peduncle
Neural groove
Ectoderm
Mesoderm B
Endoderm A
Telencephalon
FB
Diencephalon
MB Mesen cephalon
HB Rhombencephalon
Anterior
neuropore Posterior
neuropore
C D
Figs 2.5A to D Embryological background showing central nervous system develops from neural tube. A. Formation of neural plate
on ectodermal surface of 3 germ layered embroyonic disk, B. Formation of neural groove, C. Anterior and posterior neuropores,
D. Formation 3 brain vesicles
22
Nervous System in Brief
Multiplication of Single Layered Cells of Neural Tube (Fig. 2.6)
A
A B
Ependyma
Ependyma
Astrocytes
Neurons
Figs 2.6A to D Multiplication of single-layered neural tube cells. A. Single-layered neuroectodermal cells lining neural tube, B.
Following mitosis, newer cells pushed to the periphery are differentiated into neuroblast and spongioblast, C and D. Formation neuron
and neuroglia (astrocyte and oligodendrocyte) from neuroblast and spongioblast respectively
On 35th day, single layered neuroectoderm cells cells form a barrier between neuron and capillary
(Fig. 2.6A) lining the neural tube start mitotic cell allowing selective transport of substance and prev-
division. The newer cells (daughter cells) are pushed enting transport of unwanted substance (toxic
to the periphery (Fig. 2.6B). The original lining cells materials) from capillary to neuron. This is known
form the inner lining of the cavity of neural tube called as Blood Brain Barrier (Fig. 2.8). The processes of
Ependymal cells. The daughter cells pushed to the neurons situated in mantle layer are pushed outside
periphery, are differentiated into two types known as forming another peripheral zone known as Marginal
neuroblasts and spongioblasts (Fig. 2.6C) which will be Zone (Figs 2.7 and 2.8). Oligodendrocytes of neuroglial
transformed into Neurons and Neuroglia (Astrocytes cells are present in this zone which will ensheath
and oligodendrocytes) respectively (Fig. 2.6D). The (myelin sheath) the neuronal processes. Microglia of
microglia will be formed from the monocytes of blood neuroglial cells are present in both mantle as well as
squeezed out through pores of capillaries. Outside the marginal zones (Fig. 2.8).
ependymal cell lining, the cell bodies of neuron forms Initially relation of inner mantle zone and surro-
a zone called Mantle Zone (Figs 2.7 and 2.8). This unding it, outer marginal zone exists althrough the
zone also contains Astrocyte type of neuroglia. length of neural tube.
Foot processes (end-feet) of astrocytes come in
contact, on one side with neuronal cell bodies and Gray and White Matters (Fig. 2.8)
on other side with the fenestrated (pored) wall of Lipid material of myelin sheath of nerve cell process
capillaries. These astrocytes thus, help in nutritional (called nerve fiber) present in marginal zone of
transport from capillaries to neurons. Besides, these developing central nervous system gives a Whitish
23
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Ependyma
Mantle zone
Marginal zone
Fig. 2.7 Cell division of neural tube leads to formation of layer of ependymal cells, mantle zone and marginal zone
appearance. That is why this zone is called White of gray and white matters. Both components are
matter of central nervous system. Inner mantle zone intermingled.
made up of neuronal cell bodies presents grayish l In parts of brain (cerebrum and cerebellum)
appearance for which it is called Gray matter. relationship of gray and white matter is reversed.
Gray matter becomes peripheral forming the
Variations of relationship between gray matter and cortex and white matter forms the central core.
white matter This alteration is due to following reasons:
l In spinal cord, throughout the whole length, i. Due to elongation of neuronal processes the
gray matter presents its original central position nerve cell bodies forming the gray matter is
surrounding the central canal. White matter, pushed to the periphery (Fig. 2.9).
containing bundles of nerve fibers is peripherally ii. Peripheralization of gray matter (cortex) of
positioned. cerebrum and cerebellum is further caused
l In brainstem (midbrain, pons and medulla oblo- due to need for increase in surface area of gray
ngata) there is no separately demarcated zones matter through formation of foldings (gyrus).
Ependymal cell
Neuron
Astrocyte
Mantle zone Capillary
forming gray
matter Microglia
Marginal zone
M
forming white
matter
Oligodendrocyte
Forming
Myelin sheath
Fig. 2.8 Various cells of central nervous system with blood brain barrier (B) and formation of myelin sheath (M)
24
Nervous System in Brief
White matter Spinal cord is made up of 31 segments which
are regionally subdivided from above downwards as
follows
Gray matter Cervical 8
Thoracic 12
Lumbar 5
Sacral 5
Coccygeal 1
A pair of spinal nerve (right and left) comes out
from each of the segments of spinal cord which are
numbered and named accordingly (Fig. 2.10). All
the spinal nerves are mixed nerve formed by union
of ventral (motor) outgoing and dorsal (sensory),
incoming nerve roots which are attached separately
to anterolateral and posterolateral aspects of each
segment respectively.
Fig. 2.9 Peripheralization of neuronal cell bodies due to Interior of spinal cord shows centrally situated H-
elongation of neuronal process, for which gray matter becomes
shaped area of gray matter. The central connecting
superficial to white matter
limb (gray commissure) is traversed by central canal
l Diencephalon (thalamus), the central, midline lined by ependymal cells and extensive throughout
portion of forebrain is made up of only gray matter. the whole length. Each lateral half of gray matter
of spinal cord presents a broader anterior horn and
l Basal ganglia are submerged collection of gray
narrower posterior horn. All the thoracic and upper
matter in the central core of white matter of two lumbar (T1 L2) segments of spinal cord present
cerebrum. additional lateral horn. Along the length of spinal cord,
respective horns are called anterior, posterior and
Different Parts of Central Nervous System in lateral gray columns. Neurons of anterior (ventral)
Brief horn are motor (efferent) or effector in nature. Their
axons, coming out through ventral nerve root, pass
Spinal cord is the caudal (distal), elongated, narrow, via spinal nerves and end in effector organs, like
tubular part of central nervous system situated in upper voluntary muscles (Fig. 2.11).
two-third of vertebral canal. It starts as a continuation Again neurons of posterior (dorsal) horn are
of medulla oblongata at upper border of 1st cervical sensory (afferent) or receptor in nature. These
vertebra and ends at the level of lower border of 1st receive sensory informations (inputs) carried from
lumbar vertebra. Sometimes it may extend upto 2nd peripheral sensory end organs through peripheral
lumbar vertebra. It is 18 inches in length. processes of pseudounipolar nerve cells of posterior
root ganglion of posterior roots of spinal nerves. These
Posterior pseudounipolar neurons of posterior root ganglia
root are developed from neural crest cells aggregated on
Dorsal ganglion dorsolateral aspect of neural tube. The neurons of
nerve Gray matter posterior horns (tract neurons) give out axons which
root
are pushed out to the peripheral white matter in the
form of compact bundle (ascending or afferent tract)
which carry sensory informations from periphery, via
Spinal nerve posterior (dorsal) nerve root upwards to the higher
Ventral
nerve root White matter sensory centers of brain (Fig. 2.11). The neurons of
intermediate or lateral gray horn (T1 L2 segments
only) form centers for sympathetic component of
autonomic nervous system. Peripheral white matter
also contains descending (efferent) or motor tracts
coming down as long axons of neurons of motor area
of brain (upper motor neurons) to relay on motor
neuron of anterior horns of spinal cord (lower motor
Fig. 2.10 A pair of spinal nerve arises from each of the segments
neurons). Each half of peripheral white matter
of spinal cord of spinal cord is divided into anterior, lateral and
25
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Tract neuron Posterior root Sensory nerve endings
ganglia cells carry impulse from
receptors
posterior white columns. They are known as anterior, BRAINSTEM (FIGS 2.12 TO 2.14)
lateral or posterior funiculus. (Pl- funiculi). Anterior
and lateral funiculi are composed of both ascending Brainstem is the short tubular stalk-like or pedu-
(afferent or sensory) as well as descending (efferent ncular component of brain which is composed of follo-
or motor) tracts. But posterior funiculus is made up
wing parts of brain from above downwards
of only ascending (sensory) tracts.
Again in 2nd, 3rd and 4th sacral (S2, S3 and S4) 1. Midbrain
segments of spinal cord, neurons of intermediate
area (no lateral horn present here) form center for
2. Pons
3. Medulla oblongata }Ventral parts of
hindbrain
parasympathetic component of antonomic nervous Cerebral peduncle is the ventral most part of mid-
system. brain composed of compact vertical bundle of nerve
Cerebral peduncle of
midbrain
Midbrain
Pons
Cerebral peduncle
Midbrain
Superior cerebellar peduncle
fibers by which brainstem is connected above to the sulcus which lodges the basilar artery. Basilar part
cerebrum (Figs 2.12 and 2.13). of pons is continuous laterally and horizontally with
Cerebellum is connected to the three components of middle cerebellar peduncle. Ventral part of midbrain
brainstem, i.e. midbrain, pons and medulla oblongata presents compact cerebral peduncle. Dorsally mid-
through 3 compact bundle of fibers called Superior, brain presents two pairs of round bulge, upper is
Middle and Inferior Cerebellar Peduncles. Superior known as superior colliculus and lower one is called
cerebellar peduncle is thinnest whereas middle is the inferior colliculus (pl-colliculi).
thickest. Again superior and inferior peduncles are Cavity of brainstem (Fig. 2.14) cavity of
composed of both afferent as well as efferent fibers midbrain is narrow and slit-like which is known as
of cerebellum, but middle is made up of only afferent aqueduct of Sylvius. Cavity of the central nervous
fibers to cerebellum (Fig. 2.13). system opposite pons and medulla oblongata is dilated
Medulla oblongata is narrower, cylindrical and which is known as 4th ventricle of brain. It is related
most caudal part of brainstem which is continuous ventrally to the dorsal surface of pons and medulla
below with the cylindrical spinal cord. Pons presents and dorsally to cerebellum. The 4th ventricle of brain,
ventrally bilateral bulge known as basilar part. In the cavity of hindbrain is continuous below with central
midline, it presents a vertical sulcus known as basilar canal of spinal cord.
Cerebral peduncle
Cerebellum
Medulla oblongata
Gray and White Matter of Brainstem from which it is separated by the cavity of hindbrain,
the 4th ventricle of brain. It is connected to 3 parts of
Brainstem is the part of central nervous system which brainstem by 3 pairs of cerebellar peduncles, superior,
shows intermingling of white and gray matter. There middle and inferior.
is no defined separate zones of white and gray matter Phylogenetically cerebellum is divided into follo-
as found in the other parts of central nervous system. wing 3 parts:
n White matter: i. Archicerebellum Oldest (Vestibulocerebellum)
1. Vertical fibers: These are present in the form of ii. Paleocerebellum Intermediate (spinocerebel-
ascending and descending bundles. Ascending lum)
bundles are afferent or sensory fibers connecting iii. Neocerebellum Latest (Pontocerebellum).
spinal cord or different centers of brainstem vert-
ically upwards to the higher centers of cerebellum Principle of Functions
or cerebrum. Descending bundles of fibers are
Various sensory inputs are carried to cerebellum to be
efferent or motor passing down from higher centers
analyzed and to be coordinated or integrated to give
to the spinal cord.
directions for:
2. Horizontal fibers: These are afferent to or efferent
i. Maintenance of equilibrium (by archicerebell-
form cerebellum passing through three cerebellar
um).
peduncles.
ii. Maintenance of muscle tone and postural adjust-
n Gray matter: ment of muscles (by paleocerebellum).
1. Specific collection of nerve cells in a different parts iii. Coordination of muscle movements (by neoce-
of brainstem forming nuclei, e.g. rebellum).
i. In midbrain: Substantia nigra, red nucleus,
tectum. Midbrain
ii. In pons: Pontine nucleus.
iii. In medulla oblongata: Olivary nuclei, nucleus Superior cerebellar
gracilis, nucleus cuneatus, arcuate nucleus. peduncle
2. Reticular nucleus extends throughout whole len- Vermis
gth of brainstem.
3. Nuclei of cranial nerves: Nuclei (motor and sen-
sory) of lower 10 (ten) cranial nerves (3rd12th)
are present at different levels of 3 components of
brainstem.
Globose
Cerebellar
hemisphere
nucleus
nucleus
} Nucleus
Emboliform interpositus
Dentate nucleus
Inferior vermis
}
ii. Emboliform nucleus
looks like worm.
Nucleus Interpositions
b) Two lateral extensions: Cerebellar hemisphe-
iii. Globose nucleus
res. iv. Fastigial nucleus
Surface of both vermis as well as cerebellar hemi-
spheres show parallel fissures. Primary fissures Forebrain (prosencephalon) (Fig. 2.18)
divide cerebellum into lobes. Secondary fissures divide
It is the largest component of brain and subdivided into:
lobes into smaller units called lobules. Almost all the
1. Telencephalon: It is right and left lateral exte-
lobules have vermis as well as corresponding lateral nsion. Both jointly giving the appearance of a
extensions. Tertiary fissures in each lobule demarcate sphere called cerebrum. Each half, right or left
adjacent narrow linear leaf-like components known as half of sphere (cerebrum) is hemispherical called
Folia. cerebral hemisphere.
2. Diencephalon: It is the central component of fore-
Fundamental Structure
brain which forms 5 components of thalamus.
Outer or peripheral portion of cerebellum is made up Components of diencephalon is not visible in int-
of gray matter known as cerebellar cortex. Cortical act brain as it is overhung from either side by
gray matter is thrown into narrow, linear leaf-like cerebral hemispheres (Fig. 2.18). Diencephalon is
parallel pleats called folia. Inner central portion is the inferomedial portion of forebrain.
Thalamus
Diencephalon
{ Hypothalamus
A B
Superolateral surface Medial surface
Inferior surface C
Central sulcus
Parietal lobe
Frontal lobe
Parietooccipital sulcus
Frontal pole
Occipital lobe
Occipital pole
Temporal pole
Lateral sulcus
Temporal lobe
A
Insula
Figs 2.20A and B Lobes, poles, surfaces and borders of cerebral hemisphere A. Lobes and poles of cerebral hemisphere, B. Surfaces and
borders of cerebral hemisphere
A Association fibers
B Commissural fibers
C Projection fibers
Figs 2.21A to C Fibers of white matter of cerebrum A. Association fibers, B. Commissural fibers, C. Projection fibers
l Basal Ganglia (Fig. 2.22): These are collections ii. Claustrum Medial part: Globus pallidus
of gray matter deeply-seated inside white core of iii. Lentiform nucleus
cerebrum. These masses of gray matter are traversed iv. Caudate nucleus Lateral part: Putamen
by fine myelinated nerve fibers which give a striated Phylogenetically, corpus striatum (basal ganglia)
appearance. That is why they are known as Corpus are divided into
Striatum. i. Archistriatum: Amygdaloid nucleus and clau-
Basal ganglia are composed of followings: strum
i. Amygdaloid nucleus ii. Paleostriatum: Globus pallidus
Lateral ventricle
Caudate nucleus
Stria terminalis Caudate nucleus
Thalamostriate vein Claustrum
Third ventricle
Insula (central lobe)
Thalamus
Lentiform nucleus
Hypothalamus
Amygdaloid body
Fig. 2.22 Coronal section of cerebral hemisphere showing Telencephalon composed of cortical gray matter central white matter,
basal ganglia and ventricles, with diencephalon
32
Nervous System in Brief
Corpus callosum
Fornix
Caudate nucleus
Stria terminalis
Thalamostriate vein
Thalamus
Third ventricle
Hypothalamus
iii. Neostriatum: Putamen and caudate nucleus. 1. Forebrain: 2. Telencephalon 1st and 2nd
Different components of basal ganglia form a spe- (cavity dilated) ventricles
cific functioning system in brain called extrapyramidal (Both called
system which has following functions: lateral ventricle)
1. It has regulatory effect on tone of voluntary mu- Diencephalon 3rd ventricle
scles. (cavity: Narrow
2. During a desired voluntary movements, extrapy- midline cleft)
ramidal system inhibits unwanted movements of 2. Midbrain: Cavity is a narrow Aqueduct of
voluntary muscles and improves quality of motor linear slit Sylvius
functions.
Cavity of cerebral hemisphere (Figs 2.23 and 2.24): 3. Hindbrain: Cavity dilated 4th ventricle
Cavity of cerebral hemisphere (telencephalon) are 4. Spinal cord: Narrow slit
wide and usually bilaterally symmetrical. They are throughout whole
named lateral ventricle of brain. Right and left lateral length of
ventricles being the most proximal are considered as
spinal cord Central Canal
1st and 2nd ventricles. Both these ventricles comm-
unicate through aperture (interventricular foramen) Diencephalon
with the midline cavity of diencephalon called third
ventricle of brain. Diencephalon is the central or midline component of
It is the time now to notice that cavity of central forebrain. On both sides, from superolateral aspect,
nervous system is of different nature and different diencephalon is overlapped and hidden by cerebral
name in different levels as follows (Fig. 2.24): hemispheres (telencephalon).
}
Anterior horn
Central part
Interventricular foramen Posterior horn of Lateral ventricle
Third ventricle
Aqueduct of midbrain Inferior horn
Fourth ventricle
Thalamus
Metathalamus
Epithalamus
} Dorsal
diencephalon
Hypothalamic
sulcus
Midbrain
Subthalamus
Hypothalamus } Ventral
diencephalon
Lemniscus
Thalamic nucleus
Thalamus
Skin
Ascending (afferent)
tract
Spinal cord
Pseudounipolar primary
sensory neuron
A (mixed) spinal nerve
Sensory nucleus of
cranial nerve
Motor nucleus of
cranial nerve
BRAIN
3. A mixed nerve
Fig. 2.26B A cranial nerve may be motor, sensory or mixed unlike spinal nerve which is always mixed in composition
A pair of spinal nerve comes out through surface Cranial nerves V, VII, IX, X Mixed
of each of 31 segments of spinal cord. So number of Again, Ist (olfactory) and IInd (optic) cranial nerves,
spinal nerves are 31 pairs. carrying special sense of smell and vision respectively,
All spinal nerves are mixed nerve but not all the are attached to the forebrain, but other 10 pairs of cranial
cranial nerves: nerves come out from the surface of brainstem. Unlike
All the spinal nerves are mixed nerves as they are the spinal nerves, separate motor and sensory roots of
made up of both motor as well as sensory roots. Motor some of mixed cranial nerves (V, VII) are attached close
and sensory roots of spinal nerve are attached to different to each other at the surface of brainstem.
sites of surface of spinal cord called anterolateral sulcus
and posterolateral sulcus respectively. Peripheral Nerve Forming Plexus (Networks)
Out of 12 pair of cranial nerves some are sensory,
(Fig. 2.27)
some are motor whereas some of these are mixed
nerves as follows: Adjacent spinal nerves in different regions, except
Cranial Nerves I, II, VIII Sensory 3rd thoracic to 11th thoracic intercommunicate with
Cranial Nerves III, IV, VI, XI, XII Motor each other in different regions (upper cervical, lower
C5
Anterior division U
Lateral cord
C6
M
Posterior cord C7
Posterior
divisions C8
L
Medial cord
Anterior division T1
Fig. 2.27 Peripheral spinal nerves forming plexus. C5 C8 and T1 spinal nerves, through formation of brachial plexus, supply upper limb
(through various nerves derived from lateral, posterior and medial cords)
37
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Umbilicus
T10 Dermatome
Overlapping of T11 T11 Dermatome
dermatome in the area
of T10 dermatome
Fig. 2.28 Belt of skin (Dermatome) supplied by sensory component of peripheral nerve
Perineurium
Endoneurium (interstitial
connective tissue between
nerve fibers)
Fasciculi
3. Endoneurium: It is not present in the form of she- 2. Somatic efferent (motor): These fibers carry
ath. A nerve fasciculus enclosed by perineurium impulse (command) from central nervous system
is composed of number of nerve fibers. Interstitial (brain and spinal cord) to the skeletal muscles
tissue inbetween nerve fibers inside a fasciculus is (effector organs).
called endoneurium. It is made up of very delicate 3. Visceral afferent (sensory): These fibers carry
loose connective tissue. impulse (sensory inputs or information) from viscera,
Apart from the connective tissue related to a peri- like sense of pain, pressure, distension, stretch.
pheral nerve classified as above individual nerve fibers 4. Visceral efferent (motor): These fibers carry
which are myelinated are covered by myelin sheath. impulse (command) from central nervous system
(brain and spinal cord) to
Types of Nerve Fibers in a Peripheral Nerve i. Smooth (involuntary) muscles of viscera.
ii. Smooth (involuntary) muscles of cardiovascular
I. According to thickness so also velocity of conduction: channels.
Thickness Velocity of iii. Arrectores pili muscles (involuntary) of skin.
Type Example iv. Exocrine glands.
(diameter) conduction
Out of the above mentioned fibers visceral afferent
1. Type A 1.5 22 4 120 i. Motor neurons
(thickest, microns meters/sec supplying skeletal and visceral efferent fibers are fibers of autonomic
fastest and (voluntary) nervous system which are made up of sympathetic
myelinated) muscles and parasympathetic components.
ii. Most of the Somatic afferent and visceral afferent fibers enter
sensory neurons. through the same route of sensory nerve (cranial as
2. Type B 1.5 3 3 15 Preganglionic well as spinal), but relay in different groups of neurons
(medium in microns meters/sec autonomic nerve
thickness fibers
in central nervous system (brain and spinal cord).
and as well Again somatic efferent and visceral efferent fibers
as conduction come out through the same route of motor nerve
speed and (cranial and spinal). But somatic efferent fibers end
myelinated) directly to the target organs (effector organs) which
3. Type C 0.1 2 0.5 4 i. Postganglionic are voluntary muscles, and visceral efferent fibers
(thinnest with microns meters/sec automonic nerve reach the target organs (involuntary muscles or
minimum fibers
conduction ii. Autonomic exocrine glands) after a relay in postganglionic neu-
speed and afferent (sensory) rons thus forming autonomic ganglion (singular
non- fibers from viscera ganglia) (Fig. 2.30B).
myelinated) iii. Somatic Additional functional components of fibers in
afferent (sensory)
cranial nerves: During intrauterine life, six pairs of
fibers from
skin and muscles mesodermal bars develop winding primitive phar-
ynx from its dorsolateral aspect. These are called
Type AFibers are further classified as follows: pharyngeal (branchial) arches. 5th branchial arch gets
Type AMotor fiber Alpha, Beta and Gamma degenerated finally. Some muscles in the region of head
Type ASensory fibers Types I, II, III. and neck are developed from mesoderm of 5 (1st4th
II. According to area distribution (Figs 2.30A and B) and 6th) branchial arches. These muscles are voluntary
1. Somatic afferent (sensory): These fibers carry muscles but not somatic muscles. Some of cranial
impulse (sensory inputs or informations) from nerves contain fibers which supply these branchial
skin, muscles, tendons and joints. arch muscle called branchial efferent component. These
39
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Posterior root
Somatic receptor ganglion
Somatic
afferent fiber
Somatic
efferent fiber
Somatic effector
Posterior root
Autonomic receptor ganglion
Visceral
afferent fiber
Autonomic
ganglion
Visceral
efferent fiber
Autonomic effector
B
Figs 2.30A and B Types of nerve fibers in peripheral nerve. A. Somatic fibers, B. Autonomic fibers
fibers of cranial nerves are also called special visceral 5. Special visceral afferent: Fibers carrying taste
efferent component. In this connection, it is to be noted sensation.
here that, some special senses like taste (gustatory 6. Special visceral efferent (branchial efferent):
sensation) is carried from viscera like tongue, part of
Fibers supplying (voluntary) muscles developed
pharyngeal wall and soft palate. Sensory fibers of some
from branchial arch mesoderm of 1st to 4th and
cranial nerves carrying this (taste) sensation are called
special visceral afferent component. 6th arches.
So, in addition to the previously mentioned four For more clear concept about functional components
components of a peripheral spinal nerve, some of of peripheral nerve, reader is suggested to go through
cranial nerves may contain following types of fibers. the chapters of spinal cord and brainstem.
40
Nervous System in Brief
Peripheral Nerve Injury (Figs 2.31A and B) of nerve fiber towards the cell body which also
shows degenerative changes. This is known as
When a peripheral nerve is injured and cut, nerve
Retrograde or Wallerian degeneration. This so
fiber (neuronal process) may be divided into two
called after the name of Waller who first noticed
segments. The two segments are as follows:
the degenerative changes of nerve fiber.
1. Proximal: This is connected to cell body of neuron,
This degeneration process starts within 48 hours
known as proximal stump.
of nerve injury.
2. Distal: This is known as distal stump.
Following nerve injury, both the proximal as well Degenerative changes of fibers of proximal stump
as distal stump of nerve fibers undergo degeneration.
The cell body also gets degenerated along with Disintegrated myelin sheath is converted into lipid
proximal stump. droplets.
Axonal process
regrows
All axonal sprouts Schwann cells
B except one disappear proliferate
Figs 2.31A and B Degeneration and regeneration of neuron. A. Process of degeneration, B. Process of regeneration
41
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
iii. Fragmentation of Nissl bodies This is called Cellular Components of Peripheral Nervous
chromatolysis. System (Figs 2.30A and B)
iv. Neurofilaments are broken down.
In the pathway of peripheral nervous system, apart
Degenerative changes of distal stump from the peripheral nerves, there are groups or
clusters of neurons, which are called ganglia (singular
This is called anterograde degeneration. This occurs ganglion).
immediately after injury. The degenerative process is There are two different types of ganglia. Though
same as that of proximal stump fibers. both are commonly termed Ganglia structurally they
are different.
Regeneration of nerve fiber
During degeneration process of a nerve fiber, follo-
Sensory Root Ganglia
wing peripheral nerve injury, myelin sheath gets In peripheral nervous system, outside the central
disintegrated. But the endoneurium and neurolem- nervous system, these are collections of cell bodies of
mal sheath of proximal stump remain intact. That first order of sensory neurons in the afferent (sensory)
is why chance of regeneration of proximal stump pathway which form sensory component of peripheral
of nerve fiber with cell body remains alive. But in nerves (cranial and spinal nerves).
no case distal stump gets regenerated, unless and
until it is surgically connected with the proximal Sensory root ganglia of sensory components of
stump. In central nervous system, nerve fibers do not some cranial nerves
regenerate, because they are devoid of endoneurium.
These are cell bodies of 1st order of neurons present
Steps of regeneration in sensory components of cranial nerves (Fig. 2.26B)
which may be either purely sensory nerves or sensory
1. Many Schwann cells undergo proliferation at the component of a mixed nerves.
site of injury. The ganglia are as follows:
2. Some of the Schwann cells undergo changes to
macrophages which take out the tissue debris as No. and name of Type of nerve Name of the ganglia
well as lipid droplets formed by disintegration of cranial nerves (mixed or sensory)
myelin sheath. Vth Trigeminal Mixed Semilunar ganglia
3. Neuronal body return to its original nature and VIIth Facial Mixed Geniculate ganglia
shape. Its nucleus again come back to the central VIIIth Vestibu- Sensory Spiral ganglia and
position. locochlear vestibular ganglia
4. Terminal end of proximal stump presents knob- IXth Glosso- Mixed Superior and inferior
pharyngeal ganglia
like appearance from where number of sprouts
Xth Vagus Mixed Superior and inferior
come out. ganglia
5. One of the sprouts is elongated and others dis-
appear. Cells of these ganglia are mostly bipolar. Peripheral
process carries impulse from peripherally situated
6. The elongated sprouts it ensheathed by many of
sensory end organs towards the cell body. The central
the proliferating Schwann cells which thus form
process carries impulse from the cell body towards
new myelin sheath.
the central nervous system (brainstem).
Regeneration of nerve fiber occur at a speed of
1mm per day. Complete regeneration may need a
Posterior root ganglia of spinal nerves (Figs 2.26A
period of 36 months.
and 2.30)
Regeneration of a nerve fiber is arrested due to
following reasons: These are cell bodies of 1st order of neurons carrying
1. If endoneurium is not intact. sensory impulse towards the spinal cord. The ganglia
2. If the distance between the two cut segments of are attached to the dorsal (posterior) root of spinal
nerve fibers is more than 3 cm. nerve close to spinal cord. The neurons are pseudo-
3. If nerve growth factor does not act. unipolar in nature whose single process bifurcates
4. If the site of injury is infected. It is important to in Tshaped manner into peripheral and central
note here that leprosy bacillus travels beneath the process. The peripheral limb acting as dendrite carr-
endoneurium in retrogate direction and damage ies impulse from peripherally situated sensory end
the Schwann cells, thus disintegrating myelin organs (receptors). The central limb of Tshaped proc-
sheath causes infective nerve injury. ess carries impulse towards central nervous system.
42
Nervous System in Brief
It is important to note that these sensory neurons system end in a relay stations, from where another
of both cranial as well as spinal nerves are of two neuron (postganglionic) starts to reach the target
types. Some carry somatic sensations from skin, organs (involuntary muscles or exocrine glands).
muscles, tendons, joints. Some of them carry visceral These synaptic junctions with postganglionic cell
sensation forming sensory component of autonomic bodies are called autonomic ganglia. These ganglia
nervous system.
may be large and enclosed by connective tissue
The sensory ganglia are covered by connective tis-
sue capsule. Inside the ganglia, cell body of each of capsule. Again it may be small and situated in the
the neurons is enclosed by capsular or satellite cells network of autonomic nerves.
all around. These cells protect the neurons and also These autonomic ganglia lying in the peripheral
provide nutrition to them lying between neurons and nervous system are, therefore, relay stations as well
blood capillaries. as collections of cell bodies of second order (post-
ganglionic) of autonomic neurons.
Autonomic Ganglia (Fig. 2.30B) Between central nervous system and target organs,
In case of somatic neurons (cranial as well as spinal), relative position of sympathetic and parasympathetic
motor fibers coming out of central nervous system end autonomic ganglia vary. Sympathetic ganglia are more
directly to the target organs (voluntary muscles). In close to the central nervous system. Parasympathetic
case of both sympathetic as well as parasympathetic ganglia are away from central nervous system, so
components of autonomic nervous system, motor more close to the target organs (involuntary muscles
(efferent) fibers, after coming out of central nervous or exocrine glands).
43
Peripheral End Organs
3
By this time it is well-understood that a peripheral End organs at the terminal ends of sensory nerve
nerve is composed of nerve fibers. These nerve fibers fibers which receive sensory informations or inputs
may be motor or sensory in nature. Sensory fibers, are called receptors.
forming a sensory nerve, carry informations (input) End organs at terminal ends of motor nerve fibers
through its peripheral or terminal endings from which are to produce effect in the form of contraction
the periphery of body. The peripheral ends of these of muscles or secretion of exocrine glands, are called
sensory nerve fibers present specialized structure effectors.
to receive sensory inputs due to change in the
environment. Again a motor nerve is made up of nerve RECEPTORS
fibers which carry impulse (directions or command)
from central nervous system to the peripheral target Receptors are specialized structures at the terminal
organs (muscles or exocrine glands) for an effect. So, ends of sensory nerve fibers which are distributed
peripheral or terminal ends of motor nerve fibers peripherally to receive sensory informations (inputs)
come in close contact with target organs (muscles due to change in the environment (stimulus).
or exocrine glands). These sites of contact present
specialized structures. Anatomical Classification of Receptors
These specialized terminal endings of both sensory Fundamentally, receptors are classified as
as well as motor nerve fibers are called end organs l Exteroceptors.
(Fig. 3.1). l Proprioceptors.
l Interoceptors.
Exteroceptors
These receptors are distributed superficially in the
Receptor Sensory nerve Central nervous system
layers of skin and subcutaneous tissue. Exteroceptors
are stimulated by external stimulus liketouch, pres-
Effector Motor nerve Central nervous system sure, pain by mechanical or chemical trauma and
alteration of temperature. These receptors are more
accurately called general exteroceptors.
Exteroceptors for perception of sense of smell
(olfactory), vision (visual), hearing (acoustic) and
Fig. 3.1 Peripheral end organs (receptor and effector) taste (gustatory) are called special exteroceptors.
Peripheral End Organs
Proprioceptors distension, compression, etc. These sensations are
carried through autonomic sensory nerves. The
When a joint moves due to contraction of a muscle or a
sensory end organs in the wall of viscera from where
group of muscles, we can feel it. This is called sense of
these sensations are carried, are called interoceptors.
movements. Again, due to contraction of muscle, when
So, receptors are classified through following
a part of body is stretched or adjusted, we can also
table:
feel it. This is called sense of position. These feelings
In this chapter, general receptors (general exter-
or perceptions are because of impulse that are carried
oceptors and general proprioceptors) are described.
through chain of sensory neurons from concerned part
of periphery of body to central nervous system. The For special receptors, the reader is to consult the
informations are carried from peripheral end organs chapters of respective sensory pathways.
located in muscles, tendons and joints. These sensory General exteroceptors
end organs are called general proprioceptors.
Specialized receptors are located in specialized These receptors located in skin and subcutaneous
site of internal (innermost) ear, whose function is tissue are subdivided into two groups
related to perception and maintenance of balance 1. Nonencapsulated.
or equilibrium of body. These are called special 2. Encapsulated.
proprioceptors. Impulse is carried through vestibular Nonencapsulated receptors (Fig. 3.2)
component of vestibulocochlear nerve (eighth cranial
These receptors do not present any specialized struc-
nerve).
tures made up of modified cells of the tissue. These
are free endings of sensory nerve fibers in different
Interoceptors
forms which directly come in contact with tissue-cell
Both exteroceptors as well as proprioceptors, defined or intercellular spaces.
above, are related to endings of somatic sensory nerves, Types of nonencapsulated receptors:
thus carry sensations called somatic sensations. 1. Free nerve endings: These nerve fibers may be
There are various sensations carried from viscera. myelinated or nonmyelinated. But finally ends
These are sense of pain (due to ischemia), stretch, of the fibers loose myelin sheath. Apart from the
Epidermis
{
Dermis
End bulb of
krause
End bulb of
Meissners corpuscle Pacinian corpuscle Ruffini
skin, these receptors are also located in cornea, for example palm of hand, sole of foot, external
periosteum of bone and root of teeth. In skin, these genitalia, nipple and eyelids.
free nerve endings come in contact with basal cells Meissners corpuscles are oval in shape and pre-
of epidermis or with collagen fibers of dermis. sent a capsule surrounding a central core made up of
Mostly, they carry pain sensation. But they may be modified Schwann cells. At the center of the corpuscle
stimulated by touch, pressure as well as temperature. schwann cells are intermingled with free nerve
2. Hair follicle receptors: These are also free endings.
nerve endings, but in different forms. Terminal These receptors gives a special tactile power to the
unmyelinated ends of nerve fibers form a spiral skin. Because of their function, a person is able to feel
two points of skin touched close to each other. This is
arrangement around the root of hair follicles below
called power of two point discrimination.
the position of sebaceous gland.
2. Pacinian corpuscles: Pacinian corpuscles are
These receptors are stimulated initially when largest in size, widely distributed in the body, oval
the hair is bent. But so long hair remains bent, the in shape being about 2mm in measurement.
receptors remain silent. When hair is released, a They lie in dermis of skin and subcutaneous tissue,
second burst of stimulation occurs. being most abundant in palm, sole, breast. Apart from
3. Merkel disks: These are also called Tactile Dis- the skin, these are also found in the structures related
ks of Merkel. In this cases free nerve endings to joints, e.g. capsules, ligaments, synovial membrane.
present small disk-shaped endings which come in Firm pressure stimulates these receptors.
contact with specialized dark cells in the basal or The oval corpuscles are 2mm in length and 0.5mm
deeper part of epidermis of skin. These cells are in diameter. Structurally it is made up of:
called Merkel cells. i. Outermost capsule.
These receptors are located in nonhairy skin. ii. Inside the capsule, the central core is formed
Stimulation of these receptors makes a person aw- by concentric layers of flattened cells.
are of degree of pressure exerted while touching an iii. A large myelinated sensory nerve fiber pierces
object. one pole of the corpuscle, looses its myelin
sheath. The naked nerve fiber traverses the
Encapsulated receptors (Fig. 3.3) center of central core of flattened cells and end
These receptors present outer connective tissue cap- in a small swollen terminal.
sule surrounding a central core inside which lies the Though pacinian corpuscle is known as pressure
free nerve ending. They are found in different size receptor, it is also sensitive to vibration.
and shape. 3. End bulbs: These are so called because they are
1. Meissners corpuscles: These are the receptors bulbous and, spherical or fusiform in appearance
for touch and that is why called Tactile Corpuscles at the end of nerve terminal. They are of following
of Meissner. They are present in dermal papillae types:
of skin and are mostly found in the skin of those a) End Bulb of Ruffini: They are fusiform in outline
parts of body which are very sensitive to touch, and present in the dermis of skin. Capsule of
46
Peripheral End Organs
Sensory nerve
Neuromuscular spindle
(Intrafusal fiber)
Neurotendinous spindle
(Golgi tendon organ)
Fig. 3.4 Proprioceptive sensory end organs in skeletal muscle and its tendon
these receptors is cellular in nature and central and position of voluntary muscles. Central nervous
core is made up of fine collagen fibers. Each system uses this information for control of activity of
corpuscle presents multiple large unmyelinated voluntary muscles.
nerve fibers ending within the center of colla- Neuromuscular spindle is a fusiform or spindle-
gen fibers. They are stretch receptors and stim- shaped organ whose long-axis is parallel to the length
ulated when skin is stretched. of a muscle. Length of this end organ varies from
b) End Bulb of Krause: These are spherical in 14 mm. It is enclosed by a connective tissue capsule.
outline. The capsule is made up of cells as well Inside the capsule of this fusiform organ, units of this
as fibers. The nerve fiber, after piercing the sensory receptors are situated. These are specialized
capsule, presents a club-shaped appearance at muscle fibers called intrafusal fibers. In contrast to
the central core of the bulb. these intrafusal fibers (inside the spindle), usual
Though these end organs are enlisted here, these muscle fibers (myocytes) of voluntary muscle, outside
are not universally accepted as receptors. These are the spindle, are called extrafusal fibers which are
considered by many as degenerating or regenerating effector in nature (Fig. 3.5).
nerve terminal rather than a receptor. The intrafusal fibers of neuromuscular spindle are
of following two types
General proprioceptors 1. Nuclear bag fibers.
These are deep-seated receptors present in the mus- 2. Nuclear chain fibers.
cles, tendons and joints. These receptors are Both these types of fibers are specialized muscle
1. Muscle Spindle or Neuromuscular Spindle: These fibers. Their long-axis are parallel to the length of the
sensory end organs are present in muscles. spindle. Their number in a spindle varies from 614.
2. Golgi Tendon Organ or Neurotendinous Spindle: Each of them presents a central part (equatorial
The receptors are present in tendons. part) and two terminal ends. Fundamentally term-
3. Proprioception sensation is also carried from inal ends of both these fibers present transverse
joint structures like: Capsule, ligaments and striations of voluntary muscles and are contractile
synovial membrane. These receptors are Pacinian in nature. Central or equatorial part lacks striation
corpuscles which have been already discussed. property and present accumulation of many nuclei
(Figs 3.6 and 3.7).
Neuromuscular spindle (Fig. 3.4)
n Nuclear bag fibers: Equatorial part of these
Neuromuscular spindles are also known as muscle fibers presents spherical sac which is filled up with
spindles. These are sensory end organs present in nuclei. Length of nuclear bag fiber is more. Their ends
voluntary muscles. They are more abundant in number project beyond the capsule and are fixed through their
in the muscle close to its junction with tendons. These attachment to connective tissue of extrafusal fibers.
receptors, on stimulation, send information to the n Nuclear chain fibers: Structurally these differ
central nervous system regarding state of contraction from nuclear bag fibers. These are shorter in length
47
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Intrafusal fibers
{ Nuclear chain fiber
Central equatorial
parts containing
nuclei
Extrafusal fibers
Terminal striated
contractile parts
Capsule of neuromascular
spindle
Fig. 3.5 Neuromuscular spindle composed of intrafusal fibers, and its relation with extrafusal fibers
and uniform in breath althrough. But the equatorial proprioceptive sensory end organs, intrafusal fibers
part presents collection of nuclei in the form of rows inside the spindle act as both receptor as well as
or chains. effector. Equatorial or central noncontractile part acts
Both intrafusal fibers are receptor as well as as receptors and terminal cross striated, contractile
effector organs It is important to notice at this parts act as effectors, which receive sensory and
stage that, though the neuromuscular spindle are motor nerve fibers respectively.
Higher centers
Basal ganglia
Reticular formation
Cerebellum
2.
Axon of gamma neuron innervates
terminal contractile parts of intrafusal
fibers
3. Stretching of both ends of nuclear bag
type of intrafusal fiber stimulates central
noncontractile part
Fig. 3.6 Illustration to explain mode of function of neuromuscular spindle (nuclear bag fiber)
48
Peripheral End Organs
n Mode of function of neuromuscular spindle Even when a muscle is in a resting stage, in
(Figs 3.6 and 3.7): It is understood that central unnoticed (subconscious) state of an individual, motor
(equatorial) nonstriated as well as noncontractile part impulse is carried from higher centers (Figs 3.6 and
of both nuclear bag and nuclear chain type intrafusal 3.7) of brain, e.g. basal ganglion, cerebellum, reticular
fibers are receptor of voluntary muscle. From receptors formations to the gamma motor neurons of spinal cord
proprioceptive sensations are carried by sensory root through descending motor fiber tracts (Figs 3.6 and
of spinal nerves to the spinal cord. The terminal 3.7). Impulse pass via axons of gamma neurons to both
contractile parts of both type of intrafusal fibers receive the contractile ends of intrafusal fibers. When both the
efferent (motor) nerves which are axons of small-sized ends are contracted, central noncontractile receptor
(less than 25 microns) gamma motor neurons of gray part (proprioceptor) gets stretched and so stimulated.
mattter of spinal cord. Again extrafusal fibers, lying Sensory impulse is carried from here through afferent
outside neuromuscular spindle, are supplied by axons (sensory) roots of spinal nerve to the gray matter of
of large sized (more than 25 microns) alpha motor spinal cord where it forms synapse with alpha motor
neurons of spinal cord gray matter. neurons. Stimulation of alpha neurons helps to keep
It is very important as well as interesting to note the extrafusal fibers so the whole voluntary muscle
at this stage that functions of the neuromuscular in a partially contracted stage (in resting condition)
spindle proprioceptors is interrelated to the function which maintains thus the tone of the muscle.
of contractile terminal parts of intrafusal fibers supp- n Neuromuscular spindle acting for stretch
lied by gamma motor neurons as well as function of reflex: In reference to the above stages of functions,
extrafusal fibers supplied by alpha motor neurons. even if the influence of higher centers of brain, e.g.
Higher centers
Basal ganglia
Reticular formation
Cerebellum
Fig. 3.7 Illustration to explain mode of function of neuromuscular spindle (nuclear chain fiber)
49
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
basal ganglia, cerebellum or reticular formation is not muscle presents neuromuscular spindle (intrafusal
there to stimulate gamma neuron so the intrafusal fibers) and also extrafusal fibers. A tendon contains
fibers, stretching of the voluntary muscle, causing Golgi tendon organs or neurotendinous spindles.
elongation of intrafusal fibers at their ends will These are receptors present in tendon. Increase in
stimulate the central receptor part. Sensory impulse tension of a muscle also causes increase in tension of
will be carried to the spinal cord via afferent nerve tendon which stimulates the neurotendinous spindles.
which will synapse with motor neurons supplying
Afferent (sensory) impulse is carried through sensory
extrafusal fibers at the spinal cord segement level.
nerve root of spinal nerve to reach the spinal cord.
This is called stretch reflex.
Afferent nerve form synaptic reflex arc with alpha
Neurotendinous spindles (Golgi tendon organ) Fig. 3.4 neuron through an intermediate (internuncial) neur-
on. Alpha neuron ends in extrafusal fibers which
These are fusiform or spindle-shaped proprioceptive remain in a contracted state through stimulation
receptors present in the tendons of voluntary muscle.
of alpha neurons. But when impulse is carried
They are situated in the muscle-tendon close to its
through internuncial neurons to alpha neuron, these
junction with fleshy belly. These receptors send
information to the central nervous system to make an internuncial neuron produces inhibitory effect to
individual aware of the state of tension of a muscle- alpha neuron, being inhibitory in nature. Result is
tendon. the release of tension of the muscle.
Like neuromuscular spindle, neurotendinous spin-
dles are also fusiform in outline and covered by a General proprioceptors in relation to joints
connective tissue capsule. But it is filled with parallel These sensory end organs are situated in the substance
bundles of collagen fibers along long axis of the spindle.
of capsule, ligaments and synovial membranes of
Fibroblasts are larger and more in number in between
joints. Sense of position of joints and sense of their
the bundles of collagen fibers. The myelinated nerve
pierces the capsule, looses its myelin sheath and movements are detected when these receptors are
divides into finer branches which end in knob-like stimulated. Moreover sense of stretch, pressure and
endings in between the collagen fibers. When these pain are also carried due to stimulation of these
fibers are stretched due to tension of a tendon, these receptors.
knob-like endings are squeezed and thus carry the n Types: These are of following four types
impulse. l Type I: These are nothing but Ruffini endings
n Mode of Function of Neurotendinous Spindle structurally. They carry sense of position and
(Fig. 3.8): A tendon is continuation of a muscle. A movement of the joint.
Fig. 3.8 Illustration explaining mode of action of neurotendinous spindle (Golgi tendon organ)
50
Peripheral End Organs
l Type II: Structurally these are Pacinian corpu- 6. Osmoreceptors: They are stimulated by change
scles. They carry the sense of pressure. of osmotic pressure in the tissue.
l Type III: These are neurotendinous organ or
Golgi tendon organ. As found in tendons, these Structural Classification (Fig. 3.9)
are present in ligaments. Due to stretching of
In general we know that receptors are specialized
ligament these carry inhibitory impulse through
cells present in the peripheral tissue from where start
internuncial neurons of spinal cord, these prevents the sensory neurons to carry the impulse.
excessive movements of voluntary muscle. These afferent (sensory) neurons carry impulse to
l Type IV: These are free nerve endings which carry the central nervous system. Variation in this usual
pain sensations from synovial membrane. structural pattern divides receptors in three different
types. In first variety the specialized cells are
RECEPTORS OTHER WAYS OF CLASSIFICATION epithelial cell. So the receptors are called epithelial
receptors (1). Majority of the receptors are examples of
this type. Sometimes, these specialized cells forming
According to Nature of Stimulation receptors are modified neurons which are present in
1. Mechanoreceptors: These are stimulated by mec- the epithelial lining, as are the bipolar neurons in the
hanical deformation, i.e. Receptors which carry epithelial linings of nose, carrying sensation of smell
(olfactory sensation). These are called neuroepithelial
sense of
receptors (2). In third variety, no specialized cells are
i. Touch, pressure and stretch
present to be defined as receptors. In this case, free
ii. Sense of hearing Through sound waves nerve endings of peripheral dendritic processes of first
iii. Sense of body balance (equilibrium). order of sensory neurons themselves act as receptors.
2. Thermoreceptors: These are stimulated by cha- Examples are nonencapsulated exteroceptors (cutan-
nge of temperature in the environment surround- eous receptors). These are named as neuronal rece-
ing them. ptors (3).
i. Rise of temperature Heat
ii. Fall of temperature Cold. MOTOR END ORGANS (EFFECTORS)
3. Chemoreceptors: These are stimulated by chem-
ical change in their environment. Effectors are the specialized junctional areas where
i. Receptors for taste terminal ends of motor nerve fibers come in contact
ii. Receptors for smell. with effector organs. These effector organs are of
4. Nociceptors: These receptors are stimulated due following three types
to injury or damage in the tissue. Due to stimulation 1. Somatic effectors: These are skeletal muscle
of these receptor, unpleasant sensations are felt fibers (myocytes) which receive terminal ends of
like-pain, irritation or discomfort. somatic motor nerve fibers. These specialized sites
5. Photoreceptors: They are stimulated only by are known as somatic neuromuscular or myon-
light causing perception of vision. Example eural junctions.
Receptors in retina of eyeball called rods and cones 2. Visceral effectors: These are smooth muscle
cells. fibers (myocytes) which receive terminal ends of
Each of the somatic (skeletal) muscle fibers gets variety, axon terminal runs along the length of muscle
direct contact with endings of motor nerve fibers fiber. While running along, it divides, into series of
for innervation. This site of contact is called neuro- short branches which end into knob-like endings on
muscular junction or myoneural junction. the surface of muscle fiber.
These muscle fibers are of two types n C. Trail endings (Fig. 3.11B): In this type, axon
i. Extrafusal fibers: Which receive endings of terminal run along the length of muscle fibers and
alpha neuron end in multiple finer endings.
ii. Intrafusal fibers: Which receive endings of En Grappe and trail endings are found in
gamma neuron. It has already been studied intrafusal fibers of muscle spindles.
Axon of a motor
Axon terminal neuron
Noncontractile equatorial
part containing nuclei
Striated
contractile part
Figs 3.11A and B Neuromuscular junction of intrafusal fibers. A. En-grappe endings, B. Trail endings
MOTOR UNIT (FIGS 3.12A AND B) 2. Small: When one axonal process supplies less
number of muscle fibers (10 in number), as found
A motor unit is defined as a single alpha motor neuron in small muscles of hand for finer movements.
and number of skeletal muscle fibers (extrafusal
fibers) innervated by it. So composition of a motor Neuromuscular Junction or Myoneural
unit is as follows: Junction
i. A motor neuron cell body in central nervous It is called motor end plate which is defined as
system (alpha neuron). specialized junction between terminal end of one of the
ii. Its axonal process coming out as motor nerve divisions of axon of a motor neuron (neural element)
fiber. and a skeletal muscle fiber (muscular element).
iii. Number of muscle fibers (myocytes) innervated A motor nerve enters inside a skeletal muscle
by a single axon. along with its blood vessels for innervation through a
Depending upon the number of muscle fibers supp- point called neurovascular hilum. Inside the muscle,
lied by a single motor neuron, a motor unit may be of the nerve divides further into number of axons. One
two types axonal process divides into number of branches. Each
1. Large: When one axonal process supplies more of these branches of axon presents a terminal knob-
number of muscle fibers, as many as(!) 500, as like endings (telodendria). This terminal swelling
found in coarse muscle for gross movements, like comes in contact with a gutter or depression on mi-
Gluteus maximus (muscle of buttock). ddle of surface of a single muscle fiber (myocyte).
53
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Figs 3.12A and B Motor unit. A. Large motor unit, B. Small motor unit
This junctional area is called motor end plate Synaptic knob at the terminal end of division of axonal
(neuromuscular junction or myoneural junction). process is swollen because axoplasm is crowded here
with
Structure of motor end plate (Fig. 3.13) i. Many mitochondria.
ii. Large number of electron-dense, membrane
Motor end plate presents structural characteristics bound vesicles called presynaptic vesicles.
similar to that of a typical synaptic junction between These vesicles are filled with Acetylcholine
two neurons. Structure of motor end plate shows follo- which acts as neurotransmitters.
wing 3 components. At the site of motor end plate, sole plate is
1. Neural element: It is the terminal, nonmyel- characterized by a surface elevation which is at the
inated, swollen end of the division of axon of middle of the muscle fiber. This elevation is due to
motor neuron (Telodendria). It is called synaptic condensation of sarcoplasm (cytoplasm of muscle
knob. fiber) which shows granular appearance beneath the
2. Muscular element: It is the central, raised sur- sarcolemma (cell membrane of muscle fiber). This area
face of a muscle fiber with a gutter which comes also presents accumulation of more number of nuclei,
in contact with synaptic knob. This is called sole mitochondria, Golgi apparatus and endoplasmic
plate. reticulum.
3. Synaptic cleft: It is the gap between neural and The raised surface of sole plate presents a
muscular element measuring 3040 mili micron or depression called primary cleft which is related to
nanometer. axon terminal. But, as already mentioned, axolemma
54
Peripheral End Organs
Axolemma
Myelin sheath
Presynaptic vesicle
Synaptic cleft Synaptic knob
Receptor
Mitochondria
Nucleus
Myofilaments
(cell membrane of axon) at the site of axon terminal muscle spasm, function of this drug can be utilized.
is separated by synaptic cleft from primary cleft of It becomes possible because the drug binds with
sole plate covered by sarcolemma. Surface of primary the receptors at postsynaptic membrane, thus not
cleft is thrown into number of foldings to increase the allowing acetylcholine to come in contact with the
surface area. These are called secondary cleft. Bottom receptors to result depolarization for generation of
(floor) of the secondary cleft presents specialized action potential.
features called receptors.
Myasthenia Gravis an Autoimmune Disease
Mechanism of neuromuscular transmission
Myasthenia gravis is an autoimmune disease which is
When the nerve impulse reaches axon terminal at characterized by generalized muscular weakness and
the site of neuromuscular junction, Acetylcholine muscular fatigue. Muscles of eye, face, respiration
is released from presynaptic vesicles into the syn- and swallowing are mostly affected. This disorder
aptic cleft through a process called exocytosis. Rele-
is due to formation of an antibody. This antibody
ased Acetylcholine diffuses at a high speed through
binds with many (not all) of the receptors which are
synaptic cleft and binds with the receptors at the
thereby destroyed. So acetylcholine finds less number
secondary cleft of postsynaptic membrane of sole
plate. The receptors get activated. Activation of of receptors at postsynaptic membrane to bind for
receptors causes depolarization of postsynaptic mem- generation of action potential. This disorder can be
brane which results in muscular contraction due to compensated by administration of a drug named neo-
generation of action potential. stigmine which posseses anticholinesterase activity
Contraction of a muscle fiber (so also the whole which prevents breakdown of acetylcholine at the
muscle) is to be followed by relaxation. This becomes synaptic cleft.
possible because, as soon as depolarization occurs
to cause contraction of muscle fiber, Acetylcholine Myoneural junction of smooth muscle
is broken down (hydrolyzed) by the enzyme cholin- This does not show classical structure of neuro-
esterase into choline and acetic acid. This enzyme is muscular junction or motor end plate. Axon terminal
bound to both pre as well as postsynaptic membrane. does not come in contact with surface of muscle fiber.
Choline is reutilized back into the axoplasm for re- Rather, there is considerable gap between the two.
synthesis of acetylcholine. Terminal segment of axon is nonmyelinated and may
be covered by cytoplasm of Schwann cells. At the
Neuromuscular Blocking Agent terminal end axoplasm presents vesicles containing
Tubocurarine is a drug which blocks neuromuscular neurotransmitter. In case of parasympathetic nerve
transmission. In clinical conditions causing violent ending neurotransmitter is acetylcholine, but in
55
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Epithelium
lining acini of
exocrine gland
Myoepithelial
cell
Axon terminal
Secretomotor
nerve axon
Fig. 3.14 Secretomotor nerve endings supplying myoepithelial cells related to acini of exocrine gland
56
Spinal Cord
4
DEFINITION AND SITUATION n Termination: Spinal cord terminates as a coni-
cal end known as conus medullaris at the level of
Spinal cord is the distal, narrow, cylindrical and intervertebral disk between first and second lumbar
elongated part of central nervous system which is vertebrae. A connective tissue filaments known as Fil-
situated in upper two-thirds of vertebral canal as a um terminale extends from conus medullaris down-
continuation of medulla oblongata of hindbrain (Fig. wards to be attached to the back of first piece of coccyx.
4.1).
IMPORTANT NOTES IN CONNECTION WITH
ROLE OF SPINAL CORD AS A PART OF CENTRAL TERMINATION
NERVOUS SYSTEM
Upto third month of intrauterine life, rate of growth of
1. It provides innervation (nerve impulse) to the
body wall so also the vertebral column is coextensive
trunk and limbs through its peripheral outflow
known as spinal nerves. with that of spinal cord. Subsequently vertebral
2. It receives sensory information from the receptors column with the trunk grows at a rapid rate than
distributed peripherally in the trunk and limbs spinal cord, when appears the disparity in length of
and transmits to the brain. the two. At birth spinal cord is found to extend upto
3. It contains cell groups at some levels (not thro- lower border of body of third lumbar vertebra.
ughout whole length of spinal cord) which form In 40% cases of adult, spinal cord extends upto the
spinal autonomic centers (sympathetic and para- level of lower border of second lumbar vertebra or the
sympathetic) to send impulses to the autonomic disk between second and third lumbar vertebra. On
effector organs (smooth muscles and exocrine
rare occasions, spinal cord terminates at the level of
glands) and to receive sensory information from
the visceral wall. lower border of twelfth thoracic vertebra.
4. It forms local circuit (at its segmental level) kno- The knowledge of termination of spinal cord is
wn as reflex arc which regulates some bodily important for the clinicians to avoid injury to the spinal
functions at unconscious level. cord during lumbar puncture to take out cerebro-
spinal fluid.
EXTENT
PARAMETERS OF SPINAL CORD
n Beginning: Spinal cord begins as continuation of
medulla oblongata beyond foramen magnum at the l Length: 45 cm
level of upper border of 1st cervical vertebra (atlas). l Weight: 30 gm
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Medulla oblongata
Spinomedullary junction
Cervical part
Thoracic part
Spinal cord
Lumbar part
Cauda equina
Sacral part
1 Coccygeal
segment
Conus medullaris
Filum terminale
Fig. 4.1 Spinal cord (lateral view)the distal, narrow, elongated and tubular part of central nervous system
A spinal nerve
Fig. 4.2 Segments of spinal cord (left lateral view) showing ventral and dorsal roots of spinal nerves coming out through corresponding
sulcus
(afferent) root. Attachment of ventral roots forms a come out through sacral hiatus. To adjust the disparity
fine and shallow anterolateral sulcus and similarly of numbers of cervical spinal cord segments (8) and
posterolateral sulcus is defined along the line of atta- cervical vertebra (7), cervical spinal nerves (1st to 7th)
chment of dorsal nerve roots. Dorsal nerve roots, come out above the pedicles of corresponding vertebra
close to the site of surface attachment present a small and 8th cervical nerve comes out below the pedicle of 7th
enlargement known as posterior root ganglion which cervical vertebra, through the intervertebral foramen
contains the cell bodies of first order of sensory neurons between 7th cervical and 1st thoracic vertebra.
located outside the central nervous systems (Fig. 4.2). As the spinal cord is shorter in length than the
vertebral column, lower spinal nerves (lumbar, sacral
EXIT OF SPINAL NERVES FROM VERTEBRAL FORAMEN and coccygeal) are to descend through the vertebral
canal in the form of a bunch to reach corresponding
All the spinal nerves come out of vertebral canal intervertebral foramen. These bunch of nerves are
through the corresponding intervertebral foramina known as cauda equina as they look like a horses
except fifth sacral nerve and coccygeal nerve which tail (Fig. 4.3).
Conus medullaris
Filum terminale
Fig. 4.3 Lower spinal nerves form cauda equina before they come out through corresponding intervertebral foramina at a lower level
59
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Key to remember level of
2 enlargement
3
Cervical enlargement
(C3T2 Segments)
Lumbosacral enlargement
(L1S3 Segments)
1 3
Key to remember level of
enlargement
Spinal nerve
Lateral anterior
spinal vein
Anterolateral sulcus with exit of
anterior root of spinal nerve and
presence of anterior spinal vein
Anterior spinal artery
with corresponding
vein in anterior median
fissure
Subarachnoid sheath
Spinal nerve
Dura
Meninges
of spinal
cord
{ mater
Arachnoid
mater
Pia mater
Intervertebral foramen
L1
Conus medullaris of
spinal cord
L2
Subarachnoid space
L3
Lumbar vertebrae
Lumbar puncture needle inserted
L4 between L3 and L4 spine
L5
Interspinous and
supraspinous ligaments
S1
S2
Sacrum
S3
Dura and arachnoid ending at the
S4 level of lower border of S2 vertebra
S5
Fig. 4.7 Distal part of vertebral canal in sagittal section and prominent spinal subarachnoid space with illustration for site of lumbar puncture
62
Spinal Cord
Lumbar Puncture (Spinal Tap) layer of fibroreticular tissue into which is embedded
network of fine blood vessels. Spinal pia mater
Various diseases of spinal cord so also whole central
presents following special features.
nervous system may cause abnormal increase in
n Filum terminale: It is a thin, white, delicate and
normally freely flowing quantity of cerebrospinal
fluid or may cause change of physical, biochemical or shining thread-like structure which extends vertically
microscopical characteristics of cerebrospinal fluid. In downwards from conus medullaris of spinal cord. Its
these cases for diagnosis and treatment of the disease, lower end is attached to the dorsal aspect of first piece
cerebrospinal fluid (CSF) may be required to be drawn of coccyx.
out from lumbar cistern below the termination of Length 20cm
spinal cord. Again some drugs may be required to be Structural composition: It is mainly composed
injected into the spinal subarachnoid space (lumbar of nonnervous pial connective tissue. But its upper
cistern) for treatment of some neurological disease or end also contains nervous element. It is supposed to
for induction of (spinal) anesthesia. This procedure is be rudiments of 2nd, 3rd and 4th coccygeal nerve.
known as lumbar puncture (spinal tap). Central canal of spinal cord extends beyond conus
medullaris for about 5mm in the upper end of filum
Anatomical Guidelines for Lumbar Puncture terminale, which is called terminal ventricle.
(Fig. 4.7) Parts: Spinal dura and arachnoid end at the level
l Site: Puncture (introduction of needle cannula to of 2nd sacral vertebra. But filum terminale extends
draw fluid) is done through the interspinous space from L1/L2 vertebra to 1st piece of coccyx. That is why
of vertebral column. it is divided into following two parts.
l Level: Spinal cord normally extends upto the level 1. Filum terminale internum: It is proximal 15cm
of intervertebral disk between 1st and 2nd lumbar lying inside subarachnoid space.
vertebrae. On rare occasion it may extend lower 2. Filum terminale externum: It is distal 5mm which
down upto 2nd lumbar vertebra. Ideal level for is beyond S2 vertebra.
puncture is the space between 3rd and 4th lumbar n Linea splendens: It is condensation of pia mater
spines. along the anterior median line of spinal cord, where it
l How to locate the levels of lumbar spines: Trans- dips into anterior median fissure.
cristal line is the line passing through the level of n Subarachnoid septum: It is a thin fenestrated
highest point of both iliac crests. It passes through pial septum along the posterior median line of spinal
the level of 4th lumbar spine which will help to cord extending from posterior median sulcus to deep
locate the interspinous space between 3rd and 4th surface of arachnoid mater.
lumbar spines. n Ligamentum denticulatum: This is a bilateral
l Position of body: Trunk of the body so also the
pial septum extending throughout whole length of
vertebral column must be ventrally flexed either
in lateral lying down position in bed or in sitting spinal cord in between lines of attachment of ventral
position to achieve two advantages. and dorsal nerve roots. Lateral margin of ligamentum
i. Interspinous space becomes wider. denticulatum is ragged and presents 21 tooth like
ii. Lower end of spinal cord is raised slightly pointed projections. First pair is situated above the
upwards. margin of foramen magnum of skull. Last pair is
longer and oblique. It is attached at the level of conus
Knowledge of Planes of Puncture medullaris and descends obliquerly downwards and
laterally between twelfth thoracic and first lumbar
During introduction of the needle-cannula, gentle nerves.
and uniform (sustained) pressure is to be applied.
After supraspinous and interspinous ligaments, and
tough layer of dura mater are penetrated, suddenly a INTERNAL STRUCTURE OF SPINAL CORD
loss of resistance is felt. It confirms that needle has n Embryological background: Knowledge of internal
reached the subarachnoid space. At this stage patient
structure of spinal cord is based on fundamental
may feel tingling root pain as nerve of cauda equina is
concept of its embryological background. Spinal cord
touched by the tip of needle. But it is just for a while
is developed from caudal elongated narrow tubular
as it floats away in the cerebrospinal fluid.
portion of neural tube which is ectodermal in origin.
Pia Mater At 4th week of intrauterine life surface ectoderm
along the midline gets condensed anteroposteriorly
Pia mater is a thin delicate membrane which closely known as neural plate (Fig. 4.8). Neural plate lies
invests the surface of spinal cord. It is made up of fine dorsal to notocord which is related on either side to
63
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Neural plate
Ectoderm
Notochord
Mesoderm
Endoderm
A
Neural groove
Neural crest
Ependyma
Surface
ectoderm Neural tube
Neural crest cells
Proliferating cells
E F
Figs 4.8A to F Illustrating development of spinal cord. A. Embryonic disk (Sectional view), B. Formation of neural plate, C. Formation of
neural groove, D. Formation of neural crest, E. Neural tube lined by single layer neuroectodermal cells, F. Proliferation of neural tube cells
Mantle
layer
(zone)
{ Basal lamina
Mantle zone
Marginal zone
Sensory neurons
developed in alar
lamina
Posterior root
ganglion cells
Spinal nerve
Motor neurons
developed in
basal lamina
will form neurons of spinal cord whose processes will divided into dorsal and ventral groups by two
be elongated to be pushed to the periphery to form parallel cephalocaudal linear grooves on lateral
more peripheral marginal zone. Spongioblasts will wall of ependymal lining called sulcus limitans.
form supporting cells (neuroglia) of larger size known Ventral and dorsal groups of neurons are known
as macroglia (astrocytes and oligodendrocytes). The as Basal and Alar lamina respectively. Neurons
most of the glial cells are pushed to the peripheral of basal lamina will be motor neurons and
marginal zone. Cells bodies of neurons present in
those of alar lamina will form sensory neurons.
the mantle zone showing grayish appearance will
Alar laminae of both sides are apposed towards
form central gray matter of spinal cord. Processes of
neurons (nerve fibers) located in peripheral marginal each other so obliterating dorsal part of central
zone will be myelinated by oligodendrocyte group of canal of spinal cord. Two basal laminae diverge
cells of macroglia. This myelination will give whitish ventrolaterally forming future ventral median
appearance of marginal zone of spinal cord for which fissure of spinal cord.
it is called white matter. The neurons of basal lamina from two different
cell columns as
FORMATION OF DIFFERENT FUNCTIONAL CELL i. Somatic efferent (motor): Medial and close to
GROUPS (FIG. 4.9B) floor plate. The processes of these neurons
will supply voluntary (skeletal) muscles after
1. Cells of ependymal (matrix) layer: As already leaving the spinal cord through ventral root of
stated, these are original cell layer lining central spinal nerve.
canal of spinal cord called ependymal cells. ii. Visceral efferent (motor): Lateral to and away
The cells lined by stereocilia posses absorptive from floor plate. Their processes leave spinal
function. cord also through ventral root of spinal nerve
2. Cells of mantle zone: On either side of midline as preganglionic fibers for involuntary (smo-
the neurons developed from neuroblasts are oth) muscles and exocrine glands.
65
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
The neurons of alar lamina form the following the segments of spinal cord by two roots known as
cell columns. anterior (ventral) and posterior (dorsal) roots. Along
i. Somatic afferent (Sensory): This cell column is the length of spinal cord anterior and posterior roots
medial and close to roof plate. Neurons of this are attached along the lines of anterolateral sulcus
column receive connections from the sensory and posterolateral sulcus respectively. Anterior or
cells outside central nervous system (posterior ventral roots of spinal nerve are outgoing (efferent)
root ganglia cells) carrying somatic sensation fibers of spinal nerve which go to the peripheral target
from peripheral receptors. organs, e.g. muscles or glands. They are called motor
ii. Visceral afferent (Sensory): These neurons or efferent fibers. Posterior or dorsal roots of spinal
form cell column which is lateral to somatic nerve are the incoming (afferent) fibers of spinal nerve
afferent column and away from roof plate. which carry informations from peripheral sensory end
They receive sensory impulse from the wall of organs known as receptors. They are called sensory
viscera via posterior root ganglia cells. or afferent fibers.
Somatic efferent and somatic afferent cell columns All spinal nerves are mixed nerve: It is very clear
of gray matter of spinal cord extend throughout from the above that each of the spinal nerves, either
whole length of spinal cord to be present in all 31 right or left, is composed of outgoing or efferent
segments of spinal cord. Visceral efferent and visceral (motor) and incoming or afferent (sensory) fibers. So
afferent cell columns being close to each other in the all of them are considered as mixed nerve.
intermediate and lateral area of gray matter form It is to be remembered at this stage that, out of
spinal center of autonomic nervous system. 12 pair of cranial nerve, some are mixed like spinal
But these cell groups, unlike somatic centers do not nerve, whereas others are either motor or sensory.
extend throughout all the segments of spinal cord.
Neuronal groups of these columns extending from 1st INTERNAL STRUCTURE OF SPINAL CORD
thoracic (T1) to 2nd lumbar (L2) segments of spinal
cord form sympathetic center and those of second, Internal structure of spinal cord can be understood
third and fourth sacral (S2, S3 and S4) segments through the study of its cross section (Fig. 4.10).
form parasympathetic center of spinal autonomic Cross section of spinal cord shows fundamentally
nervous system. following two components.
Beside the above four groups of neurons developed 1. Central gray matter: This is so called due to
in the mantle zone (gray matter) of spinal cord, some grayish color of cell bodies of neurons. Central
cells are known as interneurons or internuncial zones of gray matter looks like butterfly on cross
neurons which are functionally connecting neurons. section. Roughly it resembles the capital letter
3. Cell of marginal zone(Marcoglia): They are H. Intermediate bar of H represents the body,
supporting cells called marcoglia group of neuroglia whereas wings of butterfly are represented by two
which are astrocytes and oligodendrocytes. Some limbs of the letter.
glial cells are also present in mantle zone. Astro- Basic components of spinal gray matter: Inter-
cytes form connecting link between neurons and mediate part of spinal gray matter is traversed
capillaries for selective transport of nutritive centrally be central canal of spinal cord throughout
substances from capillaries to neurons and prev- its whole length.
enting entry of toxic materials (blood neuron Central canal of spinal cord is lined by ependymal
barrier). cells. The gray matter anterior and posterior to
4. Migrated cells from bloodstream (Microglia): central canal are known as anterior and posterior
Microglia are characterized by letter M. It is gray commissures respectively.
mesodermal in origin, derived from, monocytes Each side of spinal cord gray matter is composed
and migratory in nature to act as macrophages. of following components:
a) Anterior known as anterior horn
b) Intermediate area
PERIPHERAL OUTFLOW OF SPINAL CORD
c) Posterior known as posterior horn.
When considered the whole length of spinal cord,
Spinal Nerves anterior gray horn forms the anterior gray column and
Spinal cord is made up of 31 segments. These segments posterior gray horn forms the posterior gray column.
are numbered regionally as Cervical-8, Thoracic-12, In addition to the above mentioned three comp-
Lumbar-5, Sacral-5 and Coccygeal-1. A pair of nerve onents, first thoracic to second lumbar segments
(right and left) is attached to the surface of each of (T1 L2) of spinal cord gray matter show a lateral
66
Spinal Cord
Posterior median
septum
Posterior funiculus
Posterior gray
commissure
Intermediolateral
gray horn
Lateral funiculus
Anterior white
commissure Anterior gray
commissure
Anterior
funiculus
Anterior median
fissure
projection of intermediate area, which is known as of white matter known as anterior white
intermediolateral cell column. Neurons of this area commissure.
constitute sympathetic center of autonomic nervous b) Lateral funiculus: It is the part of white mat-
system. It is important to note at this stage that spinal ter demarcated between outgoing fibers of
center of parasympathetic nervous system is formed ventral root and incoming fibers of dorsal root
by neurons of intermediate area of second, third and of spinal nerve.
fourth (S2, S3 and S4) sacral segments of spinal cord. c) Posterior funiculus: It is the part of white matter
The different components so also the entire gray between posterior median sulcus and incoming
matter of spinal cord show variations in appearance fibers of dorsal root of spinal nerve attached to
in different regions of spinal cord, because it depends the posterolateral sulcus. Posterior funiculi of
upon the relative amount of nerve cells. Basically gray both sides are separated incompletely or even
matter is proportionately broader in lower cervical completely by posterior median septum.
and lumbosacral regions of spinal cord. The bundles of fibers either ascending (sensory or
2. Peripheral white matter: This is mainly made afferent) or descending (motor or efferent) are called
up of compact bundles of nerve fibers running tracts or fasciculi (Singular-Fasciculus).
vertically either in ascending or in descending It is interesting to note at this stage that posterior
direction.
funiculus is composed of only ascending tracts wher-
These fibers in the bundles are myelinated. The
eas anterior and lateral funiculi are composed of both
lipid-protein substance of myelin sheath of nerve
ascending as well as descending tracts.
fibers is white in color for which this peripheral zone
n Fundamental cell groups of spinal gray matter:
of spinal cord is called white matter.
All neurons of spinal cord are multipolar.
The bundles of ascending fibers carry sensory
Fundamentally the three different zones of spinal
informations to the centers of brain above the level
of spinal cord. The descending bundles carry impulse gray matter are made up of following four different
from higher motor centers of brain (above spinal cord) neuronal groups.
to the motor neurons situated in anterior horn of 1. Posterior horn: Sensory (afferent ) or tract neurons
spinal cord. 2. Anterior horn: Motor (efferent) neurons.
On either side of midline, the white matter is 3. Intermediate area:
composed of following three components called i. Interconnecting neurons (interneurons), and
Funiculi (Singular Funiculus). ii. Parasympathetic neurons at S2, S3 and S4
a) Anterior funiculus: It is the part of white segments only.
matter between anterior median fissure and 4. Intermediolateral area: Sympathetic neurons
anterolateral sulcus presenting outgoing fibe- (only T1 L2 segmetns).
rs of ventral nerve root. Anterior funiculi of Both the sympathetic as well as parasympathetic
two sides are bridged by a thin midline strip areas are composed of motor and sensory neurons.
67
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Somatic afferent neuron
Internuncial neuron
Tract neurons
Visceral afferent neuron
Sensory neuron Primary sensory
neurons
Carrying
somatic
Skin sensation
Carrying
visceral
sensation
Supplying
smooth muscles,
exocrine glands
Supplying
voluntary
muscles
Substantia gelatinosa
of Rolando
Nucleus proprius
Clarkes column (nucl. dorsalis)
Visceral afferent column
Intermediomedial cell column
Intermediolateral cell
(spinal parasympathetic center)
column
(Spinal symp center) Substantia gelatinosa centralis
Retrodorsolateral group
Dorsolateral group Central group
Dorsomedial group
Ventrolateral group
Ventromedial group
Lamina I
Lamina II
Lamina III
Lamina IV
Lamina V
Lamina VI
Lamina VII
Lamina X
Lamina VIII
Ascending tract
Short primary
sensory neuron
Fig. 4.13 Principle of formation of ascending tract as a part of sensory pathway made up of three orders of neuron
72
Spinal Cord
level of spinal cord, e.g. nucleus gracilis and Before further study of ascending tracts, it is impor-
nucleus cuneatus of medulla oblongata. tant to note following points.
Axons of tract neurons of spinal cord and axons 1. Only major ascending tracts from above table are
of long primary sensory neuron, as compact bundles, described below.
carrying one specific type of sensation (exteroceptive 2. All ascending tracts (so also descending tract) are
or proprioceptive), ascend through different funiculi bilateral, and symmetrical in position in both side.
of spinal cord to form ascending tracts. 3. Fibers of adjacent tracts may present overlapping.
Second order neurons are therefore tract neurons 4. Some of the tracts are uncrossed (ipsilateral) and
of spinal cord, or some nuclei above spinal cord, where some are crossed (contralateral). Decussation (cro-
long primary sensory neurons relay. ssing) occurs mostly at the level of spinal cord.
Third order neuron is present in the thalamus Some cross in supraspinal level. For example,
in the form of different nuclei receiving inputs for ventral (anterior) spinocerebellar tract crosses at
the level of midbrain.
different sensations. Axons of third order of neurons
5. Ascending tracts are described below only upto the
finally send projection fibers to sensory areas of
level of their primary destination beyond spinal
cerebral cortex.
cord. Their further course has been mentioned
At this stage, it is important to repeat that ascending
while studied cross section (internal structure) of
tract and sensory pathways are not synonymous different levels of brainstem and forebrain.
term. It is already understood that ascending tract is
a part of sensory pathway. It is further important to Dorsal column (Fig. 4.14)
note that, some of sensory pathway is made up of less
than three neuronal chain, e.g. pathway for spino- Note: Reader must consult the figure while reading.
This is the ascending tract passing through dorsal
cerebellar tract. Again, some are composed of more
white column of spinal cord for which it is so called.
than three orders of neurons, e.g. visual pathway.
Dorsal white column or posterior funiculus is made up
l Classification of ascending tracts on functional
of this ascending tract which is ipsilateral in nature.
basis:
Dorsal column transmits following sensory infor-
A tract, as classified below, may carry either mations.
exteroceptive or proprioceptive sensation. Again one 1. Exteroceptive: Discrimination touch with the
may transmit sensations of both these kinds. help of ability to localize two points touched very
Type of sensation Name of tract closely on the body surface.
2. Proprioceptive: Sense of position and movements
Discriminative touch, i.e. ability Tracts of posterior funiculus,
to localize two points touched very called dorsal column (fasc-
from muscles and joints, and vibration sense.
close to each other on skin, fine iculus gracilis and fascic- Discriminative touch (and pressure also) sensation
touch or light touch, sense of vibr- ulus cuneatus). is carried from peripheral receptors to the spinal cord
ation, sense of position and move- through its posterior nerve root. Primary sensory
-ments carried from muscles and
joints.
neurons carrying this exteroceptive sensation are
called long primary sensory neurons because their
Pain and thermal sensation Lateral spinothalamic tract. axons, i.e. central process of the posterior root ganglia
(heat or cold).
cells, do not form synaptic connection with spinal
Crude touch and pressure. Anterior spinothalamic tract. sensory neurons. They pass vertically upwards
Unconscious information (unconsc- Dorsal (posterior) and ven- through the posterior funiculus to form the dorsal
ious proprioceptive) from muscles, tral (anterior) spinocere- column tract.
tendons, joints and even from sub- bellar tract. Short primary sensory neurons carrying vibration
cutaneous tissue for automatic,
stereotyped postural adjustment sense and sense of position and movements from
of body. muscles and joints relay in tract cell in Clerkes
Pain, thermal and tactile informa- Spinotectal tract to superior
column and other cell group of laminae IV to VI.
tion to the midbrain level for reflex colliculus of tectum of Axons of these second order neuron ascend through
visual response through pathway midbrain. posterior column to take part in formation of dorsal
for spinovisual reflex. column tract along with axons of long primary
Impulse from skin, muscles and Spinoreticular tract sensory neurons carrying discriminative touch (and
joints to reticular nuclei of brain- also pressure to some extent).
stem for awakefulness. So, it is clear from above description that, dorsal
An alternative and indirect Spinoolivary tract (part of column tract is formed by axons of two different kinds
pathway of spinocerebellar tract. spinoolivocerebellar tract). as follows.
73
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Nucleus gracilis
Nucleus cuneatus
Central canal
Fasciculus cuneatus Fasciculus gracilis
Fasciculus cuneatus
Fasciculus gracilis
} = Dorsal column
Posterointermediate
septum demarcating
fasciculus gracilis from
Short primary afferent neuron carrying fasciculus cuneatus
sense of position, movement and
vibration from upper half of body
Fasciculus gracilis
1. Axons of long primary sensory neurons carrying Both kinds of fibers of fasciculus gracilis and fasciculus
sensory impulse for discriminative touch and cuneatus, i.e. axons of long primary sensory neurons as
pressure. well as those of tract neurons of lamina IV to VI, relay
2. Axons of tract neurons from Clarkes column and in nucleus gracilis and nucleus cuneatus in posterior
other sensory neurons of lamina IV to VI carrying part of lower half of medulla oblongata. Posterior
impulse for sense of position and movements and surface of lower half of medulla oblongata presents
also vibration sense. two round bulge known as gracile tubercle and cuneate
Fiber tracts of dorsal column carrying sensory tubercle beneath which lies corresponding nucleus.
impulse from lower half of body (below midthoracic
level), entering through lower group of spinal nerves, Spinocerebellar tracts
are placed in the medial part of posterior funiculus.
It is called fasciculus gracilis. It is superadded by n General consideration: These tracts are two in
similar kind of fiber bundle which enter the spinal number, called ventral (anterior) and dorsal (post-
cord carrying similar sensation from upper half of erior) spinocerebellar tracts.
body (above midthoracic level). These fiber bundles of Instead of going upto sensory area of cerebral
dorsal column ascend through lateral part of posterior cortex via thalamus, they terminate in cerebellar
funiculus lateral to medially placed fasciculus gracilis. cortex.
It is called fasciculus cuneatus. It is demarcated Functions of spinocerebellar tracts are concerned
from fasciculus gracilis by intermediolateral septum. wih coordination of movements.
74
Spinal Cord
Impulse is carried from neuromuscular spindle segment to T1 segment. It receives therefore input
(muscle spindle), neurotendinous spindle (Golgi ten- from the trunk through T1L2 / L3 segmental spinal
don organ) and joint receptors. nerve. It is interesting to note that it also receives
End organs are stimulated due to stretching of inputs from lower limb. Proprioceptive impulse from
muscles and tendons, and movements of the joints. neuromuscular spindle, neurotendinous spindle and
Both the spinocerebellar tracts are situated in joints of lower limbs are carried by dorsal column
the form of narrow strip covering the peripheral (fasciculus gracilis). Reaching upto L2 / L3 segments,
part of lateral funiculus, being anteroposteriorly collaterals are given from dorsal column to relay in
related. Clarkes column of cells of L2/L3 segments.
Both the tracts are ipsilateral. But it is important These collateral are given by the fibers of dorsal
to note that fibers for ventral spinocerebellar tract column carrying impulse from the lower limb
cross at the level of corresponding spinal cord through spinal segment, as they reach the level of
segments. But for the second time the tract crosses as L2/L3 segments. Again above T1 segment, propri-
a whole at the level of midbrain. oceptive sensations from neuromuscular spindle,
Both the tracts are made of myelinated fibers of
large diameter. Ventral spinocerebellar tract also neurotendinous spindle and joint receptors ascends
contains some thin calibered fibers. through fasciculus cuneatus to relay also in accessory
Individual characteristics of either of the tracts cuneate nucleus which is a smaller oval bulge
will be clear from their description below. superolateral to nucleus cuneates. Fibers from this
nucleus reach the cerebellum via cuneocerebellar
Dorsal spinocerebellar tract (Fig. 4.15) tract.
It is formed by axons of Clerkes column of cells.
Ventral spinocerebellar tract (Fig. 4.16)
Therefore this tract start formation and so also starts
ascending from second or third lumbar segment of Ventral (anterior) spinocerebellar tract is formed by
spinal cord. It is also not difficult to understand that axons of tract neurons of lamina V to VII of spinal
dorsal spinocerebellar tract gets formed from L2 / L3 cord in addition to Clarkes column of cells.
Fasciculus gracilis
Dorsal spinocerebellar tract-formed
by axons of Clarkes column of cells
1
2
Collaterals from fasciculus gracilis
Impulse from muscle, tendon conveys inputs from lower limb
and joint receptors carried proprioceptors to Clarkes column
3 of cells axons of which form
through posterior spinal nerve
roots (T1L2 segments) relay in dorsal spinocerebellar tract
Clarkes column of cells
Fasciculus gracilis
These second order neurons, receives information both the spinothalamic tracts, concerned sensory
from muscle, tendon and joint receptors via the impulse pass from respective receptors through prim-
first order neurons, which are primary sensory ary sensory neurons or first order neurons, which are
neurons of posterior root ganglia. In addition, ventral posterior root ganglia cells. Their central process enter
spinocerebellar tract carries sensory information from spinal cord to relay in second order neurons.
skin and subcutaneous tissue also.
These sensation are carried via ventral spino- Lateral spinothalamic tract (Fig. 4.17)
cerebellar tract from trunk as well as upper and lower This tract is positioned in lateral funiculus, medial
limb. to anterior spinocerebellar tract and lateral to ante-
Before the tract is being formed by the axons of rior gray horn and emerging fibers of anterior nerve
lamina V to VII and also Clarkes column of cells, root.
majority of fibers cross the midline along ventral It is formed by axons of tract neurons which are
white commissure of spinal cord, while the minority second order neuron situated in substantia gelatinosa
of fibers remain in same side. Fibers take the position of posterior gray horn. The fibers cross the midline and
over a narrow strip of anterior peripheral part of ascend upwards through lateral funiculus, carrying
lateral funiculus to ascend upwards in front of dorsal therefore sensation from opposite side of body. This
spinocerebellar tract. Fibers of ventral spinocerebellar tract carries pain and temperature sensations.
tract run upwards carrying contralateral fibers,
through the brainstem beyond spinal cord. Reaching Anterior (ventral) spinothalamic tract (Fig. 4.18)
the level of midbrain, fibers cross the midline for second
It is so called because it ascends through anterior
time to reach cerebellar hemisphere of the same side
through superior cerebellar peduncle. white column of spinal cord. It is placed medial to
emerging fibers of ventral root of spinal nerve.
Spinothalamic tracts This tract is formed by axons of tract neurons of all
the sensory laminae of posterior gray horn. Before the
These are two in number, known as lateral and tract is formed, the fibers cross the midline, thereby
anterior (ventral) spinothalamic tracts passing thr- carrying sensation from opposite side of body.
ough lateral and anterior white columns of spinal cord This tract carries coarse (nondiscriminative) touch
respectively. Lateral spinothalamic tract conducts and pressure sensations.
pain and temperature sensations, whereas through Positions of the important ascending tracts,
anterior spinothalamic tract pass sensations of coarse discussed above are shows in both sides of spinal cord
(nondiscriminative) touch and pressure. In cases of are shown in Figure 4.19.
76
Spinal Cord
1. Fasciculus gracilis
Ipsilateral
(uncrossed)
tract { 2. Fasciculus
cuneatus
3. Dorsal
spinocerebellar tract
4. Ventral
Contralateral
(crossed)
tract
{ spinocerebellar tract
5. Lateral
spinothalamic
tract
6. Ventral (anterior)
spinothalamic tract
Medulla oblongata
Fig. 4.20 Corticospinal tract Originating from different areas of motor cortex
Termination of corticospinal tract (Figs 4.21A and B) But it is very important to notice at this stage that,
though anterior corticospinal tract is an uncrossed
While descending through respective funiculus, in
every segment of spinal cord successively, fibers of (ipsilateral) one, in every segment of spinal cord fibers
both the tracts (axons of upper motor neuron) relay in for the respective segment cross the midline through
both alpha and gamma motor neurons (lower motor anterior white commissure and relay in opposite
neurons) of anterior gray column. As the lateral sided motor neurons of spinal cord (Fig. 4.21A and
corticospinal tract is a crossed tract, it is very clear B). So it is not difficult to understand that, ipsilateral
to understand that, it possesses influence on anterior anterior corticospinal tract also possesses influence
horn cell of contralateral side (Fig. 4.21A and B). on contralateral lower motor neurons.
Medulla oblongata
Olive
Pyramid
Fig. 4.21A Both lateral (crossed) and anterior (uncrossed) corticospinal tracts beyond medulla oblongata, and their position in lateral
and anterior white columns of spinal cord respectively
79
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Fig. 4.21B Corticospinal tracts. Lateral corticospinal tract A crossed (contralateral) tract which descends through lateral funiculus.
Anterior corticospinal tract An uncrossed (ipsilateral) tract which descends through anterior funiculus
Corticospinal tracts terminates indirectly through 2. Fibers arising from parietal cortex, i.e. postcentral
interneurons gyrus (area 3, 1, 2) and adjacent parietal area (area
5), projecting on neurons of posterior gray horn,
Most of the fibers of corticospinal tracts terminate
modulate spinal reflex activities and transmission
contralaterally on interneurons of laminae V to VII,
of afferent informations to higher sensory centers.
which finally relay in alpha as well as gamma motor
neurons of lamina IX. Direct termination on motor
Noncorticospinal tract
neurons are mostly found in segments of cervicothoracic
and lumbosacral enlargements of spinal cord. These are the descending tracts which originate
from various centers of brainstem, below the level of
Variations of corticospinal tract cerebral cortex, which are considered as subcortical
centers.
1. Corticospinal fibers may be totally crossed. Like corticospinal tracts, cell of these centers are
2. All the fibers may remain uncrossed in very rare upper motor neurons which project on lower motor
occasion. neurons, i.e. alpha and gamma motor neurons of
spinal cord.
Principle of functions of corticospinal tract These tracts are described below in reference to
1. Fibers arising from primary motor cortex and the following points:
l Origin
premotor cortex (area 4 and 6 respectively), thro-
l Nature, i.e. extent and, crossed or uncrossed
ugh their influence on both alpha and gamma l Localization in spinal cord
motor neurons of spinal cord, facilitate activities l Termination
of extensor group of muscles. They are concerned l Function.
with prcised and skillful movements, particularly,
of distal part of limbs. It is proved by lesions of the RUBROSPINAL TRACT
tract, which very commonly occurs due to cerebro-
vascular accident. It affects mostly the movements n Origin: Central core (tegmentum) of upper
of distal part of limbs with fingers and toes. half of midbrain (at the level of superior colliculus)
80
Spinal Cord
Rostral Aqueduct of midbrain
parvocellular part
Caudal magno-
] Red
nucleus
Red nucleus
cellular part
Ventral tegmental
decussation
Rubrospinal tract
Rubrospinal tract
Fig. 4.22A Rubrospinal tract originates from caudal Fig. 4.22B Fibers of rubrospinal tract originating from red nucleus
magnocellular part of red nucleus cross midline at midbrain to form ventral tegmental decussation
presents a reddish gray colored ovoid mass of nerve Before terminating into alpha and gamma motor
cells, called red nucleus which is divided into rostral neurons of spinal cord, fibers from polysynaptic
parvocellular part made up of smaller neurons and connection via interneurons of laminae V to VII.
caudal magnocellular part made up of larger neurons. n Functions: Functions of rubrospinal tract are
Rubrospinal tract originates from caudal magno- similar to those of corticospinal tract.
cellular part of red nucleus which contains 150200
neurons (Fig. 4.22A). TECTOSPINAL TRACT
n Morphology: In man, rubrospinal tract is rudim-
entary and poorly defined. In animals, it extends upto n Origin: Dorsal part of midbrain, which is behind
lumbosacral segments of spinal cord. aqueduct (central canal) of midbrain, is called Tectum.
l Nature: Rubrospinal tract is a crossed tract. When viewed from behind, tectum is seen to be made
Fibers of this tract cross horizontally, just after their up of one upper and one lower pair of bulges called
origin from red nucleus. It is called ventral tegmental superior and inferior colliculi (Singular-colliculus).
decussation. After decussation fibers descend through
These colliculi are made up of clusters of nerve
central core (tegmentum) of brainstem to reach spinal
cells which are arranged in the form of superficial,
cord (Fig. 4.22B).
n Localization: Fibers of rubrospinal tract are
intermediate and deep layers.
localized in the lateral white column of spinal cord, Tectospinal tract originates from intermediate
just in front of lateral corticospinal tract with which and deep layers of cells of superior colliculus of both
its fibers are intermingled (Fig. 4.23). sides at the upper half of midbrain.
n Termination: Rubrospinal tract extends upto n Nature: Tectospinal tract is crossed tract like
only upper three cervical segments of spinal cord. rubrospinal tract. Fibers of this tract also cross
Fasciculus gracilis
Fasciculus cuneatus
Rubrospinal tract
Ventral spinocerebellar tract Lateral reticulospinal tract
Medial reticulospinal tract
Lateral spinothalamic tract
Anterior corticospinal tract
Fig. 4.23 Cross-section of spinal cord showing ascending (afferent) and descending (effercent) tracts
81
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
horizontally in front of aqueduct of midbrain, in a VESTIBULOSPINAL TRACTS
more posterior plane, just after their origin from
tectum. It is called dorsal tegmental decussation. l They are two in number known as lateral and
After decussation, fibers of this tract descend through medial vestibulospinal tracts.
central core (tegmentum) of brainstem to reach the l Though called lateral and medial, both are present
level of spinal cord. in anterior white column of spinal cord, but latero-
n Localization: Tectospinal tract is localized in
medially positioned.
anterior white column of spinal cord, in front of
l These tracts arise from vestibular nuclear com-
anterior corticospinal tract, just by the side of ventral
plex situated at the lateral angle of floor of
part of anterior median fissure (Fig. 4.23).
fourth ventricle at pontomedullary junction (Fig.
n Termination: Tectospinal tract extends only upto
upper cervical segments of spinal cord. 4.24A).
Before terminating into alpha and gamma motor n Origin (Fig. 4.24B):
neurons of spinal cord, fibers form polysynaptic Lateral vestibulospinal tract from lateral vestib-
connection via interneurons of laminae VI to VIII. ular nucleus.
n Functions: Before the function of tectospinal Medial vestibulospinal tract from
tract is understood, it is to be noted that, this tract i. Medial and inferior vestibular nuclei
forms efferent component of a reflex pathway known ii. Some fibers From lateral nucleus.
as spinovisual reflex. Activity of this pathway is n Nature:
manifested by turning neck with head away when a Lateral uncrossed (ipsilateral)
powerful light falls on retina of eyeball. Medial crossed (contralateral) as well as uncros-
5 components of this reflex pathway are following: sed (ipsilateral).
1. Receptor: Rod and cone cells of retina (photor- Fibers of medial vestibulospinal tract extend upto
eceptors) which are stimulated by light falling
midthoracic level.
on retina.
n Localization: Both the tracts are located in
2. Afferent path: Visual pathway from retina - optic
ventral marginal part of anterior white column
nerve optic chiasma optic tract lateral
geniculate body superior brachium. (Fig. 4.23).
3. Center: Superior colliculus of midbrain which n Termination: Both vestibulospinal tracts term-
receives collaterals from lateral geniculate body inate in alpha as well as gamma motor neurons of
through superior brachium. spinal cord via interneurons of laminae VII and VIII.
4. Efferent path: Tectospinal tract. n Function: Lateral vestibulospinal tract is excitatory
5. Effector: Voluntary muscles of neck. to the spinal motor neurons which supply extensor
Superior colliculus
Inferior colliculus
Vestibular triangle
Cuneate tubercle
Gracile tubercle
Fig. 4.24A Vestibulospinal tract arises from vestibular nuclear complex lying beneath vestibular triangle of floor of 4th ventricle at
pontomedullary junction
82
Spinal Cord
muscles of neck, back and limbs. It is inhibitory to ii. Steering of head and trunk movement in
neurons which supply flexor muscles of limbs. response to external stimulus.
Medial vestibulospinal tract inhibit spinal motor iii. Stereotyped movement of muscles of limbs.
neurons which supply muscles of neck and upper part Lateral reticulospinal tract: It is involved in regu-
of back. lation of:
i. Motor function
ii. Perception of pain sensation.
RETICULOSPINAL TRACT
Reticulospinal tracts are two Medial and lateral. OLIVOSPINAL TRACT
These tracts project from reticular nuclei of brainstem
There is doubt in existence of this tract in man now-
(upper motor neurons) to alpha and gamma motor
adays. It was thought that this tract originates from
neurons (lower motor neurons) of spinal cord either
inferior olivary nucleus and project on motor neurons
directly or through interneurons of laminae VII and
of spinal cord. It was thought to be localized in lateral
VIII. Upper motor neurons for these tract are called
white column of spinal cord.
reticular nuclei because the cells are intermingled
with network (reticulum) of fibers.
HYPOTHALAMOSPINAL TRACT
n Origin:
Medial: From reticular nuclei of pons and medulla It is better to be called hypothalamospinal fibers
oblongata. rather than tract as the fibers do not form compact
Lateral: From reticular nuclei of medulla oblongata. bundle.
n Nature: n Origin: From paraventricular (and some other)
Medial: Crossed as well as uncrossed. nuclei of anterior and posterior half of hypothalamus.
Lateral: Uncrossed. n Nature: Uncrossed (ipsilateral)
n Localization (Fig. 4.23): n Localization: Lateral funiculus of spinal cord.
Medial: Located in anterior white column, medial n Termination:
to base of anterior horn. i. Sympathetic neurons of intermediolateral cell
Lateral: Located in lateral white column, lateral column of T1 to L2 segments of spinal cord.
to base of anterior horn, close to lateral corticospinal ii. Parasympathetic neurons of intermediate area
tract and rubrospinal tract. of S2, S3 and S4 segments of spinal cord.
n Termination: Both the tracts terminate in alpha n Function: Supraspinal control of sympathetic
as well as gamma neurons of anterior horn cells and parasympathetic visceral function.
(Lamina IX) of spinal cord either directly or through
interneurons of laminae VII and VIII. SOLITARIOSPINAL TRACT
n Function:
Medial reticulospinal tract: It is concerned with n Origin: Nucleus tractus solitarius of medulla
i. Postural adjustment oblongata. It is a composite special visceral sensory
83
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
nucleus having parts for VIIth, IXth and Xth cranial fe through the posterolateral part of cord to cut
nerves. It receives sensory fibers of these cranial descending (motor) tracts which are posterior to the
nerves carrying taste sensation from tongue and soft plane of ligamentum denticulatum.
palate.
n Nature: Mostly crossed Knowledge of Termination of Spinal Cord in
n Localization: Clinical Practice
i. Anterior funiculus and
ii. Anterior part of lateral funiculus. Upto 3rd month of fetal life, rate of growth of vertebral
n Termination: column and that of spinal cord are co-extensive. After
i. Anterior horn cells of C3, C4 and C5 segment of 3rd month vertebral column grows more rapidly
spinal cord supplying diaphragm. than spinal cord. That is why, at birth spinal cord is
ii. Anterior horn cells of thoracic segments of found to end at the level of lower border of body of 3rd
spinal cord supplying intercostal muscles. lumbar vertebra. This status remains in infancy. But
n Function: Reflex movements of intercostal mus- finally, spinal cord is found to end at the level of lower
cles and diaphragm on stimulation of nucleus tractus border of body of 1st lumbar vertebra. Sometimes,
solitarius. it may extend upto 2nd lumbar vertebra in case of
adults.
But arachnoid and dura maters extend upto lower
CLINICAL ANATOMY OF SPINAL CORD
border of body of 2nd sacral vertebra. So subarachnoid
space below the level of termination of spinal cord (L1/
Protection of Spinal Cord L2), and above S2 level, is prominent which is filled
Spinal cord, which is part of central nervous system with cerebrospinal fluid where float the fibers of cauda
and, made up of delicate and sensitive nervous tissue, equina. This area of prominent spinal subarachniod
is well-protected by: space is approached from outside through a procedure
1. Vertebral column Inside which, in vertebral called spinal tap or lumbar puncture which helps in
canal, it is lodged. diagnosis and management of some central nervous
2. Spinal meninges Dura, arachnoid and pia system diseases.
maters, mainly dura mater which is toughest,
outermost fibrous membrane. Lumbar Puncture (Spinal Tap) (Fig. 4.7)
3. Cushion of cerebrospinal fluid Inside subarac-
hnoid space. It is the clinical procedure to approach spinal
subarachnoid space below the level of termination of
Factors Holding Spinal Cord in Position spinal cord for following two purposes.
1. Diagnostic: For the purpose of diagnosis of some
1. Spinal nerves (31 pairs), formed by union of ventral diseases of nervous system which is related to
and dorsal roots, come out through intervertebral alteration of character of cerebrospinal fluid, this
foramen. Dural sheath of spinal nerves is attached procedure is adopted to take out the sample of fluid
at the margin of intervertebral foramen. for its physical, chemical/biochemical, microscopic
2. Ligamentum denticulatum One on either side, and bacteriological examination.
with 21 pairs of tooth-like pial projections bind 2. Therapeutic: Instead of withdrawal of cerebro-
lateral surface of spinal cord to the inner surface spinal fluid, some drugs are injected for the
of arachnoid mater. following two purposes:
3. Filum terminale It is the nonnervous filamentous i. Some drugs in the form of anesthetics are
band which ties conus medullaris of spinal cord injected for induction of spinal anesthesia
below to the back of 1st piece of coccyx. before performing surgical operations. There
are some indications where surgeons prefer
Ligamentum Denticulatum A Guide for spinal anesthesia to general anesthesia.
Selective Cordotomy ii. Some drugs are injected through this route for
treatment of some diseases of central nervous
l Anterolateral cordotomy is done to relieve excrut- system.
iating pain. Surgeon passes his knife through
anterolateral part of cord to cut ascending (sensory)
tracts which are anterior to the plane of ligamentum
Where to Perform Lumbar Puncture?
denticulatum. Lumbar puncture needle, specially designed, is
l Posterolateral cordotomy is done to relieve ab- introduced through interspinous space in the back
normal muscular spasm. Surgeon passes his kni- between 3rd and 4th lumbar spine.
84
Spinal Cord
How to Locate L3/L4 Interspinous Space? venous pressure by application of pressure over
internal jugular vein does not cause rise of CSF
It is the space just above L4 spine. To find out the
pressure. This is called positive Queckenstedt sign.
space, L4 spine is located. L4 spine is at the level of a
horizontal plane which passes through highest point
of two iliac crests (transcristal plane).
Lesion of Spinal Nerve Emerging Through
Intervertebral Foramen
How to Perform Lumbar Puncture? Intervertebral foramen is bounded above and below
After taking proper aseptic measures, patient is by the pedicles of two adjacent vertebrae. The
placed in lateral position in bed or upright sitting foramen is bounded anteriorly by intervertebral disk
position and vertebral column is flexed. Two and posteriorly by zygapophyseal joint or facet joint
advantages are enjoyed in flexed position of spine. of articular processes. This foramen transmits spinal
Interspinous space becomes wider and lower end of nerve root formed by union of ventral and dorsal
spinal cord is further elevated above lower border of rami. At this site the spinal nerve may be lesioned
body of L1 vertebra. due to stretching, pressure or edema resulting from
Lumbar puncture needle is introduced through i. Fracture dislocation of vertebra
midline interspinous space between L3 and L4 ii. Osteoarthritis due to inflammation of facet
spines. The tip of the stellate followed by needle is joint or
directed horizontally with slight upward inclination. iii. Herniation of intervertebral disk.
A sustained resistance is felt till the needle crosses Compression of spinal nerve root in the interv-
supraspinous and interspinous ligament and finally ertebral foramen due to above reasons leads to a
it passes through dura mater with arachnoid mater. clinical condition known as root canal pressure (Fig.
n Queckenstedt sign: Normal CSF pressure is 4.25A). Herniation of intervertebral disk causing
60150 mm of water. Pressure applied over internal root canal pressure is not midline but posterolateral.
jugular vein leads to cerebral venous congestion Disruption or tear of annulus fibrosus squeezes out
causing rise of subarachnoid CSF pressure as a the nucleus pulposus to press over spinal nerve root
result of less absorption of CSF through arachnoid (Fig. 4.25B). Common sites of herniation are cervico-
granulations. In case of expanding tumor of spinal thoracic and lumbosacral junction of vertebral column
cord (glioma) or meninges (meningioma), due to where mobile part of vertebral column changes into
blockade of subarachnoid space, even rise of cerebral immobile part.
Pedicle
Fig. 4.25A Spinal nerve is predisposed for compression at intervertebral foramen which may cause root canal pressure
Fig. 4.25B Disruption of annulus fibrosus squeezes out nucleus pulposus of intervertebral disk to press over spinal nerve roots
85
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
n Effect of root canal pressure: Spinal nerve, those muscles which are concerned for skilful
being mixed nerve, when compressed or irritated, voluntary movements of distal part of limbs. Non-
gives rise to motor as well as sensory manifestations. corticospinal tracts control gross, basic voluntary
Motor effect will be painful muscular spasm with movements resulting easy and rapid movements of
weakness of the muscles. Involvement of sensory the joints for maintenance of posture.
fibers ranging from irritation to compression leads to
variable effects like altered sensation (paresthesia) to Muscle Tone
exaggerated sensation (hyperesthesia) with tingling Muscle tone is defined as a state of continuous partial
pain over the belt of skin (dermatome) supplied by the contraction of a muscle which is obviously the result
corresponding segmental nerve. of continuous stimulation of extrafusal fibers. But
n Pyramidal and extrapyramidal tracts two
it is interesting to note that, this effect depends,
reciprocal components of descending (motor) beforehand on impulse received by gamma motor
pathway: Efferent (motor) descending pathway ori- neurons at intrafusal fibers through corticospinal
ginating from different areas of cerebral cortex, e.g. (facilitatory) and noncorticospinal (inhibitory) tra-
primary motor area (area 4), premotor area (area 6) cts. This impulse (facilitatory and inhibitory) from
and even primary sensory area (area 3, 1, 2) project to intrafusal fibers is carried back to spinal cord by
motor neurons (alpha as well as gamma motor neurons) proprioceptive reflex arc with alpha motor neurons
of spinal cord. Thereby this tract is called corticospinal which supply extrafusal fibers.
tract. Before crossing the midline in lower medulla It is interesting to note the following points at this
to relay in lower motor neurons of spinal cord, this stage:
tract passes through the bulge of pyramid of medulla l Normal muscle tone is maintained by balanced
oblongata. That is why it is called pyramidal tract. facilitatory effect of corticospinal tract and inhib-
Other types of descending tracts originating from itory effect of noncorticospinal tract on intrafusal
subcortical centers, various nuclei of brainstem are fibers of muscle spindle through gamma motor
called noncorticospinal tracts. As these tracts are not neurons.
passing through pyramid of medulla oblongata, they l In case of lesions of upper motor neurons or
are called extrapyramidal tracts. descending tracts, patient presents manifestations
Two basic motor activities, namely voluntary which are the effect of combined damage to
movements following contraction of skeletal mus- pyramidal and extrapyramidal tracts.
cles and maintenance of muscle tone are the l Lesions of extrapyramidal (noncorticospinal) tract
result of balanced combined activity of pyramidal leads to release (withdrawal) of inhibitory effect
(corticospinal) and extrapyramidal (noncorticospinal) on gamma motor neurons, which thereby causes
tracts. spasticity due to increase of muscle tone.
SPINAL CORD INJURIES It is the initial phase of blackout faced by spinal cord
following injury of any type causing damage to spinal
Incidence of spinal cord injuries (spinal injuries) cord.
is very common in modern days. These injuries are n Duration: In most of the cases, this phase lasts
catastrophic as there is very little or no chance of for 1 day (24 hours). In some cases, of course, it may
regeneration of damaged neural tissue. It leads to extend upto 1 week to 1 month (4 weeks).
permanent disabilities. n Clinical features: Fundamentally it is charac-
terized by depression or loss of all cord functions
Principles of Management (motor and sensory) below the level of lesion. These
1. Decompression of spinal cord by realignment of are
vertebra fractured and/or dislocated. 1. Flaccid paralysis
2. Stabilization of injured area. 2. Hypotonia or atonia, i.e. loss of muscle tone
3. Rehabilitation. 3. Loss of tendon jerks and reflexes
4. Recently, use of certain drugs, e.g. GM1, Ganglioside 4. Loss of all sensation below the level of lesion
and methylprednisolone, soon after injury results 5. If the lesion is higher level, hypotension (fall
in improvement of neurological deficit. of blood pressure) due to loss of sympathetic
vasomotor control
6. Loss of bladder and bowel function.
Causes of Spinal Cord Lesion
Regeneration of function of cord
1. Traumatic: i) Fracture dislocation of vertebra After the phase of spinal shock is over, partial
ii) Penetrating injury e.g. stab injury, gunshot regeneration of cord function occurs because
injury. i. Neurons, which are not permanently damaged,
2. Vascular: i) Arterial occlusion or compression get back the power of irritability and cond-
causes degeneration of nerve cells and fibers. uctivity.
ii) Venous compression causes edema of neural ii. Edema of the affected neural tissue subsides.
tissue. After the period of spinal shock is over, neurological
3. Infective: Viral or bacterial. impairment (clinically called neurodeficit) is categ-
4. Degenerative: Causing demyelination of nerve orized as following syndromes.
fibers. 1. Complete cord transection syndrome
5. Neoplastic: By expanding tumor. 2. Anterior cord syndrome
88
Spinal Cord
3. Central cord syndrome 2. Panetrating injury Stab injury or gunshot injury.
4. Cord hemisection syndrome (Brown-Squard 3. Expanding tumor.
syndrome).
These syndromes differ from one another depen- Effects
ding upon the area of the segment of spinal cord All motor and sensory impairments will be bilateral
affected. as follows
The clinical findings are combination of following 1. Damage of anterior horn cells (LMN) and emerging
fundamentally motor nerve roots of the segment affected will
1. Lower motor neuron lesion at the level of segment cause bilateral lower motor neuron paralysis of
affected. the muscles supplied by motor nerve roots arising
2. Upper motor neuron lesion below the level of lesion. from the particular segment.
3. Sensory loss below the level of lesion. This paralysis will ultimately will be followed by
Combination of clinical manifestations in any of atrophy of the muscles affected.
the above syndromes will vary according to the level 2. Damage of both sided corticospinal as well as non-
of spinal cord lesion. corticospinal tracts will cause following bilateral
manifestations below the level of lesion.
Complete Cord Transection Syndrome (Fig. i. Spastic paralysis
4.26A) ii. Babinski sign positive
iii. Loss of abdominal and cremesteric reflexes.
3. Damage of all sensory tracts in anterior, lateral
Causes
and posterior funiculi of both sides will cause
1. Fracture dislocation of vertebral column (spinal bilateral loss of all sensations (exteroceptive as
injury). well as proprioceptive) below the level of lesion.
A B
C D
Figs 4.26A to D Various types of spinal cord syndrome. A. Complete cord transection syndrome, B. Anterior cord syndrome, C. Central
cord syndrome, D. Cord hemisection syndrome (Brown-Squard syndrome)
89
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
4. Loss of voluntary control of bladder and bowel segment of spinal cord. Paralysis will be followed
function due to damage of descending autonomic by atrophy of muscles.
fibers. 2. Bilateral spastic paralysis with all features of
upper motor neuron lesion. It is due to damage to
Anterior Cord Syndrome (Fig. 4.26B) both corticospinal and noncorticospinal tracts. It
affects both upper and lower limbs as the lesion is
Causes in the cervical part of cord.
3. Bilateral loss of pain, temperature and pressure
1. Traumatic: i) Fracture dislocation of anterior sensation as lateral and anterior spinothalamic
component of vertebral column ii) Herniation of tracts are affected. The sensory loss is below the
intervertebral disk. level of lesion, which in this type of injury is at
2. Ischemic: Occlusion or compression of anterior cervical level. Though the lesion of central cord
spinal artery which supplies anterior two-third of syndrome is in cervical region, lower limb may
spinal cord. remain unaffected for somatomotor and somato-
Effect sensory loss, because in both motor and sensory
tracts, peripherally placed sacral fibers are spared
Effects are bilateral: (Fig. 4.26C).
1. Damage of anterior horn cell and emerging ante- Though crude touch is affected fine touch is
rior nerve roots will cause lower motor neurons preserved as peripheral parts of fasciculus gracilis
paralysis of the muscle supplied by the segment (from lower half of body) and fasciculus cuneatus
affected. (from upper half of body) remain undamaged. For
The paralysis of the muscle affected will be follo- the same reason, sense of position, movement and
wed by muscular atrophy. vibration is also not affected.
2. Bilateral spastic paralysis below the level of les-
ion due to damage of anterior corticospinal and Brown-Squard Syndrome (Fig. 4.26D) (Cord
various noncorticospinal tracts. hemisection syndrome)
3. Lesion of anterior and lateral spinothalamic tracts
will cause bilateral loss of pain, temperature Cause
(lateral spinothalamic tract) and pressure and light Penetrating injury like gunshot injury or stab injury.
touch (anterior spinothalamic tract) sensation.
Touch is not affected as fine touch and discrim- Effect
inative touch sensation is carried through dorsal
Fundamental difference of this spinal cord injury from
white column (fasciculus gracilis and fasciculus
above mentioned types is that it produces unilateral
cuneatus). Due to same reason, sense of position and
effects which are as follows.
movements, and vibration sensation are also not lost.
1. Ipsilateral lower motor neuron paralysis of the
muscles which are supplied by the lesioned spinal
Central Cord Syndrome (Fig. 4.26C) cord segment. It is caused due to injury to the
anterior horn cells and emerging anterior nerve
Cause root of the particular segment. The paralysis is
Severe hyperextension of cervical part of vertebral followed by muscular atrophy.
column (called hyperextension injury) which occurs 2. Ipsilateral loss of all cutaneous sensations (an-
esthesia) over the dermatome supplied by the
due to violent force applied to the back of neck in
incoming sensory nerve root of the affected
automobile accident.
segment. Initially this area of dermatome may
In this type of injury, central part of spinal cord
present hyperesthesia (exaggerated sensation)
is compressed by vertebral bodies and ligamentum due to irritation of posterior nerve root.
flavum from front and back respectively. 3. Ipsilateral spastic paralysis due to lesion of
same sided corticospinal and noncorticospinal
Effect
tracts passing through lateral and anterior white
All the manifestations as explained below are bilateral. column. Paralysis is below the level of lesion.
As this lesion occurs classically in cervical region, Depending upon the level of lesion, clinical
both motor and sensory loss involve both upper and finding may include Babinski sign positive, loss of
lower parts of body. abdominal and cremesteric reflexes, exaggerated
1. Lesion of anterior horn cells causes lower motor tendon jerks.
neuron lesion manifested by paralysis of the 4. Ipsilateral loss of fine as well as discriminative
muscles which are innervated by that particular touch (exteroceptive sensation) and sense of
90
Spinal Cord
position, movement with vibration sensation ischemic or neoplastic origin. Various infective or
(proprioceptive sensation) are manifested due to degenerative causes may give rise to selective lesion
lesion of dorsal white column tracts (fasciculus of different motor and/or sensory tracts, upper or
gracilis and fasciculus cuneatus). Sensory loss is lower motor neurons which are as follows.
below the level of lesion.
5. Contralateral loss of pain and temperature (lateral Tabes Dorsalis A Sensory Lesion (Fig. 4.27A)
spinothalamic tract) and pressure sensation (ante- It is a neurological disease caused by syphilis when
rior spinothalamic tract) is observed below the central nervous system is affected (neurosyphilis).
level of lesion. It damages selectively the posterior white column
Touch sensation is not affected as crude touch (fasciculus gracilis and fasciculus cuneatus) and
of the same side and fine touch of opposite side are also posterior nerve root fibers entering dorsal
preserved due to noninvolvement of opposite half of column. Commonly thoracic and lumbosacral segm-
spinal cord. ents are affected.
A Tabes dorsalis
B Anterior poliomyelitis
C Syringomyelia
Figs 4.27A to E Various types of selective lesions of spinal cord. A. Tabes dorsalis, B. Anterior poliomyelitis, C. Syringomyelia,
D. Multiple sclerosis, E. Amyotrophic lateral sclerosis
91
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
1. Loss of sense of position and movement, and loss are affected. At the site of lesion cavitation followed
of vibration sensation. by gliosis gives rise to following clinical findings.
2. As the patient is not aware of position of limbs 1. Before formation of lateral spinothalamic tract,
while walking, the limbs strike against the ground fibers carrying sensation from opposite side of
causing stumping gait. Patient tries to compensate body, decussate in front of central canal in the
this disability with the help of vision. anterior gray and white commissures of the seg-
3. If visual help is withdrawn by closure of eyes, in ments commonly affected (lower cervical and
standing position, due to loss of sense of position, upper thoracic). Cavitation of central canal causes
patient will have a tendency to fall. It is known as damage to these fibers causing loss of pain and
positive Romberg sign. temperature sensation over skin of neck, upper
4. Loss of sensation of fullness of urinary bladder, as limb and upper part of trunk. Area of anesthesia
this sensory pathway traverses dorsal column. simulates area of body covered by a jacket. That is
Due to lesion of posterior nerve root fibers
why it is called Jacket type of anesthesia.
5. Loss of exteroceptive sensation over the dermatome
2. Dilatation of central canal (in lower cervical
areas of skin opposite the segments of spinal cord
and upper thoracic segments) starts from C8T1
affected.
segments of spinal cord and proceeds upwards as
Due to irritation of dorsal nerve root ganglia
well as downwards. So initially dilatation is maxi-
6. Paresthesia (altered sensation) or hyperesthesia
(exaggerated sensation) with stabbing pain sen- mum at C8T1 segments for which at these two
sation of the dermatome areas corresponding to segments lesion extends peripherally to damage
affected spinal cord segments. anterior horn cell which causes paralysis of small
muscles of hand followed by muscular atrophy.
Poliomyelitis Acute Viral Infection of Spinal Subsequently other muscle of upper limb are also
paralyzed.
Motor Neurons (LMN) (Fig. 4.27B)
3. If excavation of central canal progresses further
It is the neuronal disease caused by poliovirus which laterally, it will damage corticospinal and noncort-
cause selective damage to the motor neurons of icospinal tracts leading to spastic paralysis with
anterior gray column of spinal cord and motor nuclei exaggerated tendon jerks of both lower limbs, i.e.
of cranial nerves supplying muscles of face, tongue, below the level of lesion.
larynx and pharynx.
Worldwide immunization program by poliovac- Multiple Sclerosis A Demyelinating Disease
cine remarkably reduced the horror of incidence of (Fig. 4.27D)
the disease among children.
The viral infection is characterized by edema It is a degenerative disease of spinal cord caused by
of neural tissue with selective damage of anterior demyelination of both descending as well as ascen-
horn cells (LMN). It causes paralysis with wasting ding tracts. Following are the cause alone or in
of muscles. Lower limb is more affected than upper combination
limb. If motor nuclei of cranial nerves are affected, it 1. Heredity
causes paralysis of muscles of face, tongue, pharynx 2. Autoimmunity
and larynx. In severe poliomyelitis, respiratory mus- 3. Infection.
cles (diaphragm and intercostal muscles) may be Young adult age groups are affected. Because of
paralyzed. above mentioned predisposing factors, functioning of
Patient recovers from disease when edema sub- blood brain barrier looses it integrity. It will cause more
sides and motor neurons regain power. Permanent chance of infection which will lead to entry of leukocytes
death of some neurons is characterized by residual
in central nervous system tissue. Inflammation will
paralysis.
cause loss of myelin sheath (demyelination) of tract
fibers of spinal cord. Demyelination will cause initial
Syringomyelia A Lesion of Embryological
reduction and ultimate loss of velocity of action
Cause (Fig. 4.27C) potential of tract fibers.
Syringomyelia is a degenerative lesion of spinal cord During active phase of the disease following
characterized by excavation (dilatation) of central demyelination, the patient present impaired sens-
canal of some segments of spinal cord due to some ation, weakness of muscle at different levels depending
developmental reason. Usually cervicothoracic (lower upon level of spinal cord affected. There may be signs
cervical and upper thoracic) segments of spinal cord of ataxia as tracts of the cerebellum is affected.
92
Spinal Cord
The disease is characterized by Recovery and the level of lesion. It is associated with damage to
Recurrence. Recovery is due to remodeling of plasma anterior horn cells causing lower motor neuron lesion
membrane of demyelinated axons which become able of the muscles supplied by the affected segment.
to regenerate velocity of action potential. The disease turns to a fatal state within 5 to 6
But in unfortunate cases of progressive type of the years.
disease, instead of recovery, loss of myelin sheath is
followed by permanent damage of the axons. Combined Degeneration of Spinal Cord In
Pernicious Anemia
Amyotrophic Lateral Sclerosis A Progressive
Pernicious anemia, a type of megaloblastic anemia is
Degenerative Disease (Fig. 4.27E)
caused due to vitamin B12 deficiency. The disease is
It is a progressive degenerative disease of unknown associated with combined degeneration of descending
cause victimizing middle-aged people. It damages (motor) and ascending (sensory) tracts of spinal cord
selectively the corticospinal and noncorticospinal due to lesion of posterior and lateral white column. It
descending tracts causing spastic paralysis below is characterized by widespread motor and sensory less.
93
Brainstem
5
Brainstem is the tubular stalk-like part of the brain which is formed by posterosuperior surface of basilar
made up of midbrain, pons and medulla oblongata parts of sphenoid and occipital bones.
from above downward (Fig. 5.1). It is so called beca- n With tentorium cerebelli: Tentorium cerebelli
use it is like stem of a tree. Main mass of the brain, is a crescentic horizontal shelf of dura mater of brain
cerebrum with cerebellum rests on the brainstem and lying between posterior part of cerebrum (occipital
through it, is connected to spinal cord below. Long lobe) and cerebellum. It posseses peripheral convex
axis of brainstem is oblique, directed downward and border. In front of concave anterior border (tentorial
backward. notch), brainstem passes downwards. Midbrain is the
n Extent: Above, upper end of brainstem (midbrain)
supratentorial part and, pons with medulla oblongata
is continuous with diencephalon of forebrain.
is the infratentorial part of brainstem lying above and
n Below: Lower end of brainstem (medulla oblon-
below the tentorium cerebelli respectively (Fig. 5.2).
gata) passes out of cranial cavity through foramen
n With cerebrum and cerebellum: Cerebrum
magnum to become continuous with spinal cord at the
level of upper border of first cervical vertebra. with thalamus (diencephalon) is above and, cerebe-
llum is behind the brainstem. Ventral compact part
Relations of Brainstem
n With cranial cavity: Brainstem lies in posterior
Supratentorial
cranial fossa of skull and rests on the slope of clivus part of
brainstem
Tentorium
cerebelli
Midbrain
Infratentorial
Pons part of
brainstem
Medulla oblongata
Fig. 5.3 Cerebellum and peduncles (cerebral as well as cerebellar) related to brainstem
of midbrain, composed of bundle of descending l Pons and upper part of medulla oblongata: A wide
fibers connects the brainstem (midbrain) above with tent shaped space forming cavity of hindbrain
cerebrum. It is called cerebral peduncle having right called fourth ventricle of brain.
and left identical halves. Cerebellum is connected to l Lower part of medulla oblongata: A narrow central
midbrain, pons and medulla oblongata of brainstem by canal of medulla continuous below with central
three pairs of compact bundle of white matter. These canal of spinal cord.
are called superior, middle and inferior cerebellar
peduncles respectively (Fig. 5.3). Structural and Functional Characteristics
n With fourth ventricle of brain: Fourth ventricle
is the cavity of hindbrain. It is related anteriorly Intermingling of gray matter and white matter
to pons and medulla oblongata and posteriorly to
cerebellum (Fig. 5.4). Brainstem is the part of central nervous system where
gray matter and white matter are not demarcated
into two separate zones. Unlike spinal cord, it is not
Cavity Related to Brainstem
divided into central gray matter and peripheral white
Cavity related to brainstem is of different shapes and matter. Again, unlike cerebrum and cerebellum it
natures at different level as follows: does not show superficial cortex and deeper medullary
l Midbrain A narrow linear slit known as aqueduct substance. Brainstem presents intermingling of gray
of Sylvius. matter and white matter.
Aqueduct of Sylvius
Cerebral peduncle
Basilar sulcus
Inferior colliculus
Cuneate tubercle
Vagal triangle
Gracile tubercle
front winding round posterolateral aspect superior run vertically upwards along the length of basilar
cerebellar peduncle (Fig. 5.6). sulcus.
l 3rd cranial nerve (oculomotor) emerges from At the upper end of pons, basilar artery bifurcates
medial surface of crus cerebri of cerebral peduncle. into right and left posterior cerebral arteries.
5 sets of branches from vertebral artery and 5
Arteries related to surface of brainstem (Fig. 5.8) sets of branches from basilar artery are related to the
Arteries of vertebrobasilar system are related to ventral surface of brainstem as seen in Figure 5.8.
ventral surface of brainstem. 5 sets of branches of vertebral artery:
Right and left vertebral arteries run verti- 1. Meningeal arteries
cally from below upwards winding round the 2. Medullary arteries
posterolateral aspect of medulla oblongata. In the 3. Anterior spinal artery
midline of pontomedullary junction two vertebral 4. Posterior spinal artery
arteries unite to form basilar artery. Basilar artery 5. Posterior inferior cerebellar artery.
Medullary arteries
Diencephalon
Telencephalon
Mesencephalon
Diencephalon
Metencephalon
Mesencephalon
Rhombencephalon Myelencephalon
] Rhombencephalon
Spinal cord
Fig. 5.9 Components of neural tube Fig. 5.11 Differentiation of 3 components of developing brainstem
5 sets of branches of basilar artery: Pons is developed from ventral part of metence-
1. Pontine arteries phalon, dorsal part forming cerebellum. Medulla
2. Labyrinthine artery oblongata is developed from myelencephalon. Prox-
3. Anterior inferior cerebellar artery imal part of myelencephalon, which is adjacent to
4. Superior cerebellar artery pons is wider and, in due course of time, will follow
5. Posterior cerebral artery. the developmental characteristics as that of pons (see
below). Distal part of myelencephalon, adjacent to
Embryological Background of Brainstem spinal cord will remain narrower and in future will
show structural pattern more like spinal cord. So, mid-
Internal structure of brainstem is not only important, brain and hindbrain vesicles are differentiated into
it is very interesting. For its better understanding, following four parts (Fig. 5.12).
a reader must have a basic concept of embryological 1. Mesencephalon will form midbrain
background of brainstem. 2. Ventral part of
Three components of brainstem, midbrain, Metencephalon will form pons
pons and mudulla oblongata develop from two of 3. Proximal part of
three brains vesicles. These are midbrain vesicle Myelencephalon will form upper wider part of
(mesencephalon) and hindbrain vesicle (rhomben- medulla oblongata
cephalon) (Figs 5.9 and 5.10). 4. Distal part of
Rhombencephalon is further divided into proximal Myelencephalon will form lower narrower part
metencephalon and distal myelencephalon (Fig. 5.11). of medulla oblongata
4 ] Myelencephalon
Lower narrower part (medulla oblongata)
Spinal cord
Fig. 5.10 Caudal two components of 3 brain vesicles to from Fig. 5.12 Differentiation of part of neural tube to form various
future brainstem components of brainstem
100
Brainstem
Fig. 5.13 Formation of mantle zone and marginal zone due to proliferation of neuroectoderm layer of cells, which remains as ependymal layer
But all these four components of primitive brain- However, this interrelationship between inner
stem will follow the common (similar) embryological mantle zone (gray matter) and outer marginal
steps as follows: zone (white matter) will not persist in all the
1. Initially, all components will be lined by single components of developing brainstem. Ultimately
layer of neuroectodermal cells (Fig. 5.12). there will be intermingling of gray and white
2. Cells of this single layer proliferate by mitosis. matter (see below).
The newer cells (daughter cells) are pushed to the 5. Midlines of dorsal and ventral aspects of epen-
periphery and form a definite layer called mantle
dymal layer present roof plate and floor plate
zone (Fig. 5.13).
respectively.
Two different types of cells, neuroblasts and
spongioblasts in mantle zone will form neurons 6. Each half (right and left) of mantle zone is
and neuroglia (macroglia) respectively. divided into dorsal and ventral components by a
3. Original lining cells will form outline of the cavity linear sulcus called sulcus limitans. Dorsal part
of these parts of neural tube, called ependymal is called alar lamina (alar plate) and ventral part
cells. is called basal lamina (basal plate). Neurons
4. The processes of developing neurons in the mantle of alar lamina will be sensory in function and
zone will be pushed to the periphery outside the those of basal lamina will be motor in function
mantle zone to form marginal zone (Fig. 5.13). (Fig. 5.14).
Floor plate
Basal plate
Midbrain
Pons
Fig. 5.15 Pons and upper wider part of medulla oblongata show stretching of roof plate
Dissimilarity in Development in Different d) Basal and alar laminae are thereby not vent-
Components of Brainstem rodorsally related. Alar lamina becomes dorso-
lateral to basal lamina.
l Mesencephalon (midbrain) remains compara-
tively stunted in growth, thus remaining as short
Organization of Internal Structure at Different
segment of brainstem. Its central cavity becomes
very narrow to be named as aqueduct of Sylvius. Level of Brainstem
Alar lamina is dorsal and basal lamina is ventral in Central cavity of brainstem show different charact-
position (Fig. 5.16). eristics and names at different level. At lower end of
l Caudal or lower part of myelencephalon (medulla medulla it is a narrow canal continuous below with
oblongata), continuous below with spinal cord remain central canal of spinal cord. At the level of pons and
narrow and tubular like spinal cord. Its central canal
upper half of medulla oblongata, it becomes wide
becomes narrow. Alar lamina and basal lamina are
to form the cavity of 4th ventricle of brain. At the
related dorsoventrally (Fig. 5.16).
level of midbrain it is a narrow slit called aqueduct
l Metencephalon (pons) and proximal or upper
part of myelencephalon (medulla oblongata) show of Sylvius.
following changes (Figs 5.15 and 5.17). Fundamentally, neurons of basal plate are motor
a) Roof plate is stretched outwards on both side. and those of alar plate are sensory in function. Thro-
b) That is why cavity of this part of neural tube ughout the whole length of developing brainstem,
(pons and upper part of medulla oblongata) is initially, many neurons of both basal as well as alar
widened which will form 4th ventricle of brain. plate will form number of continuous columns of cells
c) Dorsal aspect of cavity of 4th ventricle of brain which are as follows:
will be lined only by ependymal layer as a n In basal plate (from medial to lateral) (Fig. 5.18)
result of stretching of roof plate. 1. Somatic efferent
Alar plate
Mantle zone
{ Basal plate
Ependymal layer
Marginal zone
Fig. 5.16 Similar relationship of differents layers of developing brainstem at the level of midbrain and lower half of medulla oblongata
102
Brainstem
Sulcus limitans
Dorsolateral alar plate
Fig. 5.17 Relationship of different layers of developing brainstem at the level of pons and upper half of medulla oblongata
Somatic afferent
Alar plate
Special visceral afferent
Fig. 5.18 Cell columns forming cranial nerve nuclei in developing brainstem where central canal is narrow (midbrain and lower half of
medulla oblongata)
2. Branchial efferent (special visceral efferent) in open part, i.e. pons and upper part of medulla
3. General visceral efferent. oblongata (Fig. 5.19).
n In alar plate: From medial to lateral in closed 1. Somatic afferent
part of brainstem, i.e. midbrain and lower end of med- 2. Branchial afferent (special visceral afferent)
ulla oblongata (Fig. 5.18) and, from lateral to medial 3. General visceral afferent.
Stretched out roof plate
(lined by ependyma only) Cavity of 4th ventricle of
brain
Somatic afferent
Alar plate
Special visceral afferent
Fig. 5.19 Cell columns forming cranial nerve nuclei in developing brainstem where roof plate is outstretched widening central canal to
form fourth ventricle of brain (at the level of pons and upper half of medulla oblongata)
103
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Nucleus gracilis
Nucleus cuneatus
Alar plate
Basal plate
} Mantle zone
Marginal zone
Fig. 5.20 Dorsal migration of cells of alar plate of lower closed part of medulla oblongata leads to development of nucleus gracilis and
nucleus cuneatus
Ultimately, neurons of all these columns will 2. Horizontal: These are fiber bundles connecting
persist in some level and disappear in some level. various centers of central nervous system with
So they will no longer be present in the form of cerebellum in both direction, passing through 3
continuous cell column althrough. These cell groups cerebellar peduncles.
will form different motor and sensory nuclei of 3rd to n Migration of cells of alar plate to form various
12th (last 10) cranial nerves.
nuclei: As already stated, neurons of alar plate form
n Migration of neurons of alar lamina: Apart
from formation of sensory (afferent) nuclei of cranial various sensory neclei of last 10 pairs (3rd12th) of
nerves, neurons of alar plate will migrate from its cranial nerves. Besides, neurons from alar plate migrate
original position either ventrally or further dorsally either ventrally or further dorsally to form various
to form some other named nuclei in different level of nuclei in different levels of brainstem as follows.
brainstem (described below). This nuclei, as migrated, 1. At the level of lower closed part of medulla
will intermingle with the components (white matter) oblongata (Fig. 5.20): Cells of alar plate migrate
of marginal zone. further dorsally on either side of posterior median
n Derivatives of marginal zone: It is already und-
sulcus to form two nuclei.
erstood that, marginal zone is composed of processes
a) Medial: Nucleus gracilis
of nerve cells of mantle zone. These processes will
form different groups of bundles of nerve fibers which b) Lateral: Nucleus cuneatus.
are basically of following two types 2. At the level of upper half of medulla oblon-
1. Vertical: These are either ascending (afferent) or gata: Cells of alar plate migrate ventrally in the
descending (efferent) tracts of nerve fibers conn- peripheral plane of marginal zone in the form of
ecting spinal cord with various higher centers. following nuclei (Fig. 5.21).
Basal plate
Cavity of hindbrain (4th ventricle)
Ependymal roof
Alar plate
Migration of cells of
alar plate forms
Arcuate nucleus
Fig. 5.21 Ventral migration of cells of alar plate in upper half of medulla oblongata forms inferior olivary nucleus and arcuate nucleus
104
Brainstem
Cavity of hind brain Ependymal roof
(4th ventricle)
Rhombic lip to form
cerebellum
Migration of cells of
alar plate
Alar plate
Mantle zone
{ Basal plate
Pontine nucleus
Fig. 5.22 Migration of cells of alar plate of developing pons leads to formation of: VentrallyPontine nucleus DorsallyRhombic lip for
development of cerebellum
a) Medial: Arcuate nucleus, placed ventral to from marginal zone. This is nucleus pontis or
vertical descending bundle of corticospinal (py- pontine nucleus.
ramidal) tract fibers. b) Dorsally: These cells migrate dorsally over the
b) Lateral: Inferior olivary nucleus, placed lateral ependymal lining of 4th ventricle of brain from
both sides which finally fuse together. This is
to corticospinal (pyramidal) tract fibers.
called rhombic lip. This will form cerebellum.
These nuclei develop from the alar plate cells which 4. At the level of midbrain (Fig. 5.23): As in
are called bulbopontine extension (caudal part). other parts of brainstem, neurons of alar plate
3. At the level of pons (Fig. 5.22): The cells of of midbrain form sensory nuclei of some cranial
alar plate at this level migrate in two different nerves. Some of the neurons migrate in following
directions: two directions to form specific nuclei of midbrain.
a) Ventrally: These cells migrate ventrally in the a) Ventrally: These cell groups migrate ventrally
beyond basal plate into marginal zone to
plane of marginal zone of pons. These are the
form two nucleiRed nucleus and Substantia
cells of cephalic part of bulbopontine extension. nigra. Red nucleus is present in upper half of
These neurons are present in scattered fashion midbrain, whereas substantia nigra extends
intermingled with white matter developed throughout its whole length.
Tectum
Alar plate
Mantle zone
{ Basal plate
Migration of cells of
alar plate
Substantia nigra
Red nucleus
Marginal zone
Fig. 5.23 Migration of cells of alar plate in developing midbrain form various nuclei as following, Ventrally = Red nuclens and
substantia nigra, Dorsally = Tectum (nuclei of superior and inferior colliculi)
105
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
First order sensory neurons in
posterior root ganglia developed
from neural crest cells
4. Somatic afferent
{
visceral
afferent
Mantle
zone
Basal plate 2. General visceral
efferent
Marginal zone
1. Somatic efferent
Fig. 5.24 Neural tube forming spinal cord gives rise to four cell columns. Basal plateSomatic efferent and general visceral efferent,
Alar plateSomatic afferent and general visceral afferent
b) Dorsally: Some of cells of alar plate migrate sympathetic center) and S2S4 segments (forming
further dorsally to form two pairs of bulged parasympathetic center). But both somatic centers
area called superior and inferior colliculi which (efferent and afferent) extend althrough the segments
form dorsal part of midbrain called tectum. of spinal cord.
A cranial nerve (3rd12th), unlike the spinal
Cranial Nerve Nuclei in Brainstem nerve is not always a mixed nerve. It may be mixed,
motor or sensory. However, a cranial nerve out
A spinal nerve is formed by union of ventral and of last 10 pairs, may not only contain all the four
dorsal roots which are functionally motor (efferent) functional components as spinal nerve, it may contain
and sensory (afferent) components respectively. Mo- in addition, another two components, one motor and
tor fibers in the ventral root are of two types, somatic one sensory. These are called special visceral efferent
motor (somatic efferent) and visceral motor (general (branchial efferent) and special visceral afferent
visceral efferent) (Fig. 5.24). Somatic efferent fibers (branchial afferent).
supply skeletal (voluntary) muscles and general So, for clear understanding of functional compo-
visceral efferent fibers supply smooth (involuntary) nents of cranial nerve, background knowledge of
muscles and exocrine glands. Again, sensory fibers special visceral efferent and special visceral afferent
in the dorsal root of spinal nerve are two types components is important as well as interesting as
somatic sensory (somatic afferent) and visceral stated below.
sensory (general visceral afferent) (Fig. 5.24). Somatic In embryonic life, six pairs of mesodermal arches
afferent fibers carry somatic sensations liketouch, (branchial arches or pharyngeal arches) embrace
pressure, pain, temperature (exteroceptive) and sense ventrolateral aspects of primitive pharynx. Out
of position and movements (proprioceptive). General of these six, fifth (5th) arch disappears. Muscular
visceral afferent fibers carry sense of stretch, pain, elements of existing five pairs of branchial arches give
distension, compression from the viscera. Cell bodies rise to some muscles in the region of head and neck.
of these types of neuronal processes are present in the All of which are voluntary muscles (but not somatic
form four cell columns in the spinal cord gray matter. muscle). Some of these voluntary muscles are even
In embryonic period, initially all these columns used related to wall of some viscera like palate, larynx and
to extend throughout the whole length of developing pharynx. So these muscles developed from branchial
spinal cord. Both of the motor or efferent columns arch mesoderm, not developed from paraxial mesod-
exist in basal plate. Somatic efferent is medial and ermal somites, being voluntary in nature, of which
general visceral efferent is lateral (Fig. 5.24). Both some related to viscera, are called branchial arch
the sensory or afferent columns exist in alar plate muscle. These muscles lying in the head and neck
of mantle zone throughout whole length of spinal region, need inervation from cranial nerves. So some
cord. Somatic afferent column is medial to general of cranial nerves (between 3rd12th), need to have
visceral afferent column (Fig. 5.24). But ultimately, an additional component to supply branchial arch
general visceral efferent and general visceral afferent muscles which is called branchial efferent or special
columns persist only in T1L2 segments (forming visceral efferent.
106
Brainstem
Somatic afferent
Basal plate
Special visceral efferent
Somatic efferent
Fig. 5.25 Neural tube forming brainstem (midbrain and lower closed part of medulla) prescents six (3 + 3) columns of cells forming
nuclear components of cranial nerves
Again from some viscera liketongue, soft palate 2. Special visceral efferent
and upper end of pharyngeal wall, special sense, 3. General visceral efferent.
liketaste (gustatory) sensation, need to be carried 3 in alar plate (from medial to lateral where deve-
by special components of some cranial nerves. These loping brainstem is a closed canal, e.g. midbrain and
component is called special visceral afferent or lower end of medulla oblongata are as follows (Fig. 5.25):
branchial afferent. 1. Somatic afferent
So, in comparison to four functional components
2. Special visceral afferent
of spinal nerve, six functional components of cranial
3. General visceral afferent.
nerves are the neuronal processes of following six
functional columns of cell groups In the parts of developing brainstem, where roof
3 in basal plate (from medial to lateral) are as plate is stretched, e.g. pons and upper part of medulla
follows (Fig. 5.25): oblongata, above three afferent columns are related
1. Somatic efferent lateral to medial (Fig. 5.26).
Special visceral
afferent
General visceral
afferent
General visceral
efferent
Basal plate Special visceral
(ventromedial) efferent
Somatic efferent
Fig. 5.26 Developing brainstem at the level of pons and upper part of medulla oblongata present six (3 + 3) columns of cells which form
different functional components of cranial nerves
107
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Functional components of cranial nerve nuclei in dif- will receive special somatic sensation likesense of
ferent level of brainstem hearing (exteroceptive) and sense of equilibrium or
balance of body (proprioceptive).
Before the positions of various nuclei of 3rd12th ii. All the 7 cell columns (3 motor and 4 sensory)
cranial nerve in different levels of brainstem is will finally not remain continuous althrough the
studied, it is very important to note the following two brainstem. In case of each column, somewhere
points. the cells will persist and in some level, cells will
i. Somatic afferent columns in developing brainstem disappear or degenerate. So, continuity of the
are of two types (Fig. 5.27 inset) cells in the columns will be interrupted, leading to
n General somatic afferent column: These cell formation of various cranial nerve nuclei.
groups will form general somatic afferent nuclei which
will receive general somatic sensation liketouch, Location and function of cranial nerve nuclei in
pressure, pain and temperature (exteroceptive) and different level of brainstem
sense of position and movements from muscles and Considering stretching of root plate, which results
joints (proprioceptive). abduction of alar plate, various functional groups of
n Special somatic afferent column: These cell cranial nerve nuclei are positioned from medial to
groups will form special somatic afferent nuclei which lateral as follows (Fig. 5.27):
Floor plate Basal plate Sulcus limitans Alar plate
3 Mes.N
Midbrain 3
EWN
5
4
5
PSN S
Pons 5 D
6 7 7 SSN 8
5 8 L
9 NTS M
ISN V
9 7 SP.N I Vest.N
12 Coch.N
Medulla 10 NA 9 5
oblongata 10
DN 10 DN 10
11
Spinal cord 11 C2
C5
NTSNucleus tractus solitarius
NA Nucleus ambiguous
PSNPrincipal sensory nucleus
EWN Edinger Westphal nucleus
(superior sensory nucleus) Sulcus limitans
SSN Superior salivatory nucleus
SP.N Spinal nucleus of trigem Nr.
ISN Inferior salivatory nucleus Sp. somatic afferent
Mes N. Mesencephalic nucleus of
DN Dorsal nucleus of vagus
trigem nerve
General somatic
afferent
Sp. visceral afferent
Floor plate Gen. visceral afferent
Gen. visceral efferent
Sp. visceral efferent
Somatic efferent
}
1. Somatic efferent supply muscles developed from mesoderm of five (1st
2. Special visceral efferent In the basal plate (between to 4th, and 6th) branchial arches.
(Branchial efferent) floor plate and sulcus These nuclei are as follows
3. General visceral efferent limitans) 1. Vth (trigeminal) nerve nucleus: This is the only
}
motor nucleus of trigeminal nerve. It is situated
4. General visceral afferent
in upper half of pons. Motor fibers (axons) arising
5. Special visceral afferent In the alar plate (lateral to
from this nucleus supply all the muscles developed
6. General somatic afferent sulcus limitans)
from 1st branchial arch.
7. Special somatic afferent
Muscles developed from first branchial arch are 8
Somatic efferent nuclei in number (4+2+2) which are
4 Muscles of mastication: i) Masseter
These are motor nuclei of some of the cranial nerves ii) Temporalis
which send axons to supply the skeletal muscles iii) Lateral pterygoid
developed from somites of preoccipital and occipital iv) Medial perygoid
myotomes. 2 Tensor muscles: v) Tensor palati (tensor
Muscles developed from preoccipital myotome are of soft palate)
all extrinsic muscles of eyeball, i.e. vi) Tensor tympani
(tensor of tympanic
i. Levator palpebrae Elevator of upper
membrane of ear)
superioris eyelid
2 Companion muscles
}
ii. Superior rectus
in neck: vii) Anterior belly of
iii. Inferior rectus
digastric
iv. Medial rectus 4 Recti muscles
viii) Mylohyoid
v. Lateral rectus
vi. Superior oblique
vii. Inferior oblique } 2 Oblique muscles 2. VIIth (facial) nerve nucleus: This motor nuc-
leus of facial nerve is situated in lower half of pons.
Motor fibers (axons) arising from this nucleus are
These extrinsic muscles of eyeball are supplied by branchial efferent or special visceral efferent fibers
fibers (axons) of following somatic efferent nuclei of facial nerve and these fibers supply muscles
1. IIIrd (oculomotor) nerve nucleus: Situated in developed from mesoderm of second branchial
upper half midbrain supplies all extrinsic muscles arch.
listed above except Muscles developed from second branchial arch are
a) Superior oblique following:
b) Lateral rectus. 1. Muscles of scalp Occipitofrontalis
2. IVth (trochlear) nerve nucleus: Situated in 2. Extrinsic as well as intrinsic muscles of auricle
lower half of midbrain, supplies superior oblique. 3. All muscles of facial expression with platysma
3. VIth (abducent) nerve nucleus: Situated in 4. A small muscle in middle ear cavity Stapedius
lower part of pons, supplies lateral rectus. 5. Two companion muscles in neck Posterior belly
Muscles developed from occipital myotome are all of digastric and stylohyoid.
the muscles of tongue except palatoglossus. These mus-
cles are supplied by axonal fibers of 3. Nucleus ambiguous: This is a composite nuc-
4. XIIth (hypoglossal) nerve nucleus: It is the leus of branchial efferent or special visceral effer-
nucleus of somatic efferent column and situated ent column present in medulla oblongata and
in upper two-thirds of medulla oblongata. Axonal extending upto upper 5 cervical segments of spinal
processes of this nerve supply all muscles of cord.
tongue except palatoglossus, which are developed Nucleus ambiguous is composed of following 4
from occipital myotome. parts of which first 3 parts lie in medulla oblongata
All the above four somatic efferent nuclei of and last part lies in spinal cord.
brainstem (IIIrd, IVth, VIth and XIIth nerve nuclei) l 1st part: Nucleus of IXth cranial (glossopharyngeal)
are in the line with and homologous to anterior horn nerve. It supplies one muscle developed from 3rd
cells of all segments of spinal cord which supply branchial arch which is stylopharyngeus.
somatic segmental muscles of body. l 2nd part: Nucleus of Xth cranial (vagus) nerve. It
supplies one muscle developed from IVth branchial
Special visceral efferent (Branchial efferent) nuclei
arch which is cricothyroid.
These are the motor nuclei of some of cranial nerves l 3rd part: This is the nucleus of XIth cranial (acce-
which, through their axons (outgoing motor fibers) ssory) nerve. As it lies in medulla oblongata (part
109
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
of brain), it is called cranial nucleus of accessory i. Smooth muscles of tracheobronchial tree.
nerve which supplies muscles developed from ii. Smooth muscles (myocardium) of heart.
mesoderm of 6th branchial arch. iii. Smooth muscles of gut (foregut and midgut)
These muscles are upto right two-thirds of transverse colon.
a) All muscles of soft palate except tensor palati iv. Mucous glands of tracheobronchial tree and
b) All muscles of pharynx except stylopharyngeus above mentioned parts of gut.
c) All muscles of larynx except cricothyroid.
l 4th part: This part is also nucleus of 11th cranial
General visceral afferent nucleus
(accessory) nerve. It is called spinal nucleus
of accessory nerve as it is formed by central Nucleus of this column of brainstem receives incom-
group of anterior horn cells of first five cervical ing nerve fibers which carry general sensation from
segments of spinal cord. This component of viscera, e.g. sensation of pain (due to ischemia),
nucleus ambiguous supplies two muscles of neck stretch, distension or compression.
named sternomastoid and trapezius which are
In this column there is one and only one nucleus
also considered to be muscles developed from
which is dorsal nucleus of vagus (sensory component).
mesoderm of 6th branchial arch.
Dorsal nucleus of vagus nerve is a composite nucleus
General visceral efferent nuclei which is composed of a motor and a sensory part. It
lies in the lower part of medulla oblongata. Sensory
Cranial nerve nuclei of this column of brainstem
form the centers for parasympathetic system in brain part of dorsal nucleus of vagus nerve receives
(brainstem). incoming sensory fibers of vagus nerve which carry
Cell group of these nuclei send axons (motor fibers) visceral sensations as stated above from wall of
to i) Smooth muscles and ii) exocrine glands. tracheobronchial tree and, gastrointestinal tract upto
These nuclei are following: right two-thirds of transverse colon.
1. Edinger-Westphal nucleus: This is general visc-
eral efferent nucleus of IIIrd cranial (oculomotor) Special visceral afferent nucleus
nerve. Axons of this nucleus supply two smooth
muscles of eyeball Ciliaris and sphincter pupillae. Nucleus of cranial nerve of this column receives
Being the part of oculomotor nerve nucleus, it is incoming sensory (afferent) fibers which carry special
situated in upper part of midbrain. sensation from the viscera, e.g. tongue, palate and
2. Superior salivatory nucleus: upper part of pharynx, that is taste.
n It is the general visceral efferent nucleus of VIIth In this column there is only one composite nucleus
cranial (facial) nerve. This nucleus is so called as which is named
it gives fibers which supply secretomotor fibers n Nucleus tractus solitarius: It is a composite
to the two out of three salivary glands. These are nucleus of special visceral afferent column situated in
submandibular and sublingual glands. medulla oblongata. This nucleus is composed of three
n This nucleus has a component called lacrimatory
parts as follows
nucleus which gives out secretomotor fibers to lacri-
l Upper part: It is the nucleus of seventh cranial
mal gland.
(facial) nerve which receives the incoming sensory
n Preganglionic secretomotor fibers for mucous
glands of palate, nasal cavity and upper part of fibers carrying taste sensation from anterior two-
pharynx also arise from this nucleus. thirds of tongue soft palate and upper part of pharynx.
Superior salivatory nucleus is situated in lower l Middle part: It is the nucleus of ninth cranial
part of pons. (glossopharyngeal) nerve which receives the incoming
3. Inferior salivatory nucleus: It is situated in upper sensory fibers carrying taste sensation from posterior
part of medulla oblongata. This general visceral one-third of tongue.
efferent nucleus supplies secretomotor fibers to l Lower part: It is the nucleus of tenth cranial (va-
another salivary gland, i.e. parotid gland.It is the gus) nerve which receives the incoming sensory fibers
nucleus of IXth cranial (glossopharyngeal) nerve. carrying taste sensation from posterior most part of
4. Dorsal nucleus of vagus: This is the general tongue, vallecula and epiglottis.
visceral efferent nucleus of Xth cranial (vagus)
nerve. It is situated in lower part of medulla oblon-
General somatic afferent nuclei
gata. Vagus nerve is a very long cranial nerve
having extensive course in head and neck, thorax Sensory nuclei of cranial nerves of this group receive
and abdomen. Through this nerve, fibers from general somatic sensations from the area of face
dorsal nucleus of vagus are distributed to including forehead.
110
Brainstem
General somatic sensations are of two types, which ceptive sensations from muscles of mastication,
are carried to the respective nuclei. They are muscles of eyeball, muscles of face, roots of teeth and
temporomandibular joint.
Exteroceptive Proprioceptive n Special point to note: Cells of mesencephalic
This nucleus receives This nucleus nucleus posses a special characteristic. In case of
exteroceptive receives proprioceptive all other sensory pathway, cell bodies of 1st order of
sensations from the sensations from some neuron lie outside the central nervous system and
area of face which muscles and joints their central processes enter the central nervous
are touch, pressure, in the area of head system to relay in second order of neurons which
pain and temperature. which are constitute the corresponding sensory nucleus. But
i. Muscles of mesencephalic nucleus of trigeminal nerve is made
mastication up of cell bodies of 1st order of sensory neurons lying
ii. Muscles of eyeball inside the central nervous system which carries
iii. Muscles of facial proprioceptive sensation from the end organs as
expression stated above.
iv. Roots of teeth
v. Temporomandibular Special somatic afferent nuclei
joint.
Both the above types are sensory nuclei of Vth Nuclei of this group of cranial nerve receive sensory
cranial (trigeminal) nerve. fibers which carry special somatic sensation.
Names of these general somatic afferent nuclei of All these nuclei are situated in pontomedullary
trigeminal nerve are junction.
All of these are nuclei of VIIIth cranial (vestibulo-
}
i. Nucleus of spinal tract of trigeminal nerve Exteroceptive cochlear) nerve.
nuclei These nuclei are of following two groups:
ii. Superior (principal) sensory nucleus
iii. Mesencephalic nucleus of trigeminal nerve
Proprioceptive nucleus Exteroceptive Proprioceptive
In the brainstem these three nuclei are as follows Dorsal and ventral Four vestibular nuclei
from below upwards. cochlear nuclei. named superior,
1. Nucleus of spinal tract of trigeminal nerve These nuclei receive inferior, lateral and
(Spinal nucleus of trigeminal nerve) incoming fibers medial vestibular nuclei.
This nucleus presents three components: of cochlear part of These nuclei receive
i. Middle or main component: Extends throughout vestibulocochlear incoming fibers of
the whole length of medulla oblongata nerve which carry vestibular part of
ii. Upper end: Extends into lower end of pons sense of hearing vestibulocochlear nerve
iii. Lower end: Continued in upper two cervical (cochlear sensation). which carry sense of
segments (C1, C2) of spinal cord. equilibrium (balance).
Nucleus of spinal tract of trigeminal nerve receives n Important guideline: While studying IIIrd
all the incoming sensory (afferent) fibers of trigeminal XIIth (last 10) cranial nerves in the chapter of cranial
nerve which carry pain and temperature sensations
nerve, a reader must consult the text, as well as
from same side of whole area of face.
figures of the following components of the chapter of
2. Superior (principal) sensory nucleus of trige-
Brainstem as described here.
minal nerve
This nucleus is situated in pons. i. Embryological background of brainstem.
Superior sensory nucleus receives all the incoming ii. Functional components of cranial nerve nuclei
sensory (afferent) fibers of trigeminal nerve which in different level of brainstem.
carry touch and pressure sensations from same half Reader must develop a clear concept on Figure
of the whole area of face. no. 5.27. He/she must practice drawing of this figure
3. Mesencephalic nucleus of trigeminal nerve again and again till to have a confidence to draw the
It is so named because this nucleus is situated in same from memory without any help.
midbrain (mesencephalon). Reader must study the Figure no. 5.27 to find the
Mesencephalic nucleus of trigeminal nerve is the answers of following questions:
proprioceptive sensory nucleus. It receives incoming i. What are the types of IIIrdXIIth cranial nerve
sensory fibers of trigeminal nerve which carry proprio- motor, sensory or mixed?
111
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
ii. What are the functional components of the cells of alar plate. Many of them are migrated
cranial nerves, from IIIrdXIIth? from their original position ventrally to the region
iii. What are the cranial nerve nuclei in a of basal plate, e.g. olivary nucleus of medulla
particular functional column? oblongata. Some of these are migrated further
For example: Somatic efferent column present dorsally, e.g. tectum of midbrain.
nuclei of IIIrd, IVth, VIth and XIIth cranial b) Cranial nerve nuclei (IIIrdXIIth): Motor nuclei
nerve. of these cranial nerves are developed from cells of
iv. What are the motor nuclei (nuclei in the basal basal plate and the cells of alar plate give rise to
plate) and what are the sensory nuclei (nuclei sensory nuclei.
in alar plate)?
v. What are the cranial nerve nuclei present in Internal Structure of Medulla Oblongata
each of the three segments of brainstem? i.e.
in midbrain, pons and medulla oblongata. Internal structure of medulla oblongata is studied in
For example: In midbrain lies somatic efferent following three levels (Fig. 5.28)
nuclei of IIIrd and IVth cranial nerve, general 1. At the lower end of medulla oblongata: Below the
visceral efferent nucleus of IIIrd nerve (EWN) bulge of pyramid, where decussation of motor
and somatic afferent nucleus (mesencephalic fibers of pyramidal tract (corticospinal tract),
nucleus) of Vth cranial nerve. passing through the pyramid, takes place (at the
vi. What are the motor and/or sensory components plane of motor decussation).
of a cranial nerve, from IIIrd to XIIth? 2. Above the middle of medulla oblongata, at the level
of middle of bulge of pyramid. At this level sensory
fibers from nucleus gracilis and nucleus cuneatus
Internal Structures of Brainstem
decussate before these sensory tracts pass further
n Fundamental points: Internal structure will be upwards (At the plane of sensory decussation).
crystal-clear to a reader if one goes thoroughly with 3. At the upper end of medulla oblongata, close to
the previous parts of chapter of Brainstem. pontomedullary junction.
Internal structure of brainstem, at any level,
shows intermingling of gray matter and white Medulla oblongata at its lower end (at the plane of
matter unlike spinal cord, cerebellum and cerebrum. motor decussation) (Fig. 5.29)
It may be remembered, in spinal cord, white matter
is peripheral and gray matter is central, whereas Structural characteristics
in cerebellum as well as cerebrum, arrangement is
reverse. 1. At this level structure of medulla oblongata is
Any level of brainstem shows following components almost similar to the structure of spinal cord, with
of internal structure centrally positioned gray matter and peripheral
1. White matter: white matter.
a) Vertical fibers two types 2. Ventral horn of gray matter gets separated from
i. Ascending (Afferent): Passing from a lower main mass due to decussation of pyramidal tract fib-
center to a higher center. ers which pass backwards and laterally to approach
ii. Descending (Efferent): Passing from a higher lateral white column before passing downwards to
center to a lower center. the spinal cord.
b) Horizontal fibers: In each of the three components
of brainstem, passing horizontally through respe- 7 Level of superior colliculus
ctive cerebellar peduncles, e.g. 6 Level of inferior colliculus
i. In midbrain: Passing through superior cere-
bellar peduncle.
ii. In pons: Passing through middle cerebellar 5 Upper half of pons
peduncle. 4 Lower half of pons
iii. In medulla oblongata: Passing through inferior 3 At upper end of medulla oblongata
cerebellar peduncle. 2 At the level of pyramid
2. Gray matter: It is present in the form of following
two varieties of nuclei 1 Lower end of medulla
a) Various named nuclei of brainstem: These are cell oblongata
stations of ascending or descending tracts passing
through the brainstem. These are developed from Fig. 5.28 Different level of brainstem to study internal structure
112
Brainstem
Ventral spinocerebellar
Lateral spinothalamic tract tract
Detached anterior
Anterior spinothalamic tract
grey horn
Fig. 5.29 Internal structure of lower end of medulla oblongata (below pyramidal elevation at the level of motor decussation)
Fig. 5.30 Internal structure of medulla oblongata at the level of sensory decussation
2. Gray matter of posterior horn presenting nucleus thalamic tracts are found to be in corresponding
gracilis, nucleus cuneatus and spinal nucleus positions as noticed in previous section of medulla
of trigmenial nerve gets detached from central oblongata.
gray matter. This detachment is because of the 4. Nucleus gracilis and nucleus cuneatus are seen to
arched fibers arising from nucleus gracilis and be more prominent in this section. These nuclei
nucleus cuneatus which decussate ventrally to receive fibers from fasciculus gracilis and fasciculus
form ascending fiber tract which is called medial cuneatus which carry conscious proprioceptive
lemniscus. sensation and sense of tactile discrimination from
3. Central canal surrounded by central gray matter lower and upper halves of body respectively.
is pushed more dorsally. Central gray matter 5. Dorsolateral to nucleus cuneatus, a smaller
presents appearance of cranial nerve nuclei. accessory cuneate nucleus is seen. It receives
4. It is the plane of medulla oblongata from where fibers of fasciculus cuneatus which carry same
sensations from uppermost part (head-end) of
upward typical relationship of central gray ma-
body. Cuneocerebellar tract from this nucleus end
tter and peripheral white matter of spinal cord
in cerebellum as spinocerebellar pathway above T1
is lost. It results intermingling of gray and white
spinal cord segment.
matters.
6. Central core of the section presents scattered
nerve cells and reticulum (network) of fibers to
Structural details
form brainstem reticular formation.
1. On either side of ventral median fissure bulge of 7. Posterior gray horn separated from central gray
pyramid presents sections through descending matter is represented by spinal nucleus of trige-
(efferent) fibers of pyramidal (corticospinal) tract. minal nerve which is capped on the surface by
2. Lateral to fibers of pyramid, inferior olivary nucl- fibers of sensory root of trigeminal nerve carrying
eus starts appearing. It looks like a small irregular- pain and temperature sensation, called spinal
walled sac whose cavity opens backwards and tract of trigeminal nerve.
medially. Nucleus gracilis and nucleus cuneatus are the
Inferior olivary nucleus is the most prominent medial and lateral mass of gray matter on either
part of olivary nuclear complex of human brain. side of posterior median septum. These are also the
Rudimentary components are dorsal and medial oliv- components of posterior gray horn which are detached
ary nuclei which together are known as accessory from central gray matter.
olivary nuclei. Reason for separation of spinal nucleus of trige-
3. Ascending (afferent) tracts, e.g. dorsal and ventral minal nerve, nucleus gracilis and nucleus cune-
spinocerebellar tracts, lateral and anterior spino- atus from central gray matter is due to following
114
Brainstem
characteristic of structure of medulla oblongata at i. Hypoglossal nerve nucleus (XII): It is the
this level. nucleus of somatic efferent column, lying
Fasciculus gracilis and fasciculus cuneatus are the ventral to central canal of medulla oblongata.
two ascending tracts of posterior column of spinal cord ii. Nucleus ambiguous (IX, X, XI): It is the nuc-
which carry sense of conscious proprioception and leus of special visceral efferent column, lying
tactile discrimination from lower and upper halves ventrolateral to central canal of medulla
of body respectively. Reaching the medulla oblongata oblongata.
upto this level, fibers of these two tracts relay in iii. Dorsal nucleus of vagus (X): It is the nucleus
corresponding nuclei lying ventrally. Processes of having both general visceral efferent as well
next order of neurons in nucleus gracilis and nucleus as general visceral afferent components, lying
cuneatus, before ascending further upwards to relay ventrolateral to central canal.
in thalamus, decussate to cross the midline. During iv. Nucleus tractus solitarius (VII, IX, X): It is the
decussation, these fibers presents following three nucleus of special visceral afferent column,
characteristics. lying lateral to central canal.
1. Fibers of both nucleus gracilis and nucleus cune-
atus pass forwards arching along the lateral Medulla oblongata at the level of olive (close to pon-
aspect of central gray matter horizontally in a tomedullary junction) Fig. 5.31
curved fashion that is why they are called internal
arcuate fibers. Structural characteristics
2. After decussation, the fibers form a compact bundle 1. Stretching of roof plate at this plane of medulla
just behind the bulge of pyramid, before this compact oblongata in embryonic life causes outward
bundle of fibers ascend upwards to reach thalamus. deviation (abduction) of alar plate. This results
This bundle is known as medial lemniscus (Plural widening of central canal to form cavity of fourth
Lemnisci). ventricle. Stretched dorsal surface of medulla
3. During formation of medial lemnisci, fibers from oblongata forms floor of fourth ventricle.
nucleus gracilis (carrying sensations from lower 2. Central gray matter presenting the cranial nerve
half of body) are positioned anterior to the fibers nuclei pushed more dorsally to lie just beneath the
from nucleus cuneatus (carrying sensation from dorsal surface of medulla oblongata.
upper half of body). 3. Fibers from medulla oblongata which will connect
Behind medial lemniscus, pass tectospinal tract cerebellum will form compact bundle of inferior
medial longitudinal fasciculus. cerebellar peduncle seen to be present in poste-
n Central gray matter: It encircles the central rolateral part.
canal of medulla oblongata which is pushed more 4. Bulge of olive containing inferior olivary nucleus
posteriorly. It presents following cranial nerve nuclei is related to anterolateral and posterolateral sulci
which are interrelated ventrolaterally. on it medial and lateral sides respectively.
Dorsal nucleus of vagus Tectospinal tract
Vestibular nucleus
Hypoglossal nerve nucleus Dorsal cochlear nucleus
Nucleus tractus solitarius Inferior cerebellar peduncle
Arcuate nucleus
Trigem lemniscus
Pontocerebellar
Medial lemniscus
Trapezoid body
Pontine
nuclei
fibers
Bundles of descending
fibers
} Basilar
part of
pons
Fig. 5.32 Transverse section through lower end of pons adjacent to pontomedullary junction
Facial nerve nucleus (nucleus of motor nerve of l Vestibular nucleus of vestibulocochlear nerve:
face) originally used to be situated in embryonic life, This is proprioceptive type of special somatic afferent
lateral to abducent nerve nucleus more superficially. nucleus of vestibulocochlear nerve. It is composed of
Spinal nucleus of trigeminal nerve, which is sensory superior, lateral, medial and inferior parts. Vestibular
nerve for skin of face, is situated in deeper plane of nucleus is situated partly in lower part of pons and
tegmentum of pons. To facilitate quicker reflex cont- upper part of medulla. It is placed in superficial plane
raction of facial muscles, facial nerve nucleus moves at the lateral angle of pontomedullary junction. This
deeper to come in close relation to sensory nucleus for nucleus receives afferent fibers which are nothing
but vestibular fibers of VIIIth cranial nerve carrying
sensation of facial skin, i.e. spinal nucleus of trige-
sense of equilibrium or balance. Efferent fibers are
minal nerve. This becomes possible by elongation
i. Vestibulocerebellar fibers
of motor fibers of facial nerve nucleus which winds
ii. Vestibulospinal fibers
round the abducent nerve nucleus. This process is iii. Medial longitudinal bundle: Which connect vesti-
known as neurobiotaxis. bular nucleus with nuclei of IIIrd, IVth, VIth and
l Superior salivatory nucleus: It is general visceral XIth cranial nerves and anterior horn cells of
efferent nucleus of facial nerve, situated lateral to upper cervical segments of spinal cord. It causes
motor nucleus of facial nerve. It has a component reflex movement of eyeball and head and neck in
called lacrimatory nucleus. Parasympathetic secre- response to change of position body.
tomotor fibers from these nuclei are directed to supply l Cochlear nucleus of vestibulocochlear nerve: It is
to submandibular and sublingual salivary glands, exteroceptive type of special somatic afferent nucleus
and lacrimal gland. of cochlear component of vestibulocochlear nerve. It
l Spinal nucleus of trigeminal nerve: This is exte-
is made up of dorsal and ventral components lying
dorsal and ventral to inferior cerebellar peduncle
roceptive variety of general somatic afferent nucleus
fibers at the level of pontomedullary junction.
of trigeminal nerve, which receives pain and temp-
n Connections of cochlear nuclei:
erature sensation from skin of face. Though called
l Afferent: Fibers of cochlear component of vesti-
spinal nucleus, main part of this nucleus extends bulocochlear nerve carrying sense of hearing from
throughout whole length of medulla oblongata. Its receptors (organ of Corti) at internal ear relay in
lower end extends upto 2nd cervical segments of dorsal and ventral cochlear nuclei.
spinal cord and upper end extends to the lower half l Efferent: Axons of cochlear nuclei will have to
of pons. This nucleus is situated in the lateral part of reach upto corresponding thalamic nuclei to carry
tegmentum of lower end of pons. It receives sensory impulse to sensory area of cerebral cortex. While
fibers of trigeminal nerve which caps dorsal aspect of ascending through central core of brainstem to reach
the nucleus to form spinal tract of the nerve. the thalamus, at the level of lower end of pons, relay
118
Brainstem
in a nucleus, called nucleus of trapezoid body. Before compact bundle called trigeminal lemniscus which
the relay, axons of both dorsal and ventral cochlear is placed between medial and spinal lemnisci.
nuclei partly remain in the same side, partly cross 4. Medial longitudinal fasciculus (bundle): It is a
the midline to relay in nucleus of trapezoid body of compact bundle of fibers passing through cent-
opposite side. In horizontal section, the fibers show a ral tegmental core of brainstem. These fibers
trapezoid shape, for which the decussating and non- interconnect nuclei of IIIrd, IVth, VIth and XIth
decussating fibers are called trapezoid body, so the nerves with vestibular nucleus and anterior
nucleus is also accordingly named. horn cells of upper cervical segments of spinal
n White matter:
cord. Functionally this fasciculus causes reflex
1. Trapezoid body: Axonal process of dorsal and
movement of eyeball, head and neck during
ventral cochlear nuclei before ending in thal-
amic level, i.e. in medial geniculate body (metath- alteration of equilibrium or balance of body.
alamus), show following change 5. Tectospinal tract: It is placed ventral to medial
Before ascending through upper half of pons longitudinal fasciculus.
further upwards, fibers pass forwards and medially 6. Rubrospinal tract: It lies in front of tectospinal
towards central tegmentum of midbrain. While doing tract.
so, some fibers may remain in same side, some cross These two fiber bundles are extrapyramidal tracts,
the opposite side to form a trapezoid outlined area, in the group of noncorticospinal tract.
called trapezoid body. 7. Spinal tract of trigeminal nerve: These are fiber
In the trapezoid body, fibers relay in nucleus of bundles which form a cap over the dorsal aspect of
trapezoid body. spinal nucleus trigeminal nerve. Spinal nucleus of
Then the fibers will run upwards to form lateral trigeminal nerve present along the whole length of
lemniscus. medulla oblongata extends upwards in the lower
2. Medial lemniscus: This is a compact bundle of end of pons. Spinal tract is made up of incoming
fibers already formed at the level of medulla as a sensory fibers of trigeminal nerve vertically
continuation of internal arcuate fibers from nucleus
disposed in brainstem. These fibers relay in the
gracilis and nucleus cuneatus, carrying sense
sensory nuclei of trigeminal nerve. Axons of next
of dirscriminative touch, sense of position and
movement and vibration sense. Medial lemniscus order of neurons, i.e. the sensory nuclei will ascend
is situated close to midline, behind basilar part of upwards as trigeminal lemniscus placed between
pons. Fiber bundle is rotated for 90, wtih fibers medial lemniscus and spinal lemniscus.
from lower half of body placed medially. So fibers 8. Inferior cerebellar peduncle: Fibers of middle cere-
from upper half are placed laterally. bellar peduncle runs horizontally lateralwards
3. Spinal lemniscus: This compact bundle of fiber is from basilar part of pons. Behind this, cross section
the continuation of lateral spinothalamic tract. of vertically running fibers of inferior cerebellar
Axons from trigeminal nucleus form another peduncle is seen.
Cavity of fourth ventricle Superior medullary velum
Rubrospinal tract
Trigeminal nerve
Middle cerebellar Bundles of descending
peduncle tracts
Pontine nuclei
Decussating pontocerebellar fibers
]
Basilar
part of
pons
Fig. 5.33 Transverse section through upper end of pons (close to its junction with midbrain)
119
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Tegmental part at upper half of pons (Fig. 5.33) nerve to thalamus. Lateral lemniscus is made up of
bundle of fibers which are axonal processes of superior
Fundamental differences with the lower half of pons
olivary nucleus and nucleus of trapezoid body. It
are the following:
forms a part of auditory pathway.
1. At the upper end of pons, middle cerebellar
As trapezoid body of lower half of pons is continuous
peduncles are passing more obliquely lateralwards
upwards as vertical bundle of lateral lemniscus, it
than horizontally. So the fibers of this peduncle
disappears at upper half of pons.
are seen more on cross section than longitudinal,
2. Other fiber bundles: Beneath the floor of fourth
at lateral side of junction of basilar part and
ventricle, just on either side of midline, following
tegmental part.
fiber tracts are existent from behind forwards.
2. As upper end of pons approaches towards midbrain
a) Medial longitudinal fasciculus
upwards, behind the tegmental part of pons, roof
of fourth ventricle of brain is found to be formed b) Tectospinal tract
by thin lamina of white matter called superior c) Rubrospinal tract.
medullary velum extending between medial sides 3. Middle cerebellar peduncle: Internal structure
of two superior cerebellar peduncles. of upper half of pons, shows fibers of middle
3. Trapezoid body disappears as the fibers run cerebellar peduncle which are more vertically
vertically upwards forming a compact bundle of sectioned, rather than horizontal direction, lateral
ascending tract called lateral lemniscus. to junction of basilar part and tegmental part of
4. Cranial nerve nuclei seen in lower half of pons pons.
disappear. Motor as well as superior sensory nuclei 4. Superior cerebellar peduncle: Dorsolateral part
of trigeminal nerve are seen to appear. of section shows fibers of superior cerebellar
n Gray matter: Tegmentum of upper half of pons peduncles of both sides which are bridged by a thin
shows only gray matter in the form of motor and lamina of white matter called superior medullary
superior (principal) sensory nuclei of trigeminal velum.
nerve.
1. Motor nucleus of trigeminal nerve: It is the special Internal Structure of Midbrain
visceral efferent or branchial efferent nucleus of
trigeminal nerve situated deep to floor of fourth Structural characteristics (Fig. 5.34)
ventricle of brain, in the central core. Efferent 1. A little behind its center, midbrain is traversed by
fibers from this nucleus supply muscles developed its narrow central canal, called aqueduct of Sylvius
from mesoderm of first pharyngeal arch. or cerebral aqueduct. This narrow channel is
2. Superior (principal) sensory nucleus of trigeminal
lined by ependyma and communicates with third
nerve: It is situated lateral to motor nucleus and
ventricle above and fourth ventricle below.
continuous below with spinal nucleus of trigeminal
2. An imaginary line passing side to side through
nerve. This nucleus is of general somatic afferent
cerebral aqueduct bisects interior of midbrain in
type and receives touch and pressure sensation
smaller posterior part and larger anterior part.
from the skin of face.
3. Smaller posterior part is known as tectum. Tect-
Fibers from motor and sensory nuclei of trigeminal
nerve traverse tegmentum forwards and laterally and um is made up of, as seen externally, two pairs of
comes out as motor and sensory roots of the nerve round elevations. Upper pair, opposite upper half
at the junction of basilar part of pons and middle of midbrain, are called superior colliculi (Sing-
cerebellar peduncle. Motor root is medial to sensory ular colliculus). Lower pair, opposite lower half of
root. midbrain are accordingly called inferior colliculi.
n White matter: Each colliculus is a round mass of gray matter.
1. Ascending tracts as lemnisci: Just behind basilar 4. Larger anterior part, in front of cerebral aqueduct,
part of pons, from medial to lateral, pass four is known as cerebral peduncle. Cerebral peduncle
compact bundles of ascending fibers which are is made up of following three components from
medial lemniscus, trigeminal lemniscus, spinal before backwards
lemniscus and lateral lemniscus. i. Crus cerebri: Compact bundle of white matter.
Among these, medial and spinal lemnisci are ii. Substantia nigra: A strip of pigmented gray
already well-developed from a lower level. Trigeminal matter.
lemniscus is made up of fibers of trigemino-thalamic iii. Tegmentum: Central core of midbrain with
tract which extends from spinal nucleus of trigeminal admixture of both gray as well as white matter.
120
Brainstem
Tectum
Aqueduct of Sylvius
Tegmentum
Periaqueductal
gray matter
Substantia Cerebral
nigra peduncle
Crus cerebri
5. Therefore, from the above description, it is clear l Descending fibers passing through crus cerebri
that, internal structure of midbrain is divided into are following
following broad based components from before 1. Corticospinal: From cerebral cortex to anterior
backwards. horn cells of spinal cord.
2. Corticobulbar (Corticonuclear): From cerebral
}
i. Crus cerebri
cortex to motor nuclei of cranial nerves.
ii. Substantia nigra
In front of cerebral aqueduct 3. Corticopontine: From all the four lobes of cerebral
iii. Tegmentum
iv. Tectum (colliculi) Behind cerebral aqueduct cortex to pontine nuclei. These are the fibers of
corticopontocerebellar pathway. These are of four
6. Guidelines for study of structural detail groupsfrontopontine, parietopontine, occipitopo-
Internal structure of midbrain is studied at two ntine and temporopontine.
levels. These are at the levels of superior colliculus Crus cerebri is divided into following three parts
and inferior colliculus.
transmitting different types of fibers.
l Internal structure of anterior two components,
1. Intermediate 3/5th: Corticospinal and cortico-
i.e. crus cerebri and substantia nigra is similar on
bulbar (corticonuclear) fibers.
both levels.
l Internal structure of posterior two components, i.e.
2. Medial 1/5th: Frontopontine group of cortic-
tegmentum and tectum is dissimilar on two levels. opontine fibers.
Therefore, structural details of midbrain are to be 3. Lateral 1/5th: Parietopontine, occipitopontine and
studied under following headings. temporopontine groups of corticopontine fibers.
a) Crus cerebri.
b) Substantia nigra. Substantia nigra (Figs 5.35 and 5.36)
c) Tegmentum and tectum of the level of inferior Substantia nigra is a large mass of gray matter
colliculus.
extending throughout whole length of midbrain.
d) Tegmentum and tectum at the level of superior
This nucleus of extrapyramidal system is composed
colliculus.
of medium sized multipolar neurons, cytoplasm of
Structural details which is composed of melanin pigment granules.
It is crescent (curved) in shape with cocavity
Crus cerebri (Figs 5.35 and 5.36) facing backwards towards tegmentum. It is broader
medially.
l It extends throughout whole length of midbrain.
It is made up of compact bundle of descending Substantia nigra is made up of dorsal and ventral
fibers. part. Dorsal part presents smooth, concave posterior
l Right and left halves of crus cerebri are separated surface and is known as pars compacta, being packed
by a midline sulcus on ventral surface of midbrain. up with cells. Ventral part is known as pars reticularis
Crus cerebri is related posteriorly to substantia where loosely arranged neurons are intermingled
nigra. with reticulum (network) of fibers.
121
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Trochlear nerve nucleus Nucleus of inferior
colliculus
]
poropontine fibers
Melanin pigment granules are polymers of dopa- is situated lateral to cerebral aqueduct and receives
mine. Dopamine, released from cell of substantia nig- proprioceptive sensation from muscles of mastication,
ra is transported to corpus striatum (basal ganglia) temporomandibular joint, roots of teeth, muscles of
through the course of nigrostriate fibers. eyeball and face.
Substantia nigra is connected to cerebral cortex, 2. Reticular nuclei: Nuclei of reticular formation
basal ganglia (corpus striatum), hypothalamus and are less prominent than those of pons and medulla
spinal cord. oblongata. These are scattered in the central
Function of substantia nigra is concerned with tegmental area ventral to periaqueductal gray.
maintenance of muscle tone. n White matter (of tegmentum):
Tegmentum and tectum at the level of 1. Decussation of fibers of superior cerebellar
inferior colliculus (Fig. 5.35) peduncle: Ventral spinocerebellar tract is a
crossed tract at the level of formation in spinal
Tegmentum cord. It ascend through the brainstem upto this
level of midbrain as a contralateral tract. But
It is central core of midbrain. It is composed of groups fibers of this tract will have to cross for the second
of neurons in the form of nuclei (gray matter) and time before reaching ipsilateral half of cerebellum.
white matter in the form of ascending (afferent) and Decussation of these fibers are present in anterior
descending (efferent) fiber bundles. most part of tegmentum of midbrain following
n Gray matter (of tegmentum): which fibers will pass through superior cerebellar
1. Periaqueductal gray matter: It contains follo- peduncle.
wing two cranial nerve nuclei. 2. Lemnisci: Lateral to decussation of fibers of
l Trochlear nerve nucleus: It is the nucleus of som- superior cerebellar peduncle, all the four lemnisci,
atic efferent column present in periaqueductal gray namely medial, trigeminal, spinal and lateral, are
placed medial to lateral in such a curved fashion
matter ventral to cerebral aqueduct behind medial
that lateral lemniscus is placed posterior to spinal
longitudinal fasciculus. Fibers of trochlear nerve
lemniscus infront of inferior colliculus. It is to be
arising from nucleus winding round lateral aspect of
noted here that fibers of lateral lemniscus will
aqueduct, run backwards and come out of midbrain terminate in inferior colliculus.
from its posterior aspect below inferior colliculus 3. Medial longitudinal fasciculus: This bundle
piercing superior medullary velum where the fibers of fibers is paramedian in position in front of
decussate. periaqueductal gray matter.
l Mesencephalic nucleus of trigeminal nerve: It is the 4. Tectospinal tract: This descending noncorti-
proprioceptive sensory nucleus of trigeminal nerve cospinal tract is placed in front of medial longi-
present through whole length of midbrain. The nucleus tudinal fasciculus.
122
Brainstem
Motor nucleus of oculomotor EdingerWestphal nucleus
nerve
Mesencephalic nucleus of
Nucleus of superior Vnerve
colliculus
Protectal nucleus
Reticular nucleus
Spinal lemniscus
Trigeminal lemniscus
Medial longitudinal
fasciculus
Decussation of Medial lemniscus
tectospinal tract
Parietopontine, occipitopontine
and temporopontine fibers
Red nucleus
Corticospinal and
corticonuclear fibers
Substantia nigra
Frontopontine fibers
5. Rubrospinal tract: This is another noncorti- l Somatic efferent nucleus of oculomotor nerve: It is
cospinal tract descending in front of tectospinal. the main motor nucleus of oculomotor nerve which
It is placed either in front or behind decussation of supplies majority of extraocular muscles. It is situated
fibers of superior cerebellar peduncle. in ventromedial part of periaqueductal gray matter.
n Tectum (inferior colliculus): Beneath this round The nucleus of both sides is closely apposed to each
bulge, compact mass of neurons forms nucleus other forming a triangular nuclear complex ventral to
of inferior colliculus. This nucleus forms the cell aqueduct.
station in cochlear pathway. Many of the fibers of l EdingerWestphal nucleus: It is general visceral
lateral lemniscus relay in this nucleus. Efferent efferent nucleus of oculomotor nerve which gives out
fibers from nucleus of inferior colliculus pass via preganglionic fibers passing through oculomotor nerve
to supply two smooth muscles of eyeball, constrictor
inferior brachium to medial geniculate body.
pupillae and ciliary muscle. This nucleus is situated
Inferior colliculus cells are also considered to form
dorsolateral to somatic efferent nucleus.
the center of spinoauditory reflex which helps in
l Mesencephalic nucleus of trigeminal nerve: As
localizing the source of sound. stated earlier, this proprioceptive sensory nucleus
Tegmentum and tectum at the level of superior of trigeminal nerve extends throughout whole
colliculus (Fig. 5.36) length of midbrain. It is situated on lateral part of
n Tegmentum: Like inferior collicular level, periaqueductal gray lateral to cerebral aqueduct.
tegmentum at the level of superior colliculus This nucleus receives proprioceptive impulse from
fundamentally presents following features muscles of mastication, temporomandibular joint,
l Gray matter: In the form of cranial nerve nuclei roots of teeth, muscles of eyeball and face.
and, reticular nuclei. Additionally a nucleus of extrap- 2. Reticular nuclei: This part of brainstem reticular
yramidal system called red nucleus. formation is less prominent and situated in lateral
l White matter: In the form of ascending (lemnisci) part of tegmentum.
and descending tracts and, decussating fibers of some 3. Red nucleus: It is so called because it is red or
descending tract. reddish brown in color due to more vascularity and
n Gray matter (of tegmentum): iron containing pigment in neuronal cytoplasm.
1. Periaqueductal gray matter: Gray matter surroun- It is ovoid in length and round in cross section.
ding cerebral aqueduct presents following cranial This nucleus is situated dorsal to medial end of
nerve nuclei. substantia nigra. Red nucleus extends only in
123
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
upper half of midbrain at the level of superior These fiber bundles are situated lateral to red
colliculus. It is one of the centers of extrapyramidal nucleus.
system. 5. Medial longitudinal fasciculus: It is the uppermost
n Connections of red nucleus: Red nucleus end of this fiber bundle which is situated just in
functions as intermediate cell station for following front of oculomotor nucleus.
pathways. n Tectum (superior colliculus): It is a part of
1. Corticorubrospinal tract: bulge on the dorsal aspect of upper half of midbrain.
Afferent: From motor and premotor area of cere- Beneath this round elevation, dorsal part of midbrain
bral cortex (Area 4 and 6) of same side. (behind cerebral aqueduct) presents concentric layers
Efferent: To anterior horn cells of spinal cord (only of gray and white matters. Neurons of the gray matter
upper cervical segments) of opposite side. form nucleus of superior colliculus which forms cell
2. Corticorubrobulbar tract: stations for spinovisual reflex.
Afferent: From motor and premotor area of n Connections of nucleus of superior colliculus:
cerebral cortex (Area 4 and 6) of same side. Afferent: Fibers of optic tract relay in lateral
Efferent: To motor nuclei of IIIrdVIIth cranial geniculate body. Some of the fibers from neurons of
nerves of opposite side. lateral geniculate body, passing through superior
3. Cerebellorubrothalamic tract: brachium end in superior colliculus.
Afferent: From dentate nucleus of cerebellum of Efferent: These are tectobulbar and tectospinal
opposite side. fibers passing to motor nuclei of cranial nerves in
Efferent: To thalamic nucleus. brainstem and anterior horn cells of spinal cord
4. Pallidorubrothalamic tract: respectively.
Afferent: From globus pallidus of same side. Nucleus of superior colliculus acts as a center for
Efferent: To thalamic nucleus of opposite side. spinovisual reflex or visual body reflex pathway.
n White matter (of tegmentum):
1. Emerging fibers of oculomotor nerve: Both CLINICAL ANATOMY OF BRAINSTEM
somatic efferent and general visceral efferent
(parasympathetic) fibers of oculomotor nerve, MEDULLA OBLONGATA
arising from respective nucleus, traverse through
tegmentum of midbrain at the level of superior n General consideration: Traumatic, ischemic,
colliculus. While doing so, oculomotor nerve infective, degenerative or neoplastic lesions of med-
traverses through red nucleus and comes in ulla oblongata may lead to wide range of clinical
close relation to crus cerebri through which pass manifestations because
corticospinal (pyramidal) tract fibers. i. It contains various cranial nerve nuclei.
2. Decussation of rubrospinal tract fibers: It is known ii. Medulla oblongata is the part of brainstem
that rubrospinal tract is a crossed tract. Fibers which contains vital centers those regulates
arising from red nucleus decussate immediately at cardiovascular and respiratory functions.
the level of superior colliculus ventromedial to the iii. Through medulla oblongata pass many ascen-
nucleus, and then descend towards spinal cord. ding and descending tract which may be
This is known as anterior (ventral) tegmental affected in demyelinating diseases, neoplasm
decussation of Forel. or vascular disorder.
3. Decussation of tectospinal tract fibers: Like
rubrospinal tract, tectospinal tract is also a Herniation of Medulla in Increased
contralateral tract arising from tectum of mid- Intracranial Pressure
brain. At the level of superior colliculus, fibers of
Any tumor or space occupying lesion (SOL) in posterior
tectospinal tract decussate, posteromedial to red
cranial fossa will lead to increase in intracranial
nucleus before descending towards spinal cord. It
pressure. As a result, to compromise this tension,
is called posterior (dorsal) tegmental decussation
medulla oblongata with cerebellar tonsil will be
of Meynert.
pushed downwards and forwards causing herniation
4. Compact bundle of ascending tract (as lemniscus):
through foramen magnum.
Out of the four lemnisci found of the level of
inferior colliculus, lateral lemniscus was found to
Clinical manifestations
end in inferior colliculus. So, at the level of sup-
erior colliculus, three lemnisci, namely medial, l Headache
trigeminal and spinal, are placed medial to lateral. l Neck stiffness or neck rigidity
124
Brainstem
l Effect of lesion of lower four cranial nerves due to of medulla oblongata with a part of cerebellum. It is
their traction (IXXIIth). characterized by various manifestations due to lesion
of many nuclei and fiber tracts which are as follows.
Complication Area of lesion Clinical manifestations
Lumbar puncture, to release the raised intracranial 1. Spinal lemniscus (lateral Loss of pain and temperature
pressure, is contraindicated. Because it may lead to spinothalamic tract) sensation of opposite half of body.
further herniation of medulla (so also brain) through 2. Spinal nucleus and spinal Loss of pain and temperature of
tract of trigeminal nerve same side of face.
foramen magnum which may cause sudden failure of
vital functions. 3. Nucleus ambiguous Dysphagia (difficulty in
swallowing) and dysphonia
n Arnold Chiari malformation: It is a congenital (difficulty in phonation) due to
disorder associated with craniovertebral anomalies paralysis of muscles of soft
and spina bifida. palate, pharynx and layrynx.
Pathology: Herniation of cerebellar tonsil and 4. Ventral and dorsal spino- Cerebellar ataxia associated
medulla oblongata through foramen magnum. cerebellar tract, inferior with incoordination of
cerebellar peduncle and movements and in gait affecting
Effect: Herniation of medulla as well as cere- part of cerebellum limbs.
bellum will cause obstruction of foramen of Magendie 5. Vestibular nuclei Vertigo, nausea, vomiting and
and foramen of Luschka on the roof of fourth ventricle nystagmus (incoordination in
which communicate subarachnoid space with cavi- conjugate deviation of eyeball).
ties (ventricles) of brain. So it will cause internal 6. Descending sympathetic Horners syndrome characterized
hydrocephalus. fibers by ptosis, miosis, enophthalmus
and anhidrosis with flushing of
n Medial (ventral) medullary syndrome: same side of face.
It is one of the vascular disorder of medulla oblo-
ngata. In this case of vascular lesion ventral part of n Traumatic lesion of medulla oblongata:
medulla is damaged due to obstruction (thrombosis) of Sudden hyperextension injury of neck leading to
medullary branch (branches) of vertebral artery. fracture dislocation of axis (second cervical vertebra)
This syndrome is also known as Crossed paralysis causes damage to medulla oblongata. Typical example
as it will cause is Hangmans fracture of axis which presses over
1. Contralateral hemiplegia: It is due to lesion of medulla oblongata leading to suppression of functions
pyramid through which passes pyramidal tract of various functional area including vital centers
which ultimately results to death following hanging.
before decussation.
As it is upper motor neuron lesion, it is chara-
cterized by contralateral spastic paralysis with incre- PONS
ased muscle tone and exaggerated tendon jerks. Pons is the infratentorial part of brainstem which is
2. Ipsilateral paralysis of tongue: It means that lodged in posterior cranial fossa and closely related
paralysis of muscles of tongue of same side because to cerebellum with middle cerebellar peduncle and
of lesion of hypoglossal nerve of same side which fourth ventricle of brain. Lesion of pons is commonly
emerges from medulla close to pyramid. Due to due to following two reasons
this defect, as same sided genioglossus with other 1. Vascular: Pons is supplied by
tongue muscles is paralyzed, unopposed action of i. Pontine arteries
genioglossus of normal side will push the tip of ii. Anterior inferior cerebellar artery
tongue, when protruded, to the paralyzed side. iii. Superior cerebellar artery.
3. Additional sensory deficit: At this level of med- All are branches of basilar artery.
ulla (pyramidal level), medial lemniscus is situated Range of vascular lesion may be mild, moderate
behind pyramid. So, if the lesion is deeper, damage or severe. Accordingly it may affect a small area or
to medial lemniscus will cause loss of sense of whole of pons which causes bilateral manifestations.
position and movement (due to loss of proprioceptive Nature of vascular lesion may be thrombosis or
sensation from muscles, tendons and joints) and hemorrhage leading to infarction.
loss of discriminative touch of opposite side. 2. Neoplastic: Neoplasm (tumor) of pons may be
n Lateral medullary (Wallenberg) syndrome: a) Acoustic neuroma: It is a tumor at cerebello-
This is a clinical condition which occurs in thrombosis pontine angle (CP angle) developed from
of posteroinferior cerebellar artery, a branch of vert- Schwann cell sheath of statoacoustic (vestibu-
ebral artery. It leads to lesion in posterolateral part locochlear) nerve.
125
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
b) Astrocytoma: It is the tumor originating from Site of lesion Clinical manifestations
astrocytes. Incidence is common in children. 1. Vestibulocochlear nerve Vertigo, nausea, vomiting,
n Vascular lesion in paramedian area of basilar tinnitus and progressive deafness.
part of pons may be due thrombosis or infarction due 2. Middle cerebellar peduncle Cerebellar ataxia with intention
to involvement of short multiple pontine branches of tremor and staggering gait.
basilar artery. It will cause contralateral cerebellar 3. Spinal nucleus and spinal Ipsilateral loss of pain and
tract of trigeminal nerve temperature sensation of face.
ataxia with intention tremor due to lesion of cortico-
pontocerebellar pathway. Contralateral hemiplegia 4. Emerging fibers of facial Ipsilateral infranuclear facial
nerve paralysis.
will result due to damage to corticospinal tract
passing through basilar part of pons. n Pontine hemorrhage: It is extensive and bila-
n Millard Gubler Syndrome: It is the clinical teral in nature so that clinical condition will cause
condition which results due to occlusion of paramedian bilateral type of all manifestations as stated above.
pontine branches of basilar artery feeding lower and In addition, it will present following two specific
ventral part of pons. manifestations.
It involves basilar part of pons through which 1. Pinpoint pupil: Due to involvement of ocular sym-
pathetic fibers.
traverses corticospinal tract and emerge fibers of VIth
2. Hyperpyrexia: It is because of severe lesions in pons
and VIIth cranial nerve.
which disconnect the body from heat regulating
Clinical manifestations
center in hypothalamus.
i. Contralateral hemiplegia
ii. Ipsilateral lower motor neuron type (nuclear or
MIDBRAIN
infranuclear) facial paralysis.
iii. Ipsilateral medial strabismus (squint) due to Causes of lesion in midbrain may be
unopposed action of medial rectus as a result 1. Traumatic
of paralysis of lateral rectus supplied by 2. Neoplastic
abducent (VIth cranial) nerve. 3. Ischemic
n Extensive vascular lesion or expanding 4. Obstructive.
tumor (astrocytoma) of pons will cause widespread
motor and sensory deficits depending on different Traumatic Lesion
areas of gray and white matter affected as follows Midbrain, the short proximal part of the stalk, forms
Area of lesion Clinical manifestations
supratentorial part of brainstem. While becoming
continuous with infratentorial part, midbrain is rela-
1. Corticospinal tract Contralateral hemiparesis or
hemiplegia
ted to tentorial notch formed by sharp free margin of
tentorium cerebelli. Sudden lateral movement of the
2. Corticonuclear tract Weakness of muscles of face, jaw
of opposite side
head may lead to a vulnerable injury, when midbrain
(its cerebral peduncle) may be torn, stretched, twisted
3. Pontocerebellar fibers Cerebellar ataxia
or bent against free margin of tentorium cerebelli.
4. Medial and spinal lemnisci Contralateral sensory deficit of In this case most obvious feature will be invo-
trunk and limbs
lvement of oculomotor nerve at its exit. Depending
5. Superior (principal) Contralateral loss of tactile upon severity of injury, trochlear nerve and other
sensory nucleus of sensation of face, pain and
trigeminal nerve temperature sensations are
areas of midbrain will be affected.
preserved as spinal nucleus of
Vth nerve is not affected. Neoplastic Lesion
6. Abducent nerve nucleus Medial strabismus (squint) due
to unopposed action of medial
Tumors pressing and infiltrating neural tissue of
rectus muscle. midbrain may be internal or external. Any space
occupying lesion (SOL) in the vicinity will have effect
7. Vestibular nuclei Vertigo, nausea, vomiting and
nystagmus. on following structural components of midbrain.
1. Important ascending and descending tracts: For
8. Cochlear nuclei Impairment of hearing.
example Medial and spinal lemnisci, corticospinal
n Cerebellopontine angle (CP angle) tumor: It and corticobulbar (corticonuclear) tracts, medial
is the acoustic neuroma which occurs due to tumor longitudinal fasciculus.
arising from Schwann cell sheath of vestibulocochlear 2. Nuclei of cranial nerves: Like oculomotor and troc-
nerve. hlear nerves.
126
Brainstem
3. Reflex centers in colliculi Side of lesion Clinical manifestations
4. Red nucleus and substantia nigra: Which possesses 1. Corticospinal tract Contralateral hemiplegia.
remarkable influence on motor function. 2. Corticobulbar tract Paresis of lower part of face,
tongue (contralateral half).
Vascular Lesion 3. Oculomotor nerve fibers Ptosis, lateral squint, proptosis
with diplopia, dilatation of pupil
It occurs due to occlusion of a branch of posterior wih its no reaction to light and
cerebral artery. Depending upon extent of lesion accommodation.
clinical syndromes are of following two types: 2. Benedikt syndrome: This vascular lesion of
1. Weber syndrome: It is also known as Crossed midbrain is more extensive additionally affecting
oculomotor paralysis. This lesion damages cortic- medial and spinal lemnisci as well as red nucl-
ospinal and corticobulbar (corticonuclear) tracts eus. So clinical findings of Weber syndrome is
and emerging fibers of oculomotor nerve. Effects associated with contralateral sensory impairment
of this vascular lesion are following. and some involuntary movements.
127
Cerebellum
6
Superior cerebellar peduncle
Midbrain
Cerebellum
Brainstem Pons
Midbrain
Cerebellum
Pons
Medulla oblongata
Central canal of medulla
Fig. 6.2 Cerebellum in relation to fourth ventricle of brain (sagittal sectional view)
Stage I
GROSS ANATOMY (FIG. 6.3)
Cerebellum receives various kinds of sensory inf-
ormations either through direct pathway like spino-
Funamental Components
cerebellar or indirect pathway like spinothalamo-
cortical and corticopontocerebellar tracts. Cerebellum is fundamentally composed of inter-
Sources of informations are as follows mediate part called vermis and two lateral halves
1. Proprioceptive general somatic sensation: From called cerebellar hemispheres. Vermis is so called
end organs of muscles, tendons, joints. because it is somewhat like worms in appearance.
2. Exteroceptive general somatic sensations: Mainly This terminology can be compared to the word verm-
from end organs for touch and pressure. iform appendix. Centrally situated vermis is narrow
3. Proprioceptive special somatic sensation: From and constricted. It is continuous on either side with
end organ for balance, i.e. vestibular apparatus. rounded and expended cerebellar hemispheres.
4. Exteroceptive special somatic sensation: From end
organs for sight (photoreceptors) and end organs Surface views Superior and inferior
for hearing (cochlear apparatus).
When viewed from superior surface, area of vermis
Stage II seen is called superior vermis, which presents antero-
posteriorly directed midline ridge, which slopes late-
All sensory informations are analyzed and coordinated rally to become continuous with superior surface of
or integrated. cerebellar hemispheres.
Inferior aspect of cerebellum shows comparatively
Stage III independent appearance of vermis which is called
After integration of all sensory inputs, a regulatory inferior vermis which is more deeply placed as com-
effect is exerted by cerebellum, in a subconscious or pared to cerebellar hemisphere. The depression on
129
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Superior vermis
Superior half of cerebellar
hemisphere above horizontal
sulcus
Cerebellar
hemisphere Horizontal sulcus
Primary sulcus
Middle (posterior) lobe
Horizontal sulcus
Posterolateral sulcus
Flocculonodular lobe
Fig. 6.4 Cephalocaudal relationship of different components (lobules) of cerebellum. Fig also shows rostroventral bending of caudal part
of cerebellum (part caudal to horizontal sulcus) to form its inferior part
Lobules of cerebellum (Fig. 6.5): Horizontal fissure divides cerebellum into superior
and inferior halves. Lobules listed above, which are
Vermis Lateral extension in
proximal to horizontal fissure form superior half
}
cerebellar hemisphere
1. Lingula No lateral extension
and those distal to the fissure form inferior half of
2.
Central lobule Ala Anterior
cerebellum.
}
Primary 3. Culmen Anterior quadrangular lobule lobe
fissure PHYLOGENETIC CLASSIFICATION OF CEREBEL-
4. Declive Posterior quadrangular lobule LUM (FIGS 6.5 AND 6.6)
Horizontal 5. Folium Superior semilunar lobule
fissure (lobulus simplex)
In reference to the stages of evolution, cerebellum is
made up of following three phylogenetic components
6. Tuber Inferior semilunar lobule
which are also functionally different.
7. Pyramid Biventral lobule Posterior
Posterolat- 8. Uvula Tonsil lobe
eral sulcus Archicerebellum
9. Nodule Flocculus Flocculo- It is the most primitive part of cerebellum which is
nodular lobe
the only component present in fishes and amphibians.
1
Anterior lobe
2 2
Primar fissure
3 3
Archicerebellum 4
4
Posterior
lobe 5 5
Horizontal fissure
Paleocerebellum
(sulcus)
6 6
Neocerebellum 7 7
8 8
9 Posterolateral fissure
Flocculonodular 9 (sulcus)
lobe
6
Pons
9 7
8
Posterolateral fissure
Medulla oblongata
Cavity of fourth
ventricle of brain
Central canal of lower half of medulla oblongata
Fig. 6.6 Midsagittal section of vermis component of cerebellum (with 4th ventricle and brainstem) contributing to lobular elements.
1. Lingula, 2. Central lobule, 3. Culmen, 4. Declive, 5. Folium, 6. Tuber, 7. Pyramid, 8. Uvula, 9. Nodule
Stellate cell
Molecular layer
Busket cell
Golgi cell
Granular layer
Granule cell
Glomerulus
Climbing fibers
Mossy fibers
Neurons of cerebellar
nuclei
} Cerebellar efferents
Fig. 6.7 Cytoarchitecture of cerebellum showing afferent and efferent fibers and interrelationship of neurons
1. Outer molecular layer: Stellate cells and busket 2. Some afferent reaching the innermost granular
cells. layer relay in granule cells which pass further
2. Intermediate layer of Purkinje cells: Purkinje cells. superficially to relay in Purkinje cells dendrites in
3. Inner granular layer: Granule cells and Golgi molecular layer.
cells. Neuroglia are present in all the layers. Through both the ways Purkinje cells receive ex-
citatory impulse continuously. This excitatory im-
Fundamental structural and functional basis of
pulse in relayed to neurons of cerebellar nuclei in
cortical architecture
deeper white matter. Axons of cerebellar nuclei pass
Principal cells of cortex are Purkinje cells. It receives out as efferent to carry the same excitatory impulse.
afferent input entering cerebellum through following But this impulse is limited time to time by inhibitory
two different routes. influence of stellate cells, busket cells and Golgi cells
1. Some of cerebellar afferent relay in Purkinje cells of cortex on Purkinje cells, so also on cells of cerebel-
reaching upto superficial molecular layer. lar nuclei.
133
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
position between all the afferent fibers to cerebellum
STRUCTURAL DETAIL OF CEREBELLAR CORTEX
other than olivocerebellar group and the Purkinje cells.
(FIG. 6.7) These cerebellar afferent fibers are known as Mossy
Molecular Layer fibers. Granule cells present four to five dendrites
which present claw-like endings. Mossy fibers, which
This outermost layer of cortex receives cerebellar are all the afferents, other than olivocerebellar fibers
afferent called climbing fibers. Among all afferents (climbing fibers) reach upto granular layer where
to cerebellum, these are only olivocerebellar fibers. they show multiple branching. These fiber terminals
Entering through inferior cerebellar peduncle and form synaptic connection with claw-like dendrites
traversing through white matter these fibers climb up of granule cells. One mossy fiber forming synaptic
to the outermost layer of cortex. These fibers divide connection with thousand of Purkinje cells, thus
into numerous branches which wrap around the bush- producing diffuse excitatory effect.
like dendritic tree of Purkinje cells in molecular layer. Axons of granule cells are long enough to reach
These are called climbing fibers as they look like a upto superficial molecular layer traversing through
vine on a tree. One climbing fiber forms synaptic
Purkinje layer. Terminal end of granule cell axons
connections with dendritic tree of 110 Purkinje
divide in T shaped manner, ends of which run in
neurons through which all the times excitatory
opposite direction which are called parallel fibers.
sensory inputs are discharged on Purkinje cells.
Ends of parallel fibers form synaptic connection with
Neurons present in molecular layer are stellate
dendritic tree of Purkinje cells at right angle.
cells and busket cells. Stellate cells are small star-
Second type of neurons in granular layer are Golgi
shaped superficially placed cells. Axons of these
cells. Their dendrites are spread out in molecular
cells relays in dendritic spines of Purkinje cells to
produce inhibitory effect. Busket cells are placed in layer and axon split up into branches which form
deeper part of molecular layer. These are so called synapses with dendrites of granules cells at the site of
because multiple axon terminals give a busket-like their junction with mossy fiber terminals which form
appearance to hold the Purkinje cell body. Through glomerulus.
this connection excitatory impulse of Purkinje cells Neuroglial cells are also abundant in whole gran-
are limited. ular layer.
Molecular layer also receives axons of granule
cells situated in granular layer. In this layer long MECHANISM OF CEREBELLAR CORTICAL CIRCUIT
axons of granule cells divided into T-shaped manner.
Two limbs of T-shaped axon of granule cells run in Purkinje cells receive constantly the excitatory inputs
opposite direction which synapse with Purkinje cell entering cerebellum through afferent fibers. The
dendritic spines. afferent fibers are of two types. Climbing fibers are
only the olivocerebellar fibers among all afferent fibers
Purkinje Cell Layer to cerebellum. These fibers are longer to wrap around
and to relay in dendritic spines of Purkinje cells at
This layer is made up of single row of cells called molecular layer. Mossy fibers are all other afferents,
Purkinje cells. These are large, flask-shaped Golgi which also produce excitatory affect on Purkinje cells
type I neurons. Dendrites of these cells are like tree through granule cells. Axons of Purkinje cells leave
bush showing primary, secondary and tertiary or final the cortex to reach deeper white core of cerebellum
branching. Final branches present dendritic spines. where they excite neurons of cerebellar nuclei. Axons
Whole dendritic process extend into superficial of the nuclear neurons leave cerebellum as efferents
molecular layer. via superior and inferior cerebellar peduncles to reach
Long axons of Purkinje cells acquire myelin sheath centers in brainstem, spinal cord and cerebral cortex.
on entering granular layer. These pass further deeper So, it clear till now that, receiving all sensory inputs
to relay in neurons of cerebellar nuclei. through climbing as well as mossy fibers, excitation of
Axons of a few Purkinje cells end directly to vesti- Purkinje cells is conveyed via cerebellar nuclear axons
bular nuclei, without relaying in cerebellar nuclei. for motor activities, maintenance of equilibrium, muscle
tone and muscular activity coordination. But for this
Granular Layer motor activity, to reach upto optimum range, proper
This layer is so called because it is filled with densely extent and right direction, time to time modification
packed, small sized, multipolar neurons called granule or limitation of excited state of Purkinje cells conveyed
cells. The cells present scanty cytoplasm with deeply to cerebellar nuclear axons as efferent fibers are
stained nuclei. Granule cells are intermediate in necessary. This becomes possible by inhibitory whip
134
Cerebellum
of stellate cells, busket cells of molecular layer and WHITE MATTER OF CEREBELLUM
Golgi cells of granular layer. It is to be recalled that
axons of stellate cells form synaptic connection with Small amount of white matter present in vermis looks
dendrites, and axons of busket cells come in contact like trunk and branches of a tree. It is called arbor
with cell bodies of Purkinje cells. Through these vitae cerebelli. Cerebellar hemispheres present larger
amount of white matter.
connections both these cells exert inhibitory effect
White matter is made up of following three groups
on Purkinje cells. In granular layer, axons of Golgi of fibers.
cells form synaptic contact with dendrites of granule 1. Afferent fibers: These are climbing and mossy
cells, through which inhibitory influence is exerted fibers as already described. These form the main
on Purkinje cells, so on axons of neurons of cerebellar bulk of cerebellar fibers which enter mostly
nuclei coming out as efferent fibers from cerebellum. through middle and inferior cerebellar peduncles.
So, it is clear that inhibitory impulse from stellate 2. Efferent fibers: These fibers leave cerebellum
cells, busket cells and Golgi cells are transmitted by through superior and inferior cerebellar peduncles.
Purkinje cells to the cerebellar nuclei, axons of which in Most of these efferent fibers from cerebellum are
axons cerebellar nuclei neurons. Some of axons of
turn, projecting on motor centers of brainstem, spinal
Purkinje cells of flocculonodular lobe and part of
cord and cerebral cortex modify or limit muscular vermis pass, bypassing cerebellar nuclei, directly
activity for maintenance of equilibrium, muscle tone as cerebellar efferents.
and coordination of smooth and skilled movements. 3. Intrinsic fibers: These are so called as they exist
Neurotransmitters: Climbing as well as mossy within the cerebellum. It means these fibers,
fibers release glutamate or gamma-aminobutyric being the processes of different cerebellar neurons
acid (GABA) as excitatory transmitter on dendrites interconnect with each other.
of Purkinje cells. Axons of stellate cells, busket cells
and Golgi cells release norepinephrine and serotonin NUCLEI OF CEREBELLUM (FIG. 6.8)
which are inhibitory transmitter to have effect on These are small but compact masses of gray matter
Purkinje cells. embedded in central core of white matter. Axons
Afferents from vermal (median) zone of Afferents from paravermal (medial) zone to
cortex to fastigial nucleus nucleus interpositus
B B
Fig. 6.8 A. Intracerebellar nuclei, B. Afferents from vermal (median), paravermal (medial) and later zones of cerebellar cortex relaying
to respective nuclei, C. Efferents from three phylogenetic groups of nuclei leaving for different destinations
135
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
of neurons of these nuclei, as already discussed, i. Vestibular and reticular nuclei of brainstem
leave out of cerebellum through either superior or ii. Via red nucleus to spinal cord
inferior cerebellar peduncles as cerebellar efferents. iii. Via thalamus to motor and premotor areas of
Cerebellar nuclei are four in number on either side of cerebral cortex.
midline from vermis to cerebellum hemisphere. From It is interesting to note at this stage that fastigial
lateral to medial the nuclei are nucleus, nucleus interpositus and dentate nuclei
1. Dentate nucleus (Nucleus dentatus) D receive afferent (Purkinje cell axons) from three
2. Emboliform nucleus (Nucleus emboliformis) E components of cerebellar cortex which are subdivided
3. Globose nucleus (Nucleus globossus) G from medial to lateral as follows:
4. Fastigial nucleus (Nucleus fastigius) F 1. Medial (vermal): Cortex of vermis
Nucleus emboliformis and nucleus globossus are 2. Intermediate (paravermal): Cortex of medial half
together known as nucleus interpositus.
of hemisphere
Dentate Nucleus 3. Lateral: Cortex of lateral half of hemisphere.
So, afferent from three mediolaterally divided
Dentate nucleus is the most lateral and largest portions of cortex to three phylogenetic types of
among the four nuclei of cerebellum. It is most prom- cerebellar nuclei and their efferents in three different
inent in higher animals, specially in human brain.
destination are related as follows.
Phylogenetically it is the latest in evolution and
obviously related to neocerebellum. Dentate nucleus, Afferents Cerebellar Efferents
on section, looks like a folded bag with its opening from nucleus
(concavity) facing medially. From the concave side 1. Vermal (medial) Fastigial Fastigiovestibular tract
emerge efferent fibers from the nucleus. Efferent fibers zone of cerebellar nucleus to vestibular nuclei
leave cerebellum through superior cerebellar peduncle. cortex
2. Paravermal Nucleus Cerebellorubrospinal
Emboliform Nucleus (intermediate) zone interpositus tract to anterior horn
of cerebellar cortex cell of spinal cord
Emboliform nucleus is oval in outline. It is situated
3. Lateral zone Dentate Dentatothalamocortical
just medial to dentate nucleus and may be closely of cerebellar cortex nucleus tract to motor and prem-
approximated to concavity (hilum) of dentate nucleus. otor area of cerebral cortex
{
4. Par olivocerebellar tract: From medial and 3. Ischemic: Vascular occlusive disorder, e.g. throm-
superior (dorsal) olivary nuclei bosis of any of the three cerebellar arteries.
5. Olivocerebellar tract: From inferior olivary 4. Degenerative: For example multiple sclerosis.
nucleus 5. Neoplastic: Expanding tumors, medulloblastoma
{ 6. Vestibulocerebellar tract
7. Reticulocerebellar tract
in children.
(A reader can remember the fibers in groups as Cerebellar Lesion May be Compensated by
above). Other Parts of Nervous System
Efferent Cerebellar lesions may be acute due to trauma or
1. Cerebelloolivary tract sudden vascular occlusion when the symptoms
2. Cerebellovestibular (fastigiovestibular or fast- are severe. In chronic lesion, like slowly expanding
igiobulbar) tract tumor, clinical features are less severe. But it has
3. Cerebelloreticular (fastigioreticular) tract. been seen in many cases of the lesion, either acute or
A reader can remember three efferents as reverse of chronic, patient recovers from the clinical deficits due
last three afferents. to compensation of cerebellar dysfunction by other
parts of nervous system.
Middle cerebellar peduncle
Cerebellar Syndrome
It is composed of only afferent fibers. These fibers
are pontocerebellar fibers of corticopontocerebellar Cerebellar syndrome is defined as combination of
pathway. signs and symptoms which are manifested due to
lesion of cerebellum for any cause. Fundamental of
Superior cerebellar peduncle cerebellar syndrome is motor dysfunction without
motor paralysis. Following are the two types of
Afferent cerebellar syndromes.
1. Ventral spinocerebellar tract 1. Archicerebellar syndrome
2. Tectocerebellar tract. 2. Neocerebellar syndrome.
Depending upon the nature and extent of lesion in
Efferent cerebellum, a patient may present combination or
1. Dentatorubral tract: For dentatorubrospinal path- overlapping of clinical findings of two cerebellar
way syndromes.
2. Dentatothalamic tract: For dentatothalamocorti- Neocerebellar syndrome presents the symptoms
cal pathway. and signs due lesion of both paleocerebellum and
neocerebellum.
CLINICAL ANATOMY
As cerebellum has ipsilateral control on body, lesion Archicerebellar Syndrome
of one half of cerebellum leads to clinical effect on It is due to lesion of archicerebellum which is com-
same half of body. posed of Flocculonodular lobe and lingula. It affects
To study the effect of lesion of cerebellum or vermal zone or area of vermis. That is why it is also
cerebellar dysfunction, functions of cerebellum are to
called vermis syndrome. Commonest example is med-
be briefly recapitulated which are as follows:
ulloblastoma in children.
1. Maintenance of equilibrium or balance of body
through all reflex activities and voluntary move- Archicerebellar syndrome is characterized by
ments. group of clinical findings which are due to disorders in
2. Harmonization of muscle tone and maintenance of equilibrium manifested by some motor dysfunctions
normal body posture. which are as follows.
3. Cerebellum, though not concerned with initiation n Unsteadiness in stance: Due to impaired
of voluntary movements, coordinates smooth, balance, while standing, the patient will have a
precise movement upto right extent and range in tendency to fall. He or she will try to compensate this
right direction maintaining the economy of force. difficulty by overcontraction of muscles of lower limb
which presents stiffed legs. The disability will also be
Causes of Cerebellar Lesion compensated with the help of vision and the patient
1. Congenital: Hypoplasia or dysgenesis will stand on a broad base with legs and feet being
2. Traumatic always wide apert. When the patient is asked to close
137
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
eyes while standing, he or she will have a tendency to failure to reach in right direction, upto proper extent
fall. It is known as positive Rombergs sign. with optimum force. The basic defect is termed as
n Unsteadiness in gait: Gait is the pattern or cerebellar ataxia characterized by following mani-
style of walking of an individual. In archicerebellar festations.
syndrome, due to impairment of balance, patient will 1. Intention tremor: Tremor is defined as abnormal,
sway from side to side in an attempt to maintain undesired, repetitive oscillatory movement affe-
balance of body. This is called staggering gait.
cting distal part of limbs, especially hands and
n Unsteadiness of trunk of body: This is evident
in vermis syndrome in case of children suffering from fingers. In case of neocerebellar syndrome tremor
medulloblastoma. The child will be unable to keep is noticed when the patient attempts or intends for
head erect due to imbalance of head and neck. Due finer hand movements, like picking up an object,
to impairment of balance of trunk, while walking, attempts for writing or buttoning clothes. That is
body of the patient will move to and fro forwards and why it is called intention tremor.
backwards. 2. Dysmetria: This disability is due to loss of know-
ledge to assess the range of movement. It is elicited
Neocerebellar Syndrome by finger nose test. Patient is asked to touch the
tip of nose with tip of finger. While attempting for
It is the combined effect of lesion of paleocerebellum
this, either the finger tip fails to reach tip of nose
and neocerebellum.
or it overshoots (pastpointing) the target. Patient
suffers from loss of harmonization of movement
IMPAIRED FUNCTION OF PALEOCEREBELLUM
of different groups of muscles which results in
Hypotonia: This is manifested as following decomposition of movements.
1. On palpation, muscle is found to have loss of resil- 3. Dysdiadochokinesia: This is the effect of incoor-
ience. dination between antagonist groups of muscles.
2. In an attempt for passive movement of a joint, It is elicited by asking the patient to perform
diminished resistance by the patient is felt. repeated pronation and supination movements of
3. Muscle get fatigued early. Defect is known as ast- forearm. When attempted, it is found to occur in
henia. slow, jerky and incoordinated manner.
4. During shaking of a limb, excessive movement of
4. Dysarthria: This is the disorder in articulation of
terminal joints is observed due to loss of influence
speech due to incoordination of muscles of larynx,
of cerebellum on stretch reflex.
tongue and lips. During speech, two major defects
Postural Defect are observed.
i. Use of unnatural force for muscle action.
1. Head is rotated and flexed. ii. Unusual or abnormal separation of syllables
2. Shoulder is on a lower level on the affected side. leading to slurred speech.
This disorder will have a best example when the
Pendulous Knee Jark
patient is asked to pronounce the word cerebellum.
In case of normal individual, normal jerky movement of Because of disability, patient will pronounce as CEH-
knee joint is self-limited after taping patellar tendon, RREH-BEH-LLUHM.
which is due to normal stretch reflex under regulation 5. Nystagmus: This disorder is the result of incoo-
of cerebellum. When influence of cerebellum on rdination of movement of extraocular muscles.
stretch reflex is lost, a series of pendulous flexion and
It is characterized by rhythmical oscillation of
extension movement of knee joint occurs while knee
eyeball in an attempt to fix the gaze (vision) for an
jerk is elicited.
object of interest for a longer time. Incoordination
of eye movement also occurs during horizontal
IMPAIRED FUNCTION OF NEOCEREBELLUM
side to side movement. When the gaze is returned
Fundamental effect is incoordination or asynergy back after horizontal movement, sudden jerk is
of smooth and precise voluntary movement with its observed in eyeball at the end of movement.
138
Fourth Ventricle of Brain
7
Fourth ventricle of brain is the cavity of hindbrain. 1. Upper part: It is narrower part opposite the level
This cavity, being a dilated part of original neural of rhombencephalic isthmus.
tube, is lined by ependyma and contains cerebrospinal 2. Middle part: At the level of pons.
fluid (Fig. 7.1). 3. Lower part: At the level of upper half of medulla
Fourth ventricle is situated behind pons and upper oblongata.
half of medulla oblongata and in front of cerebellum.
Shape of fourth ventricle is like that of a tent. Communications
Walls of the cavity are following
1. Floor: Formed by dorsal surfaces of pons and
A. With other parts of cavity of central
upper part of medulla oblongata. It is flat like
nervous system
ground of a tent.
2. Roof: It is made up of two slopes-like roof of a Above, through aqueduct of midbrain, fourth ventricle
tent. It projects toward white core of cerebellum. communicates with cavity of third ventricle of brain.
3. Lateral walls, where roof meets with floor. Below it communicates with central canal of
n Morphological components: Fourth ventricle spinal cord through narrow canal of lower closed part
presents following three parts morphologically. of medulla oblongata.
Aqueduct of midbrain
Cerebellum
Pia mater
Fourth ventricle of brain
Pons
Foramen of Magendie
Medulla oblongata
Central canal of lower closed
part of medulla
{
Inferior cerebellar forming lower half of roof
peduncle
Foramen of Magendie in lower
Inferolateral Cuneate tubercle ependymal half of roof
boundary
Gracile tubercle
Fig. 7.2 Upper and lower halves of roof of fourth ventricle show different nature of formation
B. With subarachnoid space (Fig. 7.2) 3. Lateral recesses (Fig. 7.4): These are also bilateral
which projects between inferior cerebellar peduncle
Cavity of fourth ventricle communicates with suba-
ventrally and peduncle of floccules dorsally. End of
rachnoid space through three apertures. One is in the
the recess presents an aperture at cerebellopontine
midline on lower part of roof and two are present in
angle. Ventricular system communicates through
lateral angles. These apertures are as follows: this aperture with subarachnoid space which has
1. Foramen of Magendie: This is a midline foramen already been mentioned.
present in lower part of roof where it is lined by
ependyma only (see below) Boundaries of Fourth Ventricle
2. Foramen of Luschka: They are present at the end
of lateral recesses placed at lateral angle of cavity n Lateral boundaries: One each side, it is the side
(Fig.7.4). where roof meets with the floor.
Caudal part is bounded by two inferior cerebellar
Recesses (Fig. 7.3) peduncles which from lower angle, pass upward
and laterally. On either side of midline, lower angle
Recesses of fourth ventricle of brain are small conical of inferolateral boundary is formed by gracile and
outpouching from its cavity as following. cuneate tubercles, where former is inferomedial to
1. Dorsal recess: This is the apex of conical tent-shaped later (Fig. 7.2). Proximal part of lateral boundary is
roof projecting into white core of cerebellum. formed by two superior cerebellar peduncles which
2. Dorsolateral recesses: These are bilateral and pass downwards and laterally from upper angle.
project dorsolaterally on either side of dorsal recess.
Dorsal recess is found to be proximal to nodule of
cerebellum, dorsolateral recesses are lateral to it.
Flocculus
Dorsal
recess Lateral
recess
Dorsolateral
Foramen of
recesses
Luschka
Cavity
of fourth
ventricle
Pons
Cerebellum
Tela
choroidea
Nodule
Medulla
oblongata Olive
Pyramid
Fig. 7.6 Upper and lower half of midline roof of fourth ventricle
related to lingula and nodule of cerebellum Fig. 7.7 Choroid plexus projecting from roof of fourth ventricle
141
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
T is double. The choroid plexus invaginates through ceruleus). Beneath this area, the group of neurons,
ependyma lined lower-half of roof towards the cavity containing melanin pigment, is called substantia
of ventricle to secrete cerebrospinal fluid. ferrugenia. These neurons are rich in noradrenaline
(norepinephrine).
Floor or Rhomboid Fossa (Fig. 7.8) Lateral to sulcus limitans, rhomboid fossa presents
a wide triangular area known as vestibular area or
Floor of fourth ventricle is formed by dorsal surfaces vestibular triangle. Vestibular nuclei are situated
of pons and upper-half of medulla oblongata. beneath this area.
It is called rhomboid fossa because it is rhomboid Just below the level of facial colliculus, fine
in outline. The area is outlined superolaterally by strands of nerve fibers are found to pass beneath
superior cerebellar peduncles and inferolaterally ependyma, in mediolateral direction, from median
by inferior cerebellar peduncles. At the inferior sulcus across medial eminence towards lateral
angle, on either side of midline, floor is limited by angle. These are known as stria medullaris. These
gracile tubercle and superolateral to it lies cuneate are efferent fibers from arcunate nucleus present on
tubercle. ventral aspect from pyramid. These fibers initially
Whole area of rhomboid fossa is lined by pass in ventrodorsal direction across whole thickness
ependyma, just beneath which lie different areas of of medulla oblongata to reach rhomboid fossa, where
gray matter, which are more precisely some cranial they bend at right angle and cross the median sulcus
nerve nuclei. to pass horizontally towards lateral angle. Finally the
Floor of fourth ventricle is divided by a vertically fibers reach opposite half of cerebellum via inferior
running midline sulcus called median sulcus. cerebellar peduncle (Fig. 7.9).
Each half of the floor is again subdivided into a Below the level of stria medullaris, medial emin-
medial part called medial eminence and a lateral part ence presents a triangular area with apex directed
called vestibular area by a narrower sulcus limitans. downward. This area is known as hypoglossal triangle
Just above the horizontal line of pontomedullary beneath which lies nucleus of hypoglossal nerve.
junction, medial eminence presents a round elevation Lateral to hypoglossal triangle, lower end of sulcus
called facial colliculus. It is so called because, efferent limitans presents a small depression called inferior
facial nerve fibers from motor nucleus of facial nerve fovea.
loop around abducens nucleus beneath this bulge. Below inferior fovea, lateral to apical part of
Above the level of facial colliculus, sulcus limitans hypoglossal triangle, a smaller triangular area is
presents a small depression called superior fovea. present with the apex directed upward. This is called
Above the level of superior fovea, sulcus limitans vagal triangle as beneath this area lies dorsal nucleus
becomes flattened and forms lateral limit of floor of of vagus.
fourth ventricle. This area is bluish gray in color Inferolateral to vagal triangle, just above the
and named locus coeruleus (to be pronounced upper end of central canal of medulla oblongata, a
142
Fourth Ventricle of Brain
Ependyma lining floor of fourth Stria medullaris 2. Foramen of Magendie and foramen of Luschka in
ventricle the wall of fourth ventricle permit cerebrospinal
fluid to circulate freely from ventricular system
to subarachnoid space. This communication thus
maintains the balance or harmony between secr-
etion and absorption of cerebrospinal fluid.
143
CerebrumCortical Gray Matter
8
n The whole cerebrum a sphere (Fig. 8.1): The
INTRODUCTION
total cerebrum, when seen from above, looks like a
Cerebrum (telencephalon) is the largest part of sphere which is slighty broader in its posterior part.
the brain. It is largest in size because of maximum Its maximum diameter is opposite the level of an
proximalization of various motor as well as sensory
imaginary line joining two parietal tuberosities skull.
centers of human brain. It means that, during evo-
lution, many motor and sensory centers of central n Outer gray matter and inner white matter:
nervous system have shifted to cerebrum from Superficial part of cerebrum is made up of grayish
lower brain. colored neuronal cell bodies which forms gray matter.
Sulcus
Cerebrum is widest a little
Gyrus
behind the middle
Median longitudinal
fissure dividing
cerebrum into two
cerebral hemispheres
Frontal lobe
Parietal lobe
Parietooccipital sulcus
Frontal pole
ii. Below corpus callosum, smooth medial surface In total, borders are six in number. Before going
of diencephalan (thalamus) of corresponding to study and recognize the borders, readers are to
side. understand following points.
First 3 borders separate superolateral surface
3. Inferior surface (Fig. 8.5) from medial surface (1 border) and inferior surface (2
Outline of temporal pole divides this surface into two borders).
parts. Next 3 borders separate medial surface from
i. Anterior: It is smaller and anterior to temporal inferior surface. These borders together are known as
pole. It is flat and called orbital surface as it inferomedial border.
rests on the roof of orbit formed by anterior 1. Superomedial border: It separate superolateral
cranial fossa of skull. surface from medial surface (Figs 8.4 and 8.6).
ii. Posterior: It is elongated and slightly concavo- 2. Inferolateral border: This border separates
convex lying behind temporal pole. It is called superolateral surface from posterior tentorial
tentorial surface because it rests on a hori- part of inferior surface. It extends from temporal
zontal fold of dura mater (outermost covering pole to occipital pole (Fig. 8.5). A little in front of
of brain) called tentorium cerebelli. occipital pole, this border presents a notch called
preoccipital notch.
Borders 3. Superciliary border: This is a small curved
Borders are to demarcate (separate) adjacent surface. border which separates superolateral surface from
These are as follows: anterior orbital part of inferior surface (Fig. 8.5).
Fornix Corpus callosum Septum pellucidum Frontal pole
Superomedial Superciliary
Medial orbital
border border
border Temporal pole
Optic
}
chiasma Orbital
Infundibulum surface
Inferior
of pituitary
surface
Mammillary Tentorial
body surface
Posterior
Hippocampal
perforated
border
substance
Midbrain
Fig. 8.4 Medial surface of cerebral hemisphere Fig. 8.5 Inferior surface of cerebral hemisphere
146
CerebrumCortical Gray Matter
Superomedial border
Superolateral surface
Medial surface
Inferior surface
Medial surface of cerebral hemisphere is separated It has two adjacent walls and floor which are lined
from 3 components of inferior surface by following by layer of gray matter overlying the core of white
3 borders (Fig. 8.5). matter.
4. Medial orbital border: It separates medial sur-
face from anterior, frontal part of inferior surface Some important sulci
(orbital surface).
5. Hippocampal border: It separates medial sur- Sulci of cerebral hemisphere are many. Some are
face from middle, temporal part (hippocampal named and some are unnamed. It is not yet the stage
gyrus) of interior surface. of this chapter to know the names of all the sulci. But
6. Medial occipital border: It separates medial it is the time to be acquainted with some of the sulci
surface from posterior, occipital part of inferior which are important embryologically and functionally.
surface.
1. Lateral sulcus (Fig. 8.8A)
Gyri and Sulci
Lateral sulcus is also called fissure of Sylvius. It is
Gyri, so also sulci are present in human brain and brain most prominent sulcus recognized between temporal
of higher mammals. These are called gyrencephalic pole and orbital surface from where it begins as stem.
brain. Cerebral cortex of lower mammals, birds and The stem passes upwards and backwards on the
reptiles, presents smooth surface called lissencephalic superolateral surface. Immediately then, at a point
brain. known as sylvian point, it divides into 3 limbs as
Sulci of cerebral cortex are of variable length and follows
depth. A suclus separates two adjacent gyri (Fig. 8.7). i. Anterior horizontal limb: 2.5 cm in length,
passes horizontally forwards.
Sulcus
ii. Anterior ascending limb: Also 2.5 cm in length,
Gyrus passes vertically upwards.
Gyrus
iii. Posterior limb: 7.5 cm long, passes upwards
and backwards. Its end is curved and directed
upwards.
Anterior vertical
ramus Curved upper end of parieto-
occipital sulcus
Anterior horizontal
ramus
Stem of lateral
sulcus A
Curved upper end of
central sulcus
Parietooccipital sulcus
Figs 8.8 A and B A.Some important sulci on superolateral surface, B. Some important sulci on medial surface
Wall of ventricle
Calcarine sulcus is an
example of complete sulcus
Postcalcarine sulcus is an
example of axial sulcus
Figs 8.9A and B A.Varieties of sulcus (superolateral surface), B.Varieties of sulcus (medial surface)
postcalcarine sulcus whose both walls are primary lines on superolateral surface of cerebral hemisphere.
visual area. The central lobe is submerged at the bottom (floor) of
6. Operculated sulcus (Fig. 8.9A): This is the stem of lateral sulcus.
sulcus where the two lips are two functional 3 important sulci separating the lobes on
areas and both the walls are lined by third superolateral surface are (Figs 8.3 and 8.11A)
functional areas. Example is lunate sulcus which l Central sulcus
is a small semilunar sulcus present just in front l Stem of lateral sulcus and its continuation as
of the occipital pole on superolateral surface with posterior limb.
concavity backward. l Curved upper end of parietooccipital sulcus
extending on to the superolateral surface after cutting
Lobes of Cerebral Hemisphere
superomedial border.
Each of the cerebral hemisphere is divided into five l 2 lines drawn on superolateral surface are (Fig.
lobes as i) Frontal lobe, ii) Parietal lobe, iii) Occipital 8.11A).
lobe, iv) Temporal lobe and v) Central lobe. l A vertical line drawn from curved upper end of
The first four lobes are incompletely separated from parietooccipital sulcus on supermedial border to pre-
each other by 3 important sulci and two imaginary occipital notch on inferolateral border.
149
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
B
Formation of temporal lobe starts
Parietal lobe
Frontal lobe
Occipital lobe
Lateral sulcus
C Temporal lobe
Figs 8.10 A to C Stages of development different lobes of cerebral cortex with gradual development of primary and secondary sulci
A horizontal line extending from end of posterior n Embryological backgrounds: It is not the
limb of lateral sulcus up to the vertical line as menti- fifth, rather embryologically it is the first lobe of
oned above. cerebral hemisphere. Around this insula, rotational
The four lobes outlined on superolateral surface overgrowth of the cortex sequentially gives rise to
(Vide Figs 8.3 and 8.11A) are following: formation of frontal, parietal, occipital and temporal
1. Frontal lobe lobes (Fig. 8.10).
2. Parietal lobe n Sulci and gyri of insula (Fig. 8.11B): Whole
3. Occipital lobe of area of insula is surrounded by a circular sulcus.
4. Temporal lobe. A vertical sulcus called central sulcus of insula
subdivides central lobe (insula) into anterior and
Central lobe (Insula or Island of Reil) (Fig. 8.11B) posterior parts both of which present vertical gyri.
Central lobe is also called insula or island of Reil. It Anterior to central sulcus of insula, gyri are shorter
is situated at the bottom or floor of stem of lateral therefore called gyrus brevis which are 34 in number.
sulcus. It is submerged and is visualized when two Posterior group of gyri are longer and 12 in numbers.
lips of stem of lateral sulcus are everted. They are called gyrus longus.
150
CerebrumCortical Gray Matter
Frontal lobe Parietal lobe
Circular sulcus
Central sulcus
of insula
Gyrus brevis Gyrus longus
Figs 8.11A and B A. Four lobes of cerebral hemisphere, B. Central lobe (insula) of cerebral hemisphere
n Operculum: Insula is hidden or overlapped by frontal pole. These three gyri are situated in front
areas of frontal, parietal and temporal lobes which are of precentral sulcus and are demarcated from each
called frontal, frontoparietal and temporal opercula. other by two anteroposteriorly directed sulci called
superior and inferior frontal sulci.
Sulci and gyri on three surfaces of cerebral 3. Subdivisions of inferior frontal gyrus: Infe-
hemisphere rior frontal gyrus is divided into three parts by
two limbs of lateral sulcus which are anterior
Superolateral surface (Fig. 8.12) horizontal and anterior ascending limbs.
On this surface, sulci and gyri can be divided according i. Pars orbitalis: Part of inferior frontal gyrus
to four different lobes as follows. (Sulci and gyri of below anterior horizontal limb of lateral
central lobe or insula has already been described sulcus.
above). ii. Pars triangularis: It is the part between ante-
rior horizontal and anterior ascending limbs of
Frontal lobe lateral sulcus.
iii. Pars opercularis: It is the part of inferior frontal
1. Precentral gyrus: This gyrus is situated in
front and parallel to central sulcus which limits gyrus between anterior ascending ramus and
frontal lobe from parietal lobe. Precentral gyrus is posterior limb of lateral sulcus.
bounded in front by precentral sulcus. Parietal lobe
2. Superior, middle and inferior frontal gyri:
These are three anteroposteriorly directed gyri, 1. Postcentral gyrus: It is the anterior most
parallel to each other, extending forward towards gyrus of parietal lobe running downwards and
151
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Superior frontal gyrus Precentral gyrus
Superior frontal sulcus Central sulcus
Parietooccipital sulcus
Supramarginal gyrus
Lunate sulcus
Posterior ramus of lateral Upturned posterior end
sulcus of postcalcarine sulcus
Inferior temporal gyrus
Superior temporal gyrus Inferior temporal sulcus
Superior temporal sulcus Middle temporal gyrus
Fig. 8.12 Important sulci and gyri on superolateral surface of cerebral hemisphere
forwards from superomedial border. It is bounded 2. Upper and lower occipital lobules: One antero-
posteriorly by postcentral sulcus. posterior sulcus subdivides remaining parts of
2. Superior and inferior parietal lobule: Rema- occipital lobe anterior to lunate sulcus into upper
ining part of parietal lobe behind postcentral and lower occipital lobule. The sulcus is known as
gyrus is divided in upper and lower segments, transverse occipital sulcus.
called superior and inferior parietal lobules with Another small vertical sulcus called lateral occi-
the help of anteroposteriorly directed horizontal pital sulcus runs vertically for short distance, in front
sulcus called intraparietal sulcus. of parietooccipital sulcus. It divides upper occipital
3. Subdivisions of inferior parietal lobule: These lobule into anterior and posterior parts.
are two small semilunar gyrus as follows.
i. Supramarginal gyrus: It is anterior of the two, Temporal lobe
which caps round the upturned posterior end
1. Superior, middle and inferior temporal gyri:
of posterior limb of lateral sulcus.
These are three anteroposteriorly directed gyri
ii. Angular gyrus: It is posterior of the two small
of temporal lobe situated from above downwards
semilunar gyrus which caps over the posterior
respectively, below and parallel to stem and
end of superior temporal sulcus.
posterior limb of lateral sulcus.
These three gyri are separated by two antero-
Occipital lobe
posterior sulci called superior and inferior temporal
1. Occipital pole: It is the posterior end which sulci.
is cut from remaining part of occipital lobe by a 2. Transverse temporal gyri: These are two in
small semilunar sulcus which is convex forwards. number. These gyri is visualized when two lips of
This sulcus is known as lunate sulcus. This polar stem of lateral sulcus are widened with fingers.
area of occipital lobe is bisected into anteroinferior They are lateromedially directed on the superior
and posterosuperior lips by continuation of post- surface of superior temporal gyrus. Anterior
calcarine sulcus from medial surface of cerebral of two transverse temporal gyri is known as
hemisphere on its superolateral surface. Heschls gyrus.
152
CerebrumCortical Gray Matter
Paracentral lobule Fornix
Suprasplenial sulcus
Callosal sulcus
Cuneus
Parietooccipital sulcus Medial frontal gyrus
Anterior commissure
Calcarine sulcus
Thalamus
Postcalcarine sulcus Paraterminal gyrus
Rhinal sulcus
Medial temporooccipital gyrus
Uncus
Temporooccipital sulcus
Lateral temporooccipital gyrus Collateral sulcus
Fig. 8.13 Different features (with important sulci and gyri) of medial surface of cerebral hemisphere
MEDIAL SURFACE (FIG. 8.13) and forwards upto rostral end of corpus callosum.
It is called fornix. Fibers in the fornix connect
Before going to study the gyri and sulci of medial different areas of same cerebral hemisphere and is
surface of cerebral hemisphere, a reader must note an example of association fibers.
the following two important points. 3. Septum pellucidum: It is a thin bilaminar
1. Medial surface presents some prominent stru- membrane bridging between fornix and anterior
ctures which are other than cortical gyri. part of corpus callosum. Lateral to this septum lies
2. Gyri and sulci are not studied in individual the cavity of cerebral hemisphere (telencephalon)
lobewise because some of them are continuous called lateral ventricle of brain.
from one lobe to adjacent lobe. 4. Thalamus: Below posterior part of corpus
callosum and behind fornix, medial surface of
Structures Other than Cortical Gyri thalamus (diencephalon) is visible. On either side
1. Corpus callosum: It is a C shaped compact band of midline, medial surface of thalamus of both
of white matter (fibers) with convexity directed cerebral hemispheres forms lateral boundary of
upwards, present at the center of medial surface third ventricle of brain (cavity of diencephalon).
of cerebral hemisphere. Thalamus is continuous with hypothalamus below
Fibers passing through all the parts of corpus and in front, and with subthalamus below and
callosum cross the midline and connect identical behind.
cortical areas of all the parts of both cerebral hemi- 5. Anterior commissure: It is small cross section
spheres. This is an example of commissural fibers. of compact bundle of commissural fibers which is
Most rostral (cephalic) part of corpus callosum situated in front of anterior end (anterior column)
is thin and directed downwards and backwards. It of fornix.
is called rostrum. Next, the bend is known as genu.
Behind genu the main part is known as body which Gyri and Sulci on Medial Surface
ends posteriorly into a blunt rounded end called
splenium. 1. Cingulate gyrus: It is a thick curved gyrus with
2. Fornix: Below the middle of corpus callosum starts convexity upwards, above and surrounding the
a white band of fibers which extends downwards curvature of corpus callosum.
153
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
It is separated from corpus callosum by callosal sulcus. 5. Paracentral lobule: It is another quadrangular
Cingulate gyrus is demarcated above by cingulate cortical area in front of precuneus.
sulcus. This sulcus starts at its anteroinferior end n Boundaries:
below rostrum of corpus callosum. Its posterior end is l Behind: Posterior limb of posterior upturned end
upturned behind upper end of central sulcus. A small of cingulate sulcus.
limb from it extends upwards towards superomedial l In front: Upturned anterior limb of cingulate
border in front of central sulcus. sulcus.
l Below: Posterior end of cingulate sulcus.
n End of cingulate gyrus:
l Above: Superomedial border of cerebral hemis-
l i. Anterior end: It is very narrow end which is
phere.
below rostrum of corpus callosum. It is called
l Subdivision: Paracentral lobule is bisected by
paraterminal gyrus.
upward continuation of central sulcus on medial
l ii. Posterior end: It curves round splenium of
surface into anterior and posterior parts. These two
corpus callosum and ends at the posterior end parts are upward continuation of precentral gyrus
of temporal lobe. It is called isthmus. and postcentral gyrus respectively on medial surface.
Next group of gyri are studied from occipital pole 6. Medial frontal gyrus: It is the wide, flat and
to frontal pole. curved gyrus on medial surface of frontal lobe
2. Lingual gyrus: It is a curved gyrus with convexity starting in front of paracentral lobule, curving
upwards like that of tongue, situated on lower part over the frontal pole and ending below genu and
of medial surface of occipital pole. It is bounded in front of rostrum of corpus callosum.
above calcarine and postcalarine sulci.
3. Cuneus: It is a triangular area of cortex bounded Gyri and Sulci on Medial Surface of Temporal
by parietooccipital sulcus and postcalcarine sulcus. Lobe (Consult both Figs 8.13 and 8.14)
It is situated above posterior end of lingual gyrus. These gyri and sulci are continuous from medial
4. Precuneus: It is the quadrangular area in front surface to inferior surface (tentorial part) of cerebral
of cuneus. It is bounded behind by parietooccipital hemisphere which are mentioned below.
sulcus and in front by posterior limb of curved
upturned end of cingulate sulcus. Inferiorly it is Gyri and Sulci on Inferior Surface (Fig. 8.14)
demarcated from posterior end of cingulate gyrus
by superosplenial sulcus which is a small curved These are divided into two parts
sulcus posterosuperior to splenium of corpus l Gyri and sulci on inferior surfaces of occipital and
callosum. temporal lobes (tentorial surface).
}
Olfactory sulcus Anterior
Olfactory bulb
Medial
Olfactory tract Orbital gyri
Lateral
Gyrus rectus
Posterior
Lateral olfactory stria
Optic chiasma Anterior perforated substance
Infundibulum Uncus
Mammillary body
Parahippocampal gyrus
Posterior perforated substance
Medial temporooccipital gyrus
Midbrain
Temporooccipital sulcus
Collateral sulcus
Fig. 8.14 Different features (with sulci and gyri) of inferior surface of cerebral hemisphere
154
CerebrumCortical Gray Matter
l Gyri and sulci on inferior surface of frontal lobe c) Neocortex: It is the major part of human ce-
(orbital surface). rebral cortex which is evolved latest. It is
represented by 90% of human cortex.
TENTORIAL SURFACE (FROM MEDIAL TO LATERAL) 3. Structural composition: Cerebral cortex is
made up of
1. Parahippocampal gyrus: It is anterior continu- i. Neurons with chain of synapses.
ation of lingual gyrus extending from medial surf- ii. Neuroglia.
ace to inferior surface of temporal lobe. This gyrus Total number of neurons in human cerebral cortex
is demarcated laterally by collateral sulcus. is 14000 millions.
Parahippocampal gyrus presents anteriorly a Neurons are arranged in stratification of layers.
hook-like ending known as uncus which is bounded Maximum number of layers are six (6) in neocortex.
outwards by a small curved sulcus called rhinal Minimum number are three (3) in archicortex.
sulcus. 4. Gross functions: In reference to both motor com-
2. Medial and lateral temporooccipital gyri: mands and sensory responses, cerebral cortex
As the name suggests, these two gyri extend posseses influence over opposite half of body.
anteroposteriorly and parallel to each other from Basic functions of cerebral cortex are as follows:
temporal lobe to occipital lobe. These two gyri are i. Perception of various sensations.
separated from each other by the sulcus known ii. Reaction or response as per perception of
as temporooccipital sulcus. Medial of the two sensation.
gyri is separated from parahippocampal gyrus by iii. To send motor commands to opposite half of
collateral sulcus. body.
iv. Various types of higher functions for mental
activities, e.g. memory, intelligence, learning,
ORBITAL SURFACE
creative thinking, etc.
1. Gyrus rectus: It is a thin and narrow anterop-
osteriorly running straight gyrus just lateral to TYPES OF NEURONS IN CEREBRAL CORTEX (FIG. 8.15)
medial border of orbital surface. It is laterally
bounded by an anteroposterior sulcus called There are five varieties of neurons in cerebral cortex
olfactory sulcus. It is so called because it lodges as stated below. But first two types, namely pyramidal
olfactory tract with its anterior rounded end called cells and granule cells are most important.
olfactory bulb. 1. Pyramidal cells: These are so called because of
2. Orbital gyri: They are four in number present pyramidal shape. Their long axis are at right angle
lateral to olfactory suclus. They are named as per to the surface of cortex. In longitudinal section
their interrelationshipanterior, posterior, medial cells are triangular in appearance with their
and lateral. These four orbital gyri are separated apices directed towards the surface and bases face
from each other by a Hshaped orbital sulci. towards white matter. Dendrites are connected to
the angles. From the bases, long axons arise and
pass to the depth of white matter of cerebrum.
SOME IMPORTANT POINTS ABOUT CEREBRAL CORTEX
Types of pyramidal cells as per size.
1. As per as evolution concerned, cerebral cortex i. Small size 10 um (micron)
indicates the highest stage of development of ii. Medium size 50 um (micron)
human brain. iii. Large size 100 um (micron). These cell group
2. Phylogenetic subdivision: are also called Betz cells or pyramidal cells of
a) Archicortex: In human brain, phylogenetically Betz.
it is the most primitive part of cerebral cortex. 2. Granule cells: These cells are also called stellate
It is composed of parts of rhinencephalon inclu- cells as they are small star-shaped cells with many
ding hippocampus (parahippocampal gyrus). radiating dendrites and short axon. Diameter of
Therefore, archicortex covers small area of cell bodies are 8 um (micron). Small cell bodies
cerebral cortex. give granular appearance of the cortex for which
But in lower vertebrates, archicortex is of they are called granule cells.
considerable size. 3. Cells of Martinotti: These are small multipolar
b) Paleocortex: It is intermediate in evolution. cells present in all the layers of cortex. Figure 8.15
In human brain it is represented by cingulate shows their axons projecting towards the surface
gyrus. of cortex.
155
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
1
Horizontal cell of Cajal
4 Cells of
Martinotti
Fusiform cell
5
Betz cell
White matter
4. Horizontal cells of Cajal (pronounce as cahal): cells are at right of the angle to the plane of the
The cells are fusiform in outline with the long axis cortex. Apex of the cells are directed towards the
of cell body placed parallel to cortical surface. These surface of the cortex and bases are directed towards
neurons are present in all the layers of cortex. the depth. Size of the pyramidal cells gradually
5. Fusiform cells: Cell bodies of these neurons are increase from superficial to deeper plane.
spindle-shaped or fusiform in outline with their 4. Internal granular layer: This layer is made up
long axis placed at right angle to the cortical of closely packed granule cells or stellate cells.
surface. They are present in deeper layer of cortex Structurally this layer gives striated appearance
and their axons projecting towards white matter. because middle of this layer is traversed by band
of nerve fibers. This band is called external band of
LAYER OF CEREBRAL CORTEX (FIG. 8.16) Baillarger. The cortex of this type is called striate
cortex. Example of this type of cortex is visual
Neurons of cerebral cortex are arranged in multiple cortex on either lip of postcalcarine sulcus.
numbers of stratum which varies from 3 to 6. When 5. Internal pyramidal layer (ganglionic layer):
the neocortex presents 6 layers, archicortex is made This layer is made up of large pyramidal cells of
up of 3 layers. Betz. Axon of this cells form corticospinal tract.
From superficial to deep, six layers of the cortex Basal part of this layer is traversed by band of
are as follows horizontally running fibers called internal band of
1. Molecular or plexiform layer: It is made up of Baillarger.
mainly reticulum or network of nerve fibers with 6. Multiform layer or polymorphic cell layer: Charact-
intermingling horizontal cells of Cajal. eristic of this layer are following
2. External granular layer: This layer is made up i. It presents neurons of different types, size and
of granule cells or stellate cells. Characteristic of shape.
this layer is that cells are densely packed. There is ii. Cells of this layer are intermingled with nerve
intermingling of minimum number of fibers. fibers.
3. External pyramidal layer: It is made up of small iii. This cellular layer merges with white matter
and medium size of pyramidal cell. Long-axis of the deep to it.
156
CerebrumCortical Gray Matter
The cortical areas which show all of the above FUNCTIONAL AREAS IN FRONTAL LOBE
mentioned six layers of cortex well-defined, are called
homotypical cortex. Area-4 of Brodmann
In heterotypical cortex, all the six layers are not
equally defined. Even same may have less than six Location
layers, two main varieties of this cortex are as follows:
It is the precentral gyrus on superolateral surface
i. Granular cortex: In this type, granule cell
of frontal lobe with its extension as anterior part of
layer is well-defined and pyramidal cell layer
paracentral lobule on medial surface.
is poorly developed. Example is sensory cortex.
It is called primary motor area (Fig. 8.17).
ii. Agranular cortex: This cortex shows poor dev-
elopment of granule cell layer with well-defined Functions
pyramidal cell layer. Example is motor cortex.
Area 4 (primary motor area) controls or commands
movements of voluntary muscles of opposite half of
FUNCTIONAL AREAS OF CEREBRAL CORTEX
body through corticospinal and corticonuclear tracts.
It has already been seen that cerebral cortex presents Different parts of the gyrus, starting from lower
different named areas in different surface. It has also end to uppermost end extending to anterior part of
been seen many of them are structurally different. paracentral lobule on medial surface, controls muscle
It is the time now to note that they are functionally groups of different part of body.
different. In the year 1909, Brodmann classified Different areas of body are represented to the
these areas from number 147 and thereby called gyrus in upside down manner. It called inverted
Brodmanns area. It is important to note that these homunculus (Fig. 8.19).
functional areas are not numbered serially or On superolateral surface, from lower end to upper
sequentially. end, precentral gyrus (area 4) controls voluntary
So the cortical areas are mentioned below with muscles of following regions of body in inverted
their names, Brodmanns numbers and respective order as pharynx, larynx, tongue, face, neck, hand,
functions (Figs 8.17 and 8.18). forearm, arm, shoulder, thorax and abdomen.
157
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Primary motor area Primary somatosensory area
Premotor area
Sensory association area for
Frontal eye field stereognosis
4 5
6 3 2
8
Prefrontal area 9 7
1
40
43
44 2
45 41, 4 19 Visual association area
39
22
Brocas area (Motor 18
speech area) 17 Primary visual area
4 6
3
1 8
2
23 9
24 Prefrontal area
10
28
Uncus
Muscles of perineum and lower limb are controlled coincide with comparatively wider part of precentral
by anterior (motor) components of paracentral lobule gyrus (area 4).
on medial surface which is the continuation of area 4. n Effect of lesion: Like other parts of brain, lesions
It is interesting to note that one part of surface of any part of cerebral cortex are mostly vascular
area of the cortex of area 4 is not directly proportional in origin. But it may be traumatic, degenerative or
neoplastic. Lesions of area 4 of Brodmann will cause
to the bulk of the muscle or area of the body it
loss of function of voluntary muscles (paralysis)
controls. Rather it coincides with the skill of the of opposite half of body. It is grossly manifested by
muscle group. For example, Figure 8.19 of inverted paralysis of contralateral upper and lower limbs. It is
homunculus shows that face with lips and eyeballs called hemiplegia.
158
CerebrumCortical Gray Matter
Functions
Like primary motor area (area 4), the premotor
area (area 6) also gives rise to corticospinal and
Shoulder
Trunk
Hip
Elbow
corticonuclear fibers which project downwards from
Wrist
Kn
nd
ee
Ha
kle
Ri le
characteristic function of premotor area is to produce
t
Lit
To
ng
es
Th Inde dle
skilled movements of voluntary muscles, whose
d
x
i
M
Ne mb
movements are planned or designed grossly by cortic-
Br ck
u
Fingers
ow
al
l ospinal and corticonuclear tracts from primary motor
eb
ey area.
ce
d
an
Fa
lid Premotor area is called secondary motor area. Both
LIZATION
ye Lips
E
primary (area 4) and secondary (area 6) motor areas
are together known as primary somatomotor area.
Ja
To w
Sw
VOCA
ng
all
ow
ue n Effect of lesion: Motor dysfunction caused by
ON
ing
lesion of premotor area is called apraxia which is
TI
A
TIC characterized by impairment of skillful movements
M AS
of voluntary muscles, even if primary motor area is
normally functioning.
}
1. Superior frontal gyrus
2. Middle frontal gyrus on superolateral surface of left eye. It is called scanning movement of eyeball.
3. Inferior frontal gyrus n Effect of lesion: From the function of frontal
4. Medial frontal gyrus on medial surface eye field mentioned above, it is clear that, lesion of
this area will cause impairment of deviation of both
In all of the above 4 gyri, area 6, 8 and 9 are located
eyeball to the opposite side. So, unopposed action of
as follows: frontal eye field of normal side will cause deviation of
i. Area 6 in their posterior parts both eyes to the side of lesion.
ii. Area 8 in their middle parts
iii. Area 9 in their anterior parts. Brocas Area or Motor Speech Area (Area 44
These areas are concerned with various functions and 45)
which are mentioned below:
Location
Area 10 and 11 of Brodmann
Most important point is to note that, this area is not
These two areas are located on medial surface of located for functioning in both cerebral hemisphere.
frontal pole as continuation of area 9. In right handed person (about 90%) it is located in left
cerebral hemisphere, so vice versa.
Brocas area for motor speech is located in pars
Premotor Area (Area 6 of Brodmann)
triangularis (area 45) and par opercularis (area 44) of
Location inferior frontal gyrus.
Leg
Arm
Elbow
Forearm
Foot
iv. Concentration and orientation for any work
Lit
Ri ddle
tle
Toes
ng
Mi dex b
v. Emotions. nitalia
In um
Ge
Th
E
No ye Fi
n Effect of lesion: Lesion of prefrontal area is Fa se
ce
ng
er
commonly due to trauma or tumor. Bilateral lesion of s
Uppe
r lip
the area causes degradation of personality through loss Lips
of functions as stated above. It is typically manifested Lower lip
by altered social behavior which is mismatched with Teeth, gums and jaw
surroundings.
Tongue
nx
Phary al
FUNCTIONAL AREAS IN PARIETAL LOBE abd
omin
Intra
Area 3, 1, 2 of Brodmann
Location
It is the postcentral gyrus on superolateral surface of Fig. 8.20 Sensory homunculus showing somatopical as well as
parietal lobe with its extension as posterior part of proportional representation in the primary somatosensory of cerebral
paracentral lobule on medial surface. cortex (Ref. and courtesy W. Penfield and T. Rasmussen, 1950)
160
CerebrumCortical Gray Matter
n Effect of lesion: Lesion of primary sensory Area 22 helps in comprehension of spoken lang-
area (area 3, 1, 2) or postcentral gyrus causes loss uage and recognition of familiar sounds.
of exteroceptive as well as proprioceptive sensations Area 39 is concerned with visual speech and
of opposite half of body. It is called contralateral reading.
hemianesthesia. It is interesting to note that, pain Area 40 is concerned for recognition and naming
sensation may not be lost, as once pain fibers reach an object by tactile and proprioceptive sensation.
upto thalamus, perception of this sensation is not
affected. n Effect of lesion: In lesion of area 22, a patient
speaks without understanding what is spoken. The
Secondary sensory area is located in upper lip of defect is called word deafness or fluent aphasia.
posterior ramus of lateral sulcus just behind lower
end of postcentral gyrus (primary sensory area). This Lesion of area 39 causes word blindness. It is
area posseses bilateral influence over pain sensation. characterized by reading difficulty (alexia) and
writing difficulty (agraphia).
Sensory Association Area (Area 5 and 7) In case of lesion of area 40, the patient suffers
from inability to name an object by touching it. The
Location defect is named tactile agnosia.
This area is located in anterior (area 5) and posterior
(area 7) segments of superior parietal lobule. FUNCTIONAL AREAS IN OCCIPITAL LOBE
Occipital Eye Field This area, also called auditory association area, is
situated in posterior end of superior temporal gyrus,
Location posterior to primary auditory area.
In human brain, it is located in secondary visual area
Function
(areas 18 and 19).
It receives inputs from primary auditory area and
Function thalamus. Here the inputs are coordinated for inter-
It produces conjugate deviation of both eyes to the pretation of auditory impulse in relation to other
opposite side, obviously related to visual stimuli. It sensory information.
162
Cerebrum White Matter
9
White matter of cerebrum are huge number of 1. Association fibers
myelinated nerve fibers of different diameter with 2. Commissural fibers
associated neuroglial cells. It forms a compact mass 3. Projection fibers.
situated in the central core of cerebrum deep to Fundamental comparison among three types:
cortex. In contrast to the term of cortical gray matter, 1. Association fibers are the fiber bundles which
white matter is referred as medullary substance. The interconnect different areas of same cerebral
compact bundle of fibers in white matter may be hemisphere. But these may be restricted in one
restricted within cerebral hemisphere or may connect lobe or may extend from one lobe to another.
areas or centers outside it. So, these fibers do not cross midline and do not
go to any subcortical centers.
CLASSIFICATION (FIG. 9.1) 2. Commissural fibers interconnect identical areas of
two cerebral hemispheres.
Bundles of white matter are classified into following So these fibers cross the midline but do not
three groups: extend to any center below cerebral cortex.
Association fibers
Cerebral cortex
Commissural fibers
Projection fibers
Lateral ventricle of brain
Thalamus
Three fundamental
types of fibers of Lentiform nucleus
white matter of brain
Brainstem
Superior longitudinal
fasciculus
Cingulum
Cingulum
Inferior longitudinal
fasciculus
Fornix
Uncinate fasciculus
Septum pellucidum Anterior commissure
It starts from visual association area (area 18 and 19) End to end length of corpus callosum is 10 cm.
and extend forwards to spread out to be distributed to Curvature
the whole temporal lobe.
1. Dorsoventral curvature: With concavity facing
downwards.
Commissural Fibers
2. Anterior (cephalic) curvature: Cephalic or ant-
Commissural fibers interconnect identical or similar erior end present one anteroposterior bend called
areas of two cerebral hemispheres. These fibers, genu.
which are also known as interhemispheric fibers,
Surface
are present in the form of bundles. The bundles are
known as commissures. 1. Dorsal convex surface
Name of important commissures 2. Ventral concave surface.
1. Corpus callosum Dorsal convex surface is covered by a thin layer of
2. Anterior commissure gray matter called induseum griseum. On each side of
3. Habenular commissure midline, surface of this gray matter presents two fine
4. Posterior commissure anteroposteriorly directed fibers, called medial and
5. Hippocampal commissure. lateral longitudinal striae.
Ventral concave surface, on either side of midline,
Corpus callosum (Figs 9.3 and 9.4) is mostly related to different parts of lateral ventricle
of brain.
Corpus callosum is the largest and most compact
bundle of commissural fibers. This thick bundle of Parts
fibers crosses the midline across the bottom of median From cephalic to caudal end, parts of corpus callosum
longitudinal fissure of brain to interconnect almost all are the following
the identical area of two cerebral hemispheres (neop- 1. Rostrum 2. Genu
alium). So, to separate two cerebral hemisphere, when 3. Body (trunk) 4. Splenium.
Falx cerebri
Tela choroidea
Septum pellucidum Fornix Pineal body
Cingulate gyrus
Body of corpus callosum
Genu
Posterior horn of lateral
Callosomarginal ventricle
artery
Anterior cerebral
Inferior horn of lateral
artery
ventricle
Rostrum
Anterior horn of Body or central part of
lateral ventricle lateral ventricle
l Rostrum : It is so called because, it is most rostral Posteriorly: Genu forms anterior boundary of
part of corpus callosum. It is also thinnest among the ante-rior horn of lateral ventricle of brain.
four part and directed backwards and downwards l Fibers passing through: While the fibers of genu
as continued with a thin layer of gray matter called cross the midline, they are horizontal or transverse.
lamina terminalis. But on either side the fibers from a Ushaped loop to
n Relation (Figs 9.3 and 9.4): reach frontal lobe. This loop with fork-like appearance
is known as Forceps minor which interconnect identical
l Superiorly: In the midline, it gives attachment, to areas of both frontal lobes except orbital surface (Fig.
septum pellucidum. On either side of midline, rostrum 9.5).
forms floor of anterior horn of lateral ventricle. l Body (Trunk): Body of corpus callosum is also
l Inferior: On either side of midline rostrum of called trunk or central part. In the midline, in between
corpus callosum is related to paraterminal gyrus. two hemisphere, it is placed at the bottom of median
l Fiber interconnecting: Fibers of rostrum inter- longitudinal fissure (interhemispheric fissure).
connect cortical areas of orbital surface of two frontal
n Important relations:
lobes.
l Genu: Genu is the bend at the anterior end of
l In the midline: Superior surface is related to
lower free margin of falx cerebri which lodges inferior
corpus callosum with convexity directed forwards.
sagittal sinus.
It is 4 cm behind frontal pole. It is continuous
Inferior surface gives attachment to septum pellu-
below with rostrum and above with body of corpus
cidum and posterosuperior end of body of fornix (Fig.
callosum.
9.3).
n Important relations: l On either side of midline: Superior surface is
In the midline: Posterior concavity of genu gives related to cingulate gyrus from which it is separated
attachment to septum pellucidum. by pericallosal sulcus lodging pericallosal branch of
anterior cerebral artery.
LATERAL TO MIDLINE
Inferior surface forms the roof of central part or
Anterior: Genu is separated from anterior end body of lateral ventricle of brain (Fig. 9.4).
of cingulate gyrus by pericallosal sulcus where ante- l Fibers interconnecting (Fig. 9.6): Fibers pas-
rior cerebral artery divides into pericallosal and callo- sing through body of corpus callosum are better
somarginal branches. understood in coronal section. Crossing midline
166
CerebrumWhite Matter
Superior callosal
radiation
Fig. 9.6 Fibers of body of corpus callosum forming callosal radiation (seen through coronal section of brain)
167
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
n Interconnecting fibers (Fig. 9.5): Transversely classically through corpus callosum. Areas of midline
running fibers of splenium, crossing midline form U representation only are linked to contralateral hemis-
shaped loop with its concavity directed backwards phere. For example, somatic areas representing trunks
to connect occipital lobes of both sides. These fibers, or body are callosally linked, but areas representing
having fork-like appearance, form a curved bundle, limb are not.
known as Forceps major. But it has also been seen, in case of congenital
Fibers of forceps major, while passing backwards absence (agenesis) or in case where corpus callosum
and medially along the upper part of medial wall of is bisected surgically, each of the cerebral hemisphere
posterior horn of lateral ventricle, form a bulge on the becomes isolated from other. The conditions is called
wall called bulb of posterior horn. split brain syndrome in which case patient reacts in
Some of the fibers of splenium and posterior end such way that he or she has two separate brains.
of trunk of corpus callosum posses different course
and destination. These fibers arch downward, Anterior commissure (Figs 9.2 and 9.7)
backwards and laterally along the roof and lateral
wall of posterior horn and lateral wall of inferior Anterior commissure is a compact bundle of myelin-
horn of lateral ventricle to connect both sided parietal ated nerve fibers crossing midline horizontally. It
and temporal lobes. This band of fibers is known as crosses in front of anterior column of fornix being
tapetum of corpus callosum. embedded in a thin layer of gray matter called lamina
Clinical significance of corpus callosum: terminalis. In sagittal section, it is oval in outline
It is already known that corpus callosum links or with longer vertical diameter measuring 1.5 mm.
interconnects identical areas of two cerebral hem- n Division of fibers: On either side of midline
isphere. It is called homotopic connection. But it bundle of anterior commissure splits into anterior
may link also heterogeneous areas of cerebral cortex. and posterior divisions.
These areas of two sides may be functionally similar n Anterior limb: Fibers of anterior limb extend
but anatomically different. This types of connection is anterolaterally toward frontal lobe and interconnect
known as heterotopic connection. following identical areas of both sides.
Interhemispheric connection for all the identical 1. Olfactory bulb
areas of both hemisphere does not functionally exist 2. Anterior olfactory nucleus
Olfactory bulb
Olfactory tubercle
Anterior perforated
substance
Uncus
Hippocampus
Habenular commissure
Posterior commissure
Posterior commissure
Distal lamina
B Pineal gland
Fig. 9.8 Pineal gland showing two laminae of its stalk through which traverse two types of commissural fibers. A. Sagittal section of
pineal gland, B. Posterosuperior view of pineal gland
169
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Habenular commissure
passing through proximal
lamina of pineal stalk
Thalamus
Habenular trigone
Habenular nucleus
Pineal gland
Superior colliculus
Inferior colliculus
Posterior commissure (Fig. 9.10) Fornix is a band of myelinated fibers which starts
as efferent pathway from hippocampus to mammillary
Posterior commissure is a thin bundle of fibers which body of hypothalamus. These efferent fibers start as
cross the midline through distal lamina of pineal stalk. posterior column of fornix from hippocampus and
It connects identical areas of both sides which are curve round forwards and upwards where fibers
as follows: of posterior column of both side meet to form body
1. Superior colliculus of fornix. Fibers of body of fornix again diverge
2. Pretectal nucleus. downwards and forwards as anterior column to end
in mammillary body of hypothalamus in same side.
So fibers of fornix extending from hippocampus (part
Hippocampal commissure (Fig. 9.11) of cerebrum) to hypothalamus (part of diencephalons)
(commissure of the fornix) beyond cortex are considered as projection fibers.
But fibers of hippocampal commissure, starting
As per the name, hippocampal commissure is made
from hippocampus of one side pass along posterior
up bunch of fibers which interconnect hippocampal column of fornix upto posterior end of body. From this
formation of both sides. It is also called commissure of level commissural fibers follow the path of posterior
the fornix because its fibers cross the midline following column of fornix of other side to reach other sided
the course of fibers of posterior column of fornix. hippocampus (consult Figure 9.11).
Proximal lamina of pineal
stalk
Superior colliculus
Midbrain
Pretectal nucleus
Anterior column
fornix Fibers of hippocampal
commissure passing from
posterior column of fornix of one
Mammillary side to that of other connecting
body hippocampal gyrus of both side
Hippocampus
Frontopontine fibers
Corona radiata
Occipitopontine fibers
Temporopontine fibers
Fig. 9.12 Projection fibers forming corona radiata adjacent to cortex, then form compact subcortical component before they reach
midbrain to be mediolaterally directed
172
CerebrumWhite Matter
Frontopontine fibers Anterior thalamic radiation
Genu
Corticorubral fibers
Corticospinal fibers
Auditory radiation
Optic radiation
corticopontine fibers are mediolaterally directed l Inferior thalamic radiation: It connects metath-
as follows (Fig. 9.12): alamus (medial geniculate body) with temporal lobe
1. Frontopontine = In medial 1/5th of crus cerebri of cerebral hemisphere. Corticopetal fibers of inferior
}
2. Parietopontine thalamic radiation extend from medial geniculate
3. Occipitopontine = In lateral 1/5th of crus cerebri body to transverse gyrus (area 41 and 42) on superior
4. Temporopontine surface of superior temporal gyrus, known as auditory
2. Thalamic radiation: These are the fibers which area. These fiber bundle is called auditory radiation.
connect thalamus with four lobes of cerebral It is clear therefore, auditory radiation is the
hemisphere in both directions. Corticopetal fibers afferent component of inferior thalamic radiation.
of thalamic radiation, i.e. the fibers which extend 3. Corticospinal fibers: These are the fibers of
from different parts of thalamus to cerebral cortex, motor (descending) tracts arising from motor area
are the axons of last order of neurons of various (area 4) and premotor area (area 6) of frontal lobe
sensory pathways to terminate in respective sen- of cerebral hemisphere. These are axons of upper
sory areas of cerebral cortex. motor neurons (UMN) projecting on contralateral
Thalamic radiations are anterior horn cells of spinal cord known as lower
l Anterior thalamic radiation: It connects thalamus motor neurons (LMN). This bundle of fibers,
with frontal lobe. as passing through the pyramidal elevation of
l Superior thalamic radiation: It connects thalamus medulla oblongata lower down, are termed as
with parietal lobe. Corticopetal fibers of superior pyramidal tract.
thalamic radiation extending from ventropostero- 4. Corticobulbar (corticonuclear) fibers: These
lateral nucleus of thalamus to postcentral gyrus (area are descending (efferent) fibers from motor area of
3,2,1) of parietal lobe carry somatic sensations from cerebral cortex to the all motor nuclei of cranial
opposite half of body. nerves of contralateral side.
l Posterior thalamic radiation: It connects metath- 5. Corticorubal fibers: These fibers project from
alamus (lateral geniculate body) to occipital lobe of cerebral cortex to red nucleus of midbrain.
cerebrum. Corticopetal fibers of this thalamic radi-
ation extends from lateral geniculate body to primary Fibers Passing Through Different Parts of
visual area (area 17) of occipital lobe. These fibers Internal Capsule (Fig. 9.13)
bundle is called optic radiation. So optic radiation
is the afferent component of posterior thalamic l Anterior limb:
radiation. 1. Frontopontine fibers
173
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
2. Anterior thalamic radiation Arteries supplying internal capsule are direct
l Genu: branches of circle of Willis lodged in interpeduncular
1. Corticobulbar (corticonuclear) fibers cistern of subarachnoid space at the base of brain.
2. Anterior part of superior thalamic radiation These branches are called central, nuclear or ganglionic
l Posterior limb: branches, because in addition to central white matter
1. Parietopontine fibers core of cerebral hemisphere, they supply centrally
2. Superior thalamic radiation placed masses of gray matter like caudate nucleus and
3. Corticospinal fibers in the form of multiple, lentiform nucleus which are known as basal ganglia.
compact, discrete bundles. Fibers for head-neck, These central branches are example of end arteries.
upper limb, trunk and lower limb are placed in
anteroposterior order. Arteries Supplying Different Component of
4. Corticorubral fibers
Internal Capsule
l Retrolenticular (retrolentiform) part:
1. Occipitopontine fibers 1. Anterior part of anterior limb:
2. Posterior thalamic radiation: Corticopetal comp- a) Striate branches of anterior cerebral artery
onent of posterior thalamic radiation form optic b) Recurrent artery of Heubner: Branch of ante-
radiation. rior cerebral artery.
l Sublenticular (sublentiform) part: 2. Posterior part of anterior limb, genu and
1. Temporopontine fibers anterior two-third of posterior limb:
2. Inferior thalamic radiation Corticopetal comp- a) Striate branches of middle cerebral artery.
onent of inferior thalamic radiation is auditory One of the lateral striate branches is very long.
radiation. which is very often subjected to be ruptured
following cerebrovascular lesion. This branch
Blood Supply of Internal Capsule (Fig. 9.14) is called Charcots artery of cerebral hemo-
Various types of vertically running projection fibers rrhage.
(both efferent as well as afferent types) pass through b) Genu is also supplied by direct branch from
compact and condensed area of internal capsule. The internal carotid artery.
compact band of white matter of cerebral hemisphere 3. Posterior one-third of posterior limb, retrol-
is supplied by multiple sources of arteries. So vascular entiform and sublentiform parts: Branches
lesion in advanced age is very common. from anterior choroidal artery.
Branches for internal Parent arteries
capsule
Recurrent artery of Heubner
SL Basilar artery
175
Basal Ganglia
10
General Consideration limbs as a function of extrapyramidal system
which reciprocates function of pyramidal system
l Basal ganglia are subcortical masses of gray mat- concerned with skilled and precise movements.
ter inside cerebral hemisphere.
2. Basal ganglia exert influence on the centers for
l They are also known as basal nuclei.
voluntary motor function through
l Basal ganglia or basal nuclei are embedded in
a) Initiation of desired movement
the central white core of cerebral hemisphere
b) Restriction or limitation of unwanted movement
(telencephalon) at the level of diencephalon.
c) Cessation of movement when needed.
l Though basal ganglia are concerned with control
3. As basal ganglia parallelly inhibit unwanted
of posture and voluntary movements, they do not
move-ment. It means that these centers helps in
have any direct input or output connections with
smoo-thening of voluntary movement.
spinal cord.
l Basal ganglia are the important components of 4. Basal ganglia also influence stereotyped associated
voluntary movements, e.g. swinging of arms while
extrapyramidal system.
walking.
Principle of Functions Components of Basal Ganglia
Grossly, it can be stated that basal ganglia is conc- 1. Caudate nucleus
erned with execution of quality of movements 2. Lentiform nucleus
through maintenance of muscle tone and posture with 3. Amygdaloid nucleus (body)
coordination of voluntary movements. But function 4. Claustrum.
of basal ganglia is actually the result of integration
Subthalamic nuclei, substantia nigra and red
of neurocircuit connecting various centers of central
nucleus are correlated and colisted with the comp-
nervous system with it.
onents of basal ganglia clinically only because all
First, basal ganglia receive afferent informations
these masses of gray matter are the centers for
from motor as well as sensory areas of cerebral
extrapyramidal system.
cortex, thalamus, subthalamus, brainstem including
substantia nigra.
Other Terminologies
Informations are then integrated.
Then outflow from basal ganglia passes to cerebral Head end of coma-shaped caudate nucleus and
cortex and centers of brainstem for the following lentiform nucleus are separated by vertically runn-
directives. ing fibers of anterior limb of internal capsule.
1. For initiation of gross movements of voluntary Anteroinferior aspects of both these nuclei are conn-
muscles of trunk and proximal joints of the ected by a narrow band of gray matter. This band
Basal Ganglia
Internal capsule
Lentiform nucleus
Caudate nucleus
Fig. 10.1 Connecting band of gray matter between caudate nucleus and lentiform nucleus present striated appearance as traversed by
fibers of internal capsule
of gray matter mass is traversed by some fibers of Difference between striatum and pallidum
anterior limb of internal capsule, so presenting a
Striatum (Caudate nucleus Pallidum
striated appearance (Fig. 10.1). That is why caudate and Putamen) (Globus pallidus)
nucleus and lentiform nucleus together are termed 1. Phylogenetically newer part Phyltogenetically older part
corpus striatum. (Neostriatum). (Paleostriatum).
Lentiform nucleus, biconvex in outline is divided 2. Neurons are round or Neurons are polygonal.
into a lateral and medial part by a thin lamina of wh- spherical.
ite matter called external medullary lamina. Lateral 3. Darker in color as more Paler in color as less
part is termed putamen and medial part is known as vascular. vascular.
globus pallidus. Internal medullary lamina, another 4. Receptive part of corpus Effector part of corpus
striatum- So receives inputs. striatum-So sends output.
thin lamina of white matter divides globus pallidus
into lateral (external) and medial (internal) parts. It
Phylogenetic Classification of Basal Ganglia
is the putamen of lentiform nucleus that is connected
to caudate nucleus by intermediate band of gray Phylogenetically, basal ganglia are classified as
matter (Fig. 10.1). follows:
Caudate nucleus and putamen of lentiform nucleus l Archistriatum: Amygdaloid nucleus and claustrum
are jointly known as striatum. Globus pallidus is l Paleostriatum: Globus pallidus
simply termed as pallidum. l Neostriatum: Caudate nucleus and putamen.
Internal capsule
Body of caudate nucleus
Lentiform nucleus
Thalamus
Amygdaloid body
Anterior horn
Body of caudate nucleus
Caudate nucleus (Figs 10.2 and 10.3) Head of caudate nucleus forms inferolateral boun-
dary of anterior horn of lateral ventricle (Fig. 10.4).
Caudate nucleus is C-shaped or coma-shaped
mass of gray matter forming a component of corpus Body of caudate nucleus extends from head as
striatum or striatum. elongated and gradually tapering part till it curves
It presents curvature because it curves round around posterior pole of thalamus to be continued as
thalamus and its convex side fits with concavity of tail.
cavity of lateral ventricle (Fig. 10.3). It forms the floor of central part or trunk of lateral
ventricle lateral to superior surface of thalamus.
Parts On the floor of central part of lateral ventricle from
lateral to medial are placed body of caudate nucleus,
1. Head: Proximal, expanded and rounded end.
2. Body: Intermediate and gradually tapering part. stria terminalis, thalamostriate vein and superior
3. Tail: Distal anterioinferior end which is connected surface of thalamus (Fig. 10.5).
to rounded amygdaloid body (nucleus). Tail of caudate nucleus is the long and narrow
Head of caudate nucleus is demarcated from the body continuation of body around posterior end of thalamus.
by the landmark of interventricular foramen of Monro. Following the curve of lateral ventricle, tail is related
Head is joined below with putamen of lentiform to roof of inferior horn of the ventricle. It ends at its
nucleus by a band of gray matter which is traversed anterior extremity being attached to amygdaloid body
by fibers of internal capsule (Fig. 10.1). (nucleus) (Fig. 10.3).
Corpus callosum
Septum
pellucidum
Fig. 10.4 Head of caudate nucleus forming inferolateral boundary of anterior horn of lateral ventricle (coronal sectional view)
178
Basal Ganglia
Amygdaloid body
Thalamostriate vein
Fig. 10.5 Caudate nucleus viewed from above with related structures
Lentiform nucleus (Fig. 10.6) ace, outside the capsule is related to lateral striate
branches of circle of Willis which pierce the capsule to
It is so called because this mass of gray matter looks
supply the nuclear mass.
like a biconvex lens in outline, as evident both in cross
section as well as in coronal section.
Subdivisions of lentiform nucleus
Medial surface of the nucleus presents more acute
cervature, whereas its lateral surface is uniformly Primarily, a thin lamina of white matter, called exter-
curved. nal medullary lamina subdivides lentiform nucleus
Inferiorly, lentiform nucleus merges with gray into lateral part called putamen and medial part,
matter of base of brain at the site of anterior perforated globus pallidus. Globus pallidus is again divided
substance. into medial (internal) and lateral (external) parts
by another thin sheet white matter called internal
Capsules of lentiform nucleus medullary lamina.
Both the medial as well as lateral surfaces are covered
Relations of lentiform nucleus
by capsules made up of band of white matter. Medial
surface is covered by thick compact internal capsule n Medial: On medial side lentiform nucleus is sepa-
and lateral surface is covered by thinner lamina of rated from head of caudate nucleus and thalamus by
white matter, called external capsule. Lateral surf- compact band of fibers of internal capsule.
Internal capsule
Fornix
Caudate nucleus (head)
Internal ventricle
Putamen
Thalamus
Globus pallidus
Claustrum
Insula
Extreme capsule
External capsule
Fig. 10.6 Coronal section of brain to show lentiform nucleus with other components of basal ganglia and related structures
179
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Stria terminalis
Septal area
Anterior
Ant. perforated substance Hypothalamic nuclei
Amygdaloid body
Olfactory bulb
Olfactory tract
Olfactory stria
n Lateral: From medial to lateral, lateral surface of But functionally it is considered to be part of limbic
lentiform nucleus is related to following structures. system.
1. External capsule Very simply, it can be stated that amygdaloid body
2. Claustrum help to adjust emotion and behavior of an individual
3. Extreme capsule according to the environmental situation. Amygdaloid
4. Insular cortex at the floor of stem of lateral sulcus. body is concerned with feeling and expression of
n Inferior: Below, lentiform nucleus merges with fear, rage and irritability. The nucleus functions for
cortical area of base of brain forming anterior perfo- limitation for interest for intake of food and sexual
rated substance. activity.
In a patient suffering from highly aggressiveness,
Amygdaloid body (nucleus) (Fig. 10.7) bilateral destruction of amygdaloid body result in
1. Decreased aggressiveness with change in docile
Identity and location attitude.
2. Decreased emotional instability and diminished
Amygdaloid body or amygdaloid nucleus is an almond-
restlessness.
shaped mass of gray matter attached to the tip of
3. Increased interest for food.
tail of caudate nucleus. It is located deep to uncus of
4. Increased sexual activity.
temporal lobe and related to anterior most end of roof
of inferior horn of lateral ventricle (Fig. 10.3).
Claustrum (Fig. 10.6)
Connections Claustrum is a thin, curved and wavy sheet of gray
n Afferents: From olfactory bulb via olfactory tract matter which is well demonstrated in cross section of
and from primary olfactory area. cerebrum.
n Efferent: Efferent fibers start from amygdaloid It is situated lateral to lentiform nucleus from
nucleus in the form of a curved fibrous band which which it is separated by external capsule.
runs around the curve of thalamus following reverse Laterally claustrum is related to insular cortex,
course of, and parallel to curve of caudate nucleus. It but separated by extreme capsule.
is called stria terminalis. Reaching close to anterior Developmentally, claustrum is a component of
commissure and anterior pole of thalamus, stria archistriatum.
terminalis ends in Connections and functions of claustrum are not
i. Septal area known.
ii. Anterior hypothalamic nuclei
iii. Anterior perforated substance. Connections of corpus striatum (Fig. 10.8)
Fundamentals of connections of corpus striatum are
Functions
to be understood first. Neostriatum (caudate nucleus
Developmentally, so anatomically amygdaloid body and putamen) receive inputs from various parts
is a component of archistriatum (basal ganglia). of central nervous system. Informations are then
180
Basal Ganglia
Glutamate
GABA
Substantia nigra
Serotonin
Brainstem
Spinal cord
Caudate nucleus
Putamen
Globus pallidus
Fasciculus lenticularis
Thalamus
Internal capsule
Globus pallidus
Putamen
Putamen
Globus pallidus
Pallidotegmental fibers
Tegmentum of midbrain
Figs 10.9A to C Some of the pallidofugal fibers. A. Ansa lenticularis and fasciculus lenticularis (Pallidothalamic fibers), B. Subthalamic
fasciculus, C. Pallidotegmental fibers
182
Basal Ganglia
n Fasciculus lenticularis (Fig. 10.9A): These Sydenham Chorea
fibers also reach the same nuclei of thalamus, but
This disorder is infective in origin. Children suffering
traversing through posterior limb of internal capsule.
from rheumatic fever due to streptococcal infection
n Subthalamic fasciculus (Fig. 10.9B): These
are affected. Streptococcal antigen attacks the neurons
pallidofugal fibers connect subthalamic nucleus in
of basal ganglia. The disease is characterized by
both directions. Subthalamic nucleus is a small mass
rapid involuntary and irregular movements of limb,
of gray matter which presents biconvex appearance
trunk and face which is characterized by choreiform
in coronal section. It is located caudal to thalamus
movements. However, prognosis of the disease is good
and inferomedial to globus pallidus from which it is
as patient gets a full recovery.
separated by fibers of internal capsule. Subthalamic
fasciculus connect globus pallidus with subthalamic
nucleus in both directions. The fibers of the fasciculus BALLISMUS
traverse internal capsule. It is the disorder caused due to vascular lesion of
n Pallidotegmental fibers (Fig. 10.9C): These
subthalamic nucleus.
fibers descend from globus pallidus to motor centers Subthalamic nucleus functions for integration
situated in tegmentum of brainstem. of smooth movements of different parts of body.
Ballismus due to lesion in subthalamic nucleus is
CLINICAL ANATOMY characterized by small strokes of sudden outburst
Disorder of function of basal ganglia results from of violent involuntary movements affecting trunk,
lesion in basal ganglia. Lesion of basal ganglia may girdle and proximal part of limb of opposite half of
be vascular in orgin or due to genetic disorder, less body. Usually both upper as well as lower limbs of
commonly may be infective or degenerative. contralateral side are affected, for which disorder is
Lesion of basal ganglia is clinically characterized known as hemiballismus. If restricted to one limb, it
by two general types of disorders. is called monoballismus.
n Hyperkinetic disorder: Showing excessive
abnormal involuntary movements as seen in chorea, ATHETOSIS
athetosis and ballism (ballismus).
n Hypokinetic disorder: Presenting slow and
This is a degenerative disease of globus pallidus.
sluggish abnormal involuntary movements. Degeneration of neurons of globus pallidus leads
n Parkinson disease is characterized of course, by
to breakdown of neurocircuit, globus pallidus
both types of disorders. thalamuscerebral cortex. The disorder is charac-
terized by slow, sinuous writhing movements of distal
part of limbs affecting muscles of fingers and toes.
CHOREA
The patient of chorea presents nonrepetitive irre- PARKINSON DISEASE
gular, quick and jerky movements.
Swift and sudden movements of head and limbs are Parkinson disease is also known as Parkinsonism or
good examples which exhibits typical dancing gait. paralysis agitans.
Two different forms of choreiform disease are as It is a progressive degenerative disease of unknown
follows. cause.
The disease starts between the age of 45 years to
Huntington Disease (Huntington Chorea) 55 years. It is the result of degeneration of neurons
of substantia nigra and to a lesser extent, those of
It is an autosomal dominant inherited disease due to globus pallidus, putamen and caudate nucleus.
single gene defect on chromosome 4. Onset of disease Substantia nigra contains melanin pigment
is in adult life. Prognosis is bad as death occurs by 15 containing neurons. These neurons release dopamine
20 years after onset. Males and females are equally through their axons (nigrostriate fibers) to corpus
affected. striatum. Dopamine exerts inhibitory effect on striatal
At the onset muscles of limbs and face are affected. neurons. So, reduction of dopamine due to lesion of
This results in choreiform movements with twitching neurons of substantia nigra causes loss of inhibitory
of face characterized by facial grimacing. Later on effect on function of neurons of corpus striatum.
more muscles are affected. So patient ultimately be- Clinically it is characterized by Release phenomenon.
comes confined and swallowing and speaking become Patient of Parkinson disease presents following
difficult. clinical manifestations.
183
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
1. Tremor: This is repetitive alternating, involun- Parkinson disease rigidity is present in opposing
tary movement of agonists and antagonists of muscle groups to an equal extent. Again nature
limbs. This movement is observed in resting cond- of rigidity varies depending upon presence or
ition of patient and disappears when he or she absence of tremor. If tremor is present, uniform
performs a voluntary movement. That is why it and sustained resistance during passive move-
is called static tremor or resting tremor. It is ment of limb joint is overcome by a series of
to be remembered here that, patient of cerebellar jerky movement. Resistance and jerky movement
disease present intention tremor which is observed occurring alternately is like movement of cogwheel
when the patient intends to perform a movement. of a watch. That is why it is called Cog-wheel
2. Hypokinesia: Parkinson disease is characterized rigidity. In absence of tremor, uniform and
by combination of both hyperkinetic and hypok- sustained resistance during passive movement
inetic disorder. Tremor is a manifestation of shows plastic rigidity on lead-pipe rigidity.
hyperkinetic disorder. In Parkinson disease feat- 4. Postural disorder: Patient of Parkinson disease
ures of hypokinesia are also observed. Akinesia presents a stooping (forward bend) posture with
is lack of initiation of movement. Bradykinesia knee and elbow joints flexed partially which are
is slowness in performance of movement. Face is due to rigidity of muscles of trunk and limbs
found to be expressionless. Voice is slurred and its respectively.
modulation is absent. While walking, swinging of 5. Disorder in gait: Patient walks slowly in short
arm is absent. steps and may run to maintain balance and may
3. Rigidity: Rigidity of muscles is elicited by pas- be unable to stop when starts walking which is
sive movement of a joint, when a resistance is due to loss of limitation of voluntary movement.
felt. Unlike rigidity in pyramidal tract lesion, in The typical style of walking is called shuffling gait.
184
Lateral Ventricle of Brain
11
Lateral ventricle of brain is the cavity of telencep- 1. Anterior horn in frontal lobe
halon. So it is the cavity of ventricular system present 2. Central part of body in parietal lobe
in cerebral hemisphere. 3. Posterior horn in occipital lobe
Lateral ventricles are two in number, right and 4. Inferior horn in temporal lobe.
left, present inside the respective cerebral hemisp- Out of three horns, inferior horn is largest. Poste-
here. rior horn is not only smallest, it is also variable and
Lateral ventricle presents C-shaped curvature
very often asymmetrical in two sides.
with a short variable posterior prolongation (Fig. 11.1).
The concavity of the ventricle curves round thalamus
and caudate nucleus. Central parts of the ventricles Ventricular System (Fig. 11.3)
of both sides are just paramedian in position where Ventricles of brain are developmentally derived
they are separated by a midline septum called septum from cavity of neural tube. Ventricles are four fluid-
pellucidum. filled cavities located inside different parts of brain.
They are intercommunicating with each other and
Parts of Lateral Ventricle (Fig. 11.2) other parts of cavity of central nervous system. The
Lateral ventricle presents four parts. Each of the four ventricles are therefore lined with ependyma and
parts of the ventricle coincides with the position of contain cerebrospinal fluid. Ventricles are four in
four lobes of cerebral hemisphere. number.
Anterior horn
Interventricular foramen
of Monro Central part
Lateral ventricle
Third ventricle
Inferior horn
Cerebral aqueduct of Sylvius
Posterior horn
Fourth ventricle
Central canal
Fig. 11.1 Two lateral ventricles in superior view with other parts of ventricular system
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Anterior horn Central part or body
FL PL
OL
TL
Fig. 11.2 Parts of lateral ventricle in relation to four lobes of cerebral hemisphere
Interventricular foramen
of Monro Posterior horn of lateral
ventricle
Third ventricle
Fourth ventricle
1. Lateral ventricle: Two in number, right and left, 3. Fourth ventricle: It is the cavity of rhombenc-
present on either side of midline. They are cavities ephalon (hindbrain) located between cerebellum
of telencephalon (cerebral hemisphere). behind, and pons and medulla oblongata in front.
2. Third ventricle: Narrow, single midline cavity Cavity of fourth ventricle communicates with third
of diencephalon, situated between the thalamus ventricle above through aqueduct of midbrain (of
of two sides. Superiorly, on either side of midline Sylvius), and with narrow central canal of spinal
it communicates with lateral ventricle through cord through central canal of lower-half of medulla
interventricular foramen of Monro. oblongata below. Lower part of ependymal roof of
186
Lateral Ventricle of Brain
fourth ventricle presents foramen of Magendie in Boundaries
the midline, and foramen of Luschka on either side, n Anteriorly: Anterior horn is limited by posterior
through which ventricular cavity communicates surface of genu of corpus callosum (Fig. 11.4A).
with subarachnoid space. Choroid plexus of ventr- n Posteriorly: Anterior horn is continuous with
icles liberate cerebrospinal fluid which freely central part of lateral ventricle (Fig. 11.4A).
circulates in subarachnoid space through foramen n Superiorly: Roof is formed by inferior surface of
of Magendie and foramen of Luschka. Constant anterior part of body of corpus callosum (Fig. 11.4B).
secretion of cerebrospinal fluid is balanced by its n Inferiorly: Floor of anterior horn is formed
constant absorption by arachnoid granulations medially by superior surface of rostrum of corpus
projecting in intracranial venous sinus from callosum and laterally by head of caudate nucleus
arachnoid mater. (Fig. 11.4B).
n Medially: Septum pellucidum intervens anterior
Different Parts of Lateral Ventricle horn of both sides.
Central Part or Body
Anterior horn
Central part or body of lateral ventricle coincides
It is the anterior most part of lateral ventricle proje- with the position of central core of parietal lobe below
cting into frontal lobe. Its anterior end is blind and central part (trunk) or body of corpus callosum.
posteriorly it becomes continuous with central part or n Extent: From the landmark of interventricular
body of lateral ventricle at the level of interventricular foramen of Monro to the level of splenium of corpus
foramen of Monro. callosum.
Body of
Corpus callosum
Genu of
Corpus callosum
Fig. 11.4A Lateral ventricle is sagittal section. Anterior horn is bounded by body, genu and rostrum of corpus callosum superiorly,
anteriorly and inferiorly respectively
Septum pellucidum
Septum pellucidum
Body of caudate nucleus
Fornix
Stria terminalis
Thalamostriate vein
Fissure between thalamus and
fornix for invagination of tela Thalamus
choroidea
Hypothalamus
Choroid plexus of
third ventricle
Fig. 11.6 Common invagination of tela choroidea for lateral as well as third ventricles
Optic radiation
Tapetum
Bulb of posterior horn
Forceps major
Calcar avis
Calcarine sulcus
Alveus Tapetum
Collateral eminence
Fimbria
Hippocampus
Dentate gyrus
Parahippocampal
gyrus
Collateral sulcus
is expanded and slightly furrowed at its anterior end 2. Communicating hydrocephalus: In this var-
which is called pes hippocampus. Ventricular surface iety, there is no blockage anywhere between site
of hippocampus is covered by a thin layer of white of formation and exit of cerebrospinal fluid from
matter called alveus. Alveus is formed by axons of the ventricular system to subarachnoid space. So it
neurons present in hippocampus. The axons converge is the effect of either overproduction or impaired
on the medial side of hippocampus to form a band of absorption of fluid.
white matter called fimbria. Fiber bundle of fimbria is
continuous posteriorly as posterior column of fornix. Causes of Hydrocephalus
Choroid fissure 1. Abnormal increase in formation of cerebrospinal
fluid is a rare condition which occurs in case of
Choroid fissure of the inferior horn is a slit on medial
tumor of choroid plexus.
side in the interval between stria terminalis of roof
and fimbria of the floor. Choroid plexus of lateral 2. Blockage in circulation of cerebrospinal
ventricle turns round posterior end of thalamus to fluid Obstruction may be at different level
invaginate ependyma through choroid fissure of leading to different types of manifestations.
inferior horn from medial side. a) Tumor adjacent to interventricular for-
amen of Monro: It will cause unilateral obst-
CLINICAL ANATOMY ruction of lateral ventricle of one side leading to
its dilatation. It will ultimately cause atrophy
Ventricular system so also subarachnoid space contain
normally an optimum quantity of cereb-rospinal fluid of surrounding neural tissue.
due to balance maintained between its secretion b) Obstruction anywhere beyond interven-
by choroid plexus of ventricles and absorption by tricular foramen, e.g. in third ventricle,
arachnoid granulations in subarachnoid space. cerebral aqueduct or foramen of Magendie and
In pathological conditions there may be overacc- foramen of Luschka will cause symmetrical
umulation of cerebrospinal fluid which is known as distension of both lateral ventricles along with
hydrocephalus. Hydrocephalus is associated with distension of third ventricle.
raised intracranial pressure. Obstruction of foramen of Magendie and
foramen of Luschka may occur due to expanding
Varieties of Hydrocephalus tumor or inflammatory exudate, e.g. in case of
meningitis.
1. Noncommunicating hydrocephalus: In this
case, blockage in flow of cerebrospinal fluid may 3. Impaired absorption of cerebrospinal fluid
be at any point between its formation at choroid through arachnoid granulations may be due
plexus and its exit from ventricular system through to following causes.
the foramina at the roof of fourth ventricle. a) Inflammatory exudate
190
Lateral Ventricle of Brain
b) Pressure or thrombosis of venous sinuses i. Expanding tumor
c) Obstruction of internal jugular vein. ii. Intracerebral hemorrhage which may be ext-
In these cases distension of lateral ventricles with radural, subdural or intracerebral.
other ventricles is secondary to overaccumulation of Lesion in one side will cause deviation of brain
cerebrospinal fluid in subarachnoid space. with lateral ventricle to the opposite side which
neurologically termed as midline shifting.
Radiological Investigation of Lateral Ventricle Assessment of these types of pathology of lateral
ventricle and also different areas of brain in different
Size, shape and situation of lateral ventricle are levels are done by two easy and safe radiological
assessed by radiological investigations for its investigations which are known as
a) Distension as a result of obstruction in i. Computed tomography scanning (CT Scan)
ventricular system or subarachnoid space ii. Magnetic resonance imaging (MRI).
b) Distortion Pneumoventriculography is another radiological
c) Displacement (shifting). investigation in which case straight X-ray of cranium
These types of abnormality in outline of lateral is taken after injecting oxygen or air inside cavity of
ventricle may be due to lateral ventricle which will replace cerebrospinal fluid.
191
Diencephalon
12
Diencephalon is the central midline portion of fore- Parts of diencephalon: These are five in number.
brain (prosencephalon). n Dorsal diencephalon (above hypothalamic sulcus)
Superolaterally it is continuous with telencephalon 1. The thalamus (dorsal thalamus)
on either side which forms cerebral hemispheres. 2. Metathalamus
Inferiorly, it merges with midbrain component of 3. Epithalamus.
brainstem. n Ventral diencephalon (below hypothalamic sulcus)
Main mass of diencephalon (the thalamus) is
4. Subthalamus
divided into two identical halves which are separated
5. Hypothalamus.
by a narrow midline cleft which is the cavity of
diencephalon called third ventricle of brain. The thalamus is the main mass of diencephalon.
Diencephalon is primarily divided into dorsal Metathalamus is made up of lateral and medial
diencephalon and ventral diencephalon by a narrow geniculate bodies.
sulcus called hypothalamic sulcus which extends Epithalamus is the pineal gland connected to
from interventricular foramen of Monro to upper end posterior pole of thalamus by proximal and distal
of aqueduct of Sylvius (Fig. 12.1). laminae of pineal stalk. Unlike other components of
Medulla oblongata
Cavity of lateral
ventricle
Interthalamic adhesion
Thalamus
Cavity of third Subthalamic
ventricle nucleus
Subthalamus
Hypothalamus
diencephalon it is not bilateral structure, but single l It is the thalamus component of dorsal dience-
midline component. phalon, which merges with the two components of
Subthalamus is posterior part of ventral dience- ventral diencephalon as follows (Fig. 12.1).
phalon which is continuous with brainstem below. It i. In anterior plane: Merges with hypothalamus.
contains subthalamic nucleus (Fig. 12.2). ii. In posterior plane: Merges with subthalamus.
Hypothalamus is anterior part of ventral dienceph- l Ovoid mass of thalamus is anteroposteriorly elon-
alon which is divided into upper and lower part. Upper gated with following dimensions.
part forms lowermost portion of lateral wall of third Anteroposterior measurement 3.5 cm
ventricle. Lower part forms floor of third ventricle, so Transverse measurement 1.5 cm
from outer aspect it forms base of brain (Figs 12.1 and l Longer anteroposterior axis is directed forwards
12.2). and medially.
Anterior pole
Medial part
Internal medullary
lamina
Lateral part
Fig. 12.4 Internal medullary lamina dividing thalamus into anterior, medial and lateral parts
194
Diencephalon
4. Interthalamic adhesion: It is a very narrow 2. Emotional tone.
but compact bundle of white matter, round on 3. Mechanism of recent memory.
cross section, connecting medial surface of both
thalami. Though the band crosses the midline to Medial part (Fig. 12.5)
link two thalami, but fibers truly do not cross the Medial part of thalamus contains many smaller
midline. Fibers, though may cross midline, but nuclei and a large medial dorsal or dorsomedial
return back to the same sided thalamic nuclei. nucleus. The dorsomedial nucleus is made up of
So fibers of interthalamic adhesion are not true anteromedial magnocellular and posterolateral par-
commissure (Figs 12.1 and 12.2). vocellular parts.
Medial part of thalamus is concerned with
Nuclei of Thalamus integration of large number of sensory informations
(somatic as well as visceral) and correlation with
1. Larger nuclei: Larger nuclei of thalamus are
emotional feelings.
subdivided into three groups which lie in
a) Anterior part
Lateral part (Fig. 12.5)
b) Medial part
c) Lateral part. Nuclei of lateral part are divided into a dorsal tier and
2. Smaller nuclei: These nuclei are related to surf- a ventral tier.
ace or white matter lamina of thalamus. These are Dorsal tier nuclei are (from anterior to posterior)
smaller collection of nerve cells as following 1. Lateral dorsal nucleus
a) Intralaminar nuclei 2. Lateral posterior nucleus
b) Midline nuclei or paraventricular nuclei 3. Pulvinar.
c) Reticular nuclei. Ventral tier nuclei are following from before back-
Nuclei related to anterior and medial parts of thal- wards.
amus constitute paleothalamus and those of lateral 1. Ventral anterior nucleus: It influences activities
part are considered as neothalamus. of motor system.
2. Ventral lateral nucleus: This nucleus also infl-
Anterior part (Fig. 12.5) uences motor activities.
3. Ventral posterior nucleus: It is divided into
This part contains anterior thalamic nuclei. These ventroposteromedial and ventroposterolateral nu-
nuclei is concerned with. clei. These nuclei receive various sensory inputs
1. Function which is associated with that of limbic (somatic as well as visceral) and convey these to
system. sensory areas of cerebral cortex.
Anterior thalamic nucleus
(anterior zone)
}
zone)
Midline (paraventricular)
Internal medullary
nuclei
lamina
Intralaminar nuclei
Reticular nuclei on
lateral surface
These are small collections of neurons which are pres- Dorsomedial nucleus Amygdaloid body 1. Prefrontal cortex
ent in internal medullary lamina. 2. Hypothalamus
These nuclei influence level of consciousness and
Lateral part
alertness of an individual.
Dorsal tier
Midline nuclei (paraventricular nuclei)
Name of nucleus Afferent Efferent
These group of neurons are situated in the lateral
Lateral dorsal Medial nucleus Cingulate gyrus
wall of third ventricle beneath ependyma and some nucleus of thalamus
are also scattered in interthalamic adhesion. Lateral posterior Other thalamic Superior parietal
Function of these nuclei are not clearly known. nucleus nuclei lobule (Area 5)
Pulvinar Other thalamic Inferior parietal
Reticular nucleus nuclei lobule (Area 7)
This is a thin layer of nerve cells which are interposed Ventral tier
between external medullary lamina and posterior limb
of internal capsule. It means that this thin lamina of Name of nucleus Afferent Efferent
nucleus is situated on lateral surface of thalamus. Ventral anterior 1. Globus pallidus Premotor cortex
Through this nucleus, cerebral cortex regulates nucleus 2. Substantia (Area 6)
thalamic activity. nigra
GENICULATE BODIES: Lateral and medial Ventral lateral 1. Globus pallidus Motor and premotor
geniculate bodies are together known as metathala- nucleus 2. Substantia nigra cortex (Area 4 and
mus. These two small round elevations are overhung 3. Dentate nucleus 6)
by pulvinar and nowadays are considered as comp- 4. Red nucleus
onents of thalamus. Lateral and medial geniculate Ventroposterolateral 1. Spinal lemniscus Postcentral gyrus
bodies are diencephalic level relay stations of visual nucleus 2. Medial lemniscus (Area 3, 1, 2)
Ventroposteromedial 1. Trigeminal Postcentral gyrus
end cochlear pathways respectively.
nucleus lemniscus (Area 3, 1, 2)
2. Solitariothalamic
Connections of Thalamus (Fig. 12.7) tract
Connections of thalamus is better understood and
remembered if Figure no. 12.7 is consulted along with Metathalamus
study of under-mentioned text.
Name of nucleus Afferent Efferent
Anterior part
Lateral geniculate Optic tract of Primary visual
Name of nucleus Afferent Efferent body visual pathway cortex Area 17
Anterior thalamic Mammillary 1. Cingulate gyrus Medial geniculate Lateral lemniscus Auditory cortex
nuclei body 2. Hypothalamus body and inferior colliculus (Area 41 and 42)
196
Diencephalon
Prefrontal cortex and
hypothalamus
Fig. 12.8 Layers 1, 4 and 6 of right lateral geniculate body receive fibers from right half of opposite retina and layers 2, 3, 5 receive
fibers from same half (right half) of same retina
199
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Tela choroidea
Habenular commissure
Pineal recess
Pineal gland
Posterior commissure
Superior colliculus
Thalamus
Subthalamic nucleus
Lentiform nucleus
Bothway connection of subthalamic
nucleus with globus pallidus (Subthalamic
Internal capsule Ansa lenticularis fasciculus)
Fig. 12.10 Subthalamic nucleus with gray and white matters around it
203
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Hypothalamus sulcus
Thalamus
Epithalamus
Hypothalamus
Subthalamus
Preoptic area
Optic chiasma
Broadly, functions of hypothalamus can be stated as lamina terminalis. Anatomically preoptic area is a
1. It controls activities of autonomic nervous system. part of telencephalon. But functionally it is considered
Being the supreme center for regulation of auto- as anteriormost part of hypothalamus containing one
nomic nervous system, hypothalamus had been of its nuclei called preoptic nucleus.
referred by Sherington as head-ganglion of auton- Posteriorly, hypothalamus merges with subthala-
omic nervous system. mus which becomes continuous below with tegmentum
2. It controls functions of endocrine system. of midbrain.
Thus controlling both autonomic nervous system
and endocrine system, hypothalamus maintains Fundamental Subdivision of Hypothalamus
body homeostasis.
3. Hypothalamus plays an important role in emotional Mediolateral subdivision (Fig. 12.13)
activities through its influence on limbic system.
Anterior column of fornix ends in mammillary body.
Mammillothalamic tract extends from mammillary
Relations of Hypothalamus body to anterior nucleus of thalamus. These two bands
In coronal section, hypothalamus can be simulated of fibers divide hypothalamus primarily into medial
with the capital letter U. Intermediate part of U and lateral zones. Subependymal surface (medial
form the floor and, both the limbs form lower part of surface) of medial zone presents a thin strip which
lateral wall of third ventricle. is differentiated from main part of medial zone. This
So relations of four aspects of hypothalamus are thin medialmost lamina of hypothalamus possesses
following (Fig. 12.12) its own identity as paraventricular zone.
l Superiorly: Thalamus, demarcated by hypothal-
So, from lateral to medial, hypothalamus is
amic sulcus. ultimately divided into following three zones.
l Inferiorly: It is free and form components of
1. Lateral zone
interpeduncular fossa of base of the brain. It forms
}
2. Intermediate zone No. 2 and No. 3 zone
the floor of third ventricle.
l Medially: Cavity of third ventricle of brain (lower 3. Paraventricular together actually
part). or subependymal zone forms medial zone
l Laterally: Internal capsule of brain. (also called medial zone)
Hypothalamus sulcus
Fibers of internal
capsule related lateral
Hypothalamus forming to hypothalamus
lower part of lateral wall
of third ventricle
upto optic chiasma. Anatomically it is part of 2. Supraoptic region: It is the part of hypothalamus
telencephalon. But for functional reason it has above optic chiasma.
been incorporated into hypothalamus of dience- 3. Tuberal region: It is the part adjoining tuber
phalon. cinereum and infundibulum of pituitary gland.
Body of fornix
Thalamus
Lateral zone
Posterior column
of fornix
Intermediate
zone
Mammillothalamic tract
Mammillary body
Paraventricular or subependymal
zone of hypothalamus
Nuclei of Hypothalamus
1. Hypothalamus is composed of small nerve cells
which are arranged in groups called hypothalamic
nuclei. Preoptic nucleus
2. Many of these nuclei are not clearly demarcated Supraoptic nucleus
from each other. Even some may show overlapping.
3. A group of neurons, known as preoptic area,
situated between lamina terminalis and optic
chiasma, is anatomically part of telencephalon.
But from functional point of view, the area forming Tuberoinfundibular nucleus
a nucleus, preoptic nucleus is incorporated in Mammillary nucleus
hypothalamus (diencephalon).
4. Various nuclei of hypothalamus are divided Fig. 12.15 Nuclei of hypothalamus bisected for both lateral and
into three zones already stated. These zones are intermediate zone
lateral, intermediate and paraventricular or
subependymal. The last group is also known as Nuclei common for lateral and intermediate zones
medial zone. (Fig. 12.15)
5. Some of the nuclei are bisected, thereby falling
in two adjacent zones. These are preoptic, supr- 1. Preoptic nucleus
aoptic and tuberal nuclei. 2. Supraoptic nucleus
6. Nuclei which are anatomically classified, are 3. Tuberoinfundibular nucleus
not often grouped physiologically. It means that 4. Mammillary nucleus.
nuclei of two different anatomical zones may be
physiologically identical in function. Intermediate zone (Fig. 12.16)
7. For more academic interest, very often, nuclei
are classified in a complex manner. But simplest, 1. Anterior nucleus
conventional and mediolateral subdivision of nu- 2. Ventromedial nucleus
clei of hypothalamus is mentioned below. 3. Dorsomedial nucleus
4. Posterior nucleus.
Nuclei of lateral zone (Fig. 12.14)
n Lateral nucleus: This nucleus is made up of large
sized and loosely packed neurons which occupies whole
anteroposterior extent of lateral zone. Lateral nuclear
zone is also associated with abundance of fibers.
Anterior Dorsomedial
nucleus nucleus
Posterior
Ventromedial
nucleus
nucleus
Lateral nucleus
Paraventricular nucleus
Supraoptic nucleus
Mammillary body
Hypothalamohypophyseal tract
Venules
Adenohypophysis (anterior
pituitary) Neurohypophysis
Venules (posterior pituitary)
Fig. 12.18 Efferent connection of hypothalamic nuclei with neurohypophysis to form hypothalamohypophyseal tract
Tuberal nucleus
Tuberoinfundibular tract
Sinusoids in Capillaries
adenohypophysis
Hypophyseal vein
Adenohypophysis Neurohypophysis
Fig. 12.19 Efferent connection from tuberal nucleus of hypothalamus for adenohypophysis
208
Diencephalon
hormone release inhibiting factors. These sub- Neurosecretion
stances reach through tuberoinfundibular
Supraoptic and paraventricular nuclei of hypotha-
tract to infundibulum of pituitary gland from
lamus are concerned with liberation of vasopressin
hypothalamus. Through hypophyseal portal and oxytocin respectively. Vasopressin basically
system capillaries at both ends the hormone being selective vasoconstrictor in nature, causes rea-
releasing factors and hormone release inhi- bsorption of water from distal convoluted tubules
biting factors reach the adenohypophysis (ant- and collecting tubules of kidney. Oxytocin increases
erior pituitary) to produce influence on the contractility of uterine musculature and myoepithelial
endocrine cells. cells in the alveolar wall of mammary gland.
Specific functions of two hormones:
1. Hormone releasing factors: These stimulate Endocrine control
release of following hormones from the concerned
cells of adenohypophysis. Tuberoinfundibular nucleus of hypothalamus libe-
a) Growth hormones (GH) rates two hormones called hormone releasing factor
b) Adrenocorticotrophic hormone (ACTH) and hormone release inhibiting factor. Initially these
c) Thyroid stimulating hormones (TSH) hormones reach infundibulum of pituitary gland via
d) Follicle stimulating hormones (FSH) tuberoinfundibular tract. But finally through the
e) Luteinizing hormones (LH). vascular portal system of pituitary gland hormones
2. Hormone release inhibiting factors: These inh- reach adenohypophysis (anterior pituitary) to exert
ibit release of following hormones from concerned regulations on different endocrine cells liberating
cells of adenohypophysis. respective hormones. Hormones releasing factor
a) Melanocyte stimulating hormones (MSH) stimulates release of growth hormones, adrenoc-
b) Lactogenic hormones (Prolactin). orticotrophic hormone, thyroid stimulating hormone,
follicle stimulating hormone and luteinizing hormone.
Functions of Hypothalamus Hormone release inhibiting factor inhibits release
of melanocyte stimulating hormone and lactogenic
Hypothalamus exerts its influence on almost every
hormone (prolactin).
function of body. Only the important and better
studied functions are discussed below.
Control of body temperature
Autonomic control Normal body temperature is maintained due to
balance of function of anterior and posterior part of
Hypothalamus is primarily considered as higher
hypothalamus. Anterior part is concerned for heat
autonomic center to have a control on lower autonomic
center for both parasympathetic and sympathetic loss by cutaneous vasodilation and sweating which
system present is brainstem and spinal cord. result in lowering of body temperature. Posterior part
Beside this, hypothalamus is also considered as of hypothalamus, if activated, causes vasoconstriction
a center for integration of both autonomic nervous of skin and inhibition of sweating with no heat loss.
system and endocrine system, thus maintaining body Skeletal muscle is also responsible for production of
homeostasis. heat which results in shivering.
Parasympathetic and sympathetic components of
autonomic nervous system are controlled by anterior Control of food and water intake
and posterior parts of hypothalamus respectively. It is n Food intake: Intake of food by an individual is
also proved experimentally. Electrical stimulation of regulated by two centers of hypothalamus called
anterior and preoptic nuclei of hypothalamus leads to Hunger center and satiety center. Hunger center is
increased parasympathetic activities, e.g. lowering of present in lateral part of hypothalamus, whereas
blood pressure, decreased heart rate, hyperperistalsis, medial part lodges satiety center. Stimulation of
contraction of bladder wall, increased salivation and lateral part results in increase in food intake. Lesion
gastric juice and constriction of pupil. of this area will lead to anorexia and subsequent loss
Stimulation of posterior and lateral nuclei cau- of body weight. Stimulation of medial part of hypot-
ses hyperactivity of sympathetic system which is halamus containing satiety center inhibits intake
manifested by rise of blood pressure, increased heart of food. Obviously lesion in this area will results in
rate, diminished intestinal peristalsis and dilatation uncontrolled voracious appetite which finally causes
of pupil. excessive obesity.
209
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
n Water intake: Some area of lateral zone of Obesity and Wasting
hypothalamus is known as thirst center. Stimulation
These are two opposite indirect manifestations of
of this area makes an individual thirsty with severe
lesion of satiety and hunger center of hypothalamus.
urge to drink water. Again, supraoptic nucleus,
Medial zone contain the satiety center and the hunger
through its influence on liberation of vasopressin
center is present in lateral zone. Usually severe
(antidiuretic hormone), maintains optimum osmol-
obesity is the common manifestation of hypothalamic
arity of blood, thus maintains water balance of body.
lesion which is associated with genital hypoplasia.
Wasting is rare in occurrence.
Regulation of emotion and behavior
Hypothalamus is considered as principal outlet for Hyperthermia and Hypothermia
action of limbic system for emotion and behavior of
an individual through prefrontal cortex. Rage and These manifestations are the result of imbalance in
passivity are two opposite poles of emotion and normal body temperature regulation due to lesion
behavior. These are again dependent upon effect in hypothalamus. Hyperthermia is commoner than
of surrounding environment. Hypothalamus acts hypothermia. It may result following head injury
as an integrator for various informations received or neurosurgical operation in the area adjacent to
from different areas of nervous system and leads to hypothalamus. Patient of hyperthermia is otherwise
manifestations of emotion. normal, because patient is not suffering from head-
Lateral nuclei of hypothalamus are considered as ache or malaise which are the effect of pyrexia
the center for rage and ventromedial nucleus is the following any infection.
center for passivity. Tuberal nucleus by synthesis of
hormone releasing factors exert influence on secretion Diabetes Insipidus
of gonadotrophins, thus has an effect indirectly on
sexual behavior. This clinical condition is characterized by passage
of large volume of urine with low specific gravity.
Relation of circadian rhythm As a result patient remains severely thirsty and
frequently drinks large quantity of water. This effect
Hypothalamus acts as biological clock through regu- is due to lesion of supraoptic nucleus of hypothalamus
lation of circadian rhythm. Along with thalamus, or hypothalamohypophyseal tract with impairment
limbic system and reticular activating system, hypot- of secretion of vasopressin or antidiuretic hormone
halamus regulates cycle of sleeping and waking. (ADH).
Supraoptic nucleus, which receives afferent impulse
from retina through optic chiasma, plays an important Sexual Disorder
role in the biological rhythm of sleeping and waking.
Circadian rhythm controlled by hypothalamus, Craniopharyngioma is a congenital tumor arising from
also includes body temperature, adrenocortical activ- remnants of Rathkes pouch. In children, its pressure
ity, eosinophil count and renal excretion. effect on hypothalamus may show sign of sexual
retardation along with other clinical manifestation of
CLINICAL ANATOMY hypothalamic lesion. After puberty, the patient suff-
ers from impotence or menstrual disorder.
Although hypothalamus is a very tiny area of central
nervous system, its immense clinical importance Sleep Disorder
should never be ignored. Because, hardly there is
a tissue of body which is not under the influence of Patient suffers from disorder of circadian rhythm of
hypothalamus. Hypothalamus is the principal outlet sleep and wakefulness. Typically patient may suffer
of limbic system which influences three important from insomnia or frequent short period sleep during
aspects of daily life, which are autonomic function, the hours of waking.
endocrine function and emotional activities.
Lesion of hypothalamus may be due to direct reason Emotion Disorder
like vascular and inflammatory, or indirect pressure In patient of hypothalamic lesion, various kinds
effect, e.g. neoplasm or internal hydrocephalus adja- of emotional outbursts are observed. It may be
cent to it. unexplained weeping or laughter. Patient may show
Important clinical manifestations of hypothalamic uncontrollable rage. Sometimes there may be features
syndrome are following: of mental depression.
210
Third Ventricle of Brain
13
Identity two thalami and upper part of hypothalamus. So, its
four walls, anterior, posterior, superior and inferior,
Third ventricle of brain is a narrow midline cavity of
are narrow. Both the lateral walls are wider which
diencephalon.
Morphologically, it is central midline part of cavity are clearly demonstrated in midsagittal section of
of forebrain vesicle. Two lateral extensions are lateral brain.
ventricle.
Third ventricle is slit-like cleft between two tha- Lateral Wall
lami. It is limited below by hypothalamus forming Larger upper part of lateral wall is formed by me-
base of the brain.
dial surface of thalamus. Lower part is formed by
hypothalamus below hypothalamic sulcus. Surfaces
Communications (Fig. 13.1)
of thalamus and hypothalamus forming lateral wall
1. Proximal: On either side of midline, third vent- are lined by ventricular ependyma.
ricle communicates anterolaterally with lateral
ventricle through a narrow slit, called interve- Important features of lateral wall
ntricular foramen of Monro which is bounded
anteriorly by anterior end of anterior column of 1. Stria medullaris thalami (Fig. 13.2)
fornix and transversely running fibers of anterior
commissure, and posteriorly by anterior pole of It is a subependymal thin band of white matter that
thalamus. extends anteroposteriorly along the line of dem-
Interventricular foramen is directed forwards, up- arcation between medial surface and superior surface
wards and laterally. of thalamus, thus indicating upper extent of lateral
2. Distal: Third ventricular cavity communicates wall of third ventricle. Stria medullaris thalami
distally in the midline. It is posteroinferior in dire- extends from anterior pole of thalamus to Habenular
ction where the cavity is continuous with narrow nucleus.
passage of cerebral aqueduct of Sylvius passing
through midbrain. Aqueduct distally leads to cav- 2. Hypothalamic sulcus (Figs 13.1 and 13.2)
ity of fourth ventricle of brain.
It is a narrow and shallow sulcus which extends from
Boundaries (Figs 13.1 and 13.2) interventricular foramen of Monro to upper end of
It has already been mentioned that third ventricle cerebral aqueduct of Sylvius. The sulcus demarcates
is a narrow midline cleft between medial surfaces of medial surfaces of thalamus and hypothalamus.
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Interthalamic adhesion Fornix
Anterior column of
fornix
Interventricular
foramen of Monro
Anterior commissure
Tela choroidea
Suprapineal recess
Fig. 13.1 Third ventricle of brain viewed in midsagittal diagram with its boundaries, recesses and communications
3. Interthalamic adhesion (Figs 13.1 and 13.2) true commissural fibers, as instead of reaching nuclei
It is a short, narrow and compact band crossing the of opposite thalamus, they return back to the same
midline which connects very closely apposed medial side (Fig. 13.2).
surfaces of both thalami. It is round on cross-section n Gray matter: Interthalamic adhesion also contain
visible on medial surface of thalamus. It is made up of
some scattered neurons which are considered to be
both white as well as gray matter.
n White matter: These fibers arising from thalamic detached cells of paraventricular or midline nuclei of
nuclei of one side cross the midline. But these are not thalamus.
Tela choroidea
Choroid plexus
Interthalamic adhesion
Thalamus
Hypothalamic sulcus
Fornix
Tela choroidea
Corpus callosum
Stria terminalis
Ependymal roof of third
Thalamostriate vein ventricle
Cavity of third ventricle
Thalamus
Hypothalamus
Anterior Wall (Fig. 13.1) Roof is therefore narrow having the breadth
between two thalami and anteroposteriorly extends
It is formed by following structures from above down-
wards. from the level of interventricular foramen to superior
l Anterior column of fornix. lamina of pineal stalk forming Habenular commissure.
l Anterior commissure: Its fibers cross transve-
rsely in front of lower end of anterior column of fornix. Recesses of Third Ventricle (Fig. 13.1)
l Lamina terminalis: A thin layer of gray matter
Recesses are mostly small angular pockets of cavity
extending from lower end of rostrum of corpus
of the ventricle in relation to the structures forming
callosum to optic chiasma.
its boundary.
Posterior Wall (Fig. 13.1) The recesses are following:
It is shorter than anterior wall and formed by n Optic recess: It is an angular pocket of the cavity
l Pineal gland above optic chiasma which lies on the anterior end of
l Two laminae of pineal stalk called Habenular the floor. The recess is at the junction of anterior wall
commissure proximal posterior commissure and floor of the ventricle.
distal.
n Infundibular recess: This recess is comparatively
deeper which is tubular in shape with pointed lower
Floor (Fig. 13.1)
end. It extends through tuber cinereum into the stalk
From before backwards structures forming the floor (infundibulum) of pituitary gland.
are n Pineal recess: It is a small angular recess on the
l Optic chiasma
posterosuperior aspect of the cavity which is bounded
l Tuber cinereum with infundibulum of pituitary
by superior and inferior stalks of pineal gland.
gland (not the gland itself)
l Mammillary bodies which is bilateral n Suprapineal recess: It is wider and blunt recess
l Posterior perforated substance which is obviously above pineal gland but below tela
l Tegmentum of midbrain. choroidea which is below splenium of corpus callosum.
Besides these four well-defined recesses, another
Roof triangular recess is found in relation to the anterior
This wall is lined only by ependyma which extends wall. It is between two diverging anterior column
from upper border of medial surface of one thalamus of fornix, in front of interventricular foramen and
along the length of stria medullaris thalami to that behind anterior commissure. It is called anterior
of other. recess of third ventricle.
213
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Superior layer of tela
choroidea
Anterior apical end of
tela choroidea at the
level of interventricular
foramen of Monro
Fig. 13.4 Tela choroidea taken out from roof of third ventricle
Falx cerebri
Inferior sagittal sinus
Important dural septae or fold are n Ends: Anterior apical end is attached to crista
1. Falx cerebri galli of ethomoid and adjacent part of internal crest of
2. Tentorium cerebelli frontal bone.
3. Falx cerebelli Posterior basal end is anteroposteriorly running
4. Diaphragma sellae. straight border which is attached to midline of supe-
rior surface of tentorium cerebelli.
n Borders: Superior border is convex and attached
Falx cerebri (Figs 14.1 and 14.2)
to margins of a narrow linear sulcus on the inner
It is a sickle-shaped fold of dura mater which extends surface of median sagittal sutures connecting two
anteroposteriorly, through midsagittal plane and dips parietal bones.
in median longitudinal fissure of brain between two Inferior border is concave and comparatively
cerebral hemispheres. sharper free border which comes in relation to ante-
Endosteal layer of dura
Superior sagittal sinus
Supratentorial compartment
Tentorium cerebelli
Transverse sinus
Infratentorial compartment
Foramen magnum
Fig. 14.2 Dural folds on coronal section of cranium are found to form compartments
216
Meninges of Brain and Cerebrospinal Fluid
roposteriorly convex superior surface of corpus Margins
callosum.
1. Posterior margin: It is actually peripheral, conv-
Venous sinuses related ex and fixed margin which is attached on either
side of midline and from behind forwards to
It is already known that intracranial venous sinuses l Two lips of transverse sulcus of occipital bone.
lies between endosteal and meningeal layers of dura
l Superior border of petrous part of temporal
mater. Venous sinuses related to falx cerebri are
followings bone.
1. Superior sagittal sinus: Runs from before Anterior end of this margin is attached to posterior
backwards along upper convex border of the falx. clinoid process of sphenoid bone.
2. Inferior sagittal sinus: It runs also anteropo- 2. Anterior margin: It is the inner central free
steriorly, but along the lower free concave margin margin of the dural fold. Free margin of both sides
of falx cerebri. together forms a concavity which is called tentorial
3. Straight sinus: It is anteroposteriorly straight in notch. In front of this notch passes brainstem from
direction, present along the line of attachment of
supratentorial compartment to infratentorial com-
falx cerebri and tentorium cerebelli in the median
plane. partment of cranial cavity to pass through foramen
magnum.
Tentorium cerebelli (Figs 14.1 and 14.2) Anterior end of free margin is attached to anterior
clinoid process of sphenoid bone.
It is a double fold of dura mater which invaginates
horizontally forwards through the gap between the
occipital lobes of cerebrum and cerebellum (Fig. 14.3). Venous sinuses related
Tentorium cerebelli is so called because from Anterior part of peripheral margin attached to sup-
midline it slopes on either side downwards and late- erior margin of petrous part temporal bone is related
rally to adjust the slopes from raised superior vermis
to superior petrosal sinus.
to superior surface of cerebellar hemispheres on
either side (Fig. 14.2). Posterior part of peripheral margin related to tran-
sverse sulcus of occipital bone is related to transverse
Surface sinus.
Occipital lobe
Cerebellum
Fig. 14.3 Horizontal shelf of tentorium cerebelli separating occipital lobe of cerebrum from cerebellum
217
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
compartment and prevents its pressure unduely to 2. Internal carotid artery.
be applied on cerebellum in the infratentorial com- 3. A branch from middle meningeal artery.
partment.
Middle meningeal branches
Falx cerebelli (Fig. 14.1)
1. Middle meningeal artery: It is a branch from
It is a small, crescentic fold of dura mater which extends
maxillary artery. It is the largest of the meningeal
along the midline vertical plane forwards between two
arteries. Entering through foramen spinosum it
cerebellar hemisphere bellow tentorium cerebelli.
lies deep to pterion. This landmark of the artery
Margins is clinically important for neurosurgeons. Here it
Superior margin is anteroposteriorly straight. It runs divides into anterior frontal and posterior parietal
along midline being attached on the undersurface of branches. Some of the branches may ascend upto
tentorium cerebelli. vertex and anastomose with the corresponding
Posterior margin is convex and attached to internal branches of other side.
occipital crest. This margin lodges occipital sinus. 2. Accessory meningeal artery: It is also branch
Anterior margin is concave and free. It invaginates of maxillary artery and it enters cranium through
through the gap between posteroinferior aspect of foramen ovale.
two cerebellar hemispheres. Occipital sinus is lodged 3. A branch from ascending pharyngeal artery
between right and left layers of this dura fold (Fig. enters through foramen lacerum.
14.1).
Posterior meningeal branches
Diaphragma sellae (Fig. 14.4)
1. Meningeal branch of occipital artery. It may
It is a small, round and horizontal fold of dura mater
whose peripheral margin is attached to the outline of be two. One enters through jugular foramen and
hypophyseal fossa (sella turcica) of superior surface of another through mastoid foramen.
body of sphenoid on middle cranial fossa. It presents a 2. Multiple meningeal branches of vertebral
central circular aperture through which infundibulum artery.
(stalk) of pituitary gland passes upwards to be atta- Apart from very fine branches from all of the above
ched to the base of brain. meningeal arteries distributed to dura mater,
branches are also distributed to periosteum (end-
Arterial Supply of Dura Mater osteum), bone and bone marrow.
Dura mater is supplied meningeal branches of so
many arteries. These meningeal branches are divided Nerve Supply of Dura Mater
into following three sets. Sensory nerves for cranial dura mater are also divided
1. Anterior: For anterior cranial fossa. like arteries into three sets for anterior, middle and
2. Middle: For middle cranial fossa.
posterior cranial fossae. These are as following:
3. Posterior: For posterior cranial fossa.
Mammillary body
Optic chiasma
Pituitary gland
Fig. 14.4 Diaphragma sellae related to pituitary gland at the base of brain
218
Meninges of Brain and Cerebrospinal Fluid
3. Meningeal branch of maxillary nerve (Nervus 6. Circulated cerebrospinal fluid also finally drains
meningeus medius). into venous sinuses.
4. Recurrent meningeal branch of mandibular nerve 7. Blood from all venous sinuses finally drains
(Nervus spinosus). through internal jugular vein.
Confluence of sinus
Anterior intercavernous Straight sinus
sinus
Great cerebral vein of Galen
Left transverse sinus
Left sphenoparietal sinus
Sigmoid sinus
Left cavernous sinus
This paired sinus is lodged in the transverse sulcus on Inferior petrosal sinus
either side of internal occipital protuberance, at the
posterior part of peripheral fixed margin of tentorium This paired sinus extends from before backwards
cerebelli. along the groove between inferior border of petrous
Right transverse sinus is formed usually as a part of temporal bone and clivus of sphenoid bone. It
continuation of posterior end of superior sagittal sinus drains blood from cavernous sinus to bulb of internal
and posterior end of straight sinus usually continues jugular vein passing through anterior compartment
as left transverse sinus. of jugular foramen.
220
Meninges of Brain and Cerebrospinal Fluid
Sphenoparietal sinus lubricated by fluid of subdural and subarachnoid
space.
It is a bilateral narrow and small venous sinus running
along posterior border of lesser wing of sphenoid to
drain into cavernous sinus. Prolongations of Arachnoid Mater
1. Along the nerves: When cranial nerve arise from
ARACHNOID MATER surface of brain, so also spinal nerve arising from
spinal cord, they take a sleeve of meningeal dura as
Arachnoid mater is a thin, delicate, impermeable
transparent membrane which wraps over brain (as well as arachnoid mater. Dura stops at the margin
well as spinal cord). It is placed in the plane between of foramina through which the nerves come out.
dura mater outside and pia mater inside. But arachnoid continues for a short distance over
Arachnoid mater invests the surface of brain and the perineural sheath.
does not dips into any depression, fossa, sulcus or 2. Along the blood vessels: When arteries from
fissure on the surface of brain except in following two subarachnoid space penetrate brain substance,
sites. they take prolongation of arachnoid along with pia
1. Inside the median longitudinal fissure of cerebrum, to form perivascular sheath.
arachnoid mater is taken inside by the meningeal
dura to the bottom of fissure through the formation
of falx cerebri.
Processes of Arachnoid (Fig. 14.6)
2. Inside the stem of lateral sulcus of brain, arachnoid 1. Arachnoid villi: These are multiple, short
mater is pushed by posterior free margin of lesser finger-like prolongations of arachnoid mater
wing of sphenoid. which invaginate the wall of intracranial venous
Investing the brain arachnoid mater is continuous
sinuses. These villi perforate the dural wall of
below foramen magnum to cover spinal cord and ends
along with spinal dura at the level of lower border of venous sinus while pushing through it and come
body of second sacral vertebra. in contact with endothelial wall of the sinus. The
specialized mesothelial cells of the arachnoid villi
Spaces Related to Arachnoid Mater is concerned with transport of cerebrospinal fluid
from subarachnoid space to venous sinus.
Arachnoid mater is closely related to dura mater from
Maximum number of arachnoid villi are found
which it is separated by a thin potential space called
in relation to wall of superior sagittal sinus.
subdural space which contains a thin layer of fluid.
Beneath arachnoid a noticeable space is there 2. Arachnoid granulations: These are nothing but
between it and pia mater called subarachnoid space. modified forms of arachnoid villi. With adva-
The subarachnoid space is much wider in some sites. ncement of age, arachnoid villi are enlarged in
size, becomes pedunculated and clumped together
Contents of Subarachnoid Space to form arachnoid granulations whose function is
same, i.e. as absorption of cerebrospinal fluid from
Subarachnoid space contains following
subarachnoid space into venous blood.
1. Cerebrospinal fluid which, after being secreted
Prominent arachnoid granulations, in old age,
by choroid plexus of ventricle and circulated in
produce impressions in the form of multiple pits on
ventricular system, is transported into subara-
the inner surface of bones of vault of skull adjacent
chnoid space, through apertures of roof of fourth
to the sulcus for superior sagittal sinus.
ventricle.
2. Blood vessels of brain before they enter inside
or come out of brain substance.
Subarachnoid Space
3. Cranial nerves after they exit out of the brain It is the space beneath arachnoid mater, so between
and before come out through foramen of skull. it and pia mater. Subarachnoid space of brain is
4. A fine network of reticular fibers traversing sub- continuous with that around spinal cord through
arachnoid space binds arachnoid with pia mater. foramen magnum.
Bone of
cranial vault Superior sagittal
sinus
Endosteal layer
of dura
Meningeal layer
of dura
Arachnoid villi
Arachnoid mater
Fig. 14.6 Arachnoid villi invaginating dura and endothelial wall of dural venous sinus
Interpeduncular cistern
Cerebellomedullary cistern
Tight junction
Epithelial basement
membrane
Pale cell
Endothelial basement
membrane
Endothelial cell
227
Blood Supply of Brain and Spinal Cord
15
Brain and spinal cord, constituting central nervous Final sets of branches penetrate brain tissue in
system, have high metabolic demand as these are the form of two groups which are
made up of very sensitive and delicate nervous tissue. 1. Superficial (cortical): Which have two characte-
This demand is fulfilled by aerobic combustion of ristics.
glucose. For this, there is very much necessity of adeq- a) They supply superficial cortical part of brain.
uate and continuous supply of glucose and oxygen b) They form anastomosis on the surface of the
which are transported through bloodstream. brain which will help in collateral circulation.
It is interesting to note that, though central 2. Deep (central, ganglionic or nuclear): Which
nervous system (brain and spinal cord) constitutes have two characteristics
a) They supply deeper part of brain, e.g. white
only 2% of body weight, it receives 17% of cardiac
matter (fiber bundles) and deep-seated mass
output and utilizes 20% of total oxygen utilized by
of gray matter like basal nuclei.
body.
b) These branches are end arteries which do not
Central nervous system tissue is very much sensi- have any anastomosis before capillary level.
tive and highly vulnerable to injury due to lack of blood l Sources of arteries: Sources of arteries to the
supply, so lack of oxygen (hypoxia). Experimental brain are from two bilateral arterial systems which
studies as well as clinical observation established are
that, in case of arrest of blood supply to the brain for 1. Vertebrobasilar arterial system.
10 seconds, there occurs loss of consciousness and if 2. Carotid arterial system.
it continues for 10 minutes for even a tiny area of the
tissue, it leads to irreversible damage. Vertebrobasilar arterial system
This arterial system is formed by two vertebral
BLOOD SUPPLY OF BRAIN arteries. Vertebral artery originates at scelenoverte-
bral triangle of root of neck. But it is the fourth part of
Arteries of Brain vertebral artery which becomes intracranial entering
through foramen magnum to supply brain (with
Brain is richly supplied by arteries. Brain is encased spinal cord).
inside cranial cavity and covered by meninges. Fourth part of vertebral artery pierces dura mater
Source of the arteries are from outside the cranium and then arachnoid mater inside the cranium. Arteries
so these arteries will have to enter the cranium. of both sides run upwards, forwards and medially
Entering the cranium the arteries and their main over anterolateral aspect of medulla oblongata and
branches pierce dura mater and then arachnoid mater converge towards midline. Uniting with each other
and are initially placed in subarachnoid space. in midline at pontomedullary junction both vertebral
Blood Supply of Brain and Spinal Cord
Basilar artery
Posterior inferior
cerebellar artery
Meningeal arteries
Vertebral artery
Medullary arteries
arteries from basilar artery. Basilar artery runs Though posterior spinal arteries are two in number,
upwards along basilar sulcus of pons. At the upper they supply posterior one-third of spinal cord.
end of basilar sulcus basilar artery bifurcates into Distribution of both anterior as well as
posterior cerebral arteries (Figs 15.1 and 15.2). posterior spinal arteries are discussed in details in
So, branches from vertebrobasilar system are connection with blood supply of spinal cord.
divided into two groups 5. Posterior inferior cerebellar artery: It is the
1. Branches from vertebral artery. largest branch of intracranial part of vertebral
2. Branches from basilar artery. artery and presents an irregular course from
side of medulla at the level of olive towards
Branches from vertebral artery (Fig. 15.1) cerebellum. This artery is so named because it is
posterior in position among two inferior cerebellar
These are five sets of branches arteries (Fig. 15.3). The artery runs backwards
1. Medullary arteries: These are minute, multiple winding round medulla to supply inferior aspect
and medial branches of vertebral artery. These of cerebellum, both vermis as well as hemisphere.
short branches pierce medulla oblongata. These It also gives branches to posterolateral aspect of
are called paramedian branches by clinician. medulla oblongata.
2. Meningeal arteries: These are also minute and n Branches for choroid plexus: Choroid plexus
multiple but lateral set of branches. The branches of fourth ventricle is formed by branches of posterior
supply dura mater and bone of posterior cranial inferior cerebellar artery.
fossa.
3. Anterior spinal artery: This is single and midline Branches of basilar artery (Fig. 15.2)
artery which is formed by union of one contributory Basilar artery is formed by union of two vertebral
branches of each of the vertebral arteries. Each of arteries in the midline of pontomedullary junction.
the branches runs downwards and medially, and The artery runs upwards along basilar sulcus of
adjoin with each other in the midline to descend pons and at its upper end it bifurcates into right and
vertically along the anterior median fissure of left posterior cerebral arteries.
spinal cord. Anterior spinal artery though single, Branches of basilar artery are of five groups like
supplies anterior two-thirds of spinal cord. those of vertebral artery.
4. Posterior spinal artery: This is bilateral branch 1. Pontine arteries: These are short, narrow and
which arises from lateral side of vertebral artery. multiple branches, being paramedian in position.
Posterior spinal artery also descends vertically, Just after origin, these branches penetrates
but along posterolateral sulcus of spinal cord through basilar part of pons.
which coincides with the line of attachment of 2. Labyrinthine artery: It is so called because
posterior root of spinal nerves. it supplies labyrinth of internal ear. It is a long
229
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Posterior cerebellar artery
Pontine arteries
Vertebral artery
narrow branch which accompanies facial and 4. Superior cerebellar artery: It arises from
vestibulocochlear nerves to enter through internal terminal part of basilar artery close to its bifur-
acoustic meatus and supplies internal ear. cation. Initially it curves around cerebral peduncle
3. Anterior inferior cerebellar artery (Figs and finally reaches superior aspect of cerebellum
15.2 and 15.3): It is so named because it is the (Fig. 15.3). It is the artery to supply mainly sup-
anterior of the two inferior cerebellar arteries. erior aspect of cerebellum (vermis as well as
It may be recalled that posterior one arises from
hemispheres), but branches are also distributed to
vertebral artery. This branch of basilar artery
pons, pineal gland and superior medullary velum.
passes backwards and laterally to supply anterior
part of inferior aspect of cerebellum. It also gives 5. Posterior cerebral artery: These are two term-
short branches to posterolateral part of medulla inal branches (right and left) of basilar artery
oblongata and pons. arising at upper end of basilar sulcus. The artery
Sometimes labyrinthine artery arises from ante- runs upwards, backwards and laterally winding
rior inferior cerebellar artery. round cerebral peduncle to approach posterior part
Posterior inferior
cerebellar artery
Vertebral artery
Ophthalmic artery
Optic chiasma
Middle cerebral artery
Basilar artery
Fig. 15.4 Branches of carotid arterial system for brain, viewed from inferior aspect (base) of the brain
231
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
to its bifurcation into two cerebral arteries. It runs b)
Cortical branches: These branches arise while
backwards along the direction of optic tract and the parent trunk approaches superolateral
enters through the choroid fissure of inferior horn surface of cerebral hemisphere.
of lateral ventricle. It takes part in formation of
choroid plexus and also gives branches to impor- Communication Between Vertebrobasilar and
tant structures like crus cerebri, optic tract, Carotid Arterial Systems (Fig. 15.5)
lateral geniculate body and internal capsule.
4. Anterior cerebral artery: It is the narrower It has already been noticed that at the base of the
terminal branch of internal carotid artery. brain arteries of vertebrobasilar system approach
It runs forwards and medially above optic nerve. from behind and those of carotid system proceed
Then it reaches median longitudinal fissure of from the front. But a communication is established
brain. among branches of two systems of both sides. This
Here it is joined to the anterior cerebral artery arterial communication is called circle of Willis
of opposite side by anterior communicating artery or circulus arteriosus (Fig. 15.5). This arterial
which may be double or absent in some cases. circle is situated on interpeduncular fossa of base of
Finally anterior cerebral artery approaches the the brain in the plane of interpeduncular cistern of
medial surface of cerebral hemisphere where it subarachnoid space.
divides into two terminal branches called peric- Though it is called arterial circle of Willis, it is
allosal artery and callosomarginal artery. not circular but polygonal (hexagonal) in outline.
Anterior cerebral artery itself gives rise to two Arteries forming the circle of Willis are
sets of branches called cortical and central (nuclear 1. Anterior communicating artery
or ganglionic) branches. 2. Anterior cerebral artery
5. Middle cerebral artery: It is the larger terminal 3. Internal carotid artery, continued as middle cere-
branch of internal carotid artery and looks to be bral artery
the continuation of parent arterial trunk after 4. Posterior communicating artery
anterior cerebral branch is given out. It is also the 5. Posterior cerebral artery
largest branch of internal carotid artery. Middle
6. Basilar artery.
cerebral artery, after its origin at the base of brain
near anterior perforated substance, runs upwards
backwards and laterally to reach stem of lateral VARIATIONS OF CIRCLE OF WILLIS
sulcus of cerebrum.
1. Commonest variation is in relation to anterior
Like posterior and anterior cerebral arteries,
middle cerebral artery also gives out following two communicating artery. Very often it may be dou-
sets of branches. ble. Sometimes it is absent.
a) Central branches: These branches arise from 2. Incomplete circle: Posterior communicating artery
middle cerebral artery while it is in base of of one side or even of both sides may be absent
brain near anterior perforated substance. making the arterial circle incomplete.
6. Basilar artery
Fig. 15.5 Circle of Willis to establish communication between vertebrobasilar system and carotid system
232
Blood Supply of Brain and Spinal Cord
Functional Significance of Circle of Willis arise from anterior cerebral artery which presents a
recurrent course. This is called recurrent artery of
Parent arteries which contribute to formation of circle
Heubner. Anteromedial set of branches supply
of Willis are divided in following four units.
l Anterior half of anterior limb of internal capsule
1. Right internal carotid artery
2. Left internal carotid artery l Putamen
3. Right vertebral artery l Head of caudate nucleus.
4. Left vertebral artery.
In normal healthy individual, because of uniformity Anterolateral branches
of arterial pressure in four units, blood from one unit These are called striate arteries which arise from site
is not at all mixed up with blood of other unit, neither of origin of middle cerebral artery.
side to side, nor anteroposteriorly. It is important as These branches penetrate through anterior perfo-
well as interesting to note that, even in basilar artery rated substance and are divided into two groups
blood from two vertebral arteries are not admixtured.
called lateral and medial striate arteries.
So, it is very clear that in normal person, anatomical
Lateral striate arteries ascend along lateral
anastomosis of circle of Willis is not physiologically
active. But in pathological condition, if any one of surface of lentiform nucleus. These arteries supply
the arteries forming the arterial circle is blocked, l Posterior half of anterior limb and anterior two-
collateral circulation is established. So depending thirds of posterior limb of internal capsule
on the site and nature of occlusion, blood from one l Lentiform nucleus
arterial unit may flow to any part of brain. l Caudate nucleus
l Thalamus.
Branches of Circle of Willis (Fig. 15.6) One of the lateral striate arteries supplying
posterior limb of internal capsule presents a long
It has already been learnt that, brain receives two
course. It is called Charcots artery of cerebral
sets of branches from arteries of both vertebrobasilar
hemorrhage. Because of its length, it is more prone
and carotid system. These are cortical and central.
Branches from circle of Willis are all central. to be damaged in cerebrovascular accident.
These are also called nuclear or ganglionic branches Medial striate arteries ascend medial to lentiform
which are example of end arteries. nucleus and supply
Branches are divided into following four groups. l Caudate nucleus
1. AnteromedialMedian l Internal capsule.
2. AnterolateralRight and left
3. PosteromedialMedian Posteromedial branches
4. PosterolateralRight and left. These branches are median in position and originate
from posterior communicating and posterior cerebral
Anteromedial branches
arteries.
These branches arise from anterior communicating They penetrate through posterior perforated subs-
and anterior cerebral arteries. One of the branches tance and give branches to
Posteromedial branches
Basilar artery
Fig. 15.7A Areas of superolateral surface of cerebral hemisphere supplied by cortical branches of three cerebral arteries
234
Blood Supply of Brain and Spinal Cord
Anterior cerebral artery
Middle cerebral
Posterior cerebral artery
artery
Fig. 15.7B Areas of medical surface of cerebral hemisphere supplied by cortical branches of three cerebral arteries
2. Occipital lobe and medial surface of temporal Physiological control of blood flow in cerebral
lobe (except temporal pole) which is supplied by arteries
posterior cerebral artery which therefore supplies 1. Cerebral arteries are richly supplied by postga-
visual area. nglionic sympathetic fibers which arise from supe-
rior cervical sympathetic ganglion. Stimulation of
Inferior Surface (Fig. 15.7C) these fibers causes cerebral vasoconstriction.
Tentorial surface area (except temporal pole) is supp- 2. However, in normal condition, cerebral blood flow
lied by posterior cerebral artery. is under chemical regulation rather than ner-
Tentorial surface of temporal pole is supplied by vous control. Arterial blood flow to the brain is
middle cerebral artery. dependent upon concentration of carbon dioxide,
Larger lateral part of orbital surface of frontal lobe hydrogen ion and oxygen present in nervous
(Fig. 15.7C) is supplied by middle cerebral artery. tissue. Increase in carbon dioxide and hydrogen
Smaller medial part of orbital surface of frontal ion concentration and lowering of oxygen tension
lobe is supplied by anterior cerebral artery. causes cerebral vasodilatation.
Fig. 15.7C Areas of inferior surface of cerebral hemisphere supplied by cortical branches of three cerebral arteries
235
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
VENOUS DRAINAGE OF BRAIN veins drain the upper halves of both superolateral
as well as medial surfaces of cerebrum. They drain
At the beginning it is to be noted that veins draining in superior sagittal sinus. Anterior group opens at
brain are quite different from intracranial venous right angle but posterior group of veins opens obli-
sinuses. quely against the direction of blood flow (anterior
to posterior) in superior sagittal sinus. This will
Characteristics maintain their patency even when CSF pressure is
1. Veins of the brain are thin-walled due to absence increased.
of muscles in the walls.
2. These veins are devoid of valves, so blood does not Superficial middle cerebral veins (Fig. 15.8)
have unidirectional flow.
3. Arrangement of veins does not follow the arterial It runs downwards, forwards and medially along the
pattern. length of posterior ramus and then stem of lateral
4. All the veins of brain ultimately drain in intra- sulcus of brain. This vein will receive tributaries from
cranial venous sinus. the area of superolateral surface around posterior
5. Veins are situated initially in subarachnoid space. ramus of lateral sulcus.
But ultimately they pierce arachnoid mater and Superficial middle cerebral vein drains into cave-
meningeal layer of dura mater to drain into venous rnous sinus or sometimes into sphenoparietal sinus.
sinuses.
6. To maintain the patency, some of the veins drains Communications
against the direction of blood flow through the
sinus. Superficial middle cerebral vein communicates with
l Superior sagittal sinus: Through superior ana-
Groups of Veins stomotic vein.
l Transverse sinus: Through inferior anastomotic
Broadly veins of the brain are divided into following veins.
three groups l Deep middle cerebral vein: Present deep to it
l External cerebral veins
on insular cortex.
l Internal cerebral veins
l Terminal veins.
Deep middle cerebral vein
External Cerebral Veins It is situated very deep in lateral sulcus on the surface
of insular cortex and coupled with middle cerebral
Superior cerebral veins (Fig. 15.8) artery.
These veins are 612 in number. They are shorter in It runs downwards and forwards to form basal
length and parallel to each other. Superior cerebral vein joining with anterior cerebral vein.
Superficial middle
cerebral vein
Transverse sinus
Sigmoid sinus
Superior bulb of internal
jugular vein
Inferior sagittal
sinus
Straight sinus
Great cerebral vein of Galen
Basal vein Internal cerebral vein
Choroidal vein
out of cranium through foramen magnum to enter 1. It may be prominent only upto cervical level
vertebral canal. These three arteries are beyond which it may be very slender.
l One anterior spinal artery 2. In some cases, in upper thoracic level and in thor-
l Two posterior spinal arteries. acolumbar junction, anterior spinal artery may be
very narrow.
Anterior spinal artery In any of the cases, where anterior spinal artery
Inside cranium, each of the vertebral arteries gives is deficient, blood flow to the anterior spinal artery is
out one anterior spinal branch which descends down- reinforced by segmental contribution of other arteries
wards and medially towards anterior median line (discussed below).
where they meet each other to form single anterior
spinal artery. Posterior spinal arteries
Anterior spinal artery so formed, runs downwards
Posterior spinal arteries are two in number, right and
along anterior median fissure of spinal cord.
left. They arise from intracranial part of vertebral
Branches artery or sometimes from posterior inferior cerebellar
artery of respective side. Leaving cranial cavity thro-
While running along anterior median fissure, at the ugh foramen magnum, the arteries descend vert-
level of every segment of spinal cord, anterior spinal ically along posterolateral sulcus of spinal cord at the
artery gives sulcal branches which penetrate through line of attachment of posterior roots of spinal nerves.
spinal cord to anterior two-thirds of spinal cord Posterior spinal arteries give off branches in every
covering segments which enter the substance of spinal cord to
1. Anterior gray column, anterior gray commissure, supply its posterior one-third which includes
(and lateral gray column) 1. Posterior gray column with posterior gray comm-
2. Anterior and lateral white columns with anterior issure.
white commissure. 2. Posterior white column.
Sulcal branches supply anterior two-thirds of
spinal cord in alternate fashion to right and left side Variations
in successive spinal cord segment.
Channel of anterior spinal artery extends upto lower Posterior spinal arteries may be very much narrow
end of spinal cord but it may show some variations. in upper thoracic level. It is very much vulnerable
238
Blood Supply of Brain and Spinal Cord
to ischemia in upper three thoracic segments where further towards the surface of spinal cord for two
reinforcement of the artery is very much essential by purposes.
segmental arteries. 1. They encircle spinal cord from anterior and poste-
rior aspects of both sides and communicate with
Reinforcement of spinal arteries each other. While doing so, along the length of
spinal cord they form a fine arterial reticulum or
It is already understood, though both anterior and network called arterial vasocorona. Branches from
posterior spinal arteries may be existent throughout it directly enter the substance of spinal cord.
whole length of spinal cord, anatomically they are 2. The radicular artery also communicates with the
slender in different levels. This effect may interfare spinal arteries on the surface to reinforce spinal
with adequate blood flow in the affected segments of arteries. This reinforcement is important for ade-
spinal cord. But it is compensated through reinfor- quate blood flow through spinal arteries, parti-
cement of the spinal arteries by segmental arteries cularly below cervical level where spinal arteries
at every segment throughout whole length of spinal are very thin. One of the anterior redicular artery
cord. may be very much prominent to take the place of
Segmental arteries are horizontal in disposition lower two-thirds of anterior spinal artery in case
and enter vertebral canal through intervertebral fora- of its deficiency. It is called arteria radicularis
magna. Its position is variable from T1T11
mina. Segmental arteries arise from the following
segment.
regional arteries.
l Additional feeder arteries: Additional feeder arte-
1. In cervical region: Deep cervical artery, ascending ries enter the vertebral canal and anastomose with
cervical artery, and 2nd part of vertebral artery. anterior and posterior spinal arteries. But site of
2. In thoracic region: Posterior intercostal arteries. origin, number and size varies from one individual
3. In lumbar region: Lumbar arteries, may be su- to another. One of the large and important feeder
pplemented by lateral sacral artery. artery is called great anterior medullary artery
Course, distribution and communication of segmental of Adamkiewicz. It arises from aorta either in lower
arteries thoracic or upper lumbar level. It is unilateral and in
Segmental arteries enter vertebral canal through most of the cases if enters the spinal cord from left
respective intervertebral foramen. It then divides side. When this artery is present, it becomes the major
into anterior and posterior radicular arteries which source of blood flow to lower two-thirds of spinal cord.
approach respective aspect of spinal cord along the
VENOUS DRAINAGE OF SPINAL CORD
route of anterior and posterior roots of spinal nerve.
Primary role of the radicular arteries are to supply All the venous channels of spinal cord, like arteries,
corresponding nerve roots. But they continue to run are longitudinal in position being parallel to long-axis
Arterial
vasocorona
Segmental
artery
Branches supplying
Spinal branch of
nerve roots
segmental artery
Components forming
blood-brain barrier
1. Capillary endothelium
2. Basement membrane
3. Foot process of
Tight junction between astrocytes
endothelial cells
CT and MRI are indispensable techniques for diag- Tumors and blood-brain barrier
nosis of various cerebrovascular diseases. The diagn-
Tumors like anaplastic malignant astrocytoma, gliob-
osis can be made with speed, accuracy and safety.
lastoma and metastatic lesions in brain may present
Intracranial blood clot can be detected by its density. excessive vascularization. These pathological blood
These techniques have remarkably replaced the vessels do not possess blood-brain barriers.
cerebral angiography.
Drug and blood-brain barrier
Vascular lesion of spinal cord
In reference to their permeability through blood-
In comparison to the importance of nervous tissue brain barrier, drugs are classified into two groups.
of spinal cord, its arterial supply is not rich to that Some pass through while some of them do not. In this
extent. All the three spinal arteries are very slender context, it is interesting to note the following points.
and deficient in lower part. Anterior spinal artery 1. Lipid-soluble drugs possess the power of perme-
narrows down remarkably beyond cervical level. ability to pass through blood-brain barrier, e.g.
Again reinforcing segmental arteries also vary in thiopental and atropine.
number and prominence. Anterior two-thirds of spinal 2. A drug like phenylbutazone which binds with
cord covering the area of anterior (and lateral) gray macromolecules of plasma protein is unable to
column, anterior white column and major anterior cross the barrier.
part of lateral white column is supplied by anterior 3. A drug like penicillin passes through blood-
spinal artery. Occlusion of anterior spinal artery may brain barrier in small amount. It is matter of
produce following clinical manifestations. great advantage that this drug does not cross the
1. Bilateral loss of motor function which usually barrier in large concentration which is very toxic
affects lower limbs (paraplegia) is due to lesion to nervous tissue.
corticospinal tracts of both side. 4. Some drugs are not able to pass through the
2. Bilateral loss of pain and temperature sensations blood-brain barrier, like dopamine, deficiency of
due to lesion of lateral spinothalamic tract in which is the cause of disease, parkinsonism. But
lateral white column. This deficit is below the L-dopa, the precursor of domamine readily passes
level lesion. through the barrier. Administration of L-dopa in
3. Weakness of muscles and loss of tendon jerks of Parkinsonism gives good result.
244
Reticular Formation
16
Reticular formation is defined as diffuse, ill-defined 1. Above: It extends into subthalamus, hypothalamus
and scattered collections of neurons in central nervous and thalamus of diencephalon. Further, it has
system which are intermingled with the network also been proved that some areas of cerebrum and
(reticulum) of nerve fibers. cerebellum are also closely related to brainstem
n Situation: Main part of reticular formation is reticular formation.
present althrough the central core (tegmentum) of 2. Below: It extends into the spinal cord, specially
brainstem (Fig. 16.1). the cervical segments. Here reticular formation is
Topographically this component of central nervous represented by network (reticulum) of nerve cells
system is present in the areas of brainstem which are and fibers on the lateral aspect of neck of dorsal
not occupied by named and defined nuclei and fiber- gray horn.
bundles. n Phylogenetic importance: Reticular formation
Extension of Brainstem Reticular Formation is the very significant part of central nervous system
Midbrain
Brainstem
reticular Pons
formation Cerebellum
Fig. 16.1 Brainstem reticular formation extends throughout central tegmental core
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
in lower vertebrates. There it possesses the vital neurotransmitter. Raphe nuclei is also known as
centers like respiratory and cardiac, which actively median column nuclei.
controls respiration, heart rate and blood pressure. 2. Medial column nuclei: From midline this column
n Principle of function: is intermediate in position throughout tegmental
1. It maintains the state or level of consciousness, core of brainstem. Neurons of this column are large
alertness or awakefulness of an individual. sized, hence this is called Magnocellular column.
2. It also helps in arousal from sleep. 3. Lateral column nuclei: Out of three columns,
3. It contains respiratory and cardiac centers cells of this column are smallest in size. The word
through which it regulates respiration, heart rate parvus means small. That is why this column is
and blood pressure. called Parvocellular column.
4. It regulates receptive capacity of sensory end n Further classification of nuclei (Fig. 16.3):
organs and also having effect on sensory centers, The above mentioned three columns of nuclei of brai-
regulates threshold of various sensations. nstem reticular formation are divided into many
5. It controls muscular activities through its influence nuclei. Memorization of all these nuclei by a reader
on cerebral cortex, cerebellum, basal nuclei, red at this stage is not encouraged. The nuclei which are
nucleus, substantia nigra. functionally important and clinically more significant
6. It regulates visceral, endocrine and emotional acti- are only discussed below.
vities through its connection with hypothalamus
and limbic system. Median column nuclei (raphe nuclei) (Fig. 16.3)
n Architectural variation: Reticular formation is
As already mentioned, nuclei of this column are made
not only divided in various nuclear groups, but also
up of medium sized neurons. These neurons produce
shows following variations of neurons.
a neurotransmitter serotonin.
i. Cell bodies show variations in size, e.g. large,
The nuclei are
medium and small.
ii. Variations in length of axons.
1. Dorsal raphe nucleus
iii. Variations in ramification of dendrites.
This is present in midbrain. Axonal fibers from this
Classifications of Brainstem Reticular Nuclei nucleus descend as reticulospinal tract to spinal cord
n Primary classification (Fig. 16.2): Primarily, and relay on sensory neurons of apex of posterior
nuclei of brainstem reticular formation are divided horn (Fig. 16.4) which carry pain sensation from
into three groups, from midline to lateral, they are peripheral sensory nerves via lateral spinothalamic
named as tract. Transmission of pain sensation is inhibited as
1. Raphe nuclei: These are present in the midline the posterior horn sensory neurons are influenced by
of central core of brainstem. The cell bodies of inhibitory effect of serotonin (neurotransmitter) rele-
neurons are intermediate in size. Neurons of ased by neurons of dorsal raphe nucleus of midbrain
these nuclei liberate serotonin which acts as reticular formation.
Periaqueductal nucleus
Cuneiform nucleus
Subcuneiform nucleus Medial column
nuclei
Oral pontine nucleus
Gigantocellular nucleus
(pontine part) Medial column
nuclei
Ventral ret. nucleus
Gigantocellular nucleus
(medullary part)
Fig. 16.3 Important nuclei of brainstem reticular formation; Median column=Red, Medial column= Blue and lateral column= Green
2. Pontine raphe nucleus carrying fibers of trigeminal nerve from the same
This midline nucleus is situated in dorsal part of teg- half of face. Axons of this nucleus, after decussation,
mentum of pons and is in the same line with dorsal carry pain sensation upwards to thalamus through
raphe nucleus of midbrain. trigeminal lemniscus. Axons of raphe nucleus magnus
relay in the neurons of spinal nucleus (nucleus of
3. Raphe nucleus magnus spinal tract) of trigeminal nerve and through libe-
This nucleus is longer and situated in the medulla ration of serotonin (neurotransmitter) produce inhi-
oblongata. Nucleus of spinal tract of trigeminal nerve bitory influence on pain pathway from half of the face
present in medulla oblongata receives pain sensation (Fig. 16.5).
Reticulospinal tract
Fig. 16.4 Dorsal raphe nucleus exerts inhibitory effect, through release of serotonin, on pain fibers forming lateral spinothalamic tract
247
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Trigeminal nerve
Pons
Spinal tract
and
Spinal nucleus of trigeminal nerve
Lower half of medulla oblongata
Fig. 16.5 Magnus raphe nucleus in medulla oblongata exerts inhibitory effect on spinal nucleus of trigeminal nerve from where pain
sensation is carried through trigeminal lemniscus from ipsilateral half of face
Higher centers
Ascending efferent
Descending efferent
Lower centers
Connections of Reticular Formation Above mentioned two groups of functions are perf-
ormed by two components of reticular formations
To develop clear concept about connections of reticular
formation, it is important as well as interesting to which are respectively as follows
subdivide the functions of reticular formation into 1. Ascending reticular activating system
following two groups. (ascending reticular system): This part of
1. Reticular formation maintains the level of alert- reticular formation is principally lateral column
ness or consciousness of an individual. reticular nuclei. It receives inputs either directly
2. Reticular formation controls or regulates or through collaterals from various sensory path-
a) Autonomic functions like respiration, heart ways. It gives outputs to thalamus and from
rate, blood pressure and also some other visc- where finally to different areas of cerebral cortex.
eral functions. This circuit is for maintenance of alertness or
b) Muscular activities through its influence on consciousness.
lower motor neuron, itself being influenced by 2. Descending reticular system: It is influenced
cerebral cortex, cerebellum, basal nuclei, subs-
by cerebral cortex, cerebellum, basal ganglia,
tantia nigra, red nucleus.
substantia nigra, red nucleus. It projects to auto-
c) Receptive capacity of sensory pathways thro-
ugh its projection on sensory neurons (tracts) nomic centers of brainstem and spinal cord, motor
of central nervous system. and sensory neurons of spinal cord, some cranial
d) Endocrine and emotional activities through nerve nuclei, hypothalamus and limbic system.
its connections with hypothalamus and limbic It will be now easy to understand the connections
system. of two systems of reticular formation.
249
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
{
All areas of
cerebral cortex
Efferents
Intralaminar and
reticular nuclei of
thalamus
{
Ascending
reticular activating
system
Afferents
{
Cerebral cortex
Basal ganglia
Afferents Cerebellum
Substantia nigra
Red nucleus
{
Descending reticular system
252
Limbic System
17
The word limbic means border or margin. The term 1. Alveus
limbic system is used to include a group of structures 2. Fimbria
which lie in a ring-shaped manner in the demarcating 3. Fornix
zone between cerebral cortex and thalamus. 4. Mammillothalamic tract
But recent studies showed that limbic system also 5. Stria terminalis.
includes some other structures beyond demarcating
zone which are concerned with following function HIPPOCAMPAL FORMATION (FIG. 17.1)
l Emotion
l Behavior Hippocampal formation is a composite structure
l Drive which is composed of
l Memory. 1. Hippocampus
2. Dentate gyrus
Anatomical Components of Limbic System 3. Parahippocampal gyrus.
So, at the beginning, it should be very clear to the
A. Gray matter: readers that hippocampal formation, hippocampus
1. Superficial cortical structures: and parahippocampal gyrus are three different
l Hippocampal formation terminologies.
l A ring of cortical areas which is called limbic Hippocampus and parahippocampal gyrus are two
lobe. It includes components of hippocampal formation.
Cingulate gyrus, isthmus, parahippocampal gyrus Another important point is also to be noted care-
terminating anteriorly as uncus. fully. Parahippocampal gyrus is exposed area of limbic
2. Subcortical structures: These are present in the cortex which is visible on medial surface of cerebral
form of some nuclei as follow hemisphere. But hippocampus and dentate gyrus are
l Amygdaloid nuclear complex (also known as the hidden parts which form floor of inferior horn of
amygdaloid body) lateral ventricle.
l Septal area (septal nuclei)
l Part of hypothalamus namely mammillary Hippocampus
bodies Hippocampus is a smooth, curved, elongated elevation
l Anterior nucleus of thalamus of gray matter which is lying along the floor of inferior
l Olfactory areas are also included. horn of lateral ventricle and it is only clearly observed
B. White matter: Some important named band of when cavity of inferior horn of lateral ventricle is
white matter needs special mention. These are dissected out (Fig. 17.2).
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Stria terminalis
Choroid fissure
Tail of caudate nucleus
Collateral eminence
Alveus
Hippocampus
Fimbria
Dentate gyrus
Hippocampal
fissure
Parahippocampal
gyrus
Collateral sulcus
Anterior expanded end presents a few shallow Alveus is formed by the fibers which converge
cleft giving the appearance of animals foot. That is medially after originating from the nerve cells of
why it is called pes hippocampus. Hippocampus itself hippocampus. All the fibers of alveus turns further
is so named because in coronal section, it looks like posteromedially to form a bundle called fimbria (Fig.
a sea-horse. Convex ventricular surface lined with 17.3).
ependyma, when viewed on coronal section, presents The fimbria runs posteriorly to become continuous
in subependymal plane a thin layer of white matter with posterior column of fornix (Fig. 17.3). So, it is
called alveus. clear that axonal processes of neurons of hippocampus
Uncus
Pes hippocampus
Parahippocampal gyrus
Hippocampus
Floor of inferior horn of
lateral ventricle
Anterior column of
fornix
Pes hippocampus
Hippocampus
Fimbria
Posterior column of
fornix
Fig. 17.3 Alveus arising from hippocampus continued as fimbria and finally as posterior column of fornix
255
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
1. Superficial molecular layer: It is made up of
scattered nerve cells and nerve fibers. The neurons
are smaller in size.
2. Intermediate pyramidal layer: It is made up of
many large sized pyramidal cells.
3. Inner polymorphic layer: It is structurally sim-
ilar to the polymorphic layer of neocortex.
Dentate gyrus is also three layered. But it differs
from structure of hippocampus by the fact that, inter- Anterior
mediate layer is made up of granule cells instead commissure
of pyramidal cells. Neurons of the granular layer of
dentate gyrus are small in size and round or oval in
shape. Their axons terminate in neurons of pyramidal Posterior
column of fornix
cell layer of hippocampus. Some of the fibers of Septal nuclei
granular layer may be directly continued as fibers of
Hippocampus
fimbria.
Subiculum is the site of transition between six Fig. 17.4B Afferent from septal nuclei
layered cortex of parahippocampal gyrus to three
layered cortex of dentate gyrus and hippocampus. 1. From cingulate gyrus: Afferent fibers from
cingulate gyrus curve round downwards and back-
Fibrous Component of Hippocampal Formation ward, and finally forward to reach hippocampus (Fig.
17.4A).
Afferent fibers from various sources reach hippo- 2. From septal nuclei: These are nuclei lying in the
campus which are discussed below. But fibers which midline close to anterior commissure. Fibers pass via
leave as axons of neurons of hippocampus curved on fornix to reach hippocampus (Fig. 17.4B).
the subependymal surface of hippocampus to form 3. Fibers from opposite hippocampus: Fibers
alveus which converge and continues backwards from one hippocampus reach another hippocampus.
as shining band known as fimbria. The fimbria These fibers pass through posterior column of fornix
is continued backward towards posterior end of backwards. Reaching the junction between posterior
thalamus as posterior column of fornix (Fig. 17.3). column and body, instead of continuing forwards
to the body, the fibers cross the midline through
Connections of Hippocampal Formation posterior column of fornix of opposite side to reach
contralateral hippocampus. These fibers are called
Afferent connections
It is the hippocampus which receive afferent conn- Hippocampus
ections from following sources.
Cingulate gyrus
Hippocampal
commissure
Fig. 17.4A Afferents from cingulate gyrus Fig. 17.4C Afferents from opposite hippocampus
256
Limbic System
Indusium griseum Olfactory bulb
Olfactory area
(entorhinal area)
Hippocampus
Hippocampus
Fig. 17.4D Afferents from indusium griseum Fig. 17.4E Afferents from olfactory associated cortex
commissure of fornix or hippocampal commissure efferent fibers first lies in subependymal plane as
(Fig. 17.4C). alveus. The fibers of alveus converge to form a white
4. Fibers from indusium griseum: These fibers band known as fimbria. Fimbria continues posteriorly
form lateral and medial longitudinal striae. Hipp- as posterior column of fornix. Posterior column from
ocampus receive these fibers as axonal process of
both sides curve upwards and forwards around
neurons of indusium griseum which is considered as
posterior end of thalamus and join together to form
vestigial part of limbic cortex (Fig. 17.4D).
5. Fibers from olfactory associated cortex: body of fornix. Body of fornix divides into two anterior
These afferent fibers are received by hippocampus columns which pass downwards and forwards in
from anterior part of parahippocampal gyrus which is front of interventricular foramen of Monro. Next at
also called entorhinal area (Fig. 17.4E). the level of anterior commissure it divides into two
6. Fibers from dentate gyrus and parahipp- limbs called postcommissural and precommissural
ocampal: Gyrus pass to the adjacent hippocampus roots running posterior and anterior to anterior
(Fig. 17.4F). commissure respectively. Fibers of these two roots
end as efferent fibers of hippocampus in following
Efferent connections
destinations (Fig. 17.5).
Efferent connections from hippocampus are axons 1. Postcommissural roots:
of pyramidal cells lying in intermediate layer. The a) To anterior nucleus of thalamus
Dentate gyrus
Hippocampus
Parahippocampal gyrus
Precommissural fibers
Posterior column
of fornix
Septal nuclei
Hypothalamic nuclei
Anterior commissure
Postcommissural fibers
Hippocampus
b) To nucleus of mammillary body this small mass of gray matter is situated at the depth
c) To tegmentum of midbrain. of temporal lobe. It is connected to anterior end of tail
Efferent from mammillary body further proceeds of caudate nucleus on anterior end of roof of inferior
to anterior thalamic nuclei via mammillothalamic horn of lateral ventricle.
tract.
2. Precommissural roots: Connections (Fig. 17.6)
a) To septal nuclei n Afferent: Afferent connections are mostly from
b) Lateral preoptic nucleus primary olfactory area.
c) Anterior part of hypothalamus. n Efferent: Efferent fibers come out of amygdaloid
body in the form of stria terminalis. Stria terminalis is
Functions of Hippocampus a curved band of fibers which follow the similar curve
of caudate nucleus, being adjacent to it, but follow its
Hippocampus is the prime central component of lim- tail end and pass along the direction of tail, body and
bic system. finally head. Obviously it curves round thalamus and
But through the outlet of hypothalamus, hippo- along the walls of lateral ventricle until it reaches
campus acts as a center for integration for autonomic anteriorly to the level of anterior commissure. The
(visceral), endocrine and emotional activities of an fibers finally reach following destinations (Fig. 17.6).
individual. 1. Septal area
Hippocampus plays an important role for recent 2. Amygdaloid nucleus of opposite side via anterior
memory. commissure
Earlier it was regarded as part of olfactory system, 3. Anterior portion of hypothalamus
but it does not possess direct relationship with this 4. Fibers from posterior end of stria terminalis pass
function. to Habenular nucleus.
Habenular nucleus
Stria terminalis
Amygdaloid body
Olfactory bulb
Olfactory tract Prepyriform area
3. Amygdaloid body possesses an inhibitory effect on Hippocampus functions for collection and recapit-
sexual activity. ulation of recent memory.
Amygdaloid body exerts inhibitory effect on sexual
CLINICAL ANATOMY activity.
Anatomical connections of limbic system are truly n Schizophrenia: It is a psychotic condition chara-
extremely complex. Their significance are also not cterized by disordered thinking, hallucinations, blu-
clearly understood as on date. So, a reader must not nted affect and withdrawal of emotional activity.
go for too much taxation of brain. These are the manifestations because of hyperactivity
Limbic system, through the outlet of hypothala- of limbic system receptors to dopamine. That is why
mus, mainly acts as a center for integration of visceral for management of this disease, limbic receptors are
(autonomic), endocrine and emotional activities. For blocked for dopamine by using some phenothiazine
example, some visceral activities appear in reference group of drugs. But these pharmacological agents
to change in emotional status of an individual. may lead to extrapyramidal system disorders, for
Limbic system controls excitability, rage, anger, which drugs controlling extrapyramidal disorders are
fear of an individual. very often coprescribed.
259
Autonomic Nervous System
18
A COMPONENT PARALLEL TO SOMATIC NERV- AUTONOMIC NERVOUS SYSTEM AND
OUS SYSTEM ENDOCRINE SYSTEM JOINTLY MAINTAIN
INTERNAL ENVIRONMENT OF BODY
Nervous system is functionally divided into following
two components Both these systems jointly maintain together nor-
1. Somatic nervous system mal internal environment of body (homeostasis).
2. Autonomic nervous system. Autonomic nervous system regulates activities of
n Somatic nervous system is the part of nervous different organs and tissues through its action on
system that controls voluntary functions of body. It cardiac muscle, smooth muscles and exocrine gland.
means that, functions which are controlled or governed Endocrine system through its hormones circulated
as per ones own desire. It may be movements of joint in bloodstream controls functions of different organs
or voluntary movements of any organ, like movements and tissue of body. But the difference is with the fact
of eyeball or tongue, which are results of contraction
that, when autonomic nervous system exerts fine and
of voluntary muscles.
fast action, endocrine system produces slower and
n Autonomic nervous system is the component
of nervous system which controls or regulates invol- more diffuse action.
untary functions of body, i.e. those which cannot
be governed as per ones own desire. Units of these COMPOSITION OF AUTONOMIC NERVOUS
functions are fundamentally following two. SYSTEM (FIG. 18.1)
1. Increase rate and force of contraction of
Same as somatic nervous system, autonomic nervous
involuntary muscles (smooth as well as car-
diac muscles): Which results in, e.g. system is made up of following components.
a) Contraction (systole) and relaxation (diastole) 1. Receptors: These are baroreceptors, chemorec-
of cardiac muscles resulting in increase of rate eptors, osmoreceptors present in the wall of visc-
of heartbeat. era. Stretch and pain receptors are also present.
b) Contraction of smooth muscles of viscera, blood Pain receptors present in the wall of viscera are
vesicles, skin (Arrectores pili). stimulated in its ischemic change causing lack of
2. Secretion of exocrine glands: Which may be, oxygen.
larger and solitary (salivary glands, lacrimal 2. Afferent pathway: This are peripheral sensory
gland) or minute and multiple like mucous glands fibers whose cell bodies are situated outside central
of alimentary and respiratory tracts, sweat glands nervous system forming peripheral sensory nerve
of skin. root ganglia.
Autonomic Nervous System
Central nervous system
1 3
2
Fig. 18.2 Advantage of autonomic ganglia. A. One somatic neuron ends in one voluntary muscle fiber, B. Autonomic efferent neurons
1. One preganglionic neurons from synapses with, 2. Multiple postganglionic neurons to supply, 3. Many effector organs (involuntary
muscle fibers)
example, arrectores pili muscles and sweat glands system differ from each other as per following
of skin are controlled by sympathetic whereas criteria
secretomotor fibers of parasympathetic supplies 1. Structural Anatomical
exocrine glands, e.g. salivary glands or mucous 2. Functional i) Physiological
glands. Again, there are some organs where both the ii) Pharmacological.
system produce physiologically antagonistic effects.
Force of contraction of heart muscles is increased by Structural (anatomical) differences
sympathetic, diminished by parasympathetic. But 1. Center: Center for sympathetic system is formed
circular muscle fibers of tracheobronchial tree are by antonomic neurons present in intermediolateral
stimulated by parasympathetic causing broncho- cell column of spinal cord extending from T1 to L2
constriction, whereas sympathetic causes relaxation segments.
(bronchodilatation) of tracheobronchial musculature. Center for parasympathetic system is located
However, it is the balance between the activities of partly in brainstem and partly in spinal cord. In
two components of autonomic nervous system which brainstem the center is present in the form of general
maintain the stability of internal environment of visceral efferent nuclei of following cranial nerves.
body, as both operate in conjunction with each other. l 3rd EdingerWestphal nucleus in upper
half of midbrain.
Sympathetic and Parasympathetic How One l 7th Superior salivatory nucleus in lower
Differs from the Other? half of pons.
l 9th Inferior salivatory nucleus in upper
For maintenance of internal environment (home- half of medulla oblongata.
ostasis), though one reciprocates other, sympathetic l 10th Dorsal nucleus of vagus in lower half
and parasympathetic parts of autonomic nervous of medulla oblongata.
262
Autonomic Nervous System
1 2
In spinal cord, parasympathetic center is present organ, in the wall of viscera. So postganglionic fibers
in the intermediate area of 2nd, 3rd and 4th sacral are shorter to produce more localized action.
segments of spinal cord.
2. Supraspinal control: Parasympathetic and Physiological difference
sympathetic centers, as mentioned above, are
Both sympathetic and parasympathetic systems work
controlled by nuclei posterior and anterior halves
in subconscious level, but they come into action in
of hypothalamus respectively by hypothalamo-
different environment.
spinal tract.
3. Autonomic ganglia (Figs 18.3A and B): Auto- Sympathetic system gets activated during emer-
nomic ganglia of both the systems are situated gency, stress or anger. This can be explained with
outside the central nervous system and formed a classical example. A man walks around a park in
by synaptic connection between 1st and 2nd order a pleasant afternoon. Suddenly, he is chased by a
of efferent neuron along with the cell bodies of rabied street dog. The man runs away very fast to
postsynaptic neurons. save himself from the attack of the dog when his
Sympathetic ganglia interconnected by vertically sympathetic system becomes more active with the
oriented chain of fibers called sympathetic chain following changes in body.
(sympathetic trunk) are situated close to central 1. Heartbeat increases.
nervous system (spinal cord) being paravertebral in 2. Pulse rate becomes rapid with rise of blood
position. The sympathetic chain is formed because pressure.
fibers from each ganglia ascend or descend for one or 3. Pupils get dilated.
two segments up and down before proceeding toward 4. Vasodilatation of skeletal muscles due to muscular
destination. As sympathetic ganglia are close to exercise.
central neuraxis, postganglionic fibers are longer to 5. Extremities become cold due to peripheral vasoc-
produce more generalized activities on effector organ. onstriction.
Parasympathetic ganglia are very close to the target 6. Sweating due to hypersecretion of sweat glands.
1 2
Adrenal
medulla_
Adrenaline_
Acetylcholine_
Capillary
Peripheral
Viscera Cardiac muscle Cardiac muscle Blood vessels
Smooth muscle Blood vessels of Smooth muscle Sweat glands
Exocrine gland skeletal muscle of sphincters Arrector muscle
Heart and brain
cord extending from T1L2 (may be L3) segments. 3. Effector organs: Effector organs which receive
These cells are called connector neurons. axon terminal of effector neuron, are
2. Effector neuron: These neurons are situated i. Cardiac muscle fibers.
outside central nervous system (spinal cord) ii. Smooth muscle fiber of a) Different viscera,
which receive synaptic connection from axons
b) Wall of blood vessels, and c) Root of hair
of connector neuron. The synaptic connection
with cell bodies of effector neurons from knob- follicles Arrectores pili.
like structures, paravertebral in position, called iii. Sweat glands.
sympathetic ganglia, situated in vertical row. The 4. Supraspinal center: Nuclei of posterior half
ganglia are connected by chain of nerve fibers of hypothalamus which influence spinal center
called sympathetic trunk (sympathetic chain). through hypothalamospinal tract.
265
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Epidermis of skin Connector neuron of sympathetic system
Spinal nerve
Sympathetic ganglion
Sympathetic trunk
Postganglionic sympathetic
fibers accompanying blood
vessel to reach target organ
Sympathetic effector neurons
in ganglia (and plexus)
related to blood vessels
along with network of nerves form autonomic plexus l Smooth muscles of the wall of viscera including
from where postganglionic sympathetic nerves follow heart.
the branch arteries to reach wall of viscera. l Smooth muscles of wall of visceral blood vessels.
At this stage, it is important to note that, some of These medial branches are known as splanchnic
the medial branches of sympathetic ganglia come out branches (Fig. 18.6).
as postganglionic fibers to reach the target organ. 3. Some of the preganglionic fibers, after reaching the
corresponding sympathetic ganglia, may not come
Types of Outflow from Sympathetic Ganglia out either as lateral branches or medial branches.
These fibers, either ascend or descend, to reach
1. Sympathetic ganglia numbered from 1st thoracic one or two ganglia above or below, where they
(T1) to 2nd lumbar (L2), may be L3, are connected relay to pass as postganglionic branches of that
to the corresponding spinal nerve with the help ganglia (Fig. 18.7). These fibers of sympathetic
of white rami (preganglionic) and gray rami ganglia, ascending or descending for one or two
(postganglionic). It is not difficult to understand ganglia level up or down, explain the formation of
that as white rami enter the ganglia, they are sympathetic chain or sympathetic trunk.
considered as roots of sympathetic ganglia. Wher- n Outflow above T1 and below L2 ganglia: As the
eas, gray rami, as come out of the ganglia are center for sympathetic system extends from T1 to L2
known as branches of ganglia. As discussed earlier, segments of spinal cord, outflow from T1 to L2 ganglia
these are lateral branches of sympathetic ganglia, corresponds to the sympathetic connector neurons of
respective segments of spinal cord.
which are distributed through spinal nerve to,
4. Above T1 segment, there are 8 cervical segments of
l Sweat glands
spinal cord which give out 8 pair of cervical spinal
l Arrectores pili muscles of skin
nerve. These segments do not possess intermedio-
l Smooth muscles of wall of blood vessels (Fig. lateral gray column, so also sympathetic centers.
18.5). But 8 cervical sympathetic ganglia are represented
2. It has already been clarified that, medial branches as 3, namely superior, middle and inferior, which
of sympathetic ganglia are preganglionic. They correspond to upper four (C1 to C4), middle two (C5,
reach to the centrally situated, more proximal C6) and lower two (C7, C8) ganglia respectively.
arteries of body, where they form autonomic These cervical sympathetic ganglia receive prega-
ganglia named as per the name of the arteries. nglionic fibers from intermediolateral cell group of
Postganglionic fibers are distributed to, T1 segment. Postganglionic fibers are distributed
267
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Fig. 18.7 Preganglionic sympathetic fibers from one segment may ascend or descend for one or two segments up or down to relay in
higher or lower sympathetic ganglia
Note: This explains formation of sympathetic chain or sympathetic trunk
C1
Medial (splanchnic) branches from
superior cervical ganglion
C2
C3
C4
C5
Fig. 18.8 Many of preganglionic fibers from T1 segment of spinal cord ascend to relay in all the three cervical sympathetic ganglia.
Postganglionic fibers leave ganglia as
l Lateral branches (gray rami) to join spinal nerves and l Medial (splanchnic) branches to viscera and their blood vessels.
Note: Cervical spinal nerves are connected to sympathetic ganglia only by gray ramia communicantis
268
Autonomic Nervous System
as lateral and medial branches as follows (Fig. Detailed Efferent Outflow from Sympathetic
18.8). Trunk
l Lateral branches from
Distribution of branches from whole sympathetic
1. Superior cervical ganglion: As gray rami to trunk needs to be studied in following three comp-
upper four, i.e. C1C4 nerves. onents.
2. Middle cervical ganglion: As gray rami to C5 l Branches from thoracic sympathetic ganglia.
and C6 nerve. l Branches from cervical sympathetic ganglia.
3. Inferior cervical ganglion: As gray rami to C7 l Branches from lumbosacral sympathetic ganglia.
and C8 nerves.
Branches from Thoracic Sympathetic Ganglia
l Medial branches from all the three ganglia are
postganglionic to pass to the viscera of neck Thoracic part of sympathetic chain is continuous
and thorax. above with its cervical part and below with its lumbo-
5. Below L2 segment, there is no sympathetic center. sacral part.
l The thoracic part of sympathetic chain descends
But there are still sympathetic ganglia corre-
vertically one on each side of thoracic part of
sponding to lower lumbar (L3L5) sacral (S1S5) vertebral column.
and one coccygeal nerve. These ganglia receive l At its upper end it crosses the neck of 1st rib, and
preganglionic fiber from connector neurons of then crosses in front of head of the successive ribs.
lower thoracic (T11 and T12) and upper lumbar At its lower end it crosses over anterolateral aspect
(L1 and L2) sympathetic centers of spinal cord. of bodies of 11th and 12th thoracic vertebrae.
Postganglionic fibers pass from each of these l The thoracic part of the trunk contains 12 ganglia
ganglion to come out as following branches, (Fig. numbered as 1st (T1)12th (T12) thoracic ganglia.
l Sometimes, they may be 11 in number, when 1st
18.9).
ganglion fuses with inferior cervical ganglion to
n Lateral branches: As gray rami to corresponding
form cervicothoracic ganglion. It is called stellate
spinal nerve. ganglion, as its radiating branches give it a star-
n Medial branches: These branches are mostly shaped appearance.
postganglionic and called splanchnic branches. They
form different autonomic plexus in lower part of Branches (Fig. 18.10)
posterior abdominal wall and posterior wall of pelvis. n Lateral: Conventionally, lateral branches of all
Branches from autonomic plexus supply smooth the 12 thoracic ganglia are gray rami which join the
muscles of viscera and wall of blood vessels. respective thoracic spinal nerve. These branches
T11 to L2 segments
Spinal nerve
L2 ganglion
Fig. 18.9 Branches of sympathetic trunk below L1/L2 segments of spinal cord
269
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
1 1
2 2
3 3
4 4
5 5
6 6
7
7
8 8
9 9
10 10
11 11
12 12
C B A A B C
are distributed segmentally through corresponding Medial branches from T1T5 ganglia
spinal nerve to sweat glands and arrectores pili It is important to note at this stage that, these are
muscles of skin and, to peripheral blood vessels for postganglionic fibers. So these are axons of excitor
vasoconstriction effect. neurons situated in these sympathetic ganglia which
n Medial: It is already understood that medial from synaptic connection with processes of connector
branches are splanchnic branches. It is important to neurons.
note at this stage that, medial splanchnic branches Before reaching the target organs these
of 12 pair of thoracic ganglia have the duty to supply branches of sympathetic ganglia form plexuses with
branches not only to thoracic viscera, but also to parasympathetic fibers of vagus (10th cranial) nerve
upper abdominal viscera. close to the viscera. The plexuses are following
1. Cardiac plexus: It is divided into superficial
That is why medial branches of thoracic sym-
and deep cardiac plexuses. Sympathetic fibers for
pathetic ganglia are classified into following two cardiac plexus are not only derived from medial
groups. branches of T1T5 ganglia, but also from medial
1. Medial branches from T1T5 ganglia to thoracic branches of 3 cervical sympathetic ganglia. Fibers
viscera. for cardiac plexus is also derived from vagus nerve.
2. Medial branches from T5T12 ganglia to upper Thoracic sympathetic fibers join deep cardiac
abdominal viscera. plexus.
270
Autonomic Nervous System
2. Pulmonary plexus: Sympathetic fibers for Celiac ganglia of both sides are connected by net-
pulmonary plexus are derived from T2T5 ganglia. work of nerve fibers which form celiac plexus.
The plexus formed with parasympathetic fibers 2. Aorticorenal ganglia: It is also bilaterally sym-
from vagus nerve is related to root of lung. For the metrical, situated near origin of renal artery.
whole tracheobronchial tree with parenchyma of Postganglionic fibers run along branches of renal
lung sympathetic fibers cause bronchodilatation, artery.
vasoconstriction and decreased secretion of mu- Network of nerves around these ganglia forms
cous glands. Parasympathetic fibers cause bro- aorticorenal plexus.
nchoconstriction, vasodilatation and increased 3. Some fibers of greater splanchnic nerve pass
secretion of mucous glands. along the direction of suprarenal arteries to reach
3. Esophageal plexus: Sympathetic fibers arising cells of suprarenal medulla with which they
from T1T4 ganglia possess minor role in formation form synaptic connection. This is because, cells of
of esophageal plexus. These fibers are vasomotor suprarenal medulla are considered as modified
in nature. Parasympathetic fibers from vagus form of postganglionic sympathetic neurons.
are motor, secretomotor and sensory in function. Lesser splanchnic nerve:
Thoracic sympathetic fibers supply lower half of n Formation: It is formed by union of medial
esophagus. branches of T10 and T11 ganglia.
4. Aortic plexus: It is formed by medial branches n Entry to abdomen: From posterior thoracic wall,
of T1T5 sympathetic ganglia. Nerve fibers from like greater splanchnic nerve, it enters posterior
the plexus run along the wall of arteries which are abdominal wall by piercing crus of diaphragm of resp-
vasodilator in nature. ective side.
n Distribution: Preganglionic fibers coming from
Medial branches from T5T12 ganglia (Fig. 18.10) connector neurons of sympathetic center of T10 and
T11 segments of spinal cord, come out from medial
Following three fundamental points are to be noted in side of two corresponding ganglia. These fibers relay
connection with these branches. in celiac ganglia. Postganglionic fibers from celiac
1. These are preganglionic fibers coming out from ganglia are carried to the target organs along the
medial side of sympathetic ganglia. They relay in course of branches of celiac trunk.
ganglia which are in relation to the arteries close Least (Lowest) splanchnic nerve:
to midline of body. n Formation: It is formed by preganglionic medial
2. These branches leave posterior thoracic wall
branches of T12 ganglia. Sometimes, it may be absent.
to reach posterior abdominal wall from where
n Entry to abdomen: From posterior thoracic
postganglionic fibers are distributed to the upper
wall, it enters posterior abdominal wall passing deep
abdominal viscera and the blood vessels along
to medial arcuate ligament along with sympathetic
which they are carried to viscera.
trunk.
3. Nerves formed by medial branches from T5T12
n Distribution: Preganglionic fibers of least
ganglia are following
splanchnic nerve relay in aorticorenal ganglia.
l Greater splanchnic nerve: T5 T9 ganglia
Postganglionic fibers arising from the ganglia follow
l Lesser splanchnic nerve: T10 and T11 ganglia
the course of branches of renal artery to produce
l Least (Lowest) splanchnic nerve: T12 ganglia
vasomotor effect.
These three nerves are commonly termed as
thoracic splanchnic nerve.
Greater splanchnic nerve (Fig. 18.11): Cervical Part of Sympathetic Trunk
n Formation: It is formed by union of medial Cervical part of sympathetic trunks are situated on
branches of T5T9 sympathetic ganglia. either side of cervical part of vertebral column, behind
n Entry into abdomen: By piercing crus of
the carolid sheath and in front of prevertebral layer
diaphragm of respective side. of cervical fascia. The trunk presents three cervical
n Distribution: Preganglionic fibers carried thro-
ganglia Superior, middle and inferior. At the upper
ugh greater splanchnic nerve terminate in following
end of trunk, superior ganglion is situated close to
three ways.
1. Celiac ganglia: It is bilateral and placed on either base of skull. Middle and inferior ganglia, close to
side of celiac trunk. Celiac ganglia receive fibers each other, are situated at the lower end of cervical
of greater splanchnic nerve. Postganglionic fibers part of chain, near root of neck.
from the ganglia are distributed to the viscera Connection of three cervical ganglia with eighth
along the direction of blood vessels arising from cervical spinal nerves through gray rami (lateral
celiac trunk. branch of ganglia) are as follows
271
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
T5 T5
T6 T6
T7
T7
T8 T8
T9
T9
Celiac trunk
1 1
Celiac plexus
3
Left suprarenal gland
Right suprarenal
gland 3
2
2
Renal artery
Fig. 18.11 Distributions of greater splanchnic nerve preganglionic fibers arise from T5T9 ganglia postganglionic neurons with their
synaptic connections are found in 1. Celiac ganglion 2. Aorticorenal ganglion and 3. Suprarenal medulla
l Superior cervical ganglia: Homologous to upper upwards, relay one after another to the three cervical
four ganglia is connected to C1C4 nerves. sympathetic ganglia, form each of the three ganglia,
l Middle cervical ganglia: Homologous to next two postganglionic fibers emerge in following two forms
ganglia is connected to C5 and C6 nerves. 1. Lateral: These are nothing but gray rami
l Inferior cervical ganglia: Homologous to last two
communicantis which join cervical spinal nerves.
ganglia is connected to C7 and C8 nerves.
2. Medial: Like lateral branches, medial branches
At the upper end, superior cervical ganglia is tied
by its branches which radiate in different direction. of cervical sympathetic ganglia are also postga-
It is large and elongated ganglion, may be as long as nglionic which are of following two kinds
2.5 cm in size. a) Vascular: Run along the walls of different
Inferior cervical part of sympathetic trunk is arteries of head and neck.
continuous with thoracic part in front of neck of 1st b) Splanchnic: To supply some viscera.
rib.
Superior cervical ganglion
Branches from cervical sympathetic ganglia
(Fig. 18.12) n Lateral branches: These are four gray rami
communicantes to join C1C4 nerves.
Cervical sympathetic ganglia receive preganglionic n Medial Branches:
fibers from T1T4 segments of spinal cord. The 1. Internal carotid nerve: It is a very prominent
fibers, while ascending from upper thoracic ganglia branch which arises from the upper end of fusiform
272
Autonomic Nervous System
Short ciliary nerve
Deep petrosal
Nerve of nerve Facial artery
pterygoid canal
Internal carotid nerve
Superior cervical
ganglion Pharyngeal branch
Cardiac branch
Vertebral nerve
Cardiac branches
Vertebral artery
Ansa subclavia
T1 T4 segments of
spinal cord
T1 ganglion
superior cervical ganglion. It catches internal b) Deep petrosal nerve: Arising from internal
carotid artery at the base of skull and possesses carotid plexus, this nerve, joining with greater
widespread distribution along its different bra- petrosal nerve (parasympathetic fibers from
nches. Network of nerves along the wall of artery facial nerve) forms nerve of pterygoid canal,
form internal carotid plexus. Some of the important which joins sphenopalatine ganglion.
distribution of this plexus are following c) Sympathetic fibers to communicate with
a) Nerves running along ophthalmic branches of ciliary ganglion: These fibers run initially
the artery supply dilator pupillae muscle. along ophthalmic branch of internal carotid
273
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
artery, then join with long ciliary nerve to 2. This system gets activated for conservation or
communicate with ciliary ganglion. restoration of energy, thereby keeps the body in
2. Branches along external carotid artery: restful condition.
These fibers from superior cervical ganglion run 3. Like sympathetic system, it is also made up of
along external carotid artery and its branches afferent as well as efferent components.
which are mainly vasomotor. Important branches 4. Afferent component of parasympathetic system
from external carotid plexus are following. carries mainly the physiological sensations from
a) Sympathetic branches along facial artery the receptors present in the wall of viscera. For
supply vasoconstrictor fibers and also fibers to example, sense of awareness of distension of urinary
the sweat glands of one half of face. bladder is carried through parasympathetic affe-
b) Sympathetic fibers communicating otic and rent pathway, whereas pathological pain from
submandibular ganglion. wall of urinary bladder is carried by sympathetic
3. Pharyngeal branch: It forms pharyngeal plexus
afferent pathway.
along with pharyngeal branches of glossophar-
5. Efferent pathway (parasympathetic outflow) of
yngeal and vagus nerve.
parasympathetic nervous system is composed of
4. Cardiac branch: Cardiac branch from left sup-
erior cervical ganglion form superficial cardiac following components.
plexus whereas right joins deep cardiac plexus. i. Centers: cranial (in brainstem) and spinal (in
spinal cord).
Middle cervical ganglion Cranial centers: These are nothing but general
visceral efferent nuclei of four cranial nerves
n Lateral branches: These are two rami comm- present in brainstem, 3rd (oculomotor), 7th
unicantes to join C5 and C6 nerves.
(facial), 9th (glossopharyngeal) and 10th
n Medial Branches:
(vagus) nerves.
1. Tracheal and esophageal branches: These
Spinal centers: These are neuronal group pre-
branches accompany the arteries supplying the
organ and are vasomotor in nature. sent in intermediomedial area of spinal cord
2. Thyroid branch: This branch runs along inferior gray matter of S2, S3 and S4 segments.
thyroid artery. Neurons of centers of parasympathetic system,
3. Cardiac branch: Cardiac branch of both middle like those of sympathetic are preganglionic
cervical ganglia takes part in formation of deep neurons or connector neurons.
cardiac plexus. ii. Preganglionic fibers: These are longer in com-
parison to those of sympathetic and pass in the
Inferior cervical ganglion form of visceral efferent fibers of 3rd, 7th, 9th
n Lateral branches: Two lateral branches from and 10th cranial nerves, and pelvic splanchnic
inferior cervical ganglion are gray rami comm- nerves formed by union of visceral efferent
unicantes to join C7 and C8 nerves. fibers carried through S2, S3 and S4 spinal
n Medial branches: nerve.
1. Ansa subclavia: This branch from inferior cervical iii. Autonomic ganglia: They are close to the target
ganglion forms a loop around subclavian artery to organ (viscera), so postganglionic fibers are
join middle cervical ganglion. Branches from the very short.
ansa form plexus around subclavian artery. 6. Gross manifestations of parasympathetic activity
2. Vertebral nerve: It is so called because it forms i. Eyeball: Constriction of pupil due to contrac-
plexus around vertebral artery. Along with 2nd tion of sphincter pupillae.
part of the artery nerve ascends through foramen l Increase in curvature of lens helping
transversarium of upper six (C1C6) cervical accommodation due to contraction of ciliary
vertebrae. muscle.
3. Cardiac branch: Cardiac branch from inferior ii. Cardiovascular channel:
ganglion of both sides join deep cardiac plexus. l Slowering of heart rate (bradycardia) with
diminished force of contraction.
PARASYMPATHETIC PART OF AUTONOMIC NERV- iii. Respiratory tract:
OUS SYSTEM l Constriction of smooth muscles of trach-
eobronchial tree and secretion of mucous
General Considerations glands.
1. Parasympathetic system is the smaller component iv. Gastrointestinal tract:
of autonomic nervous system in comparison to its l Increase of peristalsis and secretion of
sympathetic counterpart. mucous glands.
274
Autonomic Nervous System
v. Urinary tract: with somatic motor fibers to pass through red nucleus,
l Contraction of detrusor muscle. substantia nigra and crus cerebri.
Parasympathetic efferent pathways originate fun- Emerging out of midbrain through lateral wall of
damentally from the following sites sulcus in between two halves of cerebral peduncle,
1. Cranial: From 4 parasympathetic cranial nerve the fibers follow the course of main trunk of nerve, its
nuclei which are inferior division and finally branch to inferior oblique.
a) EdingerWestphal nucleus of oculomotor Finally from branch to inferior oblique it leaves to relay
nerve (III): Present in midbrain at the level of in a tiny ganglion. It is called ciliary ganglion which
superior colliculus. is situated near the apex of orbit in the space between
b) Superior salivatory nucleus of facial nerve optic nerve and lateral rectus muscle. Postganglionic
(VII): Present in lower half of pons. parasympathetic fibers emerge from ciliary ganglion
c) Inferior salivatory nucleus of glossopharyngeal in the form of 810 short branches which are called
nerve (IX): Present in upper part of medulla short ciliary nerves which finally divide into 1520
oblongata. divisions which pierce sclera around optic nerve and
d) Dorsal nucleus of vagus nerve (X): Present in pass over the surface of choroid to supply sphincter
lower part of medulla oblongata. pupillae and ciliary muscles.
2. Spinal: It is the intermediate area of gray matter
of S2, S3 and S4 segments of spinal cord which is Communications of ciliary ganglion (Fig. 18.14)
considered to be spinal center for parasympathetic
Communications are the nerve fibers which join the
system.
ciliary ganglion from its posterior side which are
known as roots of the ganglion as follows.
Efferent outflow from Edinger-Westphal nucleus
1. Parasympathetic root: As mentioned above,
(Fig. 18.13) this is made up of preganglionic parasympathetic
Edinger-Westphal nucleus is the parasympathetic fibers which emerge from Edinger-Westphal nuc-
efferent nucleus of oculomotor nerve. It is situated leus and pass through oculomotor nerve to relay in
closely apposed and ventrolateral to main (somatic ciliary ganglion (Fig. 18.14A).
motor) nucleus of the nerve in the periaqueductal gray 2. Sympathetic root: Fibers of this root originate
matter of midbrain at the level of superior colliculus. as postganglionic fibers from superior cervical
Axons of the cells of this nucleus, traverse the ganglion and enter cranial cavity through internal
tegmentum of midbrain from behind forwards along carotid plexus. Sympathetic fibers for the orbit
Oculomotor nerve
Preganglionic parasympathetic fiber (visceral
Ciliary ganglion efferent fiber)
Somatic efferent fiber
LPS
Sphincter IO
pupillae
IR MR
Ciliary muscle
Fig. 18.13 Parasympathetic efferent pathway from Edinger-Westphal nucleus of oculomotor nerve
275
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Ciliary ganglion
Ciliary ganglion
Ophthalmic artery
Sympathetic root
Internal carotid artery
Ciliary ganglion
Nasociliary nerve
Sensory root
C
Fig. 18.14 Communication roots of ciliary ganglion. A. Parasympathetic root, B. Sympathetic root, C. Sensory root
travel via ophthalmic artery. From this fibers, a supply dilator pupillae and wall of blood vessels
root joins the ciliary ganglion. As this sympathetic (Fig. 18.14B).
root of fibers is already postganglionic sympathetic 3. Sensory root: This is the branch from nasociliary
fibers, it traverses ciliary ganglion uninterrupted, nerve which joins posterior end of ciliary ganglion.
finally to pass through short ciliary nerve to While traversing the ganglion without relay it
276
Autonomic Nervous System
divides into multiple branches which pass through 3. Sensory: To sclera, cornea and uveal tract.
short ciliary nerves for sensory innervations of
eyeball (Fig. 18.14C). Efferent outflow from superior salivatory nucleus
Superior salivatory nucleus is the parasympathetic or
Branches of ciliary ganglion
general visceral efferent nucleus of facial (VII) nerve
These are nothing but bunch of short ciliary nerves which is situated in lower half of pons. Preganglionic
which contain parasympathetic, sympathetic and efferent outflow from the nucleus comes out in the
sensory fibers for following distribution. form of two branches of facial nerve which relay
1. Parasympathetic: To sphincteral pupillae and respectively in two different ganglia from where
ciliary muscle. postganglionic fibers are distributed to two different
2. Sympathetic: To dilator pupillae and blood ves- groups of target organs which are summarized as
sels of eyeball. follows.
Branch of facial nerve
carrying preganglionic Ganglion where preganglionic Target organs
parasympathetic fibers fibers relay
Nucleus of abducent
Lacrimal nerve carrying postganglionic nerve
secretomotor fibers
Zygomatic nerve
Section of pons
Maxillary nerve
Superior salivatory nucleus of
Sphenopalatine ganglion facial nerve
Nasal branch
Fig. 18.15 Parasympathetic efferent pathway from superior salivatory nucleus of facial nerve (via sphenopalatine ganglion)
277
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
carrying preganglionic parasympathetic fibers arises placed on hyoglossus muscle in submandibular
from geniculate ganglion. It joins with deep petrosal region. Postganglionic parasympathetic fibers are
nerve to form nerve of pterygoid canal. Deep petrosal secretomotor in nature to supply submandibular and
nerve carries sympathetic fibers from superior sublingual salivary glands.
cervical ganglion along internal carotid artery.
Parasympathetic fibers along greater superficial Efferent outflow from inferior salivatory nucleus
petrosal nerve relay via nerve of pterygoid canal in (Fig. 18.17)
sphenopalatine ganglion. Postganglionic fibers from Inferior salivatory nucleus is the parasympathetic or
the ganglion pass through following branches to general visceral efferent nucleus of glossopharyngeal
supply target organs which are different exocrine nerve which is situated in upper part of medulla
glands. oblongata. Preganglionic efferent outflow from the
1. Pharyngeal branches: To the mucous glands of nucleus comes out from the glossopharyngeal nerve
pharynx. as its tympanic branch at base of skull. From the
2. Palatine branches: To mucous glands of palate. tympanic branch parasympathetic fibers reach par-
3. Nasal branch: To mucous glands of nasal cavity. otid gland through following route.
4. Branch for lacrimal gland: It passes to the Inferior salivatory nucleus glossopharyngeal
gland via following route. nerve tympanic branch tympanic plexus in middle
Sphenopalatine ganglion anterior root of comm- ear cavity lesser superficial petrosal nerve otic
unication to maxillary nervemaxillary nerve Zygo- ganglion trunk of mandibular nerve its posterior
matic branch Zygomaticotemporal branchcomm- division auriculotemporal nerve auricular branch
unication to lacrimal nerve lacrimal nerve to to parotid gland.
lacrimal gland.
Efferent outflow from dorsal nucleus of vagus
n Parasympathetic distribution through
(Fig. 18.18)
chorda tympani nerve (Fig. 18.16): Chorda tym-
pani branch of facial nerve carrying preganglionic Dorsal nucleus of vagus is a composite nucleus,
parasympathetic fibers arises 6 mm above stylom- being mixed in nature with a motor and a sensory
astoid foramen. Coming out of tympanic cavity component. Sensory part of the nucleus receives
and finally outside cranium, it joins lingual nerve inputs from different viscera (of thorax and
in infratemporal fossa. Carried through lingual abdomen) which receive efferent fibers from its motor
nerve fibers relay in the submandibular ganglion component. Dorsal nucleus of vagus is situated in
Abducent nerve nucleus
Motor root of facial nerve Facial colliculus
Section of pons
Geniculate ganglion
Superior salivatory nucleus
Lingual nerve
Facial nerve
Sublingual
gland Chorda tympani nerve
joining lingual nerve
Submandibular ganglion
Postganglionic secretomotor
fibers supplying sublingual gland
Fig. 18.16 Parasympathetic efferent pathway from superior salivatory nucleus of facial nerve (via submandibular ganglion)
278
Autonomic Nervous System
Tympanic plexus
Tympanic branch of
glossopharyngeal nerve Jugular foramen
Glossopharyngeal nerve
Lesser superficial petrosal Superior ganglion
nerve
Inferior ganglion
Foramen ovale transmitting Postganglionic parasympathetic
two roots of mandibular secretomotor fibers to parotid gland
nerve
Otic ganglion
Anterior division
and
Posterior division of
mandibular nerve Auriculotemporal nerve
Fig. 18.17 Parasympathetic efferent pathway from inferior salivatory nucleus of glossopharyngeal nerve
Dorsal nucleus of
vagus nerve
Vagus nerve
Esophageal branches
Gastric nerves
Mucous glands
Preganglionic fibers of vagus
nerve
Submucous coat
Sympathetic fibers for the gut upto right two- plexus. But the fibers are from vagus nerve. These
thirds of transverse colon pass via celiac and motor fibers of vagus arc for contraction of smooth
superior mesenteric plexuses carrying fibers muscles of gallbladder and bile duct. But it is
from greater and lesser splanchnic nerve. Stim- inhibitory to ampullary sphincter of Oddi.
ulation of these nerve fibers causes sphincteric
contraction and splanchnic vasoconstriction. Efferent outflow from spinal parasympathetic center
ii. Meissner (submucousal) plexus: These plexuses
are the sites of relay station with short postga- Spinal parasympathetic center is made up of general
nglionic parasympathetic neurons beneath the visceral efferent neuronal group present in the
mucous membrane in the submucous layer of intermediate (intermediomedial) area of gray matter
intestine. From these plexuses postganglionic of S2, S3 and S4 segments of spinal cord.
secretomotor fibers supply intestinal mucous
glands. Principles of distribution
n Enteric nervous system: The above mentioned
n Exit from spinal center: Parasympathetic pre
two plexuses extend continuously along the length ganglionic efferent fibers come out of spinal cord
of almost whole gastrointestinal tract starting from via ventral (motor) root of S2, S3 and S4 nerves, and
esophagus to anal canal. Out of the two, activity of
finally through ventral rami of the same nerves. But
Auerbach or myenteric plexus leads to coordinated
ultimately parasympathetic fibers, leaving these
purposeful contraction of smooth muscles of gut
spinal nerves join together to form pelvic splanchnic
resulting its peristalsis and segmental movements.
nerve (Fig. 18.20).
At the site of reflex, sympathetic postganglionic
n Target organs:
neurons are found to terminate on postganglionic
parasympathetic neurons. These exert an inhibitory 1. As the name suggests, pelvic splanchnic nerve
effect on parasympathetic activity. Parasympathetic supplies all pelvic viscera in both male and female.
sensory neurons are also found to relay in myenteric 2. In addition, it provides both motor as well as
plexus to form a local reflex arc. As it has been secretomotor fibers for the wall of hindgut.
found that the gut-wall plexus through formation of n Routes of distribution: Primarily, preganglionic
local reflex arc may act for segmental movement of parasympathetic efferent fibers carried via pelvic
intestine, even when isolated from central nervous splanchnic nerve, along with sympathetic contr-
system and it extends throughout the entire gut-wall. ibution, form a plexus in the pelvic cavity which
It is referred as Enteric nervous system. called pelvic plexus or inferior hypogastric plexus.
5. Branches to gallbladder and biliary tree: The plexus is situated in extraperitoneal fat, lateral
Parasympathetic fibers for gallbladder and biliary to rectum and posterolateral to urinary bladder as
tree are derived via hepatic plexus from celiac well as reproductive organs of pelvis. From inferior
281
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Left one-third of
transverse colon
Superior hypogastric
plexus
S2
Pelvic splanchnic
nerve
{ S3
S4
S2
S3
S4 } Pelvic splanchnic
nerve
hypogastric plexus fibers are distributed along two 3. Uterus: Parasympathetic fibers of pelvic splan-
directions as follows. chnic nerve antagonises contractile effect of symp-
1. For the pelvic viscera, fibers pass either directly athetic fibers on uterine musculature.
or in reverse direction of the course of branches of 4. Erectile tissue of genital organs: Parasym-
internal iliac artery. pathetic fibers of pelvic splanchnic nerve increases
2. Branches run upwards to join superior hypogastric vascular congestion through vasodilatation of ere-
plexus which is situated below bifurcation of ctile tissue.
abdominal aorta and between two common iliac
arteries. Finally the fibers ascend further to CLINICAL ANATOMY OF AUTONOMIC NERVOUS
inferior mesenteric plexus. Through this plexus SYSTEM
parasympathetic fibers are distributed along the
reverse direction of branches of inferior mesenteric It is already understood that autonomic nervous
artery to the wall of hindgut starting from left one- system is not isolated, rather it is a part of nervous
third of transverse colon. system. That is why, in some clinical conditions affec-
Like foregut and midgut, as supplied by vagus, ting nervous system in general, autonomic nervous
in the wall of hindgut, preganglionic relay with system is also affected. Again, there are some situations
postganglionic neurons, parasympathetic distribution where autonomic nervous system (sympathetic or
forms myenteric (Auerbach) and submucousal (Mei- parasympathetic or both) is selectively lesioned.
ssner) plexuses. Following are the two fundamental causes of
lesion of autonomic nervous system,
Purpose of distribution 1. Injury
2. Diseases.
1. Hindgut (upto rectum):
a) Visceromotor fibers: For coordinated peristaltic INJURIES TO AUTONOMIC NERVOUS SYSTEM
movement via myenteric plexus.
b) Secretomotor fibers: For secretion of mucous
Parasympathetic
glands via submucous plexus.
2. Urinary bladder: Contraction of detrusor mus- It may be cranial or spinal. Causes of damage to the
cles and relaxation of involuntary sphincters. cranial component of parasympathetic system is
282
Autonomic Nervous System
head injury. Head injury may cause impairment of i. Lateral branches: Gray rami to join cervical
function of following components of parasympathetic spinal nerve to arterial wall and sweat gland.
system. ii. Medial splanchnic branches.
l Oculomotor nerve: It is affected when head iii. Internal carotid branch: It runs along internal
injury is associated with herniation of uncus carotid artery to enter inside the cranium.
of temporal lobe. Visceral efferent fibers Apart from vascular branches, fibers along
of the nerve supply sphincter pupillae and ophthalmic artery, entering the orbit supply
ciliary muscles. So damage of the nerve cau- dilator pupillae and part of levator palpebrae
ses loss of light reflex with dilation of pupil superioris.
due to nonfunctioning of sphincter pupillae. A patient may suffer from Horner syndrome due to
Accommodation reflex is also affected due to lesion of anyone of following three level of sympathetic
nonfunctioning of ciliary muscle along with
pathway for head and neck.
medial rectus and sphincter pupillae.
}
l Facial nerve containing visceral efferent fibers 1. First neuron lesion Affecting
reticulospinal tract. Due to degeneration
with other functional components may be diseases like
affected in fracture of base of skull affecting
2. Second neuron lesion Affecting * Multiple sclerosis
internal auditory meatus of petrous part of 1st thoracic segment of spinal * Syringomyelia
temporal bone. Lesion of preganglionic secreto- gray matter.
}
motor fibers to the lacrimal gland causes 3. Third neuron lesion Affecting Due to
impaired lacrimation. Salivary secretion is cervicothoracic ganglion (stellate * Penetrating injury at
ganglion). root of neck
not fully impaired, as parotid gland remains
* Traction by cervical rib
functioning, because it is supplied by visceral * Metastatic lesion at root
efferent fibers through glossopharyngeal nerve. of neck
Spinal injury affecting the parasympathetic sys- 1. Horner syndrome: Important clinical man-
tem along with sympathetic system leads to disorders ifestations:
of bladder, bowel and sexual function. i. Miosis: Constriction of pupil due to unopposed
action of sphincter pupillae for nonfunctioning
Sympathetic dilator pupillae.
ii. Ptosis: Partial dropping of upper eyelid due to
It is the sympathetic trunk which in injured opposite
paralysis of levator palpebrae superioris.
the level of cervicothoracic (stellate) ganglion at the
iii. Anhidrosis: Dryness of one half of the face with
root of neck. This injury may occur due to stab or
head and neck due to impaired secretion of
gunshot wound. It may also occur due to traction by
sweat gland.
cervical rib. Beside injury, metastatic lesion at the
iv. Flushing or blanching of same half of face due
root of neck may affect stellate ganglion. Clinical
to loss of vasoconstrictor effect on skin.
condition arising from this lesion is known as Horner
2. Raynaud disease: It is a vasospastic disease due
syndrome which is described below.
to hyperactivity of vasoconstrictor sympathetic
fibers affecting digital arteries of fingers. It is a
DISEASES INVOLVING AUTONOMIC NERVOUS SYSTEM bilateral disorder which is precipitated by exposure
to cold and smoking. In case of smokers nicotine
Sympathetic System aggravates vasospasm. Clinical manifestations are
pain, pallor and cyanosis due to impaired vascular
1. Horner syndrome: Clinical manifestations of supply. Fingertips show black discoloration with
this syndrome occur due to interruption of symp- formation of dry gangrene.
athetic nerve supply to the head and neck. Center 3. Buerger disease: It is arterial occlusive disease
(connector neurons) for the sympathetic outflow of lower limb. Ischemia of muscles of leg causes
to head and neck lies in lateral horn cells of first pain due to muscular cramps intermittently. That
thoracic segment of spinal gray matter. Proximally is why the disorder is named as intermittent clau-
it gets supraspinal control through reticulospinal dication.
tract descending from brainstem reticular form-
ation. Preganglionic sympathetic fibers for head Parasympathetic System
and neck arising from 1st thoracic segment ascend
through cervical part of sympathetic chain. After
Argyll Robertson pupil
relay in cervical sympathetic ganglia, postgan-
glionic fibers are distributed to head and neck It is a disorder in a patient of neurosyphilis due to
through following branches lesion of pretectal nucleus of midbrain which is one of
283
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
the cell stations in light reflex pathway. The disease postganglionic parasympathetic neurons in the wall
is characterized by narrow pupil with no reaction to of distal part of colon. So this part of colon does not
light due to interruption of light reflex pathway which show peristaltic activity, for which part of the colon
is as follows. proximal to it presents huge dilatation with stagnant
Retina optic nerve optic chiasma optic faecal matter.
tract lateral geniculate body superior brachium
pretectal nucleus Edinger Westphal nucleus
COMBINED SYMPATHETIC AND PARASYMPA-
oculomotor nerve ciliary ganglionshort ciliary
nerve sphincter pupillae. THETIC LESION CAUSING URINARY BLADDER
In case of Argyll Robertson pupil, accommodation DYSFUNCTION IN SPINAL CORD INJURY
reflex is not disrupted as it is not passing through
Detrusor muscle of urinary bladder is supplied by
pretectal nucleus and its pathway is as follows.
parasympathetic fibers from S2, S3 and S4 segments
Retinaoptic nerveoptic chiasmaoptic tract
lateral geniculate bodyoptic radiationprimary visual through pelvic splanchnic nerve which is called nerve
cortex (Area 17) superior longitudinal fasciculus of evacuation. Sympathetic fibers for urinary bladder
Frontal eye fieldcorticonuclear tractoculomotor arising from L1 and L2 segments of spinal cord is
nucleus (somatic efferent as well as visceral efferent) called nerve of filling which supplies sphincter vesicae
oculomotor nerve to supply medial rectus, sphincter or internal urethral sphincter.
pupillae and ciliaris for accommodation. Sensory impulse from the urinary bladder is
A simple formula mentioned below may be helpful carried through both parasympathetic as well as
to remember manifestation of ArgyllRobertson sympathetic pathways. When urinary bladder is
pupil. distended, stretch receptors in the wall of bladder are
{
ARP (Accommodation Reflex stimulated and impulse for sense of fullness of bladder
Present) is carried through sensory fibers of pelvic splanchnic
ARP (ArgyllRobertson Pupil)
PRA (Pupillary Reflex Absent)
nerve to the spinal cord. Dorsal column (fasciculus
gracilis) is the tract for awareness of distension of
Adie tonic pupil bladder. But pain sensation, e.g. in case of carcinoma
or calculus, traveling through sympathetic fibers
This is a syndrome characterized by following clinical ascend through lateral spinothalamic tract which
presentations. carries somatic pain sensation. That is why patient
1. Diminished or absent light reflex due to disorder
with symptom of intractable pain due to carcinoma
of function sphincter pupillae.
of urinary bladder is managed by lateral cordotomy
2. Slow or delayed dilatation of pupil in the dark.
without any disturbance to awareness for fullness of
3. Slow or delayed accommodation to near vision
bladder which passes through dorsal column.
because of suppressed function of ciliary muscle
which is concerned for increase of curvature of lens.
All the above features are supposed to be due to DISRUPTED MOTOR FUNCTIONS OF BLADDER
suppression of parasympathetic ocular function.
Atonic Bladder
Frey syndrome
It is the dysfunction of urinary bladder during the
It is a clinical condition that is found to occur following initial phase of spinal shock following spinal injury.
healing of a penetrating wound of face over parotid Spinal shock phase lasts from a few days to a few
gland. During healing process, injured nerves of this weeks. If the level of spinal injury is above S2, S3,
area of face communicate with one another, as done by S4 segmental level of spinal cord, during the period
auriculotemporal nerve supplying parasympathetic of spinal shock, the bladder losses its normal tonic
postganglionic secretomotor fibers to parotid gland affect due to temporary withdrawal of all cord
with great auricular nerve supplying sweat glands of function. In normal condition, an individual can
this area of face. So stimulation of salivary secretion temporarily suspend the act of micturition by
during mastication of food causes sweating of area of voluntary contraction of external urethral sphincter
face supplied by great auricular nerve. with maintenance of detrusor muscle tone even
with awareness of fullness of bladder. In case of
Hirschsprung disease
spinal shock, awareness for fullness is lost with
This disease is also called megacolon. It is a congenital loss of voluntary contraction of external sphincter
disease characterized by failure of development which becomes relaxed and atonia of detrusor which
Auerbach (myenteric) plexus with absence of becomes relaxed, but internal sphincter is tightly
284
Autonomic Nervous System
closed. So atonic bladder with overdistension, tightly VISCERAL PAIN
closed internal sphincter and relaxed external
sphincter causes overflow of urine. Before this topic is discussed, following general points
When period of spinal shock is over, dysfunction of are to be taken into consideration in connection with
urinary bladder may be one of the following two types afferent autonomic pathway.
depending upon the level of lesion. Different kinds of sensations carried from the
viscera are sense of compression, distension (stretch)
Automatic Bladder and pain.
Pain sensation carried from the viscera is due
This type of bladder disfunction is observed if the to lack of oxygen as a result of ischemia, or due to
lesion is above the level of S2, S3 and S4 segments of accumulation of metabolites.
spinal cord. These sacral segment are called spinal Different kinds of sensations are carried from
micturition center which possesses excitatory effect viscera through afferent fibers of both sympathetic
on detrusor muscle and inhibitory effect on sphincter as well as parasympathetic components of autonomic
vesicae (internal urethral sphincter). Paracentral nervous system.
lobule is called cortical micturition center which Afferent fibers of sympathetic system are
possesses inhibitory control on sphincter urethrae carried from the viscera which travel through the
(external urethral sphincter). If the spinal cord lesion sympathetic ganglion to join the spinal nerve via gray
is above S2, S3 and S4 segments, it means that con- rami communicantes.
trol of cortical micturition center by descending tract Cell bodies of first order of neuron of both
is lost and spinal center (S2, S3 and S4) remains sympathetic as well as parasympathetic system are
functioning. So following changes are observed. also situated in posterior root ganglia like somatic
1. External urethral sphincter is relaxed. sensory pathway.
2. When the bladder is distended, impulse from Impulse, entering the spinal cord, stimulates
stretch receptor is carried to S2, S3 and S4 afferent tract neurons in the base (lamina VII) of
segments by afferent fibers of pelvic splanchnic posterior horn of T1 L2 and S2, S3 and S4 segments
nerves. Stimulation of motor neuronal roots of of spinal cord. These neurons are visceral afferent
cell group. Visceral afferent tract fibers ascend as
same segments through interneurons completes
axons of the cells. But these fiber tracts ascend in
the activity of local segmental reflex arc to lead to
common, intermingling with somatic afferent tracts
contraction of detrusor with relaxation of internal
for example lateral and anterior spinothalamic tracts.
sphincter which results emptying of bladder.
Before passing through the ascending tracts,
So through activity of local reflex pathway, bladder pain sensation is mostly carried through peripheral
once distended, becomes empty automatically. That is sympathetic pathway. But in case of viscera like
why it is called automatic bladder. urinary bladder, pain sensation are of two different
kinds, physiological and pathological. Physiological
Autonomous Bladder pain, due to stimulation of stretch receptors in
This type of dysfunction of urinary bladder occurs detrusor muscle wall of bladder is carried through
when spinal injury causes lesion in sacral segments parasympathetic afferent fibers entering S2, S3 and
(namely S2, S3 and S4) of spinal cord. In this case S4 segments of spinal cord. Then, it ascends through
bladder is deprived of both supraspinal voluntary dorsal column. Impulse reaching the sensory cortex
through this pathway leads to awareness for fullness
control as well as local reflex control. Voluntary
of bladder. Pathological pain due to irritation of
control is lost because influence of descending tract
bladder wall nerve endings by vesical calculus
is cut off. Again local reflex pathway circuit is cut
or due to carcinoma of urinary bladder is carried
off due to lesion of local sacral center. Urinary
through T11L2 sympathetic ganglia to corresponding
bladder is, therefore, released from its nervous segments of spinal cord via lateral spinothalamic
control and enjoys its autonomy for which it is called tract. Advantage of this dual sensory pathway is
autonomous bladder. The bladder wall becomes utilized by neurosurgeons by performing selective
flaccid and urine is getting accumulated more and lateral cordotomy for relief of intractable bladder pain
more with overdistension of the organ. As the sphin- in a patient of bladder carcinoma, in which case sense
cters are ineffective, overdistension of bladder is of fullness of bladder passing through dorsal column
characterized by continuous dribbling. is not disturbed.
285
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Explanation of Referred Visceral Pain n Gallbladder pain: Diseases of gallbladder those
commonly give rise to pain are inflammation (chol-
Visceral pain is diffuse and poorly localized. But ecystitis) and calculus (cholelithiasis).
somatic pain is comparatively more intense and Sympathetic pain fibers travel through celiac
localized more accurately. But in general, when plexus and then along greater splanchnic nerve (T5
pain fibers (sympathetic as well as parasympathetic) T9). So pain is felt over T5T9 dermatome which is the
from viscera are stimulated, instead of being felt area over lower chest wall and upper abdomen.
at the site of viscera, it is felt over the belt of skin When inflammation spreads over parietal perit-
(dermatome) supplied by somatic nerve of same oneum over peripheral part of diaphragm of right side,
segment of spinal cord supplying viscera. It is called pain is felt over right upper quadrant of abdominal
referred pain. Explanation of referred pain is not wall and area over inferior angle of scapula of right
absolutely clear. But it is based on the following two side.
theories. n Pain over tip of right shoulder: Spread of inf-
1. Pain fibers from viscera and corresponding derm- lammation from gallbladder finally to the parietal
atome ascend through same ascending tract in peritoneum over central part of diaphragm irritates
central nervous system. Sensory area of cerebral phrenic nerve (C3, C4 and C5). That is why referred
cortex is unable to locate exactly site of origin of pain is felt over tip of right shoulder which is supplied
by supraclavicular nerve having root value of C3 and
pain, viscera or dermatome. As already mentioned
C4 .
that pain from dermatome is more sharply and
accurately felt than viscera, sensory cortex locates
that pain is arising from the dermatome. STOMACH PAIN
2. In normal condition, nociceptors of dermatome are Most commonly, referred pain from stomach is felt
constantly charged by noxious stimuli, which is in epigatrium. Sympathetic pain fibers from stomach
not so in case of viscera. So when pain fibers from travel through celiac ganglion and finally along
viscera are stimulated, sensory cortex interprets greater splanchnic nerve (T5T9). So severe gastric
that impulse is coming from the respective derm- pain is felt over lower chest and upper abdominal wall
atome. which is supplied by T5T9 spinal nerves.
287
Cranial Nerves
19
n Fundamental points: l Out of 12 pairs of cranial nerves, Ist cranial
l As 31 pairs of spinal nerves are peripheral outflow (olfactory) nerve and IInd cranial (optic) nerve
from spinal cord, 12 pairs of cranial nerves are differs from IIIrd to XIIth cranial nerves as follows.
peripheral outflow from brain. Olfactory nerve carrying impulse for olfaction
l Unlike spinal nerve, cranial nerves are not seg- (smell) and optic nerve carrying impulse for vision
mental in origin. (sight) protrude from basal aspect of forebrain
l All spinal nerves are mixed in nature composed (cerebrum). So their centers are situated in forebrain.
of both motor and sensory roots. But in case of Other cranial nerves (IIIrdXIIth) come out of the
cranial nerve, some are mixed, again some are surface of brainstem. Their centers are situated inside
either purely motor or purely sensory. the three components (midbrain, pons and medulla)
l Spinal nerves have separate site of attachment of brainstem in the form of cranial nerve nuclei.
of motor and sensory roots. But in case of mixed
cranial nerves motor and sensory fibers may come
OLFACTORY NERVE AND OLFACTORY PATHWAY
out of brain commonly, e.g. glossopharyngeal (9th)
and vagus (Xth) nerves. In some cases, motor and
sensory roots come out separately, but close to Fundamental Points
each other, e.g. trigeminal (Vth) and facial (VIIth) 1. Olfactory nerve, the Ist cranial nerve, is a special
nerves. somatic afferent nerve carrying sense of olfaction
l Like spinal nerves, mixed cranial nerves are: or smell.
1. Trigeminal (Vth cranial) nerve 2. Olfactory nerve forms the part of olfactory pathway
2. Facial (VIIth cranial) nerve which starts from olfactory receptor cell, through
3. Glossopharyngeal (IXth cranial) nerve
chain of two orders of neurons to the olfactory
4. Vagus (Xth cranial) nerve.
cortex.
n Motor cranial nerves are:
3. Function of olfactory pathway is more sharp in
1. Oculomotor (IIIrd cranial) nerve
2. Trochlear (IVth cranial) nerve some animals like dogs which are considered
3. Abducent (VIth cranial) nerve as Macrosmatic. In contrast human being are
4. Accessory (XIth cranial) nerve considered as Microsmatic.
5. Hypoglossal (XIIth cranial) nerve. 4. Olfactory receptor cells located in nasal mucosa are
n Sensory nerves are: the nerve cells which act as end organs stimulated
1. Olfactory (Ist cranial) nerve by air molecules carrying odors. These neurons are
2. Optic (IInd cranial) nerve the only examples which are exposed to the body
3. Vestibulocochlear (VIIIth cranial) nerve. surface (nasal mucous membrane) (Fig. 19.1).
Cranial Nerves
Olfactory bulb
Olfactory tract
Frontal air sinus
Olfactory nerves
Lateral wall of nose
Olfactory area of nasal
cavity
Soft palate
Fig. 19.1 Olfactory epithelium area which lodges bipolar olfactory neurons acting as olfactory end organ (receptors), from where
originate bunch of olfactory nerves
5. Olfactory receptor neurons undergo a degenerative iii. Roof of the nose between above mentioned
process through continuous cycle, and these are lateral and medial walls.
replaced or renewed by fresh cells developed by l Cells of olfactory epithelium (Fig. 19.2):
basal cells of nasal mucous membrane. 1. Receptor cells: Which are specialized bipolar neu-
6. Leaving the olfactory receptor neurons, olfactory rons.
pathway is made up of only two orders of neurons 2. Supporting cells: These are tall columnar inter-
before it reaches the olfactory cortex. stitial cells which intervenes between receptor
cells having supportive function.
7. Olfactory pathway is the only sensory pathway
3. Basal cells: These are shorter cells resting on
which does not pass through any component of
basement membrane intermingled with other
nucleus of thalamus.
cells. Basal cells are progenitor cells concerned
with replacement (renewal) of receptor cells.
Components of Olfactory Pathway
Olfactory receptor cells are specialized bipolar
1. Olfactory receptors (neuroreceptors) present in neurons scattered among supporting cells. Perip-
specialized area of nasal mucosa and olfactory heral processes of these bipolar cells are wider and
nerves. extend to the surface of nasal mucous membrane.
2. Two orders of neurons. Form the end of peripheral process, a number
3. Olfactory area of cerebral cortex present in of short cilia arise which project into the mucus
temporal lobe. covering olfactory mucous membrane. These are
called olfactory hairs. These projecting olfactory
Olfactory receptors and olfactory nerve (Fig. 19.2) hairs react to odors of inhaled air and stimulates
olfactory receptor cells.
End organs or receptors for olfactory pathway are Central processes of olfactory receptors are
specialized neurons present in specialized area of finer which form olfactory nerve fibers. These finer
mucous membrane of nasal cavity called olfactory fibers aggregate to form 20 bunches. These are
epithelium. nonmyelinated. These 20 bunches of finer nonm-
yelinated fibers form olfactory nerves. It is clear
Olfactory epithelium therefore, unlike other cranial nerve, in each side,
This epithelium lines uppermost part mucous mem- olfactory nerve is multiple in number.
brane of nasal cavity which is
i. Uppermost part of lateral wall of nose along First order of neurons (Fig. 19.2)
with sphenoethmoidal recess above the level of Bunch of olfactory nerve, the central processes of
superior nasal concha. olfactory receptor cells, pass upwards from roof nose
ii. Uppermost part of nasal septum (medial wall through foramina in cribriform plate of ethmoid bone
of nose), which is formed by perpendicular to reach anterior cranial fossa. Reaching anterior
plate of ethmoid bone. cranial fossa, olfactory nerves terminate in first
289
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Granula cell
Tufted cell
Olfactory tract
Olfactory bulb
Mitral cell
Cribriform plate
of ethmoid bone
Basal cells
Olfactory
Supporting cells epithelium
Olfactory cells
Fig. 19.2 Bipolar olfactory receptor cells present in olfactory epithelium of nasal mucosa form contact with first order of neurons of
olfactory pathway in olfactory bulb
order of neurons of olfactory pathway which are opposite side. Lateral olfactory stria carries axons of
present inside an ovoid flattened structure lodged on 1st order of neurons present in olfactory bulb to the
orbital surface of frontal lobe of cerebrum. It is called primary olfactory area beyond anterior perforated
olfactory bulb. Neurons present inside olfactory bulb substance.
are of following types. Intermediate olfactory stria is a short band of
l Mitral cells fibers, being occasionally present, passes from the
l Tufted cells angle of olfactory trigone to a small elevation on
l Granule (Stellate) cells. anterior perforated substance which is called olfactory
Mitral cells are largest cells in olfactory bulb. tubercle (Fig. 19.3).
Incoming fibers of olfactory nerve form synaptic
connections with mitral cells. These synaptic junc- Second order of neurons (Fig. 19.3)
tions also receive connection from tufted cells and
granule cells. Junctional areas of these cells with Lateral olfactory stria, as continuation of olfactory
olfactory nerve ending are known as glomeruli. tract relays in second order of neurons which are
Axons of these cells, within olfactory bulb, which are present in periamygdaloid and prepyriform areas
1st order of neurons, pass backward to be continued of temporal lobe of cerebrum. These areas, placed
as olfactory tract. beyond anterior perforated substance and close to
n Olfactory tract: It is a narrow and flat band of amygdaloid body are known as primary olfactory
white matter extending from olfactory bulb to run cortex.
backwards along olfactory sulcus on orbital surface Primary olfactory cortex sends nerve fibers to other
of frontal lobe of cerebrum. Olfactory tract passes centers of brain. These connections are concerned
backward upto anterior perforated substance of base with integration of olfactory function with emotional
of the brain where it divides in an angular fashion and autonomic activities.
into lateral and medial olfactory striae. Anterior
perforated substance is embrassed anterolaterally Olfactory cortex
and anteromedially by lateral and medial olfactory
striae. The two straie form olfactory trigone (Fig. It is called entorhinal area (area 28). This area is made
19.3). up of uncus and anterior part of parahippocampal
Medial olfactory stria carries axons from cells of gyrus. It receives fibers from second order of neurons
olfactory bulb which cross the midline as a component situated in primary olfactory areas. That is why is
of anterior commissure to pass to olfactory bulb of called secondary olfactory cortex.
290
Cranial Nerves
Olfactory bulb
Olfactory tract
Loss of sense of smell is known as anosmia. It may be 1. Retina Rods and cones cells Receptor
due to variable causes of peripheral to central origin. Bipolar cell First order of
Pathology of the disorder may be in different level of neurons multipolar ganglionic
cells Sencond order of neurons
olfactory pathway starting from olfactory epithelium
}
of nasal mucosa. Cause may be minor as nasal obstr- 2. Optic nerve
3. Optic chiasma Axons of ganglionic cells
uction following attack of common cold. Again, it
4. Optic tract (second order of neurons)
may be due to meningioma of anterior cranial fossa
pressing olfactory bulb and tract or it may be effect of 5. Lateral geniculate Third order of neurons
body (metathalamus) (in thalamic level)
lesion of olfactory cortex.
Sense of smell is tested clinically separately for 6. Optic radiations - Axons of neurons of lateral
both the nostril. (Geniculocalcarine tract) geniculate body
Sense of smell and sense of taste are clinically 7. Visual center of Area 17 of Broadmann in
interrelated. Smelling of aroma of delicious food helps cerebral cortex medial surface of occipital
in appreciation of taste. lobe of cerebrum
Pigmented epithelium
Rod cell
Cone cell
Bipolar neuron
Fig. 19.4 Receptors (rods and cones) and first two orders of neurons of visual pathway present in retina
First and second order of neurons (Fig. 19.4) to bipolar cells. Secondary multiple dendrites of one
(placed in retina) ganglionic cells form synaptic junction with axons of
more than one bipolar cells. So number of ganglionic
First order of neurons are bipolar cells, so its cell
cells are far less than bipolar cells. It is histologically
body is fusiform in appearance. Its peripheral process
makes contact with inner or central end of rods and evident by larged size and lesser number of nuclei of
cones in an end to end fashion. So ratio of receptor ganglionic cells in comparison to small sized, more
cells and bipolar cells is almost 1:1. Central process number of nuclei of bipolar cells.
(axons) of bipolar cells form synaptic connection n Some important points on retina (in conn-
with dendrites of second order of neurons called ection with visual pathway):
ganglionic cells. 1. Outermost layer of retina is a layer of pigmented
Second order of neurons are called ganglionic cells epithelium. Melanin pigment of this epithelial
which are multipolar with multiple dendrites. These layer absorbs light and thereby prevent reflection
cells are larger in size with bigger nuclei, as compared of light from outer coats of eyeball.
292
Cranial Nerves
2. Next to pigmented epithelium, from outside inw- OPTIC CHIASMA
ards, cellular layer are rods and cones, bipolar
cells and ganglionic cells. Optic chiasma is attached to the base of the brain
3. Layer of pigmented epithelium (choroid side) is forming anterior most component of interpeduncular
separated from layer of rods and cones (inner or fossa. At its anterolateral angle joins the optic nerve
vitreous side) by a loose membrane called Bruchs in both sides. Posterolateral angle continues as optic
membrane. tract. It means that fibers of optic nerve continues
4. Posterior pole retina (center of posterior equator) backwards as optic tract through optic chiasma. But
contains only cone cells with a yellowish color, the optic chiasma is formed because of decussation of
called macula lutea which is the area of retina half of the fibers of optic nerve of both side.
concerned for sharpest vision. Center of macula
presents a small depression (pit) called fovea cen- Decussation of Fibers
tralis.
Fibers of optic nerve continued from medial (nasal)
5. Axons of ganglion cells are long and convergent
half of retina, which receive visual impulse (light
which form optic nerve. These fibers are innermost
layer of retina, separated from vitreous body by energy) from lateral (temporal) field of vision decu-
hyaloid membrane. ssate in the optic chiasma to be carried through optic
6. Fibers of optic nerve converge and pierce through tract of other side. Obviously, the fibers from lateral
the retina, choroid and sclera at a point which is a (temporal) half retina concerned with medial (nasal)
small circular area called optic disk. It is 34 mm half of field of vision, run along the optic tract of same
medial (nasal) to posterior pole (macula lutea) of side.
retina. As optic disk contains of nerve fibers, but
no photoreceptor cells, it is called blind spot. OPTIC TRACT
n Axons of second order of neurons: These fibers
First it is to be followed that optic tract is made up of
come out of eyeball as optic nerve which is continued
fibers which are continuation of optic nerve and these
further backwards as optic chiasma and optic tract.
are still nothing but axons of ganglionic cells (second
n Relations between retina and field of vision:
order neuron) placed in retina. Next, it is to be very
Retina of each eyeball is divided into inner (nasal)
clear that optic tract of any side carries fibers from
and outer (temporal) half. Field of vision of each eye is
also similarly subdivided. Now, it is important to note lateral (temporal) half of same retina and medial
that temporal half of retina receives visual impulse (nasal) half of opposite retina concerned with opposite
from nasal half of visual field and vice versa. Again field of vision. From this, it is the time to understand
each half of retina is divided into upper and lower that right optic tract carries fibers from temporal
quadrants which receive visual impulse from opposite (right) half of right retina and nasal (also right) half
quadrants of field of vision. of opposite retina. Similarly left optic tract carries
fibers from temporal (left) half of left retina and nasal
OPTIC NERVE (also left) half of opposite retina.
n Quadrantic representation of retina: Each
It is already understood that optic nerve is made up of half of retina, right or left, is divided into upper and
axons of ganglionic cells (2nd order of neurons) placed lower quadrants. Each quadrant of retina is related
in retina. The fibers of optic nerve converge on optic to opposite quadrant of field of vision. It means upper
disk of retina. Optic nerve comes out of eyeball finally quadrant of one-half retina receives visual impulse
piercing sclera 34 mm medial to posterior pole. from lower quadrant of opposite half of field of vision
Optic nerve fibers are myelinated. But the fibers, and vice versa.
though belong to a peripheral nerve, are myelinated
by oligodendrocytes (not Schwann cell). For this
Course and Termination of Optic Tract
reason, optic nerve is compared to fiber-tract of
central nervous system. Optic tract, starting from posterolateral angle of
Optic nerve leaves orbital cavity to enter cranial optic chiasma, runs posterolaterally around cerebral
cavity through optic canal. It runs backwards and peduncle to relay in neurons of lateral geniculate
medially to unite with the nerve of other side to form body, a component of metathalamus projecting from
optic chiasma. posterior end of thalamus.
293
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
LATERAL GENICULATE BODY (THIRD OF NEURONS) and color vision. Optic nerve fibers from macular
area of retina, through relay in lateral geniculate
It is a component of metathalamus, other one being body, end in posterior end of both the lips of calcaline
medial geniculate body. Lateral geniculate body is a sulcus continued on superolateral surface of occipital
small oval projection from posterior pole (pulvinar) lobe of cerebral hemisphere. Visual cortex (area 17)
of thalamus. It is made up of six concentric layers of on medial surface of occipital lobe is supplied by
neurons where relay fibers of optic tract which are branches of posterior cerebral artery, but macular
terminal part of axons of second order of neurons, the visual area on superolateral surface is supplied by
multipolar ganglion cells placed in retina. branches of middle cerebral artery.
Axons of lateral geniculate body, the third order of
neurons, have following destinations. Visual Association Area
1. Continuation of visual pathway: These fibers Both the upper and lower lips of visual cortex (area
pass backward as component of retrolenticular 17) are superimposed by visual association cortex
part of internal capsule to end in visual cortex (area area, area 18 and area 19, one over other. This area is
17). This area is on upper as well as lower lips of concerned with recognition of an object and perception
calcarine sulcus on medial surface of occipital lobe of its color.
of cerebral hemisphere. This bundle of fibers are
known as optic radiation or geniculocalcarine tract. Visual Reflexes
2. As superior brachium to midbrain: Superior
brachium is band of fibers which extend from These are some reflex path, afferent components of
lateral geniculate body to superior colliculus of which are formed by visual pathway.
midbrain. Fibers of this band relay in following
two groups of cells in midbrain for two different Direct and consensual light reflexes
purposes. When light is projected on one eye (retina), normally,
a) To tectum (at the level of superior colliculus): pupil of both eyes, which is a small circular aperture
These fibers form the afferent component of in iris, constricts.
spinovisual reflex pathway or visual body Constriction of pupil of the eye, on which light
reflex pathway. is projected, is the effect of direct light reflex.
b) To pretectal nucleus: These fibers form afferent Constriction of the pupil of the eye, on which light
component of pupillary light reflex pathway. is not projected, even if it is passively closed, is the
Cells of lateral geniculate body is subdivided into effect of consensual light reflex, when light projects
lateral and medial halves which possess somatotopic on another eye.
relationship with other components of visual pathway.
n Somatotopic relationship of visual pathway: Components of light reflex pathway (Fig. 19.5)
l Upper quadrant of field of vision
x 1. Receptors: Rods and cones of retina.
2. Afferent pathway: The fibers formed by chain of
Lower quadrant Lateral half Lower lip
bipolar cells, ganglionic cells and their axons as
of retina (L) of lateral of visual
optic nerve, optic chiasma and optic tract. Some
geniculate body cortex (L)
fibers from optic tract, passing through superior
So, (L)
brachium to pretectal nucleus of midbrain. Axons
l Lower quadrant of field of vision
from prectectal nucleus, which is close to and at
the level of superior colliculus, relay in Edinger-
Westphal nucleus of oculomotor nerve of same
Upper quadrant Medial half Upper lip
side as well as opposite side.
of retina (U) of lateral of visual
3. Center: It is Edinger-Westphal nucleus of oculo-
geniculate body cortex (U)
motor (IIIrd cranial) nerve. This nucleus is the
parasympathetic efferent nucleus. Situated close
MACULAR VISION to somatic afferent nucleus of the same cranial
Visual impulse from central field of vision project nerve at the level of superior colliculus of midbrain.
on macula lutea (yellow spot) which is the small Axons from this parasympathetic efferent prega-
central area of retina, on the posterior pole. This area nglionic neurons travel via oculomotor nerve to
contains only cone cells of photoreceptors. That is why supply two muscles, i.e. constrictor pupillae and
the macular area is concerned with sharpest vision ciliary muscles.
294
Cranial Nerves
Field of vision
Ciliary ganglion
Frontal eye
field Oculomotor nerve
Optic nerve
Optic chiasma
Corticonuclear
fibers
Optic tract
Optic radiation
(geniculo-
Occipitofrontal calcarine tract)
fasiculus
Visual area
Fig. 19.5 Visual pathway with routes for light reflex and accommodation reflex
4. Efferent pathway: Oculomotor nerve of same 5. Effector organ: Constrictor pupillae muscle of
side as well as opposite side. Via nerve to inferior same side as well as opposite side.
oblique, which is a branch from inferior division,
Accommodation Reflex (Fig. 19.5)
preganglionic fibers relay in ciliary ganglion. Post-
ganglionic fibers enter eyeball via short ciliary It is the reflex pathway through function of which
nerve. eyeball is adjusted from vision of a distant object
295
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
to the vision of a near object. For this reflex action 2. Afferent component: Retina neurons optic
following three changes occur in eyeball. nerve optic chiasma optic tract lateral
1. Constriction of pupil: It is caused by constrictor geniculate body superior brachium.
pupillae. 3. Center: Neurons of tectum of midbrain at the
2. Medial convergence of both eyeball: It is level of superior colliculus.
caused by contraction of medial rectus of both side. 4. Efferent component:
3. Increase of curvature of lens: It is caused by a) Tectobulbar tract which end on motor nuclei of
relaxation of suspensory ligament of lens which is some cranial nerves which are concerned with
due to contraction of ciliary muscles. movement of eyeball, eyelid, head.
b) Tectospinal tract which is concerned with
movement of neck and trunk.
Components of accommodation reflex pathway
5. Effector organ: These are voluntary muscles of
1. Receptors: Rods and cones of retina. eyeball, eyelid, head, neck and trunk.
2. Afferent pathway: It is composed of following
three components Corneal Reflex
a) Total visual pathway: Retina optic nerve
Light touching of cornea or conjunctiva with a small
optic chiasma optic tract lateral geniculate piece of cottonwool causes reflex blinking of eyelids of
body optic radiation visual cortex (area 17) both eyes. This is the effect of functioning of a reflex
of occipital lobe. called corneal reflex.
b) Superior longitudinal fasciculus: These are Corneal reflex differs from above mentioned
long association fibers extending from area 17 reflexes by the point that visual pathway does not
of occipital lobe to frontal eye field of frontal have only contribution to afferent component of this
lobe. reflex path.
c) Corticonuclear or corticobulbar fibers: These
fibers extend from frontal eye field to somatic Components of the reflex pathway
efferent nucleus and EdingerWestphal nucl-
eus of oculomotor nerve. 1. Receptors: Touch receptors in conjunctiva and
3. Center: cornea.
a) Somatic efferent nucleus of oculomotor nerve 2. Afferent pathway:
which supplies medial rectus muscle. a) Nasociliary branch of ophthalmic division of
b) EdingerWestphal (parasympathetic efferent) trigeminal nerve through which touch fibers
nucleus of oculomotor nerve which supplies end in superior sensory nucleus of the nerve
ciliary muscle as well as constrictor pupillae situated at the level of pons.
muscle. b) Fibers of medial longitudinal fasciculus conn-
4. Efferent pathway: Oculomotor nerve fibers. ecting superior sensory nucleus of trigeminal
5. Effector organ: Following three muscles. nerve with motor nucleus of facial nerve.
a) Medial rectus 3. Center: Motor nucleus of facial nerve of both side.
b) Ciliaris 4. Efferent pathway: Temporal and zygomatic
c) Constrictor pupillae. divisions of the terminal branches of facial nerve.
5. Effector organ: Orbicularis oculi muscle of
Spinovisual Reflex (Visual Body Reflex) eyelids of both eyes.
1 1
2 2
1 1
4 2
3 3
4 4
5 5
6
6
7 7
7
Fig. 19.6 Lesions of visual pathway at different levels causing various types of visual field defects
1. Right sided circumferential blindness due to retrobulbar neuritis
2. Total blindness of right eye due to damage of right optic nerve
3. Right nasal hemianopia due to partial lesion of right marginal part of optic chiasma
4. Bitemporal hemianopia due to lesion of central part of optic chiasma
5,6,7. Right sided homonymous hemianopia due to lesion of optic tract, optic radiation and visual cortex of right side
297
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
1. Expanding tumor: Like pituitary tumor or meni- temporal fibers so there will be loss of nasal field of
ngioma. vision of one eye. The defect is called unilateral nasal
2. Cerebrovascular accidents: Effect will be wide- hemianopia.
spread when lesion occurs in the pathway where Lesion of central part of optic chiasma may occur
the nerve fibers are more tightly packed, e.g. in due to pressure effect by pituitary tumor. It will cause
optic nerve and optic tract. lesion of central decussating nasal fibers resulting
loss of temporal half of field of vision of both eyes. It
Circumferential Blindness means loss of right half of field of vision of right eye
and left half of field of vision of left eye. That is why
This clinical condition is characterized by loss of circu-
the visual defect is called heteronymous hemianopia.
mferential field of vision of one eye affected. It occurs
due to optic neuritis, as a complication of infection of
sphenoidal or ethmoidal sinus. Optic neuritis causes Lesion beyond optic chiasma
infection of peripheral fibers of optic nerve while it is Lesion in optic tract, optic radiation (geniculo-
passing through optic canal. calcarine tract) or visual cortex will cause homo-
nymous hemianopia. Lesion anywhere in right side
Total Blindness will lead to loss of left half of field of vision of both
Complete lesion of one optic nerve will result total eyes. A special point to note that, if lesion occurs in
blindness which is characterized by loss of complete both the lips of calcarine sulcus (area 17), which is
(both right and left) field of vision of one eye. primary visual area, homonymous hemianopia will
be the effect with sparing of macular vision because
Hemianopia area for macular vision extends on superolateral
surface of occipital pole where extends posterior end
The term anopia means loss of vision. Hemianopia is of visual area. Upper and lower lips corresponds
characterized by loss of half of field of vision. First, it is
with lower and upper quadrant of field of vision of
to be very clear that clinically when the manifestation
of hemianopia is studied, it is considered to be in opposite side. So, lesion of one lip upper or lower only
relation to loss of right or left of field of vision, but not will cause inferior or superior quadrantic hemia-
the temporal and nasal half. If the same half, e.g. right nopia respectively.
or left (not temporal or nasal half) of field of vision is
lost in both eyes, it is called homonymous hemianopia. ARGYLL ROBERTSON PUPIL
But if right half of field of one eye and left half of field
of another eye (e.g. both temporal field) are affected, it It is the clinical condition observed in a patient
is called heteronymous hemianopia. suffering from neurosyphilis, which is characterized
In this connection, it is also to be remembered by selective lesion of pretectal nucleus of midbrain
that light from one half of field of vision projected to which is in the route of pupillary light reflex, but not
opposite half of retina, loss of one half of field of vision connected with pathway of accommodation reflex.
is the effect of lesion of opposite half of retina (right or Pathway for papillary light reflex is retina optic
left). nerve optic chiasma optic tract lateral geniculate
Beyond optic nerve, nasal fibers of both retina
body superior brachium pretectal nucleus
decussate to go the opposite side to form optic chiasma.
Beyond optic chiasma, optic tract carries fibers from EdingerWestphal nucleus oculomotor nerve
temporal half of same retina and nasal half of opposite ciliary ganglion short ciliary nerve sphincter
retina. Lesion beyond optic nerve may occur in any of pupillae.
the following sites. Pathway for accommodation reflex is, retina
1. Optic chiasma optic nerve optic chiasma optic tract lateral
2. Optic tract geniculate body optic radiation visual cortex of
3. Lateral geniculate body occipital lobe occipitofrontal fasciculus frontal
4. Optic radiation eye field corticonuclear tract oculomotornucleus
5. Visual cortex of occipital lobe. (motor nucleus as well as EdingerWestphal nucleus)
oculomotor nerve medial rectus, ciliary muscle
Lesion of optic chiasma and sphincter pupillae.
This may be of following two types. These are: So, in Argyll Robertsons pupil (ARP), due to lesion
n Lesion of peripheral part: It is usually unilateral in pretectal nucleus, accommodation reflex present
and may occur in any side. It causes damage to the (ARP), but pupillary reflex absent (PRA).
298
Cranial Nerves
3
3
Midbrain EdingesWestphal
nucleus
Mesenceph 5
nucleus
4
5 Superior
Pons salivatory Superior 5
nucleus sensory nucleus S
Dorsal
7 7
6 8 L
8
I 8 M
9 9 7 I
S Ventral Vest. nuclei
Medulla 10 N 5 coch ncl.
12 9
oblongata Nucleus of
11 10 sp. tract
10 10
C5
Nucleus ambiguous
ventrolateral to aqueduct of Sylvius at the level of 2. The visceral efferent nucleus (EWN) receives
superior colliculus of midbrain. connection from pretectal nucleus of both sides,
thus completing the pathway for pupillary light
Connections of nucleus reflex.
3. The oculomotor nucleus is connected through
1. The somatic efferent nucleus receives connection central tegmental chain of nerve fibers to nuclei
from motor area of cerebral cortex of both sides by of Trochlear (IV), Abducent (VI) and Vestibul-
corticobulbar or corticonuclear tract. ocochlear (VIII) nerves. This connection is
300
Cranial Nerves
called medial longitudinal fasciculus which is
for coordination of reflex eye movements during
alteration of equilibrium (balance) of the body.
Posterior
Intraneural course (inside midbrain) cerebral artery
Substantia
nigra Anterior free margin
of tentorium cerebelli
Posterior
clinoid process
Red nucleus
Posterior
fixed margin
of tentorium
cerebelli
Tegmentum
Somatic efferent
nucleus
Section of midbrain
EdingerWestphal nucleus
Fig. 19.10 Oculomotor nerve pierces dura mater at angle
Fig. 19.8 Nuclei of oculomotor nerve with its intraneural between anterior attachments of free and fixed margins of
course and exit from brainstem tentorium cerebelli
301
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Base of brain Endothelial Optic nerve
lining
Hypophysis cerebri Cavernous
Superior division
sinus
Oculomotor
nerve (sup. div)
Oculomotor
nerve (inf. div)
SR
Trochlear
nerve MR LR
Ophthalmic
nerve
Maxillary
nerve
Hypophyseal fossa IR
(of sphenoid) Oculomotor
Ciliary IO
Meningeal nerve
dura ganglion
Endosteal dura
Internal carotid artery Abducent nerve Inferior division Short ciliary nerves
Fig. 19.11 Superior and inferior division of oculomotor nerve Fig. 19.13 Extracranial course and distribution of oculomotor
in relation to lateral wall of cavernous sinus nerve
from above downwards, passes forwards along the compartment of superior orbital fissure. Superior
lateral wall of cavernous sinus. In the anterior part and inferior divisions of the nerve are separated by
the nerve divides into superior and inferior branches nasociliary nerve (Fig. 19.12). Abducent nerve is
(Fig. 19.11). inferolateral to these nerves.
Exit from cranium (to enter the orbit)
Extracranial course and distribution (in the orbit)
Oculomotor nerve leaves the cranium to reach the (Fig. 19.13)
orbit lodging eyeball. It passes out through middle
Oculomotor nerve may enter undivided in the orbit
Superior ophthalmic vein where division may occur. Superior division passes
Rec. meningeal br. of lac. artery upwards lateral to optic nerve to supply.
Trochlear nerve 1. Superior rectus first and a branch pierces this
Superior division muscle to supply
and 2. Levator palpebrae superioris from its inferior
Inferior division of
oculomotor nerve surface.
Inferior division supplies following muscles
1. Medial rectus
2. Inferior rectus
3. Inferior oblique.
General visceral (parasympathetic) efferent fibers
are carried so far through nerve to inferior oblique
Nasociliary from where the fibers leave finally to relay in ciliary
nerve
ganglion. This very tiny ganglion with a size like that
of a pins head, is situated behind eyeball and lateral
Abducent Frontal to optic nerve but medial to lateral rectus muscle.
nerve nerve
Nasociliary nerve
1520 branches. These branches pierces sclera and a) Head injury leading to herniation of uncus of
runs over the surface of choroid to reach forwards to temporal lobe of brain.
supply b) Aneurysm of junction between basilar artery
1. Ciliary muscle (ciliaris) and posterior cerebral artery.
2. Sphincter pupillae.
Cerebral peduncle
Trochlear nerve nucleus
Fig. 19.15 Nucleus and intraneural course of trochlear nerve with its exit from posterior aspect of brainstem (midbrain), after which it
winds round superior cerebellar peduncle and then cerebral peduncle
304
Cranial Nerves
l Same as oculomotor nerve, trochlear nerve also
Cerebral
peduncle passes forwards through the arterial window
bounded (Fig. 19.17).
Above by posterior cerebral artery
Below by superior cerebellar artery
Medially by basilar artery.
l In the lateral wall of cavernous sinus: Trochlear
nerve comes in relation to lateral wall of cavernous
sinus piercing dura mater on the posterosuperior
aspect of roof of the venous sinus. It then passes
forwards between oculomotor nerve and ophthalmic
division of trigeminal nerve. In the anterior part
of lateral wall of the sinus if crosses oculomotor
nerve to approach superolateral compartment of
Superior cerebellar superior orbital fissure (Fig. 19.18).
peduncle
Exit from cranium (to reach orbital cavity) (Fig. 19.12)
Trochlear nerve
The nerve leaves the cranium to reach orbit passing
Fig. 19.16 Emerging from back of brainstem (midbrain), trochlear through lateral (superolateral) compartment of supe-
nerve winds round superior cerebellar peduncle and then rior orbital fissure, medial to exit of frontal and
cerebral peduncle to run forward lacrimal divisions of ophthalmic nerve.
The nerve comes out from back of midbrain below Extracranial course (in the orbit) (Fig. 19.19)
inferior colliculus, piercing superior medullary velum
on either side of frenulum veli. In the orbit, trochlear nerve runs forwards and med-
ially over the eyeball to supply superior oblique pierc-
Intracranial course ing its superior (orbital) surface.
TRIGEMINAL NERVE
Posterior cerebral
artery
Introduction
Trochlear nerve Trigeminal nerve is so called because it presents
three primary divisions Ophthalmic, maxillary
Superior cerebellar and mandibular. It is Vth cranial nerve and mixed
artery in nature.
Basilar artery Functional Components
n Motor: It is the special visceral efferent component
of fibers which is concerned with innervation of mus-
cles developed from 1st branchial arch mesoderm.
Vertebral n Sensory: It is the general somatic afferent comp-
artery onent of following two types
l Exteroceptive: This component receives sensation
from
i. Skin: Touch, pressure, pain and temperature
Fig. 19.17 Trochlear nerve passes forward between posterior cere- sensation from skin of face which is divided
bral and superior cerebellar arteries, lateral to basilar artery into three areas overlying three parts of
305
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
face developed from frontonasal process, iv. Mucous lining of paranasal air sinuses.
maxillary process and mandibular process l Proprioceptive: This component carries sensations
supplied respectively by ophthalmic, maxi- from muscles of mastication, temporomandibular
llary and mandibular division of trigeminal joint and fibrous joints (gomphosis) at the roots of
nerve.
teeth of both upper and lower jaw.
ii. Mucous membrane of oral cavity and nasal
cavity.
iii. Sensitive areas of eyeball, e.g. conjunctiva, Nuclei (Fig. 19.20)
cornea, ciliary body and iris. n Motor nucleus: It is the special visceral efferent
nucleus axons from which finally travel through
mandibular division of trigeminal nerve to supply
muscles developed from mesoderm of first branchial
Fibro- arch. The motor nucleus is situated in upper half of
cartilaginous
pons.
pulley
n Sensory nuclei: Trigeminal nerve has three
Superior oblique Eyeball
muscle different nuclei of general somatic afferent nature,
present in three different components of brainstem
receiving three different types of sensations as follows:
1. Nucleus of spinal tract: It is present throughout
the length of medulla oblongata extending upwards
in the lower end of pons and downwards upto
2nd cervical segment of spinal cord. It receives
pain and temperature sensation via all the three
divisions of trigeminal nerve.
2. Superior sensory nuclei: This nucleus is present
in pons. It receives touch and pressure sensation
via the same three divisions of trigeminal nerve.
3. Mesencephalic nucleus: It is the nucleus rece-
Optic nerve
iving proprioceptive sensations from muscles of
Lateral compartment of
superior orbital fissure
mastication, temporomandibular joint and joints
Trochlear nerve
at the root of teeth. This nucleus is so called as it
Fig. 19.19 Extracranial course and distribution of trochlear nerve is situated in midbrain (mesencephalon).
306
Cranial Nerves
and fibers from medullary nucleus ascend with
horizontally directed fibers from superior sensory
nucleus and motor nucleus at the level of pons to
converge. Finally all the convergent fibers come out of
brainstem through a common site at the level of pons
Mesencephalic
(Fig. 19.20).
nucleus
Exit from brainstem (Fig. 19.21)
It is important to note that motor and sensory roots of
Superior sensory
Motor (special trigeminal nerve comes out of brainstem separately.
visceral efferent)
nucleus Both the roots come out of brainstem close to each
nucleus of
trigeminal nerve other at the junction of basilar part of pons and
middle cerebellar peduncle. Motor root is medial to
Nucleus of spinal
Sensory root
sensory root.
nucleus
(Vth nerve)
Intracranial course
Motor root (Vth
nerve) Trigeminal nerve arises from brainstem in posterior
cranial fossa. But, first it reaches middle cranial fossa
crossing over the superior border of petrous part of
temporal bone close to apex of the part of the bone
(Fig. 19.22).
Fig. 19.20 Nuclei of trigeminal nerve In the middle cranial fossa, course of trigeminal
nerve is divided as follows
Supranuclear connection i. Proximal to trigeminal ganglion
Like motor nuclei of other cranial nerve, motor nucleus ii. Distal to trigeminal ganglion.
of trigeminal nerve is connected by corticonuclear or
corticobulbar fibers to motor areas of cerebral cortex. Trigeminal Nerve Proximal to Trigeminal
Ganglion
Intraneural course
Trigeminal ganglion (Fig. 19.23) is a prominent
First, it is to be noted that exit of trigeminal nerve semilunar ganglion of considerable size located in
is on the ventral aspect of junction between basilar a small depression called trigeminal cave on anter-
part of pons and middle cerebellar peduncle. But osuperior surface of apex of petrous part of temporal
nuclei extend through the whole length of brainstem. bone. Posterior (proximal) margin of the ganglion is
Therefore, fibers from midbrain nucleus descend concave where ends the sensory root of trigeminal
Ophthalmic nerve
Maxillary nerve
Mandibular nerve
Fig. 19.21 Exit of motor (medial) and sensory (lateral) roots of trigeminal nerve. Relation of both the roots with trigeminal ganglion is
also seen
307
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Sensory root of Superior border of petrous
trigeminal nerve part of temporal bone
Semilunar ganglion Motor root of trigeminal nerve
Common tendinous ring
Midbrain
Pons
Superior orbital
fissure
Foramen rotundum
Medulla oblongata
Foramen ovale
nerve. From the convex anterior margin of the gan- pass forwards in relation to lateral wall of sinus.
glion arise three sensory divisions of the nerve, Mandibular division approaches foramen ovale below
namely ophthalmic, maxillary and mandibular nerve. the sinus.
Trigeminal (semilunar) ganglion is made up of cell Motor root of trigeminal nerve passes forwards,
bodies of 1st order pseudounipolar neurons of trige- not through the ganglion but deep to it to run along
minal pathway. So sensory trunk of trigeminal nerve with mandibular sensory divisions. The whole of
represents the central (axonal) process and three sen- motor root of trigeminal nerve therefore continues
sory divisions on convex side of ganglion represent distally as motor root of mandibular nerve.
the peripheral dendritic process of the 1st order of
sensory neurons. Trigeminal Nerve Beyond Trigeminal Ganglion
Distal to trigeminal ganglion, three sensory
divisions of trigeminal nerve are related to wall of Following two points are to be clearly understood at
cavernous sinus. Ophthalmic and maxillary division this stage.
1. Beyond trigeminal ganglion, i.e. from its distal
Maxillary nerve Cell bodies of sensory
convex margin, the trigeminal nerve is distributed
neurons
as its three primary branches, ophthalmic, maxi-
Ophthalmic nerve
llary and mandibular.
2. Motor root of trigeminal nerve is continued, beyond
trigeminal ganglion, as motor root of mandibular
branch. Sensory and motor roots of mandibular
nerve run separately but closely apposed to each
other upto foramen ovale.
OPHTHALMIC NERVE
Ophthalmic nerve is purely sensory division of
trigeminal nerve to enter orbital cavity. The nerve,
through some of its branches carries postganglionic
sympathetic fibers.
Sensory root of n Origin: Ophthalmic nerve arises from upper part
trigeminal nerve of convex distal margin of trigeminal (semilunar)
Sensory root of
Semilunar ganglion
ganglion (Fig. 19.21).
mandibular nerve
n Intracranial course: It is very short to run along
Fig. 19.23 Trigeminal (semilunar) ganglion lateral wall of cavernous sinus below trochlear nerve.
308
Cranial Nerves
At the anterior end of the sinus, the nerve reaches l Skin of upper eyelid
superior orbital fissure. l Conjunctiva.
n Division: Ophthalmic nerve divides into following
three branches before it reaches superior orbital fissure. Nasociliary Nerve (Fig. 19.24C)
l Lacrimal
l Frontal Nasociliary nerve enters orbit passing through central
l Nasociliary. compartment of superior orbital fissure in between
n Exit from cranium: All the three branches of two divisions of oculomotor nerve.
ophthalmic nerve leave cranium through superior After entering the orbit, nasociliary nerve initially
orbital fissure to reach orbit (Fig. 19.22). lies between optic nerve and lateral rectus muscle.
Lacrimal and frontal branches pass through lateral Then it crosses above optic nerve to run forward along
compartment and nasociliary branch passes through the medial side of eyeball. Close to anterior part of
central compartment of superior orbital fissure. medial wall of orbit, nasociliary nerve divides into
two terminal branches infratrochlear and anterior
Lacrimal Nerve (Fig. 19.24A) ethmoidal nerve.
Branches of nasociliary nerve
It runs from behind forwards in the lateral part of 1. Communicating branch to ciliary ganglion:
orbit along upper border of lateral rectus muscle. It is attached to the back of ciliary ganglion. It
The nerve is so called because it terminates in
traverses through ciliary ganglion and comes out
lacrimal gland. Through the gland, branches are also
from the ganglion to divide into multiple branches
distributed to conjunctiva and lateral part of upper
to pass through 1520 short ciliary nerves for
eyelid.
Beside these sensory distributions, lacrimal nerve sensory supply to eyeball.
carries postganglionic parasympathetic secretomotor 2. Long ciliary nerves: These are 23 in number.
fibers for lacrimal gland. These fibers are received from These branches arise from nasociliary nerve on the
zygomaticotemporal nerve. These are postganglionic medial side of optic nerve. They pierce sclera to run
fibers from pterygopalatine (sphenopalatine) ganglion. forward over choroid to give sensory branches to
So, lacrimal nerve is composed of both sensory (own) choroid, ciliary body, iris and cornea. Long ciliary
and motor (borrowed) components. nerve also carry postganglionic sympathetic fibers
to supply dilator pupillae muscle.
Frontal Nerve (Fig. 19.24B) 3. Posterior ethmoidal branch: It is a small bra-
nch of nasociliary nerve arising close to posterior
This nerve runs straightway forwards over the eye- part of medial wall of orbit. It leaves the orbit
ball, above levator palpebrae superioris and below through posterior ethmoidal canal to supply post-
periosteum of orbital roof. Midway between apex and erior ethmoidal and sphenoidal air sinuses.
base of orbit, frontal nerve divides into supraorbital 4. Infratrochlear nerve: It is one of the terminal
and supratrochlear nerve.
branches of nasociliary nerve which runs forward
Supraorbital nerve, being in the same line, is
as a continuation of main nerve. It is so called
considered to be the continuation of frontal nerve.
as it passes below the fibrocartilaginous pulley
It turns upwards round supraorbital margin at
for tendon of superior oblique muscle. It gives
supraorbital notch to supply skin of forehead and
branches to the following
scalp as far backwards upto lambdoid suture.
Other branches to i. Skin of upper as well as lower eyelids
l Skin of upper eyelid
ii. Skin of root of nose
l Conjunctiva
iii. Conjunctiva
l Frontal air sinus. iv. Lacrimal sac.
From the above distribution, it is clear to under- Terminal ends of infratrochlear and supratrochlear
stand that, in case of frontal sinusitis referred pain is nerves are connected by a small communicating twig.
felt in forehead and scalp. 5. Anterior ethmoidal nerve: It is another
Supratrochlear nerve is so called because it runs terminal branch of nasociliary nerve. It runs
forwards and medially above the fibrocartilaginous distally through following areas in sequence, but
pulley (trochlea) for tendon of superior oblique muscle. everywhere for a short distance.
It turn upwards round medial end of supraorbital i. In the orbit it presents brief course with no
margin to reach inferomedial part of forehead to give branch.
branches to ii. In the nasal cavity close to ethmoidal labyrinth
l Skin of inferomedial part of forehead to supply ethmoidal air sinuses.
309
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Lacrimal gland
A Lacrimal nerve
Supratrochlear nerve
Supraorbital nerve
B Frontal nerve
Infratrochlear nerve
C Nasociliary nerve
iii. Next it enters anterior cranial fossa for a iv. In the nasal cavity it divides into two internal
short distance where it runs forward over the nasal branches, medial and lateral. Medial
cribriform plate of ethmoid bone. It leaves branch supplies nasal septum. Lateral branch
cranial fossa through a narrow slit lateral to supplies small area over upper part of lateral
crista galli to enter again nasal cavity. wall of nose and finally leaves nasal cavity
310
Cranial Nerves
Sphenopalatine ganglion
Palpebral
Terminal
branches { Nasal
Labial
Pterygoid canal
Anterior superior
alveolar nerve
Pharyngeal branch
Middle superior
alveolar nerve
Nasal branch
below a small notch on inferior margin of nasal ii. In intraorbital groove and canal: Beyond infe-
bone to reach exterior of nose. rior orbital fissure in floor of orbit.
v. On the exterior of nose it supplies skin of ala, iii. Beyond infraorbital foramen, in face.
vestibule and tip of nose as external nasal
branch. Distribution (Fig. 19.25)
Like ophthalmic nerve, maxillary nerve is also purely i. Posterior superior alveolar nerves: These are
sensory division of trigeminal nerve. thin multiple branches which supply roots of
Its sensory branches are distributed to molar teeth passing through small apertures
i. Roots of teeth of upper jaw. on posterior surface of body of maxilla.
ii. Mucous membrane of palate, small area of ii. Zygomatic branch: It arises from maxillary
pharyngeal wall, nasal cavity. nerve in sphenopalatine fossa but primarily
iii. Mucous membrane of maxillary air sinus. enters the orbit through inferior orbital fissure.
iv. Skin over zygomatic area, lower eyelid, ala of It divides into zygomaticofacial and zygom-
nose and upper lip.
aticotemporal branches which leave the orbit
through two separate canals and respectively
Exit From Cranium supply areas of skin over zygomatic bone and
Just after origin from convex margin of trigeminal behind zygomatic bone.
(semilunar) ganglion, maxillary nerve emerges from
cranium through foramen rotundum to reach pteryg- 2. Branches traversing sphenopalatine ganglion:
opalatine (sphenopalatine) fossa.
Some sensory nerves, as branches of maxillary
nerve traverse through sphenopalatine ganglion
Parts of Maxillary Nerve before reaching destination. These branches
The nerve is divided from behind forward in its course, are
into following parts. i. Pharyngeal branch: Slender twig passes back-
i. In sphenopalatine fossa: Where it is connected ward through palatovaginal canal to supply
to sphenopalatine ganglion by two roots. small area of mucous membrane of pharynx.
311
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Maxillary nerve
Lacrimal gland
Nerve of pterygoid canal
Postganglionic
secretomotor ZT Greater superficial
FR petrosal nerve
fibers joining ZF
lacrimal nerve Geniculate ganglion
Sphenopalatine
ganglion
Nasal branch
Palatine branch
Deep petrosal nerve
Internal carotid
artery
Superior cervical ganglion
Pharyngeal branch
ii. Palatine branch: It runs downwards through a head and neck. It is so called because it is situated
bony canal to divide into anterior (greater) and in sphenopalatine (pterygopalatine) fossa being sus-
posterior (lesser) palatine nerves which supply pended by two roots from maxillary nerve.
mucous membrane of hard and soft palate This ganglion presents 3 roots of communication
respectively. which joins the ganglion from behind. The commu-
iii. Nasal branch: It runs medially to supply nications are
mucous membrane of nasal cavity passing 1. Parasympathetic
through sphenopalatine foramen. 2. Sympathetic
3. Sensory.
Branches from infraorbital groove and canal
Parasympathetic Root
n Middle and anterior superior alveolar nerve:
These are two separate sets of alveolar branches This is nothing but made up of preganglionic
which run along the body of maxilla and divide into parasympathetic secretomotor fibers to relay in the
branches to supply the roots of middle (premolar) and ganglion. These fibers arise from geniculate ganglion
anterior (canine and incisor) sets of teeth respectively. of facial nerve as greater superficial petrosal nerve
All the three sets of superior alveolar nerves also which joins with deep petrosal nerve (carrying
supply mucous membrane of maxillary air sinus. sympathetic fibers) to form nerve of pterygoid canal.
As a component of nerve of pterygoid canal these
Branches in face (beyond infraorbital foramen) fibers join the ganglion from behind to relay there.
These are the three terminal branches of infraorbital
Postganglionic parasympathetic distribution
nerve which is continuation of maxillary nerve beyond
inferior orbital fissure. Postganglionic branches are secretomotor to supply
i. Palpebral To supply skin of lower eyelid different exocrine glands as follows.
ii. Nasal To supply skin of ala of nose i. Pharyngeal branch: Passes from the ganglion
iii. Labial To supply skin of upper lip. backward traversing palatovaginal canal to
supply mucous glands of pharyngeal wall.
SPHENOPALATINE GANGLION (FIG. 19.26) ii. Palatine branches: Pass downward as anterior
(greater) and posterior (lesser) palatine nerves
Sphenopalatine (pterygopalatine) ganglion is the to supply mucous glands of hard palate and
largest of the four parasympathetic ganglion of soft palate respectively.
312
Cranial Nerves
iii. Nasal branches: Passes medially through 2. Skin of face overlying the area developed from
sphenopalatine foramen to supply mucous mandibular process.
glands of nasal cavity. 3. Roots of teeth of lower jaw.
iv. Lacrimal branch: This is postganglionic secre- 4. Mucous membrane of floor of mouth and anterior
tomotor fibers for lacrimal gland. From the two-thirds of tongue.
ganglion, secretomotor fibers for lacrimal 5. Proprioceptive sensory fibers from muscles of
gland pass through following routes. mastication, temporomandibular joints and root of
Sphenopalatine ganglionanterior root of teeth of lower jaw.
communication of maxillary nerve maxillary
nerveZygomatic branchZygomaticotempor-
al branchcommunication with lacrimal ner- Intracranial Course
velacrimal nerve to supply lacrimal gland. Sensory root of mandibular division of trigeminal
nerve arises from distal convex side of trigeminal
Sympathetic Root ganglion. Motor root of trigeminal nerve is continued
This is made up of postganglionic fibers from superior distally beneath trigeminal ganglion as motor root of
cervical ganglion. Initially these fibers pass through mandibular nerve. Both motor and sensory root of the
plexus around internal carotid artery. Finally the nerve descend vertically to approach foramen ovale.
fibers pass as deep petrosal nerve which form nerve
of pterygoid canal along with greater superficial Exit from Cranium
petrosal nerve. Via nerve of pterygoid canal fibers of
sympathetic root join sphenopalatine ganglion. Separate motor and sensory roots of mandibular
nerve comes out of cranial cavity through foramen
Sympathetic distribution (branches) ovale to reach infratemporal fossa.
Sympathetic fibers traversing the ganglion unint-
errupted come out as pharyngeal, palatine and Extracranial Course and Distribution
nasal branches to supply respective areas which are (Fig. 19.27)
vasomotor in nature.
In infratemporal fossa, motor and sensory roots unite
Sensory Root to form trunk of mandibular nerve below foramen
ovale. The trunk of the nerve is medially related to
It is composed of fibers of maxillary nerve which otic ganglion to which it is connected by small root.
join sphenopalatine ganglion through posterior root The trunk of the nerve immediately divides into
connecting the nerve with ganglion.
anterior and posterior divisions.
Sensory distribution (branches) from the ganglion
Before division, trunk gives following two bran-
are through the same pharyngeal, palatine and na-
ches
sal branches which have already been discussed as
branches of maxillary nerve indirectly arising from i. Nerve to medial pterygoid: It supplies medial
sphenopalatine ganglion. It is therefore clear that pterygoid muscle. This branch also sends
pharyngeal, palatine and nasal branches from sphe- motor branches to tensor palati and tensor
nopalatine ganglion are composed of three functional tympani muscles.
components, parasympathetic, sympathetic and sen- ii. Recurrent meningeal branch: It is the sensory
sory. branch to supply meninges of brain. It passes
backward to reenter cranial cavity with a
MANDIBULAR NERVE recurrent course to pass through foramen
spinosum which is in front of spine of sphenoid.
Mandibular division of trigeminal nerve is the only That is why this nerve is also called nervus
mixed part of trigeminal nerve made up of both motor spinosus.
as well as sensory components. So motor component
of trigeminal nerve joins as a whole in mandibular
Distribution from the Divisions
nerve. Mandibular nerve supplies
1. Muscles developed from mesoderm of first bran- It can be compared with distributions from anterior
chial arch which are 8 in number (4+2+2). and posterior divisions of femoral nerve. Anterior
a) 4 muscles of mastication: Masseter, temporalis, division of mandibular nerve gives all muscular bran-
lateral pterygoid and medial pterygoid. ches and one sensory branch. But from posterior
b) 2 tensors: Tensor palati and tensor tympani. division one muscular branch arises with all sensory
c) 2 muscles coupled in digastric triangle: Ante- branches. It is just reverse of branching pattern of
rior belly of digastric and mylohyoid. femoral nerve.
313
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Trigeminal ganglion Sensory root
Ophthalmic nerve
Motor root } of trigeminal nerve
Lingual nerve
Mylohyoid nerve
Inferior alveolar nerve
Buccal nerve
Inferior alveolar nerve
Mylohyoid nerve
Lingual nerve
Fig. 19.28 Some of the branches of mandibular nerve related to lateral pterygoid muscle
314
Cranial Nerves
Motor branch Fiber components of chorda tympani nerve
distributed along the course of lingual nerve are
It is called mylohyoid nerve. It does not arise directly
following
from posterior division but it is a branch of inferior
1. Special visceral afferent: These are carried
alveolar nerve. It supplies anterior belly of digastric
from upper part of nucleus tractus solitarius. Cell
and mylohyoid muscles.
bodies of first order of neurons of this sensory
pathway are situated in geniculate ganglion.
LINGUAL NERVE (FIGS 19.29 AND 19.30)
These fibers of chorda tympani nerve carry taste
Lingual nerve arising from posterior division of sensations from anterior two-thirds of tongue.
mandibular nerve carries general somatic afferent 2. General visceral efferent: These are pregan-
fibers for anterior two-thirds of tongue. glionic parasympathetic secretomotor fibers aris-
It carries therefore general sensation from anterior ing from superior salivatory nucleus. Carried
two-thirds of tongue. along with the fibers of lingual nerve, these fibers
It passes from behind forwards on the hyoglossus relay in submandibular ganglion from where
muscle and presents a curved (looped) course with postganglionic fibers are distributed to subma-
convexity downwards. ndibular and sublingual salivary glands.
It terminal part hooks round anterior end of subm-
andibular duct. INFERIOR ALVEOLAR NERVE (FIGS 19.30 AND
In intratemporal fossa, lingual nerve is joined at 19.31
an acute angle by chorda tympani branch of facial
nerve whose fibers are carried along lingual nerve. It is the only mixed component of posterior division
It is because of chorda tympani nerve fibers carried of mandibular nerve having sensory as well as motor
through, lingual nerve is joined with submandibular fibers.
ganglion which is suspended by two roots. The only motor branch is the mylohyoid nerve.
Inferior alveolar nerve, after its origin from
Distribution of Chorda Tympani Nerve posterior division of mandibular nerve between
Through Lingual Nerve lingual nerve and auriculotemporal nerve, lies deep
Chorda tympani nerve is like that blind person which, to lateral pterygoid muscle initially.
to reach its destination, needs a guide which is lingual But finally to reach mandibular foramen, it eme-
nerve. rges from lower border of muscle.
Lingual nerve
Submandibular ganglion
Submandibular gland
Hyoglossus muscle
Submandibular duct
Fig. 19.29 Lingual nerve joined by chorda tympani branch of facial (VII) nerve with distribution of fiber components
315
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Auriculotemporal nerve Posterior division of
mandibular nerve
Auriculotemporal nerve
Lingual nerve
Lingual nerve
Alveolar branches
Sphenomandibular
ligament Mylohyoid nerve Mental branch Inferior alveolar nerve
Fig. 19.30 Branches of posterior division of mandibular nerve Fig. 19.31 Distribution of inferior alveolar nerve seen from lateral
seen from medial side of mandible side of ramus and body of mandible
Before the nerve enters mandibular foramen, it lies l It arises in the infratemporal fossa.
between the sphenomandibular ligament attached to l It runs initially horizontally backward.
lingula and the ramus of mandible (Fig. 19.30). l It splits and reunites to enclose middle meningeal
Entering the mandibular foramen, inferior alveo- artery which passes upward to pass through foramen
lar nerve runs through a curved canal within the spinosum.
lower part of ramus and the body of mandible called After passing medial to neck of mandible horiz-
mandibular canal which extends from mandibular ontally backward, it changes its directions, first
foramen to mental foramen. laterally then upwards behind temporomandibular
joint and in front of auricle to reach the temple.
Branches
Branches
1. Muscular branch (Fig. 19.30)
1. Temporal branch (superficial temporal)
It is the mylohyoid nerve which arises from inferior
alveolar nerve proximal to mandibular foramen and It is terminal part of the nerve which runs upwards in
pierces sphenomandibular ligament to reach digastric front of auricle to supply skin of temple.
triangle and to supply mylohyoid and anterior belly of
digastric muscles. 2. Auricular branch
This branch is for distribution to following areas
2. Sensory branch (Fig. (19.30 and 19.31) i. Anterosuperior part of skin of lateral surface
i. Articular branches: Short multiple branches of auricle.
sprout from inferior alveolar nerve while it ii. Anterior half of wall of external auditory
passes through canal. These are alveolar bran- meatus.
ches to supply roots of teeth of lower jaw. iii. Anterior half of outer surface of tympanic
ii. Cutaneous branch: After giving incisive bran- membrane.
ches for incisor teeth, terminal part of inferior
alveolar nerve emerges out through mental 3. Articular branch
foramen as mental nerve to supply skin over To the temporomandibular joint.
mental region of face.
4. Secretomotor fibers for parotid gland carried
AURICULOTEMPORAL NERVE (FIG. 19.32) through auriculotemporal nerve
Auriculotemporal nerve, a branch of posterior division These are postganglionic fibers arising from otic
of mandibular nerve, is a purely sensory nerve. ganglion. Preganglionic fibers arising from inferior
316
Cranial Nerves
Temporal branch
Articular branch
Auricular branch
Parotid gland
salivatory nucleus at medulla oblongata, pass initially n Headache: If site of origin of pain is ear, eyes or
through tympanic branch of glossopharyngeal nerve teeth, pain is felt as generalized headache.
to tympanic plexus on the promontory of medial n Referred pain: When site of origin of pain is one,
wall of tympanic cavity. Then fibers pass through referred pain is felt over the area of skin supplied by
lesser superficial petrosal nerve to the otic ganglion. same nerve or its branch.
Postganglionic fibers from the ganglion joining the 1. In case of frontal sinusitis pain is felt over the
trunk of mandibular nerve travel via auriculotemporal skin area of forehead as both frontal sinus as well
nerve to reach parotid gland. as skin of forehead are supplied by supraorbital
nerve.
2. In case of caries tooth (upper or lower jaw) pain is
CLINICAL ANATOMY OF TRIGEMINAL NERVE felt in ear.
Trigeminal nerve, though mixed nerve, is the only 3. In case of cancer of tongue, patient feels pain over
cranial nerve whose sensory distribution through ear as well as temple.
three primary divisions are widespread. It supplies
somatic sensory branches not only to the skin of face, ABDUCENT NERVE
forehead, part of scalp with temple and external
ear, but also it gives branches to the roots of teeth of Introduction
both the jaws, sensative components of eye, mucous
membrane of mouth and part of tongue, and also It is VIth cranial nerve. It is so called because the
only muscle supplied by this nerve, the lateral rectus,
air sinuses. So irritation of any of the branches may
causes abduction or lateral deviation of eyeball.
lead to perception of pain along the distribution of
branches of trigeminal nerve which is called trige-
minal neuralgia. Pain is felt over the whole area of Type
one side of face, ear, temple and scalp. It happens to Abducent nerve is a purely motor nerve.
be excruciating pain originating from teeth (caries),
cancer of tongue, severe sinusitis, ophthalmitis. Functional Component
n Trigeminal block: In case of excruciating pain
due to trigeminal neuralgia, if it is not relieved by Only motor fiber component is somatic efferent
medication, local anesthetic is injected at the site of supplying one of the seven extrinsic (extraocular)
trigeminal ganglion or the nerve roots arising from it. muscle of eyeball which are developed from pre-
n Localized nerve block: For extraction of tooth
occipital myotome of paraxial mesoderm.
from upper or lower jaw maxillary (infraorbital) and
Nucleus
mandibular nerve block are the choice close to the
site of infraorbital foramen and mandibular foramen Somatic efferent nucleus of abducent nerve is situated
respectively. on the dorsal surface of pons on the floor of IVth
317
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Dura mater
Abducent
Superior medullary velum nerve
forming upper part of root
of fourth ventricle
Facial
colliculus Medial
eminence
Hypoglossal
triangle
Middle cranial Posterior cranial
fossa fossa
Exit of abducent
Floor of fourth ventricle nerve from brainstem Abducent nerve
Petrous part of nucleus
temporal bone Olive of medulla
Fig. 19.33 Abducent nerve nucleus is situated beneath facial Fig. 19.35 Abducent nerve fibers, arising from nucleus in the
colliculus which is situated in upper part of median eminence pons, emerge from brainstem above olive, pass upward and
on floor of 4th ventricle forward to reach middle cranial fossa from posterior cranial
fossa piercing dura mater and crossing petrous part of
ventricle on upper part of medial eminence beneath temporal bone
a round bulge called facial colliculus. It is so called
because abducent nerve nucleus is hooked on its 2. Abducent nucleus, along with nuclei of oculomotor
surface by emerging fibers of facial nerve (Figs 19.33 and trochlear nerve is connected to vestibular
and 19.34). nucleus through medial longitudinal fasciculus
which is concerned with reflex movement of eye-
Connections of nucleus ball on alteration of balance of body.
1. The nerve nucleus is connected to motor area of Intraneural course (Fig. 19.34)
cerebral cortex (opposite side as well as same side)
by corticonuclear or corticobulbar tract. Abducent nerve fibers, arising from the nucleus,
proceed from behind forwards traversing
Exit of facial nerve Exit of abducent nerve i. Trapezoid body
Basilar part of pons ii. Medial lemniscus
iii. Basilar part of pons.
Medial lemniscus
Exit from brainstem (Fig. 19.35)
The nerve comes out of brainstem above olive of med-
ulla oblongata at pontomedullary junction.
Intracranial course
In posterior cranial fossa
Abducent nerve, in posterior cranial fossa, runs
upwards and forwards and pierces dura mater post-
erolateral to posterior clinoid process (Figs 19.35 and
19.36).
Facial nerve Facial colliculus Trapezoid body
nucleus In middle cranial fossa
Abducent nerve nucleus
The nerve crosses upper border of patrous part of
Fig. 19.34 Intraneural course of abducent nerve temporal bone, close to apex, to reach middle cranial
318
Cranial Nerves
Anterior clinoid process
Abducent nerve
Foramen magnum piercing dura
(anterior margin) Internal carotid artery
Superior division of
Fig. 19.36 Abducent nerve pierces dura mater in posterior cranial oculomotor nerve
fossa posterolateral to posterior clinoid process and reaches
inferolateral to interal carotid artery
Abducent nerve
fossa where it comes in relation to inferomedial asp-
ect of cavernous sinus. At this site abducent nerve is Nasociliary nerve
inferolateral to internal carotid artery (Fig. 19.37). Inferior division of
oculomotor nerve
Exit from cranium Fig. 19.38 Exit of abducent nerve through middle compartment of
superior orbital fissure and its distribution to lateral rectus
To reach orbital cavity, abducent nerve emerges
through central or middle compartment of superior
orbital fissure inferolateral to two divisions of oculo- CLINICAL ANATOMY
motor nerve which are interposed by nasociliary
nerve (Fig. 19.38). Selective lesion of abducent nerve is rare. If it occ-
urs, it will cause medial strabismus (squint) due to
nonfunction of lateral rectus leading to unopposed
Extracranial distribution (in the orbit)
action of medial rectus.
Reaching the orbit, abducent nerve runs forwards
and laterally between optic nerve and lateral rectus FACIAL NERVE
muscle. It ends by supplying the only muscle, lateral
rectus, through its ocular (medial) surface (Fig. 19.38).
Introduction
Hypophysis cerebri Cavernous sinus Facial nerve is the VIIth cranial nerve.
Oculomotor nerve (sup div)
l It is the nerve which supplies muscles developed
from mesoderm of 2nd branchial arch. These are
a) Muscles of scalp, auricle and of facial expr-
ession with platysma
b) Stapedius muscle of middle ear
Oculomotor
nerve (inf div) c) Posterior belly of digastric and stylohyoid.
Trochlear l It supplies secretomotor fibers to submandibular
nerve and sublingual salivary glands, lacrimal gland,
Ophthalmic mucous glands of pharynx, palate and nasal cavity.
Internal carotid artery nerve l It carries taste sensation from anterior two-thirds
of tongue and form palate.
l It carries proprioceptive sensation from muscles of
Meningeal facial expression.
Abducent nerve
dura
Endosteal dura Maxillary nerve Type
Fig. 19.37 Abducent nerve in relation to cavernous sinus and It is a mixed nerve with multiple motor and sensory
internal carotid artery components.
319
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Facial colliculus
Nuclei of facial
nerve
{ Superior
salivatory nucleus
Nucleus tractus
solitarius
Vestibulocochlear nerve
Sensory root of facial nerve
(nervus intemedius)
Medulla oblongata
Fig. 19.39 Nuclei of facial nerve with its intraneural course and exit from brainstem
Contralateral
Ipsilateral corticonuclear fibers corticonuclear fibers
Dorsal part
Facial nerve
nucleus
{ Ventral part
Facial nerve
and ultimately extend forwards and laterally through reach internal acoustic (auditory) meatus on posterior
tegmentum and basilar part of pons to come out surface of petrous part of temporal bone.
from ventral surface of brainstem at pontomedullary n Entry through the meatus: Facial nerve (motor
junction. and sensory roots still separate) enters through
Afferent fibers from nucleus tractus solitarius internal auditory meatus along with vestibulocochlear
initially ascend from the level of medulla oblongata to nerve and internal auditory (labyrinthine) artery, a
reach pontomedullary junction where they come close branch of basilar artery.
to emerging fibers of motor and superior salivatory
nuclei. These fibers form lateral sensory root of the Intrapetrous Part of Facial Nerve (Fig. 19.41)
nerve.
Inside the petrous part of temporal bone facial nerve
Exit from Brainstem (Fig. 19.39) has a complicated course which is briefed in a simple
manner as follows.
Both the motor as well as sensory fibers of the nerve 1. Passing through internal auditory meatus, sepa-
converge at pontomedullary junction but motor and rate roots of facial nerve pass laterally above the
sensory roots come out of brainstem separately like
level of vestibule of labyrinth or internal ear.
those of trigeminal nerve. Like trigeminal nerve,
2. Then it reaches medial wall of middle ear cavity to
motor root is medial. Both the roots emerge from
enter a bony canal called facial canal.
pontomedullary junction lateral to olive. Further
3. At the commencement of facial canal on the medial
laterally emerges vestibulocochlear (VIIIth) cranial
wall of middle ear cavity two roots of the nerve
nerve.
unite where it shows two changes
i. The canal transmitting the nerve changes its
Intracranial Course
direction to pass backwards forming a bend or
Coming out of brainstem both motor and sensory genu.
roots of facial nerve run forwards and laterally in ii. At the site of bend or genu, the nerve presents
the posterior cranial fossa for a very short course to a ganglion called geniculate ganglion.
321
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Motor and sensory roots of facial nerve
Geniculate ganglion
Facial nerve in facial
Greater superficial petrosal canal
nerve
Promontary
Nerve to stapedius
Stapedius muscle
Medial wall of middle ear through pyramid
Posterior wall of
middle ear
Geniculate ganglion is the peripheral sensory gan- Branches of Intrapetrous (Intracranial) Part of
glion of facial nerve. Being homologous to posterior Facial Nerve
root ganglion of spinal nerve, it is composed of cell
1. Greater superficial petrosal nerve: This
bodies of 1st order of neuron of sensory pathway
nerve arises from geniculate ganglion of facial
through facial nerve.
nerve. It comes out through hiatus for greater
4. During its course horizontally backwards through
superficial petrosal nerve on anterosuperior surf-
the facial canal, the nerve passes above promontory
ace of petrous part of temporal bone and run
on medial wall of middle ear cavity (tympanic over foramen lacerum where it is joined by deep
cavity). petrosal nerve (sympathetic fibers from internal
5. At the junction of medial wall and posterior wall carotid plexus) to form nerve of pterygoid canal.
of middle ear cavity, the facial canal lodging the Via nerve of pterygoid canal, fibers of greater
nerve presents a second bend to pass vertically superficial petrosal nerve end in sphenopalatine
downwards. (pterygopalatine) ganglion. Postganglionic secret-
6. Vertical part of facial canal, in the posterior wall omotor fibers (general visceral efferent) are distri-
of tympanic cavity, is related in front to conical buted to lacrimal gland and mucous glands of
elevation called pyramid which lodges stapedius, pharynx, palate and nasal cavity.
a tiny muscle of tympanic cavity. Greater superficial petrosal nerve also contains
7. Apex of pyramid present a small aperture through special visceral afferent fibers carrying taste sensation
which stapedius muscle comes out forwards to be from palate and upper part of pharyngeal wall to
inserted at neck of stapes. upper part of nucleus tractus solitarius. Cell bodies
8. Vertical part of facial canal ends at stylomastoid of 1st order of this neuronal pathway are situated in
foramen of temporal bone. geniculate ganglion.
9. So intrapetrous part of facial nerve is in between 2. Nerve to stapedius: It is short branch arising
internal auditory meatus and stylomastoid fora- from facial nerve in vertical part of facial canal. It
men. enters the muscle lodged in pyramid.
322
Cranial Nerves
Contraction of stapedius pulls the neck of stapes carrying taste sensation from anterior two-thirds
backwards and this damps down the conduction of of tongue. Central processes reach upper part of
sound wave passing through solid medium formed by nucleus tractus solitarius.
chain of ear oscicles. So lesion of nerve to stapedius, 2. General visceral efferent: These are pregang-
leading to release of damping down effect, makes the lionic secretomotor parasympathetic fibers of
sound audible more loudly in the affected ear. This the nerve, which arise from superior salivatory
defect is called hyperacusis. nucleus. Postganglionic fibers are distributed from
3. Chorda tympani nerve: This branch arises from submandibular ganglion to submandibular and
facial nerve 6 mm above stylomastoid foramen sublingual salivary glands.
(Fig.19.41).
From posterior wall of tympanic cavity, the nerve Exit of Facial Nerve from Cranium
passes through the lateral wall formed by tympanic
membrane. Facial nerve comes out through stylomastoid foramen,
Chorda tympani nerve runs forwards through the crosses lateral aspect of styloid process of temporal
plane between fibrous and mucous layers of trilaminar bone and immediately enters parotid gland through
tympanic membrane. upper part of its posteromedial surface.
The nerve comes out through petrotympanic
fissure. Extracranial Part of Facial Nerve (Fig. 19.43)
It passes medial to spine of sphenoid bone to join Emerging through stylomastoid foramen, facial
lingual nerve at an acute angle at infratemporal fossa. nerve runs forwards crossing lateral aspect of styloid
process of temporal bone. Before it enters parotid
Distribution of Chorda Tympani Nerve (Fig.
gland through upper part of posteromedial surface,
19.42)
facial nerve gives following branches
Fibers of chorda tympani nerve are distributed thro- 1. Posterior auricular nerve: It gives auricular
ugh lingual nerve. and occipital branches. Auricular branch send
The nerve contains following functional compo- branches to the extrinsic as well as intrinsic
nents of fibers. muscles of medial or cranial surface of auricle which
1. Special visceral afferent: These fibers are includes auricularis posterior muscle. Occipital
the peripheral processes of geniculate ganglion branch supplies occipital belly of occipitofrontalis.
Lingual nerve
Nucleus tractus
solitarius
Chorda tympani
nerve
Sublingual gland
Submandibular ganglion
Lingual nerve hooking
round submandibular duct Hyoglossus muscle Deep part of submandibular gland
UB
LB
Facial nerve
emerges through
stylomastoid foramen
crosses lateral aspect of
M styloid process
enters parotid gland through
posteromedial surface
C
Fig. 19.43 Extracranial part of facial nerve with its terminal branches: TTemporal, Z Zygomatic, UBUpper buccal, LB Lower
buccal, MMarginal mandibular, and CCervical
2. Nerve to digastric and stylohyoid: This bra- a) Upper buccal branch: Supplies muscles of
nch arises near stylomastoid foramen. It sends external nose and upper lip.
branches to stylohyoid and posterior belly of b) Lower buccal branch: Supplies buccinator and
digastric muscles which form posterior boundary orbicularis oris.
of digastric triangle. 4. Marginal mandibular branch: Supplies mus-
cles of lower lip and chin.
Facial Nerve in Parotid Gland (Fig. 19.44) 5. Cervical branch: It comes through apex of parotid
Entering through upper part of posteromedial surface gland and supplies platysma on the subcutaneous
of parotid gland facial nerve divides into terminal plane of neck.
branches. These branches pass from behind forwards
through a plane between superficial and deep parts of CLINICAL ANATOMY
the gland.
Clinical Test to Judge Function of
Terminal Branches of Facial Nerve (Figs 19.43 Facial Nerve
and 19.44)
1. Frowning: Appearance of small parallel vertical
These are five in number. creases on root of nose by corrugator supercilii and
These branches come out of the gland piercing transverse creases on forehead by frontalis.
anteromedial surface very close to anterior border of
2. Tight closure of eyelids: By contraction of
parotid gland.
orbicularis oculi.
They run in temporofrontal region and face to
3. Smiling: It is associated with bilateral symme-
supply muscles of those areas.
1. Temporal branch: Supplies frontalis, corrugator trical contraction of levator anguli oris of both side.
supercilii, muscles on external surface of auricle, In paralysis of one side, there will be asymmetrical
upper part of orbicularis oculi. elevation of angle of mouth on the normal side.
2. Zygomatic branch: Supplies lower part of orbic- 4. Blowing of mouth: The person is asked to fill up
ularis oculi, zygomaticus major and minor. the mouth cavity with air with tight closure of lips.
3. Buccal branches: Upper and lower, running Then finger pressure is applied over the cheeck to
above and below parotid duct respectively. feel resistance offered by buccinator.
324
Cranial Nerves
Temporal
Anteromedial surface of
parotid gland
Upper buccal
Parotid duct
Lower buccal
Posteromedial surface of
parotid gland
Mandibular
Terminal
branches of
facial nerve
Cervical
Fig. 19.44 Facial nerve enters through upper part of posteromedial surface of parotid gland. Its terminal branches emerge close to
anterior border. (Medial view of the gland)
Facial Nerve Lesion cerebral cortex. So, understanding the above note and
consulting the (Fig. 19.40), it is clear that lesion of
Lesion of facial nerve is very common. This lesion
corticonuclear fibers of one side will lead to paralysis
may be intraneural, intracranial or extracranial.
of muscles of lower half of face of opposite side sparing
But as per the site of lesion of the nerve, it is
upper half as it has supranuclear control from the
classified into following types
same side in addition.
l Nuclear
l Supranuclear
Infranuclear lesion (Fig. 19.45)
l Infranuclear.
n It is extraneural, but may be intracranial or
Nuclear lesion extracranial: Infranuclear lesion means lesion of
It is intraneural, at the level of pons where motor facial nerve anywhere after its exit from the brain-
nuclei of facial nerve are situated. It is vascular in stem. It may be at different level with different
origin due to ischemic change of branches of basilar manifestations as mentioned below. The level of
artery supplying basilar part of pons. It leads to lesion lesion is to be correlated with the (Fig. 19.45).
of nuclei of pons with emerging nerve fiber and fibers 1. Lesion beyond stylomastoid foramen: It is
of corticospinal tract passing through basilar part of called Bells paralysis. Cause of this lesion is
pons. The lesion is called Millard Gubler syndrome compression of the nerve within stylomastoid
which is characterized grossly by contralateral hemi- foramen. Very often it results due to inflammation
plegia and ipsilateral total facial paralysis. of the neural sheath following exposure to cold.
Effect is temporary.
Supranuclear lesion (Fig. 19.40) Clinical manifestation of Bells palsy is due to
(this lesion is also intraneural) paralysis of all muscles of facial expression on
Fibers from dorsal part of facial nerve nucleus the affected side. The affected side seems to be
supply muscles of upper half of face, whereas those motionless with abolition of emotional expression.
from ventral part of nucleus supply lower half facial There is widening of palpebral fissure between
muscles. Both the parts of nucleus receive cortico- two eyelids. If attempted, tight closure of eyelids
bulbar (corticonuclear) fibers from opposite cerebral will be failed. Nasolabial furrow will be less prom-
cortex. In addition, dorsal part of nucleus also inent. Patient will complain of accumulation
receives projection from motor area of same sided of masticated food in vestibule of mouth due to
325
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
3
Nerve to stapedius
Greater superficial petrosal
nerve 2
Stylomastoid foramen
Chorda tympani nerve
Terminal Zygomatic
branches of facial 1
Upper buccal Nerve to stylohyoid and
nerve
Lower buccal posterior belly of digastric
Marginal mandibular
Cervical
paralysis of buccinator muscle. Due to paralysis Vestibular component of the nerve carries impulses
of lacrimal part of orbicularis oculi, action of required for maintenance of equilibrium or balance of
lacrimal puncta fails to drain lacrimal fluid into body.
lacrimal sac, so lacrimal fluid may dribble from Cochlear component carries impulse for perception
inner canthus of eye. Due to paralysis of frontalis, of hearing.
abolition of transverse creases on forehead will For both the components, receptor or peripheral
be noted. If patient is asked to show teeth or in sensory end organs are situated in specialized part of
case of attempt for smiling, angle of mouth will internal ear (membranous labyrinth) (Fig. 19.46).
be asymmetrically raised on normal side due to Vestibulocochlear nerve is commonly known as
unilateral contraction of elevators of upper lip and auditory nerve.
angle of mouth. As both the components of the nerve form the
2. Lesion above origin of chorda tympani parts of respective sensory pathways, the nerve is
branch: In addition to disabilities due to Bells to be studied alongwith description of the sensory
paralysis, there will be loss of taste sensation from pathways.
anterior two-thirds of tongue and salivation will
be impaired due to lesion of secretomotor fibers to VESTIBULAR PATHWAYS
submandibular and sublingual salivary gland.
It is the special somatic afferent pathway which fun-
3. Lesion above the origin of nerve to stapedius:
ctions for maintenance of equilibrium or balance of
In addition to above disfunctions, patient will body.
suffer from hemihyperacusis due to loss of dam-
ping down effect in conduction of sound wave Composition of Pathway (Fig. 19.47)
through stapes of the chain of middle ear ossicles.
4. Lesion proximal to origin of greater supe- 1. Receptor: It is the peripheral sensory end organ
rficial petrosal nerve: This branch of facial nerve called vestibular receptor which is situated in
carries secretomotor fibers for lacrimal gland and specialized area of wall of membranous labyrinth
taste fibers of soft palate. So lesion proximal to (Fig. 19.46).
origin of this nerve will cause loss of lacrimation 2. First order of neurons: These are bipolar cells
and loss of taste sensation from soft palate. (not pseudounipolar) whose peripheral processes
are carried from receptors and central processes
VESTIBULOCOCHLEAR NERVE enter brainstem. The collection of cell bodies form
vestibular ganglion. The processes from vestibular
Vestibulocochlear nerve is VIIIth cranial nerve and it nerve.
is a purely sensory nerve made up of two components, 3. Second order of neurons: Vestibular nuclei at
vestibular and cochlear. pontomedullary junctions.
326
Cranial Nerves
Macular of saccule Macula of utricle
Ampullary crest
Efferent from vestibular nuclei project to membrane. Gelatinous mass of the membrane moves
i. Flocculonodular lobe of cerebellum. in case of movements of head which stretches the
ii. Interconnect nuclei of IIIrd, IVth, VIth and microvilli of hair cells, generating action potential.
XIth cranial nerves n Organ of kinetic balance: It is called kinetic
iii. Spinal cord. receptor. It is stimulated during movements of head
4. Third order of neurons: Thalamus. and coordinates movements of eyeball and neck
5. Sensory area of cerebral cortex: Postcentral with head movements. Receptors for kinetic balance
gyrus. are situated in the wall of ampulla of all the three
semicircular ducts of membranous labyrinth. These
Vestibular receptors are called ampullary crests.
n Ampullary crest (Fig. 19.50): This end organ for
These are end organs for balance which are specialized
areas of some selective parts of wall of membranous kinetic balance is present in the form of specialized
labyrinth. area of epithelial lining of ampulla of semicircular
These are of two functional types. ducts.
n Organ of static balance is called static labyrinth.
These are situated in anterior wall of saccule and Structure of Ampullary Crest (Fig. 19.49)
utricle. The specialized areas are called macula. Surface epithelium from the wall of ampulla of
Static labyrinth is for recognition of position of head each of the three semicircular ducts of membranous
in reference to gravity. It also maintains the balance labyrinth forms ridge or crest-like elevation, which
of head during the acceleration or decelaration phase is called ampullary crest. In each ampullary wall
of momentum, for example for detection of position of
crest arise from opposite pole giving the appearance
head when a moving vehicle increase or decrease the
of lumen like figure of eight (Fig. 19.50). Surface of
speed.
the crest present hair cells which are the receptors
n Maculae (Fig. 19.48): Maculae are the specialized
for kinetic balance. Free surface of these cells present
area in the anterior walls of saccule and utricle.
stereocilia. From the basal surface free endings of
These areas of the labyrinth are lined by specialized
cells. The receptor cells are hair cells. Hair cells are vestibular nerve start. The hair cells are supported
interlaced with tall columnar supporting cells resting by tall columnar cells (supporting cells). A dome of
on basement membrane. Free surface of the hair cells gelatinous material covers the free surface of hair
which are actual receptor cells presents numerous cells. It is known as cupola (Fig. 19.49). Cupola differs
stereocilia (nonmotile) and one motile kinocilium. from otolithic membrane of macula, as it does not
Free ciliary surface of hair cells are embedded into contain particles of calcium carbonate.
a thick pad of gelatinous material which consists n Generation of action potential: For both the
of irregular particles of calcium carbonate. These cases of vestibular receptors, vibration of endolymph
irregular particles of calcium carbonate are called causes oscillation of gelatinous membrane (otolithic
otolith for which the membrane is named otolithic membrane and cupola) on the stereocilia of free
327
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Postcentral gyrus
IV nerve nucleus
Medial longitudinal fasciculus
VI nerve nucleus
Vestibulocerebellar fibers
Vestibular nuclei
Vestibular nerve
Vestibular ganglia
surface of hair cell receptors. Stretching of hair cells Entry of Vestibular Nerve in Brainstem
stimulates vestibular nerve endings at the basal
Entry of this sensory nerve in the brainstem is
surface of hair cells which generate action potential.
at the site of surface attachment of the nerve at
pontomedullary junction lateral to olive of medulla
Vestibular Ganglion and Vestibular Nerve oblongata. It is one of the two components of vestibu-
Vestibular ganglion is made up of cell bodies of locochlear nerve, attached just lateral to exit of facial
bipolar neurons which are the first order of neurons nerve, fibers of vestibular nerve are lateral to those of
in the vestibular pathway. The ganglion is located at cochlear nerve.
the bottom (fundus) of internal auditory meatus. The
bipolar neurons of vestibular ganglion are homologous It is clinically important to note that both vestibu-
to pseudounipolar neurons of posterior root ganglion locochlear nerve as well as facial nerve are related
of a spinal nerve. Peripheral processes of the bipolar to cerebellopontine angle (CP angle) in the posterior
neurons of vestibular ganglion are in contact with cranial fossa after coming out from internal auditory
base of hair cells. Central processes continue as meatus and before entering brainstem. So, the nerves
vestibular nerve. may be affected in CP angle tumors of brain.
328
Cranial Nerves
Otolith Gelatinous otolithic membrane
Stereocilia
Gelatinous mass of cupola
with no otolith
Supporting cells
Hair cells
Peripheral processes of
neurons of vestibular ganglion
Scela vestibuli
Vestibular membrane
Membrana tectoria
Hair cells
Cells of Hensen
Cells of Claudius
Interphalangeal
cells of Deiters
Basilar membrane
Peripheral processes of
bipolar cells
Scela tympani
Fig. 19.51 Organ of Corti (cochlear receptor) and origin of cochlear nerve
outer rows. Basal aspect of the hair cells present two Deiters. Secondly, basal aspect of hair cells present
characteristics. They are received or supported by contact with synaptic knobs of bipolar type 1st order
cups of columnar supporting cells whose free ends of neurons which form spiral ganglion located in
present finger-like projection in between hair cells modiolus. Free surface of hair cells also present two
for which they are called interphalangeal cells of characteristics. One cell is covered by about 100
331
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
numbers of stereocilia. Stereocilia of hair cells pass enters brainstem through anterolateral aspect of
through pores of a net-like membrane called reticular pontomedullary junction. Entering brainstem, fibers
membrane to come in contact with thick pad-like of cochlear nerve divides into two groups to end in
gelatinous membrane which is attached medially ventral and dorsal cochlear nuclei, ventral and dorsal
to the limbus of osseous spiral lamina. It is called to inferior cerebellar peduncle (Fig. 19.52).
membrana tectoria. Peripheral to outer row of hair
cells, supporting cells are typical columnar called Second Order of Neurons Cochlear Nuclei
cells of Hensen. Most laterally, adjacent to bony wall (Fig. 19.52)
of cochlear duct, cells are shorter in height, called Axons of both ventral and dorsal cochlear nuclei pass
cells of Claudius. horizontally and, forwards and medially through
central tegmental part of pons.
First Order of Neuron and Cochlear Nerve n Decussation of fibers to form trapezoid body:
In central tegmental part of pons of this level, fibers
Cochlear nerve is the central process of first order of
of both cochlear nuclei partly run in the same side
neuron in cochlear pathway. These neurons are bipolar
and partly decussate to pass to other side and relay in
cells. Cell bodies of these bipolar neurons are present a nucleus. As the fibers of both side partly decussate
in the form of cluster called spiral ganglion (Fig. 19.51). and partly run ipsilateral, these give the appearance
Spiral ganglion with adjacent part of their process of a trapezium, for which called trapezoid body. So
are present in the bony canals of modiolus which are the nucleus is called nucleus of trapezoid body (Fig.
called spiral canal. Peripheral process of cells of spiral 19.52).
ganglion form contact with basal aspect of hair cells. So, it is clear that nucleus of trapezoid body of one
Central processes form cochlear nerve which finally side receives fibers from ventral and dorsal cochlear
comes out of petrous part of temporal bone through of both sides. It proves that, impulse from one ear,
internal auditory meatus along with vestibular comp- via trapezoid nuclei of both sides ascends to higher
onent of eight cranial (auditory) nerve. The nerve sensory centers of both sides.
Inferior colliculus
Lateral lemniscus
Cochlear nerve
Spiral ganglion
Ventral cochlear nucleus
Trapezoid body Nucleus of trapezoid body
LAST FOUR CRANIAL NERVES 6. At the site of base of skull, in between great artery
and vein of neck, cranial root of accessory joins
Last four cranial nerves are the vagus losing its own identity. The spinal root
courses thereafter independently as accessory
IX Glossopharyngeal nerve nerve.
X Vagus nerve 7. From the gap between internal carotid artery and
XI Accessory nerve internal jugular vein, finally four cranial nerves
XII Hypoglossal nerve. follow different course as follows (Fig. 19.53)
Before each of these four cranial nerves are Glossopharyngeal (IX) nerve runs downwards,
discussed separately, following points are to be noted. forwards and medially passing superficial to internal
1. Four cranial nerves come out of the cranium thro-
carotid artery and deep to external carotid artery, i.e.
ugh two bony apertures, jugular foramen and
between two arteries to reach tongue and pharynx.
hypoglossal canal.
Vagus (X) nerve descends vertically downward
2. Intermediate component of jugular foramen tran-
between carotid artery and internal jugular vein.
smits IXth, Xth and XIth nerves. Hypoglossal
(XIIth) nerve comes out through hypoglossal canal. Accessory (XI) nerve (spinal root) passes down-
3. Coming out of cranial cavity, in the base of skull wards and backwards either superficial or deep to
they are initially closely related to each other internal jugular vein.
where they lie in between internal carotid artery Hypoglossal (XII) nerve runs downwards, forwards
and internal jugular vein. and medially superficial to both internal and external
4. IXth and Xth cranial nerves being mixed in carotid artery to reach the tongue.
nature, present at the base of skull superior and
inferior ganglia for their sensory component of GLOSSOPHARYNGEAL NERVE
fibers. Superior as well as inferior ganglia of both
the nerves are homologous to dorsal root ganglia of Introduction
spinal nerves or semilunar ganglion of trigeminal
nerve. Glossopharyngeal nerve is ninth (IXth) cranial nerve.
5. Accessory (XI) and hypoglossal nerve (XII) are It is the nerve to supply muscle developed from third
motor nerves. branchial arch.
Accessory nerve Vagus nerve
Hypoglossal nerve
Glossopharyngeal nerve
Internal carotid artery
External carotid artery
Glossopharyngeal nerve
Lingual artery
Vagus nerve
Fig. 19.53 Last four cranial nerves related to great vessels of neck
334
Cranial Nerves
Type one-third of tongue and also same sensation from
circumvallate papillae of anterior two-thirds. The
It is a mixed cranial nerve. fibers are carried to nucleus tractus solitarius.
2. General visceral afferent: These fibers carry
Nuclei general sensation from viscera like pharynx,
n Motor nucleus: It is special visceral efferent carotid body and carotid sinus. Fibers carry general
nucleus called nucleus ambiguous. Nucleus ambig- sensory impulse to nucleus tractus solitarius.
uous is a composite nucleus of IXth, Xth and XIth 3. General somatic afferent: These fibers of
cranial nerves. Upper part of nucleus is part for glossopharyngeal nerve carry general somatic
glossopharyngeal nerve. Fibers pass to supply stylop- sensation, e.g. touch, pain and temperature from
haryngeus which is the muscle developed from meso- posterior one-third of tongue, palate, tonsil and
pharynx. Having no general somatic afferent
derm of third branchial arch.
nucleus of its own, these fibers of glossopharyngeal
n Inferior salivatory nucleus: It is also the motor
nerve, after entering brainstem end in nucleus of
nucleus of general visceral efferent group. This is one
spinal tract of trigeminal nerve.
of the four parasympathetic nuclei of cranial nerves.
n Nucleus tractus solitarius: It is also a composite
Intraneural Course (Fig. 19.54)
nucleus for VIIth, IXth and Xth cranial nerve of
special visceral afferent group. All the nuclei of glossopharyngeal nerve are situated
All the three nuclei of glossopharyngeal nerve are more close to the dorsal aspect of medulla oblongata.
situated in medulla oblongata. Fibers from all the nuclei converge and run forwards
and laterally through the tegmental core of medulla.
Functional Components During ventrolateral course, the emerging nerve
fibers are related medially to medial lemniscus and
Motor spinothalamic tracts and laterally to nucleus of
spinal tract of trigeminal nerve. The nerve traverses
1. Special visceral efferent: These fiber component reticular formation of medulla oblongata.
is made up of axons arising from nucleus amb-
iguous to supply only one muscle developed
Exit from Brainstem (Fig. 19.54)
from third branchial arch mesoderm which is
stylopharyngeus. Glossopharyngeal nerve comes out through the upper
2. General visceral efferent: These are prega- end of a vertical sulcus between olive and inferior
nglionic parasympathetic secretomotor fibers of cerebellar peduncle. It lies in a vertical row with roots
the nerve, which arise from inferior salivatory of vagus and accessory nerves arranged serially from
nucleus, for parotid gland. above downwards.
Tympanic plexus
Glossopharyngeal
nerve
Jugular foramen
Superior ganglion
Soft palate Tympanic branch
arising from inferior
ganglion
Muscular branch to
stylopharyngeus
Pharyngeal branch
Middle constrictor muscle of
pharynx
Reticular formation
Medial lemniscus
Vagus nerve
Pyramid
Spinothalamic tract
Vagus nerve
Pharyngeal branch
Cardiac branches
Right bronchus
Anterior pulmonary plexus
Cardiac branches
Inferior cerebellar
peduncle
Inferior olivary
nucleus Spinothalamic
tract Spinal root of accessory
Pyramid nerve ascends to join
Medial lemniscus cranial root
Fig. 19.59 Intraneural course of cranial root of accessory nerve Fig. 19.60 Intraneural course of spinal root of accessory nerve
Rootlets of cranial
accessory nerve
Jugular foramen
Cranial root of
accessory nerve joining Sup. ganglion of vagus
vagus nerve
Inf. ganglion of vagus
Spinal root of
accessory nerve
entering through
foramen magnum Spinal accessory
nerve
Pharyngeal branch of
vagus nerve
Right recurrent laryngeal
nerve
Left recurrent
laryngeal nerve
Right vagus
nerve Left vagus nerve
Fig. 19.61 Surface attachment, intracranial course and exit from cranium of accessory nerve and its relation with vagus nerve
of vagus. Beyond this, cranial root does not possess rnal jugular vein, deep to parotid gland and styloid
its own identity. Its fibers are distributed through process. Here it lies in the point midway between
following two branches of vagus. angle of mandible and mastoid process. Next it
1. Pharyngeal branch of vagus: Though topogr- changes its direction to pass downwards, backwards
aphically it is a branch of vagus, it contains and laterally, superficial to internal jugular vein and
special visceral efferent fibers of accessory nerve deep to sternocleidomastoid. Here it is related to
to supply number of lymph nodes.
a) All muscles of palate except tensor palati. The nerve pierces or passes deep to anterior border
b) All muscles of pharynx except stylopharyngeus. of sternocleidomastoid at its junction of upper one-
2. Recurrent laryngeal nerve: This branch of fourth and lower three-fourths. Here it communicates
vagus is a mixed nerve. Special visceral efferent (forms a network) with IInd and IIIrd cervical nerves.
fibers are contributed by cranial root of accessory The nerve appears in posterior triangle of neck
which supply all muscles of larynx except crico- coming out of posterior border of sternocleidomastoid
thyroid. Sensory component of the nerve are the at the junction of upper one-third and lower two-
fibers of vagus which supplies infraglottic part of thirds of the muscle. Here also the nerve is related to
mucous membrane of larynx. a group of lymph nodes.
In the posterior triangle of neck, spinal accessory
Spinal root (spinal accessory nerve) (Fig. 19.62) nerve runs downwards, backwards and laterally over
Being separated from cranial root, it descends levator scapulae, being embedded in the investing
vertically between internal carotid artery and inte- layer of deep cervical fascia forming the roof of
345
Easy and Interesting Approach to Human Neuroanatomy (Clinically Oriented)
Lymph nodes
Lymph nodes
Sternocleidomastoid
Trapezius
Vagus nerve
Medial lemniscus
Inferior olivary nucleus
Pyramid
Hypoglossal nerve (left) exits through
Arcuate nucleus anterolateral sulcus of medulla oblongata
C1 nerve root
Beyond anterior border of hyoglossus, the nerve anterior wall of carotid sheath. From the ansa (C1,
divides into terminal branches inside the tongue. C2, C3) infrahyoid muscles are supplied.
4. : Some fibers of C1 nerve are carried further
Branches forwards with hypoglossal nerve and bifurcate to
supply geniohyoid and thyrohyoid muscles.
1. Terminal branches: For better understanding,
terminal branches are to be discussed first.
Terminal branches of hypoglossal nerve are the CLINICAL ANATOMY
only fibers of the nerve itself, which supply all the Lesion of hypoglossal nerve is central in origin
extrinsic as well as intrinsic muscles of tongue
and it is for vascular cause occurring as a result of
except palatoglossus.
occlusion of medullary (paramedian) branches of
Others are topographically the branches of hypo- vertebral artery. It causes damage to the ventral
glossal nerve, but these fibers are contributed by Ist part of medulla oblongata. The clinical condition
cervical nerve. These branches are as follows: is called ventral medullary syndrome. It causes
2. Recurrent meningeal branch: This branch re- crossed paralysis characterized by contralateral
enters cranial cavity through hypoglossal canal to hemiplegia and paralysis of muscles of tongue of
supply meninges of posterior cranial fossa. same half. If the lesion is extensive, it will cause loss
3. Descendens hypoglossi: This branch, arising of sense of position and movement and discriminative
from hypoglossal nerve descends first in front touch of opposite side due to involvement of medial
of carotid arteries, and joins with descendens lemniscus. If spinal lemniscus lateral to emerging
cervicalis formed by twigs from C2 and C3 nerve fibers of hypoglossal nerve is affected, it will cause
to form ansa cervicalis. Ansa cervicalis is a loop contralateral hemianesthesia.
of nerve, so formed, which is embedded in the
348
Index
354