Neuroanatomy. Dr. Maha ELBeltagy. Assistant Professor of Anatomy Faculty of Medicine The University of Jordan
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1 Neuroanatomy Dr. Maha ELBeltagy Assistant Professor of Anatomy Faculty of Medicine The University of Jordan 2018
2 THE BRAIN STEM It includes: Midbrain Pons Medulla oblongata Anterior view Anterior view 1. Optic chiasma 2. Optic nerve 3. Optic tract 4. Medial sulcus of the crus cerebri 5. Oculomotor nerve 6. Pons 7. Pyramidal eminence of the pons 8. Retroolivary fossa 9. Olive 10. Posterolateral sulcus 11. Decusssation of the pyramids 12. Anterolateral sulcus 13. Lateral funiculus 14. Pyramid 15. Foramen caecum 16. Middle cerebellar pedunculus 17. Trigeminal nerve 18. Crus cerebri 19. Posterior perforated substance 20. Mammillary body 21. Tuber cinereum 22. Infundibulum
3 The midbrain The cerebral aqueduct divides the midbrain into : Tectum (behind the duct). 2 cerebral peduncles: each one consist itof Crus cerebri (2), Substantia nigra & Tegmentum. Anterior surface of midbrain: Tegmentum Tectum Substantia nigra Is formed of the 2 crura enclosing interpeduncular fossa in between them. The oculomotor nerve (1) emerges from the medial aspect of the crus cerebri. Posterior surface: Is formed of : 2 superior colliculi (3): connected to the lateral 1 2 geniculate body (6) by superior brachium (5). 5 2 inferior colliculi (4) : connected to the medial 3 geniculate body (8) by inferior brachium (7). 6 The trochlear nerve emerges from the back of midbrain
4 The interpeduncular Fossa Boundaries: Anterior: Optic chiasma (1). Posterior: Pons Anterolateral: Optic tract t& crura cerebri bi Crus cerebri Contents: Tuber cinereum (2). Mammillary bodies (3) Posterior perforated substance (4) Oculomotor nerve (5) emerges from the medial aspect of crus cerebri bi. 5 Pons 3 4
5 The Pons Anterior surface: 15 Has a median basilar groove for basilar artery (15). 16 Pyramidal eminence (16) on either side of basilar groove with transverse pontine fibers. MCP Middle cerebellar peduncle (MCP). Trigeminal nerve (17) between the pons & MCP. Posterior surface: Forms the upper part of the floor of the 4 th ventricle. It is separated from the medulla by medullarystria (15). It has a posterior median sulcus (8) with medial eminence (9) on either side. Facial colliculus (16) is a small swelling in the lower part of the medial eminence Superior fovea (17) is a depression lateral to facial colliculus Anterior surface 9 9 Posterior surface MCP
6 The Medulla Oblongata Its upper ½ has no central canal & is known as open medulla. Its lower ½ has central canal & is known as open medulla. Anterior surface: Has: Anterior median fissure which is obliterated below by pyramidal decussation (11). Pyramid (14) on either side of the median fissure Lateral surface: Has Olive (9) separated from the pyramid by anterolateral sulcus (12) to which rootlets of hypoglossal nerve are attached. Inferior cerebellar peduncle (ICP) separated from the olive by posterolateral lsulcus (10) to which h rootlets of glossopharyngeal, vagus & accessory nerves are attached. Pyramid 12 Olive 10 Lateral surface
7 Posterior surface: Upper part: formslowerpartof the floor of the 4 th ventricle & has the following features: Posterior median sulcus. Inferior fovea ((19) which is an inverted V shaped sulcus dividing the back of medulla into; Hypoglossal triangle (14), vagal triangle (13) & vestibular area (18). Lower part: back of closed medulla which has the following features: Posterior mediansulcus. On either side of the sulcus Gracile & Cuneate tracts ascend & expand above to form Gracile (10) & Cuneate tubercle (9)
8 The fourth ventricle It is a diamond shaped cavity of the hindbrain. It lies behind the pons & open medulla & in front of the cerebellum. Its superior angle is continuous with the cerebral aqueduct of midbrain & its inferior angle is continuous with the central canal of closed medulla (at the obex). It has 2 lateral recesses which curve around the inferior cerebellar peduncle & open by lateral apertures in the subarachnoid space at the flocculus. The roof: Is tent shaped & is formed of The superior cerebellar peduncles (SCPs). the superior medullary velum (SMV) stretching between the 2 SCPs. The inferior medullary velum (IMV) which has a median aperture (of Magendie) connecting the 4 th ventricle to the subarachnoid space. SMV IMV Cerebellum Median aperture
9 The floor: Is formed of : The posterior surface of the pons: with posterior median sulcus, medial eminence (1), facial MCP colliculus (2) & superior fovea (3). Vestibular Medullary stria (4) The posterior surface of the open medulla: with inferior fovea, hypoglossal triangle (5), vagal triangle (6) & vestibular area, SCP area
10 Superficial Attachment of cranial nerves 1) Olfactory (I) Nerve is formed of about 20 rootlets which pass through the cribriform plate of ethmoid to end in the olfactory bulb. 2) Optic (II) Nerve is attached to the optic chiasma. 3) Oculomotor (III) Nerve is attached to the medial side of crus cerebri of the midbrain. 4) Trochlear (IV) Nerve emerges from the back of midbrain below the inferior colliculus then it winds around the midbrain to appear on its anterior aspect. 5) Trigeminal (V) Nerve is attached to the pons at its junction with the middle cerebellar peduncle. 6) Abducent (VI) Nerve arises from the pons at the pontomedullary junction between pons & the pyramid of the medulla. 7) Facial (VII) Nerve arises from the pons at the ponto cerebellar angle. 8) Auditory or Stato Acoust or Vestibulocochlear (VIII) Nerve arises from the pons at the pontocerebellar angle above the olive ofthe medulla. 9) Glossopharyngeal (IX), Vagus (X) & Accessory (XI) Nerves are attached to the posterolateral sulcus of the medulla. 10) Hypoglossal (XII) Nerve is attached to the anterolateral sulcus of the medulla between the pyramid & olive.
11 The Cerebellum It is formed of median vermis & 2 cerebellar hemispheres. h It has 2 surfaces: Superior surface: facing the midbrain & tentorium cerebelli. Inferior surface: divided into anterior & posterior parts. The surfaces have many parallel folds called folia It has 2 notches: th Anterior notch occupied by the brain stem. Posterior notch (vellecula) occupied by falx cerebelli. The main fissures of the cerebellum: Primary fissure: separates the anterior & posterior lobes. Horizontal lfissure: Et Extends bt between the middle cerebellar peduncles. Posterolateral fissure: Separates the flocculus & nodule from the rest of the cerebellum. Cerebellar tonsil : on either sides of uvula of inferior vermis Retrotonsillar fissure : separates tonsil from the rest of cerebellum. Anterior notch Cerebellar Hemisphere Posterior notch Tonsil 1ry fissure V E R M Cerebellar I Hemisphere S Superior surface Nodule Inferior surface Flocculusl
12 Lobes of the cerebellum: (Horizontal division) Anterior lobe: in front of the primary fissure. Posterior lobe: behind the primary fissure. Flocculo nodular lobe: Consists of the flocculus & nodule. 1ry Fissure Anterior Lobe Posterior Lobe Paravermis hemispheres
13 Cerebellar nuclei: Dentate nucleus Interposed nuclei: Emboliform Globose Fastigial "Don't Eat Greasy Food"
14 Arbor vitae In latin tree of life it is the white matter of the white matter of cerebellum. It is so called because of the tree like appearance. It brings sensory and motor sensation to and from cerebellum Vertical subdivisions of the cerebellum 1- vermis (central part on superior and inferior surfaces) represents head, neck, trunk, shoulders and hips). Projects to Fastigeal N 2- Paravemis (lateral to vermis) represents muscles of upper and lower limbs Projects to Globose and Emboliform N 3- Rest of cerebellar hemispheres Project to Dentate N Fourth ventricle Arbor vitae
15 Cerebellar peduncles: Superior cerebellar peduncle (SCP): Connects the cerebellum with the midbrain. Middle cerebellar peduncle (MCP): Connects the cerebellum with the pons. Inferior cerebellar peduncle (ICP): Connects the cerebellum with the medulla oblongata. MCP ICP
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18 Cerebellar lobules Superior view
19 Cerebellar lobules Superior view
20 Cerebellar Lobules (inferior view)
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22 Functional Subdivisions of The Human Cerebellum Archicerebellum (Vestibulocerebellum): Flocculo Nodular Lobe, Lingual Lobule+ fastigeal N It receives afferent Fibres. From vestibular apparatus of internal ear Via vestibulocerebellar tracts.. Function: Equilibrium, Vestibulo Ocular Reflex (VOR). It has connections with vestibular & reticular nuclei of brain stem through the inferior cerebellar peduncle. Efferents: to the L.M.system bilaterally ll via descending di vestibulo spinal & reticulospinal tracts.
23 Paleocerebellum (Spino cerebelllum): it is formed of Anterior lobe+ midline vermis + surrounding paravermis + globose & emboliform nuclei. It receives afferent proprio ceptive impulses from Ms.& tendons Via spinocerebellar tracts (dorsal & ventral) mainly. it sends efferents to : VL nuclei of thalamus which project to precenteral gyrus (trunk area) from which anterior corticospinal fibers arise (control axial and proximal limb muscles) red nucleus of midbrain and lateral corticospinal tracts (controlling distal limb muscles) Globose Emboliform Rubral pathway Function: it is concerned with muscle tone and postural Control.
24 Neocerebellum (cerebro cerebellum) It is the remaining largest part of cerebellum. It includes the most 2-cerebellar hemispheres h + dendate d nuclei. It receives afferent impulses from the cerebral cortex+pons Via cerebro-ponto- cerebellar pathway. it sends efferents to red nucleus and Ventro lateral nucleus of thalamus (VL). Function: 1- controls voluntary movements, planning of sequence of intended movements (even before execution of motor activity) 2- Regulation of force and timing Of Movement. The whole pathway Cortico-ponto-cerebellar- cerebellar Dentato-rubro-thalamo-cortical
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26 Structure of the cerebellum Cerebellar Cortex Outer Molecular Layer (stellate and basket cells) Middle Purkinje Cell Layer (inhibitory to all other cells) Inner Granular Layer (excitatory) Include 2G cells (granule and golgi) 2- Corpus Medullare (Medullary Center) 3- Deep Cerebellar Nuclei
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28 White matter of the cerebellum Consists of three types of nerve fibres in the white matter A. Axons of purkinje cells (efferent The only axons to leave cerebellar cortex to end in deep cerebellar nuclei specially dendate nucleus. B. Mossy fibres (afferent) They end in the granular layer first then purkinje layer (indirect activation of purkinje). C. Climbing fibres They end directly in purkinje (direct activation) or molecular layer (olivocerebellar tracts mainly)
29 Fibres entering and leaving through cerebellar peduncles Superior cerebellar peduncle (major efferent) Fibres entering the cerebellum Ventral spino-cerebellar tractt Tecto-cerebellar fibres Fibres leaving the cerebellum Cerebello-rubral rubral fibres (Globose-Emboliform-rubro-spinal) Cerebello-thalamic fibres (Dentato-thalamo-cortical) Cerebello-reticular fibres (Fastigeal nucleus) Cerebello-olivary fibres (Dentate nucleus)
30 Middle cerebellar peduncle Pontocerebellar fibres (cortico-ponto-cerebellum) to dentate nucleus) Inferior cerebellar peduncle (afferent) Fibres entering cerebellum Posterior spino cerebellar tract Cuneo-cerebellar tract Olivo-cerebellar fibres Reticulo-cerebellar Vestibulo-cerebellar fibres Trigemino-cerebellar fibres Anterior external arcuate fibers Fibres Leaving the cerebellum Cerebello-olivary fibres Cerebello-vestibular fibres cerebello reticular fibres
31 Blood Supply of the Cerebellum It is supplied by 3 cerebellar arteries Superior cerebellar artery: from the basilar artery Anterior inferior cerebellar artery: from the basilar artery Posterior inferior cerebellar artery: from the vertebral artery
32 Basal ganglia and cerebellum Cerebellum and basal nuclei are the 2 major subcortical centers which affect cortical activity Both receive input from cortex Both projet output to the cortex via the thalamus Cerebellm Receive cortico-ponto-cerebellar from contralateral cerebral cortex Projects to VL nucleus of the contralateral thalamus projects directly to areas 4,6 Controls movement of the ipsilateral half of the body Basal ganglia g Receives cortico-striate fibres from ipsilateral cerebral cortex Projects to VA nucleus of the ipsilateral thalamus which projects first to SMA then to areas 4,6 Controls movement of the contralateral half of the body
33 Syndromes Ataxia: incoordination of movement decomposition of movement dysmetria, past-pointing dysartheria dysdiadochokinesia rebound phenomenon of Holmes gait ataxia, truncal ataxia Intention Tremor Hypotonia, Nystagmus Archicerebellar Lesion: Medulloblastoma (see later) Paleocerebellar Lesion: gait disturbance dstuba Neocerebellar Lesion: hypotonia, ataxia, tremor
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35 Cerebellar Medulloblastoma Cerebellar tumors on vermis Truncal Ataxia Frequent Falling The child in this picture: - would not try to stand unsupported would not let go of the bed rail if she was stood on the floor.
36 THANK YOU
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