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Correlating
Neuroanatomywith PatientPresentation
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Supratentoria Infratentorial
SupportStructures
Pathways
Overview of the Nervous System
above tentorium cerebelli - which contains the cerebrum
below - which contains
the cerebellum
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Tentorium
Cerebelli
Supratentorial
CorticalSubcortical
Infratentorial
BrainstemCerebellum
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Cortical
Outer gray matterLocation of cell bodies (neurons, glia)
SubcorticalWhite matter (includes the internal
capsule)Highways that connect cellbodies (axons)
Deep nuclei: gray matterBasal Ganglia motor control
Thalamus sensory, motor,consciousness
Hypothalamus homeostasis
Supratentorial
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Cerebral Cortex: 5 lobes: function1. Frontal:2. Parietal:3. Occipital:4. Temporal:5. Insula:
**GOOD QUIZ QUESTION
**
movement, decision making, higher lvl of thinking, motion and personality
sensory
vision
auditory, speech, language, memory, emotion
limbic response
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Neuroanatomy: Infratentorial
Brainstem: 3 areasMidbrainPons
Medulla
Neuroanatomy: InfratentorialCranial nervesCenters for eye movementCardiac, respiratory centers
autonomic: respiratory, HR, BP
relay station
vision, hearing, motor control, sleep/wake,
arousal/alertness, temp control
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Cerebellum:Lobes, Hemispheres, Tonsils
Functional divisions
Midline (vermis)-
Lateral hemispheres-
Neuroanatomy: Infratentorial
coordination and balance
axial coordination
(limb coordination)
most important for motor control
(of gait)
ant, post, and flocculonodular lobe
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Conduit for motor and sensorypathways
Lateral corticospinal tract (LCST) Upper motor neuron axons
Dorsal columns (DC)
Antero-lateral system (ALS)
Pain/temperature Anterior horn cells ( motor neuron)
Lower motor neuron cell bodies
Proprioception, discriminative touch and vibration
contralateral
limbs
signals coming from cerebral
cortex to brainstem
SENSORY PATHWAY
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DC
LCST
ALSAlpha
LE
UE
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Ends at
Cauda equina-..Nerve roots continue to exitrespective intervertebral foramen
C2-7: above respectivevertebra
C8: between C7-T1
T, L, S roots below
conus medullaris (L1-L2)
(L2-L5)
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Neuroanatomy: Support structures
Meninges
SpacesVentricles
Cerebrospinal FluidBloodArterialVenous
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Neuroanatomy: Support structures
Meninges
(outside-in)EPIDURAL
1. Dura MaterSUBDURAL
2. Arachnoid MaterSUBARACHNOID
3. Pia Mater
Venous blood: tornbridging vein
Normally containscerebrospinal fluid
(CSF)Arterial blood:aneurysm rupture
Arterial blood: tornmeningeal artery
(outer most)
When patient has hydrocephalus: monitor CSF
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Epidural space
A potential space inthe cranium
A real space in the
vertebral canal
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Neuroanatomy: Support structures
Ventricular system
Cerebrospinal fluid (CSF)direction of flow inventricular system:
Lateral ventricles (2) Interventricular foramen of
Monro (2)
Third ventricle (1)Cerebral aqueduct (1)
Fourth ventricle (1)3 foramen
Subarachnoid space (SAS)Intraventricularhemorrhagevs. subarachnoidhemorrhage
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Neuroanatomy: Support structuresVentricular system: CSF resorption
Arachnoid villi/granulations
Project from the SASinto the sinuses
Cerebral venous sinusesimportant for drainage
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Neuroanatomy: Support structures
Anterior Circulation 2 Carotid Arteries
Posterior Circulation 2 Vertebral Arteries
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Vascular Supply
MCA - MOST common CVA location
ACA
PCA
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Neuroanatomy: Support structures
Blood SupplyAnterior Circulation
Carotid Arteries (2)
Ophthalmic artery
Posterior communicating artery
Pcomm
Anterior choroidal artery
Anterior cerebral artery (ACA)
Middle cerebral artery (MCA
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Neuroanatomy: Support structures
Blood Supply
Posterior CirculationVertebral Arteries (2)Posterior Inferior Cerebellar
(2 - PICA)Anterior Spinal Artery (1 -
ASA)
Basilar Artery (BA)Anterior Inferior Cerebellar(2 -AICA)
Superior Cerebellar (2 -SCA)
Posterior Cerebral (2 -PCA)
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Neuroanatomy: Support structures
Blood supplyArterialThe Cerebral arteries (anterior, middle,
posterior) are terminal branches
Numbered segments (first, second, third
order branches)i.e. A1, A2, A3, or M1, M2, M3, or P1, P2, P3
The internal carotid also has segmentsCervical, carotid siphon, supraclinoid
(intracranial)
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Neuroanatomy: Support structures
VenousSinusesVein of Galen
IGNORE THIS SLIDE
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Three that are important to our patients!
1. Lateral Corticospinal TractVolitional movement, the upper motor neuron
2. Dorsal Column Medial Lemniscus SystemAKA large fiberProprioception/kinesthesia, discriminative touch,vibration
3. Spinothalamic Tract / Antero-lateral systemAKA small fiberPain, temperature, crude touch, itch, tickle
What are the differences in: pathways?
modalities?
originates in spinal cord and travels up and transmits info
to thalamus
crosses over at cervico-medullary
junction
crosses over at spinal segment
DESCENDING
ASCENDING
ASCENDING
crosses over at spinal segment
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What is the name of the 1o efferent track in the SC?What cells in the CNS give rise to this efferent track?What is the other name for these cells / track?What is the name for the analogous track for the CN?
Spinal Cord
lateral corticospinal tract
pyramidal cells
cross-pyramidal (OR lateral cerebrospinal tract)
subcortical bulbar tract
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Somatosensory / Proprioceptive Input
crosses over at the level of spinal
segment
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Somatosensory / Proprioceptive Input
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Anterior horn cell / lowermotor neuron pathology:LMN
Hemi-cord pathologyaffects touch andvolitional movement on
Lateral brainstempathology often affects.
Medial brainstempathology often affects.
ThalamusInfarcts usually affectOnly.
Internal CapsuleInfarcts affect
Pain, Touch,Volitionalmovement isperceived/controlled by.IGNORE THIS SLIDE
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Distribution of Sensory Impairment1. 2. 3. 4.
a. Dermatomalb. Hemisphericc. Polyneuropathyd. Segmental
dermatomal
hempisphericpolyneuropathy
involves many nerves at a time - both motor and sensory