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MULC

LEIDSUNIVERSITAIRMEDISCHCENTRUM

LM C

U

Hersenen en AansturingIntroductie

G1HA 1314

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MULC 2Blokcordinatoren

Dr. E.L.E.M. Bollen (Neurologie)

Dr. E.A.J.F. Lakke (Neuroanatomie)

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MULC 3

[email protected]

071 527 9357 (never there)

0649 034226

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MULC Hersenen en Aansturing

Onderwerpen

Macroscopische NeuroanatomieColleges, snijzaal, WG MRI

Th 1: Het 2emotorneuron

Th 2: Het 1emotorneuron

Th 3: Hersenzenuwen en Coma

Th 4: Parkinson en AtaxieTh 5: Sensibiliteit en Dermatomen

Th 6: Visueel systeem en Cognitieve functies

Th 7: Gedragsstoornissen bij kinderen

Th 8: Depressie

Themas

Steeds HC basis, HC kliniek, studieopdracht, WG, RC

WG Populaire Neurowetenschap

4

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MULC Hersenen en Aansturing

Toetsing:

HalfwegtoetsMaandag 3 juni

16 open vragen over Macroscopische Neuroanatomie en Thema 1-3

Hiervan 9 MRI

Eindtoets

Vrijdag 5 juli64 MC/EM vragen over alles

WG Populaire Neurowetenschap

V/NV, als NV een vervangende opdracht

5

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MULC Blackboard 6

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MULC Macroscopische neuroanatomie 7

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MULC Leerdoelen

U kunt de highlights uit de geschiedenis van de neurofilosofie beschrijven.

U kunt beschrijven uit welke celtypen centraal en perifeer zenuwstelsel bestaan en wat de functie van deze

cellen is.U kunt de onderdelen van het neuron en hun functie beschrijven.

U kunt uitleggen hoe de membraan- en actiepotentiaal ontstaan, en welke rol de evenwichtspotentiaal van de

belangrijkste ionen hierin speelt.

U kunt uitleggen hoe de actiepotentiaal zich verplaatst langs het axon en wat de rol van de myelineschede

hierbij is.

U kunt uitleggen hoe de synaps functioneert, en u kunt de belangrijkste neurotransmitters beschrijven.

U kunt uitleggen wat een EPSP en een IPSP is, en hoe deze een volgende actiepotentiaal kunnen veroorzaken.

U kunt de neuromusculaire overgang beschrijven en u kunt uitleggen hoe een spiervezel tot een maximale

contractie gebracht kan worden.

U kunt de onderverdeling en onderdelen van het zenuwstelsel redelijk gedetailleerd beschrijven, en deze labelen

in plakken, CT en MRI.

U kunt de twaalf hersenzenuwen benoemen, en hun beloop en functie beschrijven.

U kunt de vascularisatie (arterieel en veneus) van het centraal zenuwstelsel beschrijven, alsmede destroomgebieden van de belangrijkste cerebrale vaten.

U kunt de doorgangen door de schedelbasis en de inhoud van die doorgangen beschrijven.

U kunt de holten in het brein beschrijven en op plakken, CT en MRI labelen.

U kunt de vliezen rond het centraal zenuwstelsel en de bijbehorende duplicaturen en ruimten beschrijven,

alsmede hun inhoud.

U kunt uitleggen hoe de liquor cerebrospinalis door de ruimten in en om het brein circuleert.

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MULC Sixty-Six Salient Structures

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MULC Sixty-Six Salient Structures

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MULC Neuroanatomie studiemateriaal

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MULC 12Slices

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MULC Links

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MULC 14Links

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MULC 15HeadNeckSpine; Brain MRI

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MULC 16Links

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MULC 17Links

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MULC 18Harvard Whole Brain

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MULC 19Harvard Whole Brain

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MULC 20Links

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MULC 21S4 Viewer

This viewer employs the same slices as in the lectures and ppt files!

Check Help function and set to ADVANCED

UL

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MULC Neuroanatomie studiemateriaal

UL

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MULC MRIcroN

UL

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MULC 24MRIcroN

UL

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MULC 25MRIcroN Viewer

Viewer & datasets

Downloaden via BlackBoard

Unzippen en installeren

Uitleg Hfdst 4.8 BlokBoek

UL

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MULC 26MRIcroN Viewer

Viewer & datasets

Downloaden via BlackBoard

Unzippen en installeren

Uitleg Hfdst 4.8 BlokBoek

DOE DIT VANDAAG

UL

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MULC Snijzaal

UL

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MULC Snijzaal

A once-in-a-l ifetime-opportunity ! !

UL

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MULC Snijzaal 29

UL

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MULC 30Snijzaal

Skillslab, in kelder van Onderzoeksgebouw

Op tijd komen!

Als te laat, telefoon naast ingang gebruiken

Schone witte jas en handschoenen verplicht

A guided tour through the central nervus system.

Maar .you can only see what you know, sothorough

preparation is of the utmost importance!!

UL

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MULC 31Snijzaal

Skillslab, in kelder van Onderzoeksgebouw

Op tijd komen!

Als te laat, telefoon naast ingang gebruiken

Schone witte jas en handschoenen verplicht

A guided tour through the central nervus system.

Als je niet weet wat je gaat zien, kun je er donder op zeggen dat

je het zelfs niet ziet als het je wordt aangewezen.

Bereid je dus steeds grondig voor (Snijzaal handleiding).

UL

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MULC 32

UL

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MULC 33

UL

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MULC 34

UL

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MULC 35

UL

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MULC 36

UL

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MULC 37

ULA k

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MULC 38Anatomie is een LEERvak

Neuroanatomie begint metleren!!

ULP l

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MULC 39Potjeslatijn

Gebruiken we veel, ervan uitgaande dat jullie dat begrijpen.

Zo niet, ZEG DAT DAN, blijf niet stil zitten hopen dat het vanzelf over gaat.

Zoek zelf de BETEKENIS van namen zo veel mogelijk op!

UL

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MULC

LEIDSUNIVERSITAIRMEDISCHCENTRUM

LM C

U

Geschiedenis van de Neurofilosofie

ULN i li hi

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MULC 41Neurosurgery in neolithic eras

Neolithic

10000 BC7000 BC

5000 BC

3500 BC

3500 BC

3500 BC

1750 BC

1500 BC

1000 BC

300 BC

300 BC

300 BC

100 AD 150 AD 150 AD

150 AD

250 AD

ULE id l h

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MULC Epiduraal hematoom 42

ULEd i S i h i l 1700 BC

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MULC 43Edwin Smith surgical papyrus; 1700 BC

ULI h t

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MULC 44Imhotep

Approx 2700 BC; Physicianpriestdeity (Asklepios to the Greeks)

Classes of severity

An ailment I will treat

An ailment with which I will contend

An ailment not to be treated

Knowledge of

Hemi- and quadriplegia

Urinary incontinence

Priapism

Contralaterality

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MUC 45

ULE ti hil h

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M C 46Egyptian neurophilosophy

Consciousness, soul & intelligence located in the heart

Heart is left in place for embalming

Other intestines in separate jars

Brain is discarded

ULA i t G k

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M C 47Ancient Greeks

Anaximander, Heraclitus Panta rei et medn agan),Pythagoras and Empedocles define earth, water, fire and air

as the basic elements

Alcmeaen proposed that the brain as the central organ of

sensation and thought

Hippocrates (460-370 BC) associated the basic elements with

four types of bodily fluids; yellow bile, black bile, blood and

phlegm; humoral theory Locates the soul in the brain!

"Tell me where is fancy bred, or in the heart or in the head"

(Shakespear)

ULTh R h i i

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M C

Galen (130-300 AD)

Advocated the use of dissection to acquire knowledge

No human dissection, proscribed by Roman law

First theory of brain function!

Heart produces vital spirit (life fluid)

Rete mirabile to brain

Brain makes animate spirit (soul fluid)

Flows through hollow nerves to cause movement or

sensation

Animate spirit is instrument of soul

Intellect located in the brain!!

Galen will remain the authority for 1500 years!!

48The Roman physician

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M C 49Rete mirabile

ULPig Human

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M C 50Pig Human

ULMiddle Ages

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M C 51

Early on a Nemesius mistakes Galen, and puts everything (intellect, soul etc) into the

ventricles

From that moment onwards, theres not much going on, brain-wise, except for heated

discussion about what is in which ventricle

Because there is no real interest in the physical brain, the ventricles become

abstracted into three spheres

Middle Ages

ULAndreas Vesalius

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M C 52Andreas Vesalius

1514-1564

UL3

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M C 53

UL54

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M C 54

ULC 55Andreas Vesalius

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M C 55Andreas Vesalius

1514-1564

1543 De humanis corporis fabr ica (Ti tiaan)

Rejects ventricular localization, but does not

renounce the spirit theory

MULC 56Thomas Willis

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M C 56Thomas Willis

1621-1675

1664 Cerebri anatome

Locates memory and will in gyri of cerebrum

Functional localization

Clinical observation

Experimental observation

MULC 57Ren Descartes

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M C 57Ren Descartes

1596-1650

1662 De homine

Reflexive theory

Human as automaton, soul for

voluntary stuff

Interaction mind-body through

pineal gland (dualistic!)

MULC 58From animal spirit to bio-electricity

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M C 58From animal spirit to bio-electricity

Jan Swammerdam (1637-1680); frog-leg preparation

Luigi Galvani (1737-1798); electrophysiology

MULC 59

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M C 59

MULC 60Showmanship enters the scene

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M C 60Showmanship enters the scene

Giovanni Aldini (1762-1834)

When one rod was moved to touch the rectum, the whole body convulsed: indeed,

the movements were so much increased as almost to give an appearance of re-

animation.

MULC 61Bell-Magendie

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M C 61Bell Magendie

Bell (1774-1842); Magendie (1783-1855)

Bell-Magendie law: dorsal roots are sensory, ventral roots are motor

=> Functional localization is back!

MULC 62Franz Joseph Gall

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M C 62Franz Joseph Gall

1757-1828

Skull features are an indication of underlying brain development

The development of specific cortical regions correlates with specific talents or

behaviours

Phrenology

MULC 63

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M C 63

MULC 64Flourens (1794-1876)

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M C 64Flourens (1794 1876)

1794-1876

Introduced the tool to study localization: the

stimulation/ablation experiment.

Studied young mammals with this

BAD CHOICE; plasticity

Concluded that cortex could not be subdivided in

functional units

At least partly influenced by his distaste of theunscientific and populist methods of Gall

MULC 65Gall vs Flourens

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M C 65Gall vs Flourens

Gall was right about cortical functional localization, but his science was bogus

Flourens was a good scientist but biased against phrenology

Bogus with the right idea against science with the wrong belief

Gall is an idiot,

and whatever he

says is wrong! !

Who cares??

Im rich and

famous anyway

MULC 66Paul Broca

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M C 66Paul Broca

1824-1880

First description of a functional area of the cortex

Centre of speech (Centre of Broca)

Finally establishes cortical localization

MULC 67Eduard Hitzig & Gustav Fritsch

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M C 67Eduard Hitzig & Gustav Fritsch

1838-1907; 1838-1927

The hunt for cortical localization is on!!

First (partial) map based on electrical stimulation,

describe motor cortex

MULC 68David Ferrier & John Hughlings Jackson

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M C 68David Ferrier & John Hughlings Jackson

1843-1924; 1835-1911

Ferrier extends work of Hitzig & Fritsch by extensive animal experimentation &

correlates the experimental map to Jacksons clinical findings

Neurosurgeons start to use functional maps of the brain to guide them in their surgical

approach

MULC 69Wilder Penfield

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M C 69Wilder Penfield

1891-1976

Stimulates cortex of patients during surgery

MULC 70Cortical somatotopy

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M C Co tical somatotopy

MULC 71Korbinian Brodmann

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M C

1868-1918

Studies the structure of the cortex

6 layers

Subtle differences

46 different areas

MULC 72Form and function

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M C f

1) The cerebral cortex consists of areas that subserve specific functions

2) The laminar construction of the cortex differs subtly between these areas

MULC 73Reticulum vs Neuron

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M C

Purkinje (1787-1869) draws the first neuron

Schwann (1810-1882) proposes that body consists of cells

Everybody says: Thats OK, but not the brain

Not surprising as it was now known that electric current, generated by the brain,

passed in some way through the nerve fibres and nerves to the muscles, and it was a

logical step to presume that the nervous system should be a reticulum.

How else could current flow from one neuron to the other if they were not incontinuity?

Deiters (1834-1863) demonstrates that nerve fibers and cell bodies belong together

MULC 74Golgi vs Ramon y Cajal

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M C g y j

Golgi (1843-1926) Reticulum doctrine

Ramon y Cajal (1852-1934) Neuron doctrine

MULC 75How do neurons talk?

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M C

Sherrington (1857-1952)

Discovers the delay incurred by going from

one neuron to the next.

Coins the term "Synaps"

MULC 76Synaps electrical of chemical?

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M C y p f

Loewi (1873-1961)

Acetylcholine; first neurotranmitter

MULC 77Axon and action potential

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M C p

Hodgkin (1914-1998) & Huxley (1917)

MULC 78Axon and action potential

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M C p

Hodgkin (1914-1998) & Huxley (1917)

MULC 79To cortex again

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C g

All breakthroughs with respect to cortical functional localization, or with respect to the

functioning of the cortex were made in the human brain!

Cortical function is high-level, and it is hard to know what animals think, feel etc.

Many rreas not even present in animal brain

=> Research in this field will remain restricted to research in humans!!

MULC 80Imaging the human brain

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MULC 81Richard Caton

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1842-1926

Records electricity from cortex (evoked potentials)

Mirror galvanometer

MULC 82Willem Einthoven

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1860-1927

String galvanometer; ECG

MULC 83Willem Einthoven

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1860-1927

String galvanometer; ECG

MULC 84Hans Berger

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1873-1941

Electroencephalogram (EEG)

MULC 85WC Rntgen 1895

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MULC 86Skull X ray

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MULC 87Ventriculography

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MULC 88Angiography

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MULC 89Computed axial tomography

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1959 GN Hounsfield; EMIDEC 1100 (first large all transistor computer)

1963 AM Cormack; mathematical equations for axial tomography

1971 GN Hounsfield; first CAT scanner (head only)

MULC 90

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MULC 91

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MULC 92

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MULC 93MRI

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1946 D Purcell; Magnetic resonance

1971 R Damadian; MR of normal and diseased tissue is different!

1977 R Damadian; first MRI of human body

MULC 94MRI scanner

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Magnetic Resonance Imaging

Harmless

Resolution still improving Many possibilities

Morphology

Functional imaging

Blood flow

Spectroscopy

MULC MRI: normal anatomy 95

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MULC 96Saturation imaging

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Active brain tissue uses oxygen!

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MULC 98fMRI ocular dominance stripes

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MULC 99Cortical plasticity

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fMRI during li p pursing; I n amputees with phantom limb pain l ip cortical representation

has extended into hand/arm region

(Flor et al. Nature Reviews Neuroscience 7, 873

881, 2006)

MULC 100

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MULC 101(f)MRI the technique of your future

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Magnetic Resonance Imaging

Resolution still improving

Many possibilities

Morphology

Functional imaging

Blood flow

Spectroscopy

MULC 102(f)MRI the technique of your future

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Magnetic Resonance Imaging

Resolution still improving

Many possibilities

Morphology

Functional imaging

Blood flow

Spectroscopy

Many questions regarding the cognitive

functioning of our brain will be resolved in

the near future using this technique

MULC 103LUMC promotion

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Leiden Institute for Brain and Cognition

Interdisciplinary

State of the art

Gorter Institute

7T MRI scanner

Highest field in the Netherlands

MULC 104LUMC promotion

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Leiden Institute for Brain and Cognition

Interdisciplinary

State of the art

Gorter Institute

7T MRI scanner

Highest field in the Netherlands