NEUROANATOMY

Neuroanatomy
• Neuroanatomy is that branch of neuroscience which
deals with the study of gross structure of the brain
and the nervous system
• The delineation of distinct structures and regions of
the brain has figured centrally in investigating how it
works.
• For example, much of what neuroscientists have
learned comes from observing how damage or
"lesions" to specific brain areas affects behavior or
other neural functions.
• The human nervous system is divided into the central
and peripheral nervous systems.
• Central nervous system
– Consists of the brain and spinal cord
– Plays a key role in controlling behavior.
• Peripheral nervous system
– Made up of all the neurons in the body outside of the CNS
– Subdivided into
• Somatic nervous system(SNS)
• Autonomic nervous systems (ANS).
• The Somatic Nervous System (SNS)
– Is made up of afferent neurons that convey sensory
information from the sense organs to the brain and spinal
cord, and efferent neurons that carry motor instructions to
the muscles.
• The Autonomic Nervous System (ANS).
– The sympathetic nervous system
• Set of nerves that activate what has been called the "fight-or-flight"
response that prepares the body for action.
– The parasympathetic nervous system
• Instead prepares the body to rest and conserve energy.
 CENTRAL NERVOUS SYSTEM (CNS)

• The part of the nervous system that functions to

coordinate the activity of all parts of the body.
• It is enclosed in the meninges.
• It consists of the brain and the spinal cord.
– Together with the peripheral nervous system it has a
fundamental role in the control of behavior.
• The CNS is contained, within the cranial cavity
(brain) and the spinal cavity (spinal cord).
• The brain is protected by the skull, while the spinal
cord is protected by the vertebrae.
MENINGES AND CEREBROSPINAL FLUID

• Brain and Spinal cord are soft and of semigelatinous

consistency.
• These vital soft organs are protected, supported, and
nourished by three membranous coverings
(MENINGES).
• From external, we have
– Dura mater (Pachymeninx)
– Arachnoid
– Pia mater
• Arachnoid and Pia mater have a similar structure
• Dura mater
– The most external connective tissue envelope that
surrounds the CNS.
– It is tough, tenacious, and poorly extensible.
– Subdivided into
• Spinal dura
• Cerebral dura
• Cerebral dura
– Serves both as an investing sheath for the brain
and as periosteum for the inner surface of the
cranium.
– Consists of two layers;
Inner layer
• Thin layer of dense fibrous tissue lined on it internal
surface with a single layer of flat cells.
Outer layer
• Forms the periosteum and it is much richer in blood
vessels and nerves.
• Between the two layers lie the large venous
sinuses of the brain.
• Cerebral dura gives off several reduplications
or septae which divide the cranial cavity into
incomplete compartments.
– Falx cerebri
– Tentorium cerebelli
– Falx cerebelli
– Diaphragma sellae
• Falx cerebri
– Sickle-shaped, median septum extending from the
crista galli to the internal occipital protuberance.
– It separates the two cerebral hemispheres.

• Tentorium cerebelli
– A tranverse, arched septum placed between the
occipital lobes and cerebellum.
– Its free anterior border forms the tentorial incisure
through which the brain stem passes.
• The diaphragma sellae or sellar diaphragm is a
flat piece of dura mater with a circular hole
allowing the vertical passage of the pituitary
stalk. It retains the pituitary gland beneath it
in the fossa hypophyseos as it almost
completely roofs the fossa hypophyseos of the
sella turcica, a part of the sphenoid bone. It
has a posterior
• Falx cerebelli
– A small sagittal septum extending from the
midline of the undersurface of the falx cerebri.
– It incompletely separates the cerebella
hemispheres.

• Diaphragma sellae
– Forms the fibrous roof of the pituitary fossa (Sella
turcica) and it is perforated by infundibullar stalk.
• Spinal dura
– It corresponds to the inner layer of the cerebral dura.
• The vertebrae have their own separate periosteium.
– Both inner and outer surfaces of it are covered by a single
layer of flat cells.
– It is separated from the periosteum by the narrow Epidural
space.

– Between the dura and arachnoid is the capillary subdural

space moistened by fluid, and
• Believed to communicate by clefts with the tissue spaces in the
sheaths of nerves.
– Subdural space has no direct communication with the
subarachnoid space.
• As the nerve roots penetrate the dura mater, they
receive a dural investment which is continuous with
the relatively thin epineurium of the Peripheral nerve.

• Spinal dura extends as a closed tough sac, from the

margins of the foramen magnum above to the level of
the second sacral vertebrae below.
• Opposite the second sacral vertebrae, it forms an
investment about the filum terminale to form a thin
fibrous cord (Coccygeal ligament).
• Blood supply to the dura mater
– Medial meningeal artery.
• A branch of the maxillary artery that enter the skull
through foramen spinosum.
– Anterior meningeal arteries
• Branch of Ophthalmic artery
– Posterior meningeal arteries
• Branches of the Occipital and Vertebral arteries.
• Clinical note
– Laceration and injury of the vessels can rapidly
produce a space-occupying epidural hemorrhage or
hematoma.
• An emergency that requires surgical intervention.
 THE ARACHNOID

• A delicate nonvascular membrane which passes over the sulci

without dipping into them.
• It extends as perineural epithelium along the roots of the
cerebrospinal nerves and along the optic nerve.
• It is partly separated from the Pia by fluid spaces
(Subarachnoid spaces) and trabeculae which pass from pia to
arachnoid.
• In the spinal regions the arachnoid trabeculae are few, hence
the space is a more continuous cavity.
• The arachnoid, trabeculae, and Epipial surface are covered by
single layer of flat cells.
• Subarachnoid space is filled with Cerebral
Spinal Fluid and is in direct communication
with the 4th ventricle of the brain via:
– A median aperture (Foramen of Magendie)
• Located in the caudal part of the thin ventricular roof
and open in the Cerebellomedullary cistern.
– Two lateral apertures (Foramen of Luschka)
• Open into the pontine subarachnoid cistern posterior to
the emerging fibers of the CN IX.
• The whole medulla is surrounded by a rather wide
subarachnoid space.
– It most extensive posteriorly where the arachnoid passes
from the posterior surface of the medulla to the inferior
surface of the cerebellum.
• Arachnoid granulation
– Prolongations of pia-arachnoid layer into the inner layer of
the dura mater that protrudes into a venous sinus or venous
lacunae.
– Are the major sites of fluid transfer from the subarachnoid
space to the venous system.
 PIA MATER

• Innermost connective tissue fibers layer that closely

invests and follows the contours of the entire brain
and spinal cord.
• It’s a vascular membrane with two layers;
– Intima pia
• An inner more membranous layer composed of closely network of
fine reticular and elastic fibers.
• It is firmly adhere to the underlying nervous tissue.
• It is avascular, obtain nutrients through diffusion from the CSF.
• Epipial layer
– Superficial layer with loose meshwork of
collagenous fiber continuous with arachnoid
trabeculae.
 APPLIED ANATOMY
• There are three types of hemorrhage involving the meninges:

• A subarachnoid hemorrhage
– Is acute bleeding under the arachnoid; it may occur
spontaneously or as a result of trauma.
• A subdural hematoma
– Is a hematoma (collection of blood) located in a separation
of the arachnoid from the dura mater.
– The small veins which connect the dura mater and the
arachnoid are torn, usually during an accident, and blood
can leak into this area.
• An epidural hematoma
– Similarly may arise after an accident or
spontaneously.
• Other medical conditions which affect the meninges
include
– Meningitis
• Fungal, bacterial, or viral infection
– Meningiomas
• From the meninges or from tumors formed elsewhere in
the body which metastasize to the meninges.
CSF
SPINAL CORD
 SPINAL CORD
• The SC is a long, thin, tubular bundle of nervous
tissue and support cells that extends from the brain
(the medulla oblongata) and continues caudally to
form the conus medullaris near the space between
first or second lumbar vertebra.
– It does not extend the entire length of the vertebral column.
– It terminates in a fibrous extension known as the filum
terminale.
– It is around 45 cm long (18 inches) in men and around
43 cm (17 inches) long in women.
– The enclosing bony vertebral column protects the relatively
shorter spinal cord.
• The spinal cord functions primarily in the
transmission of neural signals between the brain and
the rest of the body
• But also contains neural circuits that can independently control
numerous reflexes and central pattern generators.
• The spinal cord has three major functions:
– Serve as a conduit for motor information, which travels down the
spinal cord.
– Serve as a conduit for sensory information, which travels up the spinal
cord.
– Serve as a center for coordinating certain reflexes.
• So the SC is the main pathway for information
connecting the brain and peripheral nervous system.
– It is enlarged in the cervical and lumbar regions.
– The cervical enlargement, located from C4 to T1,
is where sensory input comes from and motor
output goes to the Upper limbs.
– The lumbar enlargement located between T9 and
T12, handles sensory input and motor output
coming from and going to the Lower limbs.
• In cross-section,
– the peripheral region of the cord contains neuronal
white matter tracts containing sensory and motor
neurons.
– Internal to this peripheral region is the gray,
butterfly-shaped central region made up of nerve
cell bodies.
• This central region surrounds the central canal.
– An anatomic extension of the spaces in the brain(ventricles)
– It contains cerebrospinal fluid (CSF).
• The spinal cord has a shape that is compressed dorso-
ventrally, giving it an elliptical shape.
• The cord has grooves in the dorsal and ventral sides;
– The posterior median sulcus is the groove in the
dorsal side,
– The anterior median fissure is the groove in the
ventral side.
• The spinal cord is protected by three layers of
tissue, called spinal meninges, that surround
the cord.
– The dura mater
• Tough, outermost protective layer.
– Between the DM and the surrounding bone of the
vertebrae is a space, (epidural space).
• Filled with adipose tissue
• And it contains a network of blood vessels.
• The arachnoid
– Is the middle protective layer.
– The space between the arachnoid and the
underlying pia mater is called the subarachnoid
space.
– It contains cerebrospinal fluid (CSF).
• The medical procedure known as a “spinal tap”
involves use of a needle to withdraw CSF from the
subarachnoid space, usually from the lumbar region of
the spine.
• The pia mater
– The innermost protective layer.
– It is very delicate and it is tightly associated with
the surface of the spinal cord.
 Spinal cord segments
• A region of attachment of spinal nerve rootlets, which
unite to form one pair of a spinal nerve.

• At every segment, right and left pairs of spinal nerves

(mixed; sensory and motor) form.

• Six to eight motor nerve rootlets branch out of right

and left ventrolateral sulci in a very orderly manner.
• Nerve rootlets combine to form nerve roots.
Key:
1. Spinal Nerve
2. Dorsal Root Ganglion
3. Grey Matter
4. Ventral Root (Motor)
5. Central Canal
6. Dorsal Root (Sensory)
7. White Matter
• Likewise, sensory nerve rootlets form off right and left dorsal
lateral sulci and form sensory nerve roots.
• The ventral (motor) and dorsal (sensory) roots combine to
form spinal nerves (mixed; motor and sensory), one on each
side of the spinal cord.
• Spinal nerves, with the exception of C1 and C2, form inside
intervertebral foramen (IVF).
• Note that
– At each spinal segment, the border between the central and peripheral nervous system
can be observed.
• Rootlets are a part of the peripheral nervous system.
• Fissures and sulci
– Anterior median fissure anteriorly divides the SC
into right and left sides.
– Posteriorly, the posterior median sulcus dorsally
divides the SC into right and left sides
• It is shallower than the anterior median fissure.
• The posterior median septum, extends from the sulcus
deep into the central canal of the SC and its depth
diminishes as the central canal becomes more
dorsally in positions.
• Posterolateral sulcus is a sulcus through which the
dorsal spinal roots enter the SC.
• The region of the white mater btn the posterior
median and the posterolateral sulci is called posterior
funiculus.
• The postero-intermediate sulcus is found in cervical
and upper thoracic segments, dividing the posterior
funiculus into
– Fasciculus gracilis
– Fasciculus cuneatus,
– They are tracts of fibers receiving sensory impulse from the
periphery to relay in nuclei with similar names in the medulla
oblongata.
• The Anterolateral funiculus
– The area of white mater between the anterior median
fissure and the anterolateral fissure.
• It is subdivided into
– Anterior funiculus, lying medial to and including
the exit of the anterior spinal roots, and
– Lateral funiculus lying lateraly between the
anterior roots and the posterolateral sulcus.
• In the upper cervical segments up to C4, the
nerve roots of the spinal accessory nerve exits
through the lateral funiculus on each side.
• Dorsal and Ventral spinal nerve roots traverse
the subarachnoid space separately carrying
with them the pia mater,

– They pierces the arachnoid and dura maters

leaving all behind and unite to form the spinal
nerve at the intervertebral foramina through which
they exit.
 FIBERS OF THE SPINAL CORD

• General somatic efferent (GSE)

– Axons of motor neurons that that exit as ventral
spinal roots to innervate skeletal muscles of the
trunk and limbs.
• General visceral efferent (GVE)
– Neurons of ANS (preganglionic sympathetic and
parasympathetic fibers) at certain levels, which
innervates visceral organs eg secretomotor
• General somatic afferent (GSA)
– Axons of neurons that receive sensory information
from skin, muscles and joints about pain,
temperture, pressure, mechanical stimuli and
proprioception.
• General visceral afferent (GVA)
– Are axons of neurons related to general sensory
information from the walls of the viscera e.g. GIT
• In addition;
• The cranial nerves have two types of fibers
that serve special functions:
– Special visceral efferent (SVS)
• Axons of neurons that innervate skeletal muscles that
develop from brachial arches (Branchiomeric muscles).
– Special visceral afferent (SVA)
• Axons of sensory neurons serving special senses
• e.g. Smell, Taste
 Internal organization

• SC has following structural organization

1. Gray and White mater
2. Distribution and aggregation of cells (neurons) in
the gray mater forming nuclei
3. Organization of fibers in the white mater forming
descending and ascending tracts.
4. Organization of the spinal neurons into motor,
sensory and interneurons.
 Gray mater
• Gray Mater is centrally placed and cell
aggregates to form the
– Anterior horn (AH)
– Dorsal (posterior) horn
– Intermediate horn
• The Anterior Horn
– contains cell bodies of motor neurons, which sends
axons (fibers) that exit through the ventral root to
innervate skeletal muscles of the trunk and limbs.
• Dorsal Horn contains neurons that receive sensory
information from the skin, muscles and joints of the
limbs and trunk through the dorsal root ganglion.
• Intermediate Horn
– Contains interneurons that links the sensory neurons of the
Dorsal Horn with the motor neurons of the Ventral horn.
• Some of the interneurons are monosynaptic,
connecting a certain receptors innervated by the DR
ganglion cell directly to motor neurons
– e.g. in the knee jerk reflex.
• In the KJR when there is a tap on the patella
stretches the quadriceps muscles, thereby
stretching special stretch receptors within the
muscles called Primary spindle receptors.

• Fibers of the dorsal root ganglion that

innervate these receptors synapse on
quadriceps motor neurones on the ventral
horn.
• The KJR is therefore a simple reflex.
• Other reflexes are complex and have several
interneurons
– e.g. Touching a hot surface evokes a reflex
withdrawal reflex of the hand
• This is mediated by complex Polysynaptic
interneurons in the intermediate horn of the
cervical SC.
• Interneurons can be either
– Segmental interneurons (Intrasegmental neurons)
– Propriospinal neurons (Intersegmental neurons)

• In the thoracic and lumber segments of the SC the

intermediate horn contains neurons that mediate
visceral motor functions because Autonomic
preganglionic neurons are located here.
 White mater
• Organized into
– Anterior and Lateral funiculus
– Posterior (dorsal) fasciculus
• They form fasciculus gracilis and fasciculus
cuneatus.
• The White Mater is formed by neurons that
ascend or descend through the SC and forms
most of the named tracts.
• White commissure
– Comprised of Anterior and Posterior white
commissures formed by fibers (axons) crossing
from one side to the other anterior or dorsal to the
central canal.
• The amount of gray mater at any particular
level is proportional to the amount of tissue
supplied by the spinal nerves arising from the
particular segment(s).
• The horns are therefore larger at cervical and
lumber segments corresponding to the brachial
and lumbar plexuses.
• The amount of white mater likewise increases
as one ascends the SC because fibers are
added upwards from the lower limbs, trunks
and upper limbs.
• The anterior (or ventral) white commissure (alba
anterior medullae spinalis)
– Is a bundle of nerve fibers which cross the midline of the
spinal cord just anterior to the gray commissure.
 NERVE CELL GROUPS (NUCLEI)

• Nuclei of anterior Gray horn

– Anterior horn is basically subdivided into
• Medial,
• Central and
• Lateral groupes of neuorons
– But all exhibit further subdivisions at different
spinal levels, usually again into
• dorsal and
• ventral parts.
• Ventral groups of neurons
– Extends most of the length of the SC and
innervates girdle and axial muscles.
• Central group
– Located in the cervical region usually identifiable
between c3 and c7 cervical segments
– It termed as Phrenic nucleus, which innervate
diaphragm.
• Lateral group of neurons
– Located in c5- T1 and L1- S2 spinal segments
forming innervations to limb muscles.
 NUCLEI OF THE DORSAL (POSTERIOR)
GRAY HORN
• Two nuclei extend the whole of the spinal
cord:
– Substantia gelatinosa (nucleus of Rolando)
– Nucleus proprius

• Substantia gelatinosa
– A relay station between (connecting) incoming
fibers from the dorsal root ganglion and fibers
ascending to the thalamus (Spinothalamic tract)
• Nucleus proprius ( Dorsal funicular group)
– Believed to have similar functions with the
substantia gelatinosa.
• Two nuclei are limited to certain segments of
the SC
– Nucleus dorsalis (Thoracicus) of Clarke
– Intermediate column

• Nucleus dorsalis of Clarke

– Occupies the basal region of the dorsal (posterior)
horn, immediately dorsal to the intermediate horn.
• It is identifiable from c8 – L3/L4 segments i.e.
Between the cervical and lumbosacral
enlargements.
• Neurons in this nucleus receive large diameter
primary afferent fibers that innervate muscle
spindles and relay this somatic sensory
information to the cerebellum via the
Spinocerebellar pathway.
 – Some neurones are interneuorns.

• Intermediate column
– Located between c8 and L2/L3
– Contain preganglionic sympathetic neurons and
interneurons.
 DESCENDING MOTOR PATHWAYS
• These motor pathways synapse on the SC
motor or on interneurons (both intrasegmental
and intersegmental neurons).
• There are 7 important descending motor
pathways.
– But Tracts 1-3 directly originate from the cerebral
cortex but 4-7 originates from brainstem.
1. Lateral corticospinal tract
2. Anterior (ventral) corticospinal tract
3. Corticobulbar tract
• To brainstem i.e. pons and medulla motor nuclei
4. Rubrospinal tract
5. Reticulospinal tract (medullary and pontine)
6. Vestibulospinal tract
7. Tectospinal tract
 ORGANIZATION OF THE MOTOR
PATHWAYS
• Corresponds to muscles that they innervate.
– Those that descends laterally control distal limb
muscles contralaterally.
• Lateral corticospinal and rubrospinal tracts.

– Those that descends medially control axial and

girdle muscles bilaterally.
• Ventral corticospinal, Reticulospinal, Vestibulospinal,
and Tectospinal tracts.
• Therefore;
– Brain lesion do not produce profound effects on
axial and girdle muscles.
 RUBROSPINAL TRACT

• The RT is a part of the nervous system.

• It is a part of the lateral indirect extra-pyramidal tract.
• Function
– It is the main route for the mediation of voluntary
movement.
– It is responsible for large muscle movement such as the
arms and the legs as well as for fine motor control.
– It facilitates the flexion and inhibits the extension in the
upper extremities.
 – Over time, the RT can assume almost all the duties of the
corticospinal tract when the corticospinal tract is lesioned.
• Path
• In the midbrain, it originates in the red nucleus,
crosses to the other side of the midbrain, and
descends in the lateral part of the brainstem
tegmentum.
• In the spinal cord, it travels through the lateral
funiculus in the company with the lateral
corticospinal tract.
Rubrospinal tract is 2a, in red at left.
 RETICULOSPINAL TRACT

• The reticulospinal tract (or anterior reticulospinal

tract)
– Is an extrapyramidal motor tract which travels from the
reticular formation.

• The tract is divided into two parts:

– Medial (or pontine) reticulospinal tracts (MRST)
– Lateral (or medullary) reticulospinal tracts (LRST).
• The MRST
– Is caudal to the Superior Colliculus
– Is responsible for anti-gravity muscles.
• The fibers of this tract arise from the caudal pontine
reticular nucleus and the oral pontine reticular
nucleus.
• The LRST
– Is rostral to the Superior Colliculus
– Is responsible for the muscles of movement.
– The fibers of this tract arise from the medullary
reticular formation
• Mostly from the gigantocellular nucleus, and descend
the length of the spinal cord in the anterior part of the
lateral column.
– The tract terminates in the gray spinal laminae.
Reticulospinal tract is 2b, in red, near center.
• Functions of RST
1. Integrates information from the motor
systems to coordinate automatic
movements of locomotion and posture.
2. Facilitates and inhibits voluntary
movement, influences muscle tone.
3. Mediates autonomic functions
4. Modulates pain impulses
• Clinical significance
– If the superior colliculus is damaged, it is called
decerebration and causes decerebate rigidity.

– The reticulospinal tracts also provide a pathway by

which the hypothalamus can control sympathetic
thoracolumbar outflow and parasympathetic sacral
outflow.
 TECTOSPINAL TRACT

• The TST (colliculospinal tract)

– Is a nerve pathway which coordinates head and eye
movements.
• It is part of the indirect extrapyramidal tract.
• Specifically,
– It connects the midbrain tectum and the spinal cord.
• It is responsible for motor impulses that arise from
one side of the midbrain to muscles on the opposite
side of the body.
Vestibulospinal tract is 2c, in red at bottom center.
• The function of the TST
– Is to mediate reflex postural movements of the
head in response to visual and auditory stimuli.
• The portion of the midbrain from where this tract
originates is the superior colliculus,
– which receives afferents from the visual nuclei (primarily
the oculomotor nuclei complex),
– then projects to the contralateral portion of the spinal cord.
• The Tectospinal tract descends to the cervical
spinal cord to coordinate head, neck, and eye
movements
– Primarily in response to visual stimuli.
 VESTIBULOSPINAL TRACT

• The vestibulospinal tract is one of the descending

spinal tracts of the ventromedial pathway.
• It originates from the vestibular nuclei of the medulla,
which conducts information from the vestibular
labyrinth in the inner ear.
• Motion of fluid in the vestibular labyrinth activates
hair cells that signal the vestibular nuclei via cranial
nerve VIII.
Vestibulospinal tract is 2c, in red at bottom center.
• Function
– Lateral vestibulospinal tract
• Facilitates extensor (antigravity) muscle tone and
equilibrium.
– Medial vestibulospinal tract
• Yokes CN III, IV, VI in eye movements;
– Controlling head and neck position (movement) and
gaze control
 ASCENDING TRACTS

• Ventral spinocerebellar tract

– Conveys proprioceptive information from the body to the
cerebellum.
– It is part of the somatosensory system and runs in parallel
with the dorsal spinocerebellar tract.
• Both these tracts involve two neurons.
• The ventral spinocerebellar tract will cross to the
opposite side of the body then cross again to end in
the cerebellum ("double cross"),
 – Differ from the dorsal spinocerebellar tract, which
does not decussate, or cross sides, at all through its
path.
• The ventral tract (under L2/L3) gets its
proprioceptive/fine touch/vibration
information from a first order neuron, with its
cell body in a dorsal ganglion.
• The axon runs to the dorsal horn of the grey
matter.
• They send their axons bilaterally to the ventral border
of the lateral funiculi.
• The ventral spinocerebellar tract then enters the
cerebellum via the superior cerebellar peduncle.
• This is in contrast with the dorsal spinocerebellar
tract (C8 - L2/L3), which only has 1 unilateral axon
that has its cell body in the Clarke's nuclei (only at
the level of C8 - L2/L3).
Ventral spinocerebellar tract is 4b, in blue at right.
• The fibers of the ventral spinocerebellar tract
then eventually enter the cerebellum via the
superior cerebellar peduncle.
– This is one of the few afferent tracts through the
superior cerebellar peduncle.
• Originates from ventral horn at lumbosacral
spinal levels.
• Axons first cross midline in the SC and run in
the ventral border of the lateral funiculi.
• These axons ascend up to the pons where they join
the superior cerebellar peduncle to enter the
cerebellum.
• Once in the deep white matter of the cerebellum,
– the axons recross the midline,
– give off collaterals to the globose and emboliform
nuclei,
– and terminate in the cortex of the anterior lobe and
vermis of the posterior lobe.
 Dorsal spinocerebellar tract
• The DSCT (posterior spinocerebellar tract,
Flechsig's fasciculus, Flechsig's tract)
– Conveys inconscient proprioceptive information
from the body to the cerebellum.
– It is part of the somatosensory system and runs in
parallel with the ventral spinocerebellar tract.
– Proprioceptive information is taken to the spinal
cord via central processes of dorsal root ganglia.
(first order neurons).
• These central processes travel through the dorsal horn
where they synapse with second order neurons of
Clarke's nucleus.
• Axon fibers from Clarke's Nucleus convey this
proprioceptive information in the spinal cord in the
peripheral region of the posteriolateral funiculus
ipsilaterally until it reaches the cerebellum, where
unconscious proprioceptive information is processed.
– This tract involves two neurons and ends up on the same
side of the body.
Dorsal spinocerebellar tract is 4a, in blue at right.
 SPINAL CORD INJURY

• Spinal cord injuries can be caused by trauma

to the spinal column
– Stretching, bruising, applying pressure, severing,
laceration, etc.
• The vertebral bones or intervertebral disks can
shatter, causing the spinal cord to be punctured
by a sharp fragment of bone.
• Usually, victims of SC injuries will suffer loss
of feeling in certain parts of their body.
• When a person suffers a spinal cord injury,
information travelling along the spinal nerves
below the level of injury, will be either
completely or partially cut off from the brain.

• The body will still be trying to send messages

from below the level of injury to the brain
known as sensory messages
• The brain will still be trying to send messages
downwards to the muscles in the body(motor
messages).
– These messages however, will be blocked by the
damage in the spinal cord at the level of injury.
• Nerves joining the spinal cord above the level
of injury will be unaffected and continue to
work as normal.
• In milder cases
– A victim might only suffer loss of hand or foot
function.
• More severe injuries may result
– Paraplegia
– Tetraplegia
– Quadriplegia (Full body paralysis)
• ***Below the site of injury to the spinal cord.
 Quadriplegia / Tetraplegia

• When a person has a spinal cord injury above

the first thoracic vertebra, paralysis usually
affects the cervical spinal nerves resulting in
paralysis of all four limbs.
– The abdominal and chest muscles will also be
affected resulting in weakened breathing and the
inability to properly cough and clear the chest.
– People with this type of paralysis are referred to as
Quadriplegic or Tetraplegic.
 Paraplegia

• When the level of injury occurs below the first

thoracic spinal nerve.
– The degree at which the person is paralyzed can
vary from the impairment of leg movement, to
complete paralysis of :
• the legs and
• abdomen up to the nipple line.
– Paraplegics have full use of their arms and hands.
 Cauda equina lesion
• The Cauda Equina is the mass of nerves
which fan out of the spinal cord at between the
first and second Lumbar region of the spine.
• The spinal cord ends at L1 and L2 at which
point a bundle of nerves travel downwards
through the Lumbar and Sacral vertebrae.
• Injury to these nerves will cause partial or
complete loss of movement and sensation.
• It is possible, if the nerves are not too badly
damaged, for them to grow again and for the
recovery of function.
• The resultant paralysis results in paraplegia,
but this is known as a Cauda Equina
Syndrome injury.
• Damage to upper motor neuron axons in the
spinal cord results in a characteristic pattern of
ipsilateral deficits.
– Hyperreflexia
– Hypertonia
– Muscle weakness.
• Lower motor neuronal damage (lesions) results in its
own characteristic pattern of deficits.
– Rather than an entire side of deficits, there is a pattern
relating to the MYOTOME affected by the damage.
• Additionally, lower motor neurons are characterized
by
– Muscle weakness
– Hypotonia
– Hyporeflexia
– Muscle atrophy.
• Spinal shock and neurogenic shock can occur
from a spinal injury.
– Spinal shock is usually temporary, lasting only for
24-48 hours, and is a temporary absence of sensory
and motor functions.
• Neurogenic shock lasts for weeks and can lead
to a loss of muscle tone due to disuse of the
muscles below the injured site.
• The two areas of the spinal cord most
commonly injured are
– Cervical spine (C1-C7)
– Lumbar spine (L1-L5)
 Autonomic Dysreflexia
(Hyperreflexia)
• A potentially life threatening condition which
can be considered a medical emergency
requiring immediate attention.
• It occurs where the blood pressure in a person
with a spinal cord injury (SCI) above T5-T6
becomes excessively high due to the over
activity of the ANS.
• The most common symptoms are
– Sweating, pounding headache, tingling sensation
on the face and neck, blotchy skin around the neck
and goose bumps.
• In untreated and extreme cases of autonomic
dysreflexia, it can lead to a stroke and death.
– Usually caused when a painful stimulus occurs
below the level of spinal cord injury.
• The stimulus is then mediated through the CNS and
PNS.
BRAIN (ENCEPHALON)
• The brain is the most complex part of the
human body.
• This three-pound organ is the seat of
– Intelligence,
– Interpreter of the senses,
– Initiator of body movement,
– Controller of behavior.
 Brain
• Forebrain
• Telencephalon
• Cerebrum
• Basal ganglia
• Diencephalon
• Thalamus
• Hypothalamus
• Subthalamus
• Midbrain
• Hindbrain - medulla
• Pons
• Cerebellum
• The surface of the brain is the cortex, where the
neurons for higher order processing are located.
– Sensory information from the environment is interpreted,
motor commands are given to the muscles, cognitive
functions are located in the cortex, and there are areas
responsible for behaviour.

• The two cerebral hemispheres are not symmetrical in

function, some functions show more representation in
one hemisphere than the other (language).
 GRAY AND WHITE MATER

• Gray mater
– Where neuronal somata (and dendrites) are located
– Cortex (gray mater) forms a covering for,
• Cerebral and Cerebellar cortex
• Nucleus
– A collection of neurons, functionally related (ganglion in
PNS)
• White mater
– Axons, fibre tracts
– Mostly myelinated (lipid accounts for white appearance)
• Tract
– Collection, group of axons (similar to nerve in PNS)
– Also called fasciculus, funiculus, column, lemniscus,
peduncle, brachium, or stria.
• CNS:
– Covering of gray (cortex), white matter deep
– Tracts running to and from cortex
• Spinal cord:
– Central gray (butterfly-shaped), surrounded by
white matter fibre tracts (spinal cord cortex).
 Functional areas of the Cortex
• Primary cortices
– Occupy a relatively small area of the cortical
mantle
• Association cortices
– Make up the bulk of the area; this is where human
cognition happens.
– These areas integrate the information of several
brain areas.
 Deep structures of the brain
• Basal Ganglia & Cerebellum
– For the coordination of movement
• Limbic system
– Coordinates drives, emotions and memory
• Thalamus
– Gateway to the cortex (Corticospinal tract)
• Upper Motor Neuron
• Lower Motor Neuron
 PONS (Pons Varolii)

• “The pons = a bridge”

• Is a structure located on the brain stem.
• It is cranial to the medulla oblongata, caudal to the
midbrain, and ventral to the cerebellum.
• Its white matter includes:
– Tracts that conduct signals from the cerebrum down to the
cerebellum and medulla
– Tracts that carry the sensory signals up into the thalamus.
• Most of it appears as a broad anterior bulge rostral to
the medulla.
• Posteriorly, it consists mainly of two pairs of thick
stalks called Cerebellar Peduncles.
– They connect the cerebellum to the pons and midbrain.
• The pons contains:
– Nuclei that relay signals from the cerebrum to the
cerebellum,
– Along with nuclei that deal primarily with sleep,
respiration, swallowing, bladder control, hearing,
equilibrium, taste, eye movement, facial
expressions, facial sensation, and posture.
– The Pneumotaxic Center
• Nucleus in that regulates the change from inspiration to
expiration.
 Cranial nerve nuclei
• A number of cranial nerve nuclei are present in
the pons:
– Mid-pons:
• The chief or pontine nucleus of the trigeminal nerve
sensory nucleus (V)
– Mid-pons:
• The motor nucleus for the trigeminal nerve (V)
– Lower down in the pons:
• Abducens nucleus (VI)
– Lower down in the pons:
• Facial nerve nucleus (VII)
– Lower down in the pons:
• Vestibulocochlear nuclei (vestibular nuclei and cochlear
nuclei) (VIII)
• The functions of these four nerves include
– Sensory roles in hearing, equilibrium, and taste,
– Facial sensations such as touch and pain
– Motor roles in eye movement, facial expressions,
chewing, swallowing, urination, and the secretion
of saliva and tears.
 The cerebellum
• (Latin for little brain) is a region of the brain that
plays an important role in motor control.
• It is also involved in some cognitive functions
such as attention and language,
– and probably in some emotional functions such as
regulating fear and pleasure responses, but its function
in movement is the most clearly understood.
– The cerebellum does not initiate movement, but it
contributes to coordination, precision, and accurate
timing.
• It receives input from sensory systems and
from other parts of the brain and spinal cord,
and integrates these inputs to fine tune motor
activity.
• Because of this fine-tuning function,
– Damage to the Cerebellum does not cause
paralysis,
– But instead produces disorders in fine movement,
equilibrium, posture, and motor learning.
• The cerebellum is located at the bottom of the
brain,
– with the large mass of the cerebral cortex above it
and the portion of the brainstem called the pons in
front of it.
– It is separated from the overlying cerebrum by a
layer of leathery dura mater;
• All of its connections with other parts of the brain travel
through the pons.
• Anatomists classify the cerebellum as part of
the metencephalon, which also includes the
pons;
– the metencephalon in turn is the upper part of the
rhombencephalon or "hindbrain".
• Like the cerebral cortex, the cerebellum is divided
into two hemispheres;
– it also contains a narrow midline zone called the
vermis.
• A set of large folds are conventionally used to divide
the overall structure into 10 smaller "lobules".
• Because of its large number of tiny granule cells, the
Cerebellum contains more neurons than the rest of the
brain put together, but it only takes up 10% of total
brain volume.
Folding pattern of the cortex, and interior structures
• Most of its volume is made up of a very tightly
folded layer of gray matter, the cerebellar
cortex.
• Underneath the gray matter of the cortex lies
white matter,
– Made up largely of myelinated nerve fibers
running to and from the cortex.
– Embedded within the white matter (arbor vitae
=Tree of Life) are four deep cerebellar nuclei.
• Based on surface appearance, cerebellum has
three lobes
– Flocculonodular lobe,
– Anterior lobe
• Above the primary fissure
– Posterior lobe
• Below the primary fissure
• These lobes divide the cerebellum from rostral
to caudal.
• Functionally subdivided into
– Spinocerebellum
• A medial sector
– Cerebrocerebellum
• A larger lateral sector
• A narrow strip of protruding tissue along the
midline is called the Vermis ("worm").
• Flocculonodular lobe (Vestibulocerebellum)
– It participates mainly in balance and spatial
orientation
– Its primary connections are with the Vestibular
nuclei
• Although it also receives visual and other sensory input.
• Damage to it causes disturbances of balance
and gait.
• Spinocerebellum (Paleocerebellum)
– The medial zone of the anterior and posterior lobes
– Functions mainly to fine-tune body and limb
movements.
– It receives proprioception input from
• The dorsal columns of the spinal cord (including the
spinocerebellar tract)
• The trigeminal nerve
• Visual and auditory systems.
• Also, it sends fibres to deep cerebellar nuclei
which in turn project to both the Cerebral
Cortex and the Brain stem,
– thus providing modulation of descending motor
systems.
 Cerebrocerebellum (neocerebellum)

– The lateral zone and the largest part.

– It receives input exclusively from the Cerebral
Cortex (Parietal lobe)
• via the Pontine nuclei (forming cortico-ponto-cerebellar
pathways)
– Sends output mainly to
• The ventrolateral thalamus
– In turn connected to motor areas of the Premotor cortex and
Primary motor area of the cerebral cortex)
• The red nucleus.
• The functions of the lateral cerebellum:
• It is thought to be involved in:
– Planning movement that is about to occur,
– Evaluating sensory information for action,
– A number of purely cognitive functions as well.
• Generally,
– The basic function of the cerebellum is not to
initiate movements, or to decide which movements
to execute, but rather to calibrate the detailed form
of a movement.
 Cerebellar Dysfunction

• The most salient symptoms of cerebellar

dysfunction are motor-related
– Specific symptoms depend on which part of the
Cerebellum is involved and how it is disrupted.
Damage to the Flocculonodular lobe (Vestibular
part)
• May show up as a loss of equilibrium and in particular
an altered walking gait, with a wide stance
Indicates difficulty in balancing.
Damage to the midline (Vermis) portion may
disrupt whole-body movements,
Damage localized more laterally
(Cerebrocerebellum)
Is more likely to disrupt fine movements of the hands or
limbs.
Damage to the upper part of the cerebellum
tends to cause gait impairments and other
problems with leg coordination;
 Damage to the lower part is more likely to cause
uncoordinated or poorly aimed movements of the
arms and hands,
As well as difficulties in speed.
• This complex of motor symptoms is called
"ATAXIA".
• To identify cerebellar problems, the
neurological examination includes
– Assessment of gait (a broad-based gait being
indicative of ataxia),
– Finger-pointing tests
– Assessment of posture.
• If Cerebellar Dysfunction is indicated,
– A magnetic resonance imaging scan can be used to
obtain a detailed picture of any structural changes.
• Aging
– The human cerebellum changes with age.
– So the functions of the Cerebellum also are
affected.
 CEREBRUM
• The largest, most prominent part of the human brain.
• The longitudinal fissure partitions the cerebrum into
right and left hemispheres, which are each separated
into four lobes:
• Frontal
• Parietal
• Temporal
• Occipital
• It consists of the cerebral cortex (outer gray matter)
and white matter.
• Functionally it is divided into three parts:
– Motor cortex
• Controls movement of voluntary muscles
– Sensory cortex
• Receives incoming information from visual, hearing,
pressure, and touch receptors, and so on
– Association cortex
• Interprets incoming sensory information and is the site
of intellect, memory, language, and emotion
• The motor cortex (areas) are located in both
hemispheres of the cortex.
– They are very closely related to the control of
voluntary movements, especially fine fragmented
movements performed by the hand.
• The right half of the motor area controls the
left side of the body, and vice versa.
– ((Also for sensory))
• Two areas of the cortex are commonly referred
to as motor:
– Primary motor cortex, which executes voluntary
movements
– Supplementary motor areas and premotor cortex,
which select voluntary movements.
• The inner White mater consists of myelinated
axons of neurons that link several regions of
the brain.
• These axons are arranged into bundles (tracts)
connecting the following:
– Neurons within the same hemisphere bundles (tracts)
– Right and left hemispheres
– The cerebrum with other components of the brain and
spinal cord
• Each hemisphere presents
– An outer convex surface, filling the concavity of
the corresponding half of the vault of the cranium.
– An inner flattened surface which is vertical and directed
towards the corresponding surface of the opposite
hemisphere.
• The two forms the sides of the longitudinal fissure.
– An under surface (base) of an irregular form which rest in
front on the anterior and middle fossae of the base skull,
and behind upon the tentorium cerebelli.
• The two hemispheres are two separate entities
but are connected by an arching band of white
fibers (corpus callosum) that provides a
communication pathway between the two
halves.
• Cerebrum is thrown into a number of creases
or infoldings (fissures and sulci)
• They separate surface into a number of irregular
eminences (Convolutions or Gyri)
• The number and extent of convolutions, and
depth of the intervening sulci, have a close
relation to the intellectual power of the
individual.
• Fissures
– Are infoldings (creases) of large size, few in
number
– They are produced by infoldings of the entire
thickness of the wall, producing corresponding
elevations in the interior of the ventricle.
• Hence termed as Complete fissures.
• Sulci
– Superficial depressions of the grey mater, which is
folded inwards.
– More numerous and produce no corresponding
elevations in the interior of the ventricle.
• Hence termed as Incomplete fissures.
• We have four fissures that divide hemispheres apart
and into larger divisions:
– Longitudinal fissure
– Sylvian fissure
– Fissure of Rolando
– Parietooccipital fissure
 Longitudinal fissure
– Great fissure separates the two cerebral hemispheres
– It reaches from the front to the back, and contains the falx
cerebri.
– Anteriorly and posteriorly, it extends from top to bottom of
the cerebrum, and completely separates the two
hemispheres.
– Middle portion only separates the hemispheres for about
half of their vertical extent.
• It end on the great white commissure (corpus callosum),
which connects the two hemispheres together.
Cerebral Cortex
 Types of Cortex
• PRIMARY CORTICAL REGION
– Part of cortex that is the first to receive its input or the
simplest and most direct one for output.
– For example,
• The primary visual cortex receives the visual information from the
thalamus (that came from the eyes).
• It is where visual information processing begins.
• But any sensory information processing is quite
complex, and needs more advanced cortical regions,
the ASSOCIATION REGIONS, to be completed.
• For example,
– Are you seeing a person or an animal?
– Do you recognize the face on the person?
– Is that person your mother?
• These types of questions need to be answered
by relating what you see to what you know.
• That relating of information happens in the
association cortex.
• Association areas
– Function to produce a meaningful
perceptual experience of the world, enable us to
interact effectively, and support abstract thinking
and language.
• Frontal lobes:
– They are anterior to the central sulcus.
– They are essential for planning and executing
learned and purposeful behaviors
– They are also the site of many inhibitory functions.
• The anterior portion of the frontal lobe is
called the "Prefrontal" cortex.
– It is where our personality and intellect reside.
• Olfaction
– Olfactory information enters the frontal lobe at its
anterior and inferior region through the cribiform
plate of the ethmoid bone in the skull.
FRONTAL LOBE
• Occipital Lobe
– Responsible for our visual processing.
– At its tip Contain primary visual cortex
– The rest of the occipital lobe contains more and
more advanced visual association areas.
– There is even a specific area just for facial
recognition.
– Visual information arrives in the primary visual
cortex from the thalamus.
• Parietal Lobe
– Contains Primary somatosensory cortex .
– Immediately posterior to it are the somatosensory
association areas.
• It interprets the sensation of the body from
– Touch, pain, and proprioceptive senses
• and relates this information to the rest of our sensory
information.
PARIETAL LOBE
• Temporal Lobe
– Contains Primary auditory cortex and our
auditory association areas.
– Auditory information comes to the primary
auditory cortex from the thalamus.
 Cerebral dysfunction syndromes:

• Specific syndromes include

– Agnosia
– Amnesia
– Aphasia
– Apraxia

• Psychiatric conditions
• e.g. Depression, anxiety disorders sometimes include
similar elements.
• Agnosia
– Inability to identify an object using one or more of
the senses.
– They result from damage to or degeneration of
areas of the brain that integrate perception,
memory, and identification.
– Discrete brain lesions can cause different forms of agnosia,
• May involve any sense.
• Typically, only one sense is affected.
• Amnesia
– Partial or total inability to recall past experiences.
– It may result from traumatic brain injury,
degeneration, metabolic disorders, seizure
disorders, or psychologic disturbances
• It can transient, fixed, or progressive.
– Memory deficits more commonly involve facts
(declarative memory) and, less commonly, skills
(procedural memory).
• Aphasia
– Language dysfunction that may involve impaired
comprehension or expression of words or
nonverbal equivalents of words.
– It results from dysfunction of the language centers
in the cerebral cortex and basal ganglia or of the
white matter pathways that connect them.