Brain and Spinal Cord

Central Nervous System
1. Brain
2. Spinal Cord
Brain
General
Information
•Weight about 3
pounds
•Two percent of
body weight but
–One third of blood
flow
–Twenty percent of
O2
• Basic
Subdivisions
Auxiliary structures
• Definition:
• CNS (brain and spinal cord) are

those parts of nervous system
that are within bone.
– Brain within skull
– Spinal cord within vertebral column
• Additionally CNS is ensheathed

in three membranes ... from
outside to inside
– Dura mater
– Arachnoid membrane
– Pia mater
Epidural hematoma
• Is due to rupture of the middle meningeal artery
• A blow to the head, such as in a motor vehicle crash
• Falling down and striking the head
• The signs and symptoms include severe headache, dizziness, vomiting, increased size of one
pupil or sudden weakness in an arm or leg.
Subdural hematoma
• Increased intracranial
pressure is almost always
indicative of severe medical
problems. The pressure itself
can be responsible for further
damage to the central nervous
system by decreasing blood
flow to the brain or by causing
the brain to herniate (push
through) the opening in the
back of the skull where the
spinal cord is attached.
Causes of increased
intracranial presure may
include bleeding into the
subdural space
• The dura has been reflected back (with a small portion visible at the
lower right) to reveal a subdural hematoma. Such a blood clot is
usually the result of trauma with tearing of the bridging veins.
Subarachnoid Hematoma
The subarachnoid hemorrhage from a ruptured aneurysm is more of an irritant producing

vasospasm than a mass lesion.
• The white arrow on the black card marks the site of a
ruptured berry aneurysm in the circle of Willis. This is a
major cause for subarachnoid hemorrhage .
• Dura mater
Follows major brain
structures and incorporates
major sinuses
• Arachnoid membrane
Follows dura mater
• Pia mater
Follows convoluted surface
of brain and spinal cord
Cerebrospinal fluid
• Within
– The subarachnoid space
• Brain
• Spinal cord
– brain ventricles
• Lateral (left and right)
• Third
• Fourth
• Filtered from blood in choroid plexuses of each ventricle
and flow is through ventricles and aqueduct of Sylvius to
subarachnoid space through foramen of Magendie and
finally to superior sagittal sinus through arachnoid
granulations
Cerebrospinal fluid
Cerebral hemispheres
• Remove brain from skull

– Cerebral hemispheres
– Cerebellar hemispheres
• Convoluted
– Sulci (fissures)
– Gyri
– More regular on cerebellum
On cerebral hemispheres surface area = 2sq. ft.
(about 2/3 within convolutions)
Brain
• Cortex-outer
part gray
matter
• Inner
partwhite
matter
Internal structures
Forebrain
• General considerations
• Individual cells neurons generally have three
distinct parts
– Cell body or soma
– Dendrites (many)
– Axon (one)
• General organization of cells within forebrain

– Soma form cortex, surface (gray matter) of
hemispheres
– Axon extending internally (white matter) of
hemispheres
some terminology
• Groups of cell bodies

– Within CNS are called nuclei
– Outside of CNS are called ganglion
• Groups of axons
– Within CNS are called tracts or pathways
– Outside of CNS are called nerves
Ventricles
•
Midbrain and brainstem
• Internal structures
consist of nuclei of
cranial nerves and
ascending and
descending neural
pathways
Cerebellum
• Four major internal

nuclei
– Fastigial
– Dentate
– Emboliform
– Globose
Spinal cord
• General Information
• Boney compartment for this portion of CNS is the veterbral
column
• Division brain/spinal cord
– Where CNS exits skull
• Length of cord within vertebral column
– About 2/3 of column
– lack of mytotic cellular division after birth
• Vertebral column
• Thirtythree vertebrae joined together by multiple ligments
and cartilages
– Seven cervical
– Twelve thoratic
– Five lumbar
– Five (fused) sacral
– One coccygeal (fusion of four small vertebrae)
Surface anatomy
• Shares same meninges as brain
• Dura mater
• Arachnoid
• Pia mater
• and cerebrospinal fluid
• Spinal nerves exit between vertebra
• 31 pairs
• Each divides prior to attaching to cord
– Dorsal root
• Sensory
• Cell bodies of neurons outside of cord
• Attach at posterior lateral sulcus
– Ventral root
• motor
• Cell bodies of neurons inside of cord
• Exit from anterior lateral sulcus
Internal anatomy
• General
• Opposite of brain
– Fiber processes on outside
(white matter)
– Soma inside (gray matter)
• Fibers
– Fibers connecting adjacent
levels are more medial
– Tracts and longer pathways
more lateral
Internal organization
• Central gray forms a "H"

• Defines three fiber areas
which can be generally
related to
– Dorsal -- sensory
– Ventral -- motor
– Lateral -- mixed
Sensory pathway
proprioception Pain and Temperature Simple touch

Motor pathways
• Pyramidal system
– Lateral (crossed)
– Direct (uncrossed)
• Extrapyramidal system
Disc prolapse
Clinical cases (important)
• Apatient presents with a specific right
L4 nerve lesion and a disc protrusion
at the LIII/LIV. Explain.
• Apatient presents with a right L3 nerve

root lesion and a disc protrusion at the
LIII/LIV level. Where is the disc
protrusion?
• An extradural injection of local anesthetic was
given at the LI/LII vertebral level. List three
functions that the patient is now not able to do
• It was necessary to carry out a lumber

puncture to obtain CSF in a neonate. A needle
was passed at the LII/LIII vertebral spinal inter
space. Unfortunately the baby became
paraplegic. Why?
• A 45-year-old man involved in a
serious car accident. On examination
he had a sever injury to the cervical
region of his vertebral column with
damage to the spinal cord. In fact, his
breathing became erratic and
stopped. Explain?

Brain and Spinal Cord

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Brain and Spinal Cord

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Central Nervous System

• CNS (brain and spinal cord) are

• Additionally CNS is ensheathed

The subarachnoid hemorrhage from a ruptured aneurysm is more of an irritant producing

• Remove brain from skull

• General organization of cells within forebrain

• Groups of cell bodies

• Four major internal

• Central gray forms a "H"

proprioception Pain and Temperature Simple touch

• Apatient presents with a right L3 nerve

• It was necessary to carry out a lumber

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