Cranial Fossa: Brain and Spinal Cord Clinical Anatomy Tony Serino, Ph.D. Cranial Fossa: Topic Objectives Be able to describe the distribution of grey and white matter in the
brain and spinal cord Be able to describe the arrangement of the meninges and the differences between cranial and spinal meninges Be able to describe blood flow to and from the cranial fossae Be able to describe normal CSF flow Be able to deduce consequence of CSF blockages Be able to identify the major parts and regions of the brain and
spinal cord and their development Be able to describe the functions of selected areas of the brain Understand brain blood flow and be able to predict vascular changes to the circle of Willis when an obstruction occurs in a single vessel Be able to describe Cranial Nerve location and function Be able to predict functional loss with CN paralysis
Central Nervous System (CNS) Gray vs. White matter Protection of CNS Meninges CSF flow Brain
Development Selected structures Spinal cord Selected structures Cranial Fossa
Brian and spinal cord Displays gray and white matter Gray matter are areas of CNS with many cell bodies of neurons present (little myelinated nerve fibers) White matter are area of CNS with few cell bodies but many myelinated nerve fibers
Protected by bone and membranes Gray and White Matter Since the cerebrum and cerebellum outgrow their cores, gray matter
ends up on outside of both structures. Meninges Dura Mater outermost; tough, fibrous CT In brain, divided into two layers (periosteal and meningeal)
In spine, only one layer with fat filled space above the layer called the epidural space Arachnoid middle; web-like appearance Potential space between Dura and arachnoid is the subdural space
Pia Mater innermost, delicate membrane fused with CNS surface Space between Pia and Arachnoid is the subarachnoid space Meninges of the Spinal Cord Epidural space
Subdural space Pia mater Arachnoid Dura mater Meninges
Subarachnoid space Dorsal Root Ganglion Centrum
Brain Meninges Extensions of Dura Mater hold brain in cavity Sellar diaphragm (not shown)
Venous Sinuses of Cranium Superior Sagittal Inf. Sagittal Straight Transverse Sigmoid
Cavernous Lateral Venous Lacunae Arachnoid villi
Middle Meningeal Artery Middle Meningeal A. Maxillary A. Brain Ventricles
can lead to severe brain and/or head enlargement. In an adult, such swelling would be fatal.
Brain Development Structures Functional Areas Neural Tube forming
Neural Tube Brain Vesicles Flexures and Cerebral Cortex Growth
Major Divisions of Brain Brain Stem = midbrain + pons + medulla Brain Anatomy (reqd) Projections vs. Commissures
Functional Areas of Cerebrum Primary Motor and Somatosensory Gyri Basal Nuclei: cerebral nuclei
Putamen and Globus Pallidus Subthalamic nuclei and the Substantia nigra are usually included
Reticular Formation Extends along length of brain stem; used in maintaining alertness while awake; also includes motor nuclei such as centers for Cardiac, Respiratory and Vasomotor control. RAS receives inputs from eye, ear and general sensation to maintain alertness
Limbic System: functional system; responsible for emotion and memory Cingulate Gyrus Fornix
Mammillary body Hypothalamus Control of Pituitary Posterior Pituitary Anterior Pituitary
Pineal Gland Plays a major role in circadian rhythm control through its sympathetic connection to the
hypothalamus Melatonin increases at night and decreases during daylight Implicated in the control of major life changes (such as the
onset of puberty and adulthood Internal Carotid Artery Blood Supply (Circle of Willis)
Ant. Cerebral Ant. Communicating Middle Cerebral Internal Carotid A. Post. Communicating
Post. Cerebral Basilar A. Vertebral A. Cranial Nerves
CN I: Olfactory Nerve covered by meninges and contain glial cells Cribiform plate damage after trauma could lead to CSF leakage (runny nose after head trauma) Pathway: Bulbtract med and lat. stria
prepiriform and amygdala Covered by meninges Leaves by optic canal Pathway: nervechiasma
tracts lat. geniculate and sup. colliculus optic radiation to occipital lobe CN II: Optic Nerve
Medial Rectus muscle Superior Orbital Fissure
Midbrain Superior Rectus muscle Levator Palpabrae muscle Inferior
Motor fibers Oculomotor N. (III) Pons Palsy leads to ptosis, diplopia, dilated pupil; gaze is down and out; pupil involvement usually due to increase cranial pressure due to surface location of
fibers in nerve CN III: Occulomotor Nerve Originates from brain stem: midbrain Leaves via sup.
orbital fissure Path: occulomotor nucleus muscles : levator palpebrae, sup., medial, inf. rectus, and inf. oblique. Separate
branch from EdingerWestphal nuclues ciliary ganglion parasym innervation to iris sphincter and CN IV: Trochlear Nerve
Originates from brain stem: midbrain Complete decussation in midbrain
Nucleus to Sup. oblique, runs the longest distance in cranial vault Passes through sup. orbital fissure In injury, affected eye is higher and deviated medially, head tilts away from lesion; hardest to diagnose CN V: Trigeminal Nerve
CN VI: Abducens Nerve Originates from brain stem: pons goes to lateral rectus m. Passes through sup. orbital fissure Injury: affected eye deviates medially (crosseyed look) patient may turn head to compensate
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