CNS - Misericordia University

CNS - Misericordia University

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

Anterior Middle Posterior CNS (Central Nervous System)

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

Choroid Plexus CSF (cerebral-spinal fluid) Flow Hydrocephalus Blockage of CSF flow

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

Oblique muscle Ciliary ganglion Inferior Rectus muscle Parasympathetic

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

CN VII: Facial Nerve CN VIII: Vestibulocochlear Nerve CN IX: Glossopharyngeal Nerve CN X: Vagus Nerve

CN XI: Accessory Nerve CN XII: Hypoglossal Nerve

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