#3 neuroanatomy tutorials 2012-13 bso2rdyr

FUNCTIONAL ANATOMY OF THE

NERVOUS SYSTEMTUTORIALS

BSO 2012-2013Francesco Contiero

© Francesco Contiero - All illustrations and contents are copyright of the authors

1Wednesday, 7 November 12

TUTORIAL #3

• LB HELP: IMPORTANCE OF PNS DISTRIBUTION

• INTRODUCTION TO TUTORIAL #3: REVISION• NEURONAL CHAINS ACCORDING TO

FUNCTION• INTRODUCTION TO FUNCTIONAL PATHWAYS

• CNS FUNCTIONAL ANATOMY: CNI & CNII



PNS DISTRIBUTION

FAST-FORWARDING TO ‘DYSFUNCTION ANALYSIS’

LB help



IMPORTANCE OF PNS DISTRIBUTION

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Brachial Plexus: key parts, relations, transitionsBRACHIAL PLEXUS EXAMPLE

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NR VS NERVE EXAMPLEDERMATOMES 57

Fig. 89 Approximate distribution of dermatomes on the posterior aspect of the upperlimb.

MUSCLE ROOT MUSCLE ROOT

Trapezius C3, C4 Pronator teres C6, C7

Rhomboids C4, C5 Flexor carpi radialis C6, C7

Serratus anterior C5, C6, C7 Flexor digitorum superficial C7, C8, T1

Pect. major - clavicular C5, C6 Abductor poilicis brevis C8, T1

Pect. major - sternal C6, C7, C8 Flexor pollicis brevis* C8, T1

Infraspinatus C5, C6 Opponens pollicis C8, T1

Supraspinatus C5, C6 Lumbricals I & II C8, T1

Latissimus dorsi C6, C7, C8 Pronator quadratus C7, C8

Teres major C5, C6, C7 Flexor digitorum profundus I & II C7, C8

Deltoid C5, C6 Flexor pollicis longus C7, C8

Biceps C5, C6 Flexor carpi ulnaris C7, C8, T1

Brachialis C5, C6Flexor digitorum profundus III & IV

C7, C8

Triceps C6, C7, C8 Hypothenar muscles C8, T1

Brachioradialis C5, C6 Adductor pollicis C8, T1

Extensor carpi radialis longus C5, C6 Flexor pollicis brevis C8, T1

Supinator C6, C7 Palmar interossei C8, T1

Extensor carpi ulnaris C7, C8 Dorsal interossei C8, T1

Extensor digitorum C7, C8 Lumbricals III & IV C8, T1

Abductor pollicis longus C7, C8

Extensor pollicis iongus C7, C8

Extensor pollicis brevis C7, C8

Extensor indicis C7, C8

UEX Motor distribution - adapted from O’Brien 2010.The list is not comprehensive of all the muscles, but only of those more commonly tested.UEX Motor distribution - adapted from O’Brien 2010.The list is not comprehensive of all the muscles, but only of those more commonly tested.UEX Motor distribution - adapted from O’Brien 2010.The list is not comprehensive of all the muscles, but only of those more commonly tested.UEX Motor distribution - adapted from O’Brien 2010.The list is not comprehensive of all the muscles, but only of those more commonly tested.

DERMATOMES

Fig. 88 Approximate distribution of dermatomes on the anterior aspect of the upperlimb.

Fig. 88-91 show the approximate cutaneous areas supplied by each spinal root. There isconsiderable variation and overlap between dermatomes, so tnat an isolated root lesionresults in a much smaller area of sensory impairment than is indicated in these diagrams.This variation also applies to the innervation of the fingers, but the thumb is usuallysupplied by C6 and the little finger usually by C8 (see Inouye and Buchthal (1977) Brain100: 731-748).The heavy axial lines are usually more consistent, showing the boundarybetween non consecutive dermatomes.

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PERIPHERAL NERVE MUSCLE ROOT PERIPHERAL NERVE MUSCLE ROOT

Spinal Accessory Nerve

Trapezius C3, C4

Median Nerve

Pronator teres C6, C7

Brachial Plexus

Rhomboids C4, C5

Median Nerve

Flexor carpi radialis C6, C7

Brachial Plexus

Serratus anterior C5, C6, C7Median Nerve

Flexor digitorum superficial

C7, C8, T1

Brachial Plexus

Pect. major - clavicular C5, C6Median Nerve

Abductor poilicis brevis C8, T1

Brachial PlexusPect. major - sternal C6, C7, C8

Median Nerve

Flexor pollicis brevis* C8, T1Brachial Plexus

Infraspinatus C5, C6

Median Nerve

Opponens pollicis C8, T1Brachial Plexus

Supraspinatus C5, C6

Median Nerve

Lumbricals I & II C8, T1

Brachial Plexus

Latissimus dorsi C6, C7, C8 Anterior Interosseous

Nerve(from Median

Nerve)

Pronator quadratus C7, C8

Brachial Plexus

Teres major C5, C6, C7

Anterior Interosseous

Nerve(from Median

Nerve)

Flexor digitorum profundus I & II

C7, C8

Axillary Nerve Deltoid C5, C6

Anterior Interosseous

Nerve(from Median

Nerve) Flexor pollicis longus C7, C8

Musculo-cutaneous Nerve

Biceps C5, C6

Ulnar Nerve

Flexor carpi ulnaris C7, C8, T1Musculo-

cutaneous Nerve Brachialis C5, C6

Ulnar Nerve

Flexor digitorum profundus III & IV

C7, C8

Radial Nerve

Triceps C6, C7, C8

Ulnar Nerve

Hypothenar muscles C8, T1

Radial Nerve Brachioradialis C5, C6Ulnar Nerve

Adductor pollicis C8, T1Radial NerveExtensor carpi radialis longus

C5, C6Ulnar Nerve

Flexor pollicis brevis C8, T1

Posterior Interosseous

Nerve(from Radial Nerve)

Supinator C6, C7

Ulnar Nerve

Palmar interossei C8, T1



Extensor carpi ulnaris C7, C8

Ulnar Nerve

Dorsal interossei C8, T1



Extensor digitorum C7, C8

Ulnar Nerve

Lumbricals III & IV C8, T1Posterior Interosseous


Abductor pollicis longus C7, C8


Nerve(from Radial Nerve) Extensor pollicis iongus C7, C8



Extensor pollicis brevis C7, C8



Extensor indicis C7, C8

UEX Motor distribution - adapted from O’Brien 2010.The list is not comprehensive of all the muscles, but only of those more commonly tested.UEX Motor distribution - adapted from O’Brien 2010.The list is not comprehensive of all the muscles, but only of those more commonly tested.UEX Motor distribution - adapted from O’Brien 2010.The list is not comprehensive of all the muscles, but only of those more commonly tested.UEX Motor distribution - adapted from O’Brien 2010.The list is not comprehensive of all the muscles, but only of those more commonly tested.UEX Motor distribution - adapted from O’Brien 2010.The list is not comprehensive of all the muscles, but only of those more commonly tested.UEX Motor distribution - adapted from O’Brien 2010.The list is not comprehensive of all the muscles, but only of those more commonly tested.

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IMPORTANCE OF DISTRIBUTION

RECEPTOR (E.G. SKIN)

ORGAN (E.G. HEARING)

PERIPHERAL NERVE

SPINAL CORD (“PERIPHERAL” CNS)

BRAINSTEM

FOREBRAIN (CORTEX)

SYMPTOMS DISTRIBUTION AREA

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INTRODUCTION

REVISION OF SPINAL NERVE AND SPINAL CORD SEGMENT

HOW ARE WE DOING SO FAR?

revision



ANATOMICAL STRUCTURE OF A TYPICAL PERIPHERAL NERVE

Copyrighted Material

revisio

n© Francesco Contiero - All illustrations and contents are copyright of the authors


FUNCTIONAL ANATOMY OF A TYPICAL SPINAL NERVE

MOTOR

SENSORY

AUTONOMIC

revisio



FUNCTIONAL ANATOMY OF A TYPICAL SPINAL NERVE

AUTONOMIC

PAIN

TOUCHTEMPERATURE

VIBRATION J P S

MOTOR NEURON

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FUNCTIONAL ANATOMY OF A TYPICAL SPINAL SEGMENT

1. SUBDIVISION OF THE SPINAL CORD

2. FROM SPINAL NERVE TO SPINAL SEGMENT

3. FUNCTIONS OF THE SPINAL CORD: WHAT TO EXPECT

4. FUNCTIONAL ANATOMY OF A TYPICAL SPINAL SEGMENT

revisio

n

C1 spinal nerve exitsabove C1 vertebra

Cervicalenlargement

Base of skull

C8 spinal nerveexits belowC7 vertebra(there are 8 cervicalnerves but only7 cervical vertebrae)

Lumbarenlargement

Conus medullaris(termination ofspinal cord)

Internal terminal filum (pial part)

External terminal filum (dural part) Termination of

dural sac

Cauda equina

Coccygeal nerve

Coccyx Coccygeal nerve

Cervical nervesThoracic nervesLumbar nervesSacral and coccygeal nerves

C1C2C3C4C5C6

C7

T1

T2

T3T4

T5T6

T7

T8

T9

T10

T11

T12

L1

C1C2C3C4

C5C6C7C8

T1

T2T3

T4T5T6

T7

T8

T9T10

T11

T12

L1

L2L2

L3

L5

L3

L4L4

L5

Sacrum

S1S2

S3

S4S5

S1



4 - FUNCTIONAL ANATOMY OF A TYPICAL SPINAL SEGMENT

P

A

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P

A

P-M

P-L

A-L

A-M

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Reflexes


P

A

Sensory 1

Sensory 2

Motor

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NEURONAL CHAINSACCORDING TO FUNCTION



NEURONAL CHAINS



NEURONAL CHAINS

Sensory 1

Sensory 2

Motor

FOREBRAIN

MUSCLES SENSATION 1 SENSATION 2

1

11

2 2

2

33

Spinal Cord Segment



INTRODUCTION TO FUNCTIONAL PATHWAYS



INTRO TO.. FUNCTIONAL PATHWAYS

FOREBRAIN

MUSCLES

++

++

++

++

++

++




FOREBRAIN

MUSCLES

- - ++

++

++

++

++

++

++

UPPER

LOWER




FOREBRAIN

MUSCLES TOUCH

VIBRATION

JPS

PAIN

TEMPERATURE




MOTOR SENSORY 1 SENSORY 2

Chain

Function

NAME

2 neurons

the first inhibitory3 neurons 3 neurons

Muscular Control Touch, Vibration & JPS Pain & Temperature

CORTICOSPINALDORSALCOLUMN SPINOTHALAMIC



CNS FUNCTIONAL ANATOMY:CNI & CNII



CNS FUNCTIONAL ANATOMY

FUNCTION(WHAT IS

TRAVELLING THROUGH THE

NERVE?)

ANATOMY (FROM WHERE TO WHERE?)ANATOMY (FROM WHERE TO WHERE?)ANATOMY (FROM WHERE TO WHERE?)ANATOMY (FROM WHERE TO WHERE?)DYSFUNCTION(MAIN CAUSES/

PATTERNS)

FUNCTION(WHAT IS


NERVE?)EXIT FROM THE CNS CRANIAL COURSE

EXIT FROM THE CRANIUM PERIPHERAL COURSE

DYSFUNCTION(MAIN CAUSES/

PATTERNS)

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n

I. Olfactory

II. Optic

III. Oculomotor

IV. Troclear

V. Trigeminal

VI. Abducent

VII. Facial

VIII. Vestibulococlear

IX. Glossopharyngeal

X. Vagus

XI. Accessory

XII. Hypoglossal

P

S

P

PP

S

SS

SS

EFFERENT AFFERENT

CONSCIOUS -

VOLUNTARYMOTOR CONTROL

FINE SENSATIONS

CONSCIOUS -


CRUDE SENSATIONSCONSCIOUS -


SPECIAL

CONSCIOUS -


JOINT POSITION SENSE

UNCONSCIOUS -

INVOLUNTARY

SYMPATHETIC PROPRIOCEPTION PROPER

UNCONSCIOUS -

INVOLUNTARY

SYMPATHETIC

GVA

UNCONSCIOUS -

INVOLUNTARY PARASYMPATHETIC GVA

UNCONSCIOUS -

INVOLUNTARY

ENTERICENTERIC



OLFACTORY NERVE - CNI

EFFERENT AFFERENT

CONSCIOUS -


FINE SENSATIONS

CONSCIOUS -




SPECIAL

CONSCIOUS -



UNCONSCIOUS -

INVOLUNTARY


UNCONSCIOUS -

INVOLUNTARY

SYMPATHETIC

GVA

UNCONSCIOUS -


UNCONSCIOUS -

INVOLUNTARY

ENTERICENTERIC

olfactory mucosa - sense of smell

FUNCTION

(WHAT IS TRAVELLING

THROUGH THE NERVE?)


PATTERNS)

FUNCTION

(WHAT IS TRAVELLING

THROUGH THE NERVE?)

EXIT FROM THE CNS CRANIAL COURSEEXIT FROM THE

CRANIUM PERIPHERAL COURSE


PATTERNS)




FUNCTION(WHAT IS


NERVE?)


PATTERNS)

FUNCTION(WHAT IS


NERVE?) EXIT FROM THE CNS CRANIAL COURSEEXIT FROM THE

CRANIUMPERIPHERAL COURSE


PATTERNS)

91

NEUROPHYSIOLOGYOlfactory System: Receptors

Olfactorybulb

Lateral nasal wall Septum

A. Distributionof olfactoryepithelium(blue area)

Cribriform plateof ethmoid bone

Cribriform plate

Schwann cell

Olfactory gland

Unmyelinatedolfactory axons

Basementmembrane

Sustentacularcells

Endoplasmicreticulum

Nucleus

Olfactory cells

Dendrites

Terminal bars(desmosomes)

Olfactory rod(vesicle)

Villi

Cilia

Mucus

B. Schema ofsection througholfactory mucosa

FIGURE 2.40 OLFACTORY RECEPTORS•The sensory cells that make up the olfactory epithelium respond toodorants by depolarizing. Like taste buds, an olfactory cell canrespond to more than one odorant. There are six general odor

qualities that can be sensed: floral, ethereal (e.g., pears), musky,camphor (e.g., eucalyptus), putrid, and pungent (e.g., vinegar, pep-permint).

©

91


Olfactorybulb




Cribriform plate

Schwann cell

Olfactory gland


Basementmembrane

Sustentacularcells


Nucleus

Olfactory cells

Dendrites



Villi

Cilia

Mucus




©




FUNCTION(WHAT IS


NERVE?)


PATTERNS)

FUNCTION(WHAT IS





PATTERNS)

91


Olfactorybulb




Cribriform plate

Schwann cell

Olfactory gland


Basementmembrane

Sustentacularcells


Nucleus

Olfactory cells

Dendrites



Villi

Cilia

Mucus




©

91


Olfactorybulb




Cribriform plate

Schwann cell

Olfactory gland


Basementmembrane

Sustentacularcells


Nucleus

Olfactory cells

Dendrites



Villi

Cilia

Mucus




©

Fibers from contralateral olfactory bulbFibers to contralateral olfactory bulb

Anterior commissure

Medial olfactory stria

Anterior perforatedsubstance

Lateral olfactorystria

Lateral olfactorytract nucleus

Piriform lobe

Uncus

Amygdala(in phantom)

Entorhinal area

Granule cell (excited byand inhibiting to mitraland tufted cells)

Mitral cell

Recurrent process

Tufted cell

Periglom-erular cell

Glomerulus

Olfactorynerve fibers

Olfactory epithelium Olfactory tract

Olfactory nerves Anterior olfactory nucleus

Olfactory bulb Cribriform plate of ethmoid bone

Olfactory trigone andolfactory tubercle

©




FUNCTION(WHAT IS


NERVE?)

ANATOMY (FROM WHERE TO WHERE?)ANATOMY (FROM WHERE TO WHERE?)ANATOMY (FROM WHERE TO WHERE?)ANATOMY (FROM WHERE TO WHERE?)DYSFUNCTION

(MAIN CAUSES/PATTERNS)

FUNCTION(WHAT IS




DYSFUNCTION


• Loss of olfactory fibres occurs naturally with ageing.

• The loss of smell is frequently associated with upper respiratory infections, sinus diseases and head trauma.

• In severe head traumas the olfactory bulb may torn away from the olfactory nerves, determining a loss of smell and possible CSF rhinorrhea.

MOST COMMON CAUSES OF DYSFUNCTION ABNORMAL FINDINGS

# cribriform plateUni- or bilateral anosmia, cerebrospinal fluid rhinorrhea



OPTIC NERVE - CNII

FUNCTION

(WHAT IS TRAVELLING

THROUGH THE NERVE?)


PATTERNS)

FUNCTION

(WHAT IS TRAVELLING

THROUGH THE NERVE?)




PATTERNS)

EFFERENT AFFERENT

CONSCIOUS -


FINE SENSATIONS

CONSCIOUS -




SPECIAL

CONSCIOUS -



UNCONSCIOUS -

INVOLUNTARY


UNCONSCIOUS -

INVOLUNTARY

SYMPATHETIC

GVA

UNCONSCIOUS -


UNCONSCIOUS -

INVOLUNTARY

ENTERICENTERIC

retina epithelium - sight



OPTIC NERVE - CNII

FUNCTION

(WHAT IS TRAVELLING

THROUGH THE NERVE?)


PATTERNS)

FUNCTION

(WHAT IS TRAVELLING

THROUGH THE NERVE?)




PATTERNS)

Nasal retina (temporal visual field) decussates, while the temporal retina (nasal visual field) stays ipsilateral.



OPTIC NERVE - CNII

FUNCTION

(WHAT IS TRAVELLING

THROUGH THE NERVE?)


PATTERNS)

FUNCTION

(WHAT IS TRAVELLING

THROUGH THE NERVE?)




PATTERNS)



OPTIC NERVE - CNII

FUNCTION(WHAT IS


NERVE?)


PATTERNS)

FUNCTION(WHAT IS





PATTERNS)

Optic Chiasm



OPTIC NERVE - CNII

FUNCTION(WHAT IS


NERVE?)


PATTERNS)

FUNCTION(WHAT IS





PATTERNS)

OPTIC FORAMEN (SPHENOID BONE)

Optic Nerve

Ophthalmic Artery



OPTIC NERVE - CNII

FUNCTION(WHAT IS


NERVE?)


PATTERNS)

FUNCTION(WHAT IS





PATTERNS)

OPTIC FORAMEN (SPHENOID BONE)

Optic Nerve

Ophthalmic Artery

Long ciliary nerve

Short ciliary nerves

Anterior ethmoidal nerve

Superior oblique muscle

Levator palpebraesuperioris muscle

Superior rectus muscle

Ciliary ganglion

Posterior ethmoidal nerve

Sensory root of ciliary ganglion

Sympathetic root of ciliary ganglion

Superior division ofoculomotor nerve

Frontal nerve (cut)

Lacrimal nerve (cut)

Nasociliary nerve

Abducent nucleus

Trochlear nucleus

Oculomotor nucleus

Accessory oculomotor(Edinger-Westphal)nucleus (parasympathetic)

Trochlear nerve (IV)

Oculomotor nerve (III)

Ophthalmic nerve (V1)

Infraorbital nerve

Zygomatic nerve (cut)

Inferior oblique muscle

Ciliary muscle

Dilator muscle of pupil

Sphincter muscle of pupil

Pterygopalatineganglion

Inferior division ofoculomotor nerve

Medial rectus muscle

Inferior rectus muscle

Parasympathetic rootof ciliary ganglion

Efferent fibersAfferent fibersSympathetic fibersParasympathetic fibers

Abducentnerve (VI)

Mandibular nerve (V3)

Maxillary nerve (V2)

Internal carotid arteryand nerve plexus

Lateral rectus muscle andabducent nerve (turned back)

Cavernous plexus

Common tendinous ring



MOST COMMON CAUSES OF DYSFUNCTION ABNORMAL FINDINGS

# involving optic canal

Pressure on optic pathways

Laceration or intracerebral clot

Loss of pupillary constriction*

Visual field defects*

• As the CNII is effectively part of the CNS (the myelin surrounding the CNII is formed by oligodendrocytes), pathologies affecting only the CNS like Multiple Sclerosis can affecting it.

OPTIC NERVE - CNII

FUNCTION(WHAT IS


NERVE?)



FUNCTION(WHAT IS




DYSFUNCTION




OPTIC NERVE - CNII

FUNCTION(WHAT IS


NERVE?)



FUNCTION(WHAT IS




DYSFUNCTION


MIOSIS MIDRIASIS

Afferent part of the pupillary reflex



OPTIC NERVE - CNII

FUNCTION(WHAT IS


NERVE?)



FUNCTION(WHAT IS




DYSFUNCTION


MONOCULAR OR BI

HOMONYMOUS IF THE SAME SIDE OF VISUAL

FIELD IS AFFECTED

NASAL OR TEMPORAL

HEMIANOPSIA



OPTIC NERVE - CNII

FUNCTION(WHAT IS


NERVE?)



FUNCTION(WHAT IS




DYSFUNCTION


VISUAL FIELDMONOCULAR OR BI


FIELD IS AFFECTED

NASAL OR TEMPORAL

HEMIANOPSIA



OPTIC NERVE - CNII

FUNCTION(WHAT IS


NERVE?)



FUNCTION(WHAT IS




DYSFUNCTION


VISUAL FIELD

VISUAL FIELD

MONOCULAR OR BI


FIELD IS AFFECTED

NASAL OR TEMPORAL

HEMIANOPSIA



GRAZIE !



REFERENCES

• Mazzocchi G., Nussdorfer G. Aantomia Funzionale del Sistema Nervoso (1999) Libreria Cortina (Padova)

• Snell R.S. Clinical Neuroanatomy (2009) Lippincott Williams & Wilkins

• Standring S. Gray’s Anatomy (2009, 40th Edition) Churchill Livingstone

ILLUSTRATION SOURCES:

• Netter's Atlas of Neurology - Illustrations by Netter F.H., Craig J.A., Perkins J. - Copyright of Icon Custom Communications, 2002

• 3D Medical Images - 3DMEDICAL.COM - Copyright of 3DMedical.com, LLC 2011


#3 neuroanatomy tutorials 2012-13 bso2rdyr

Documents

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c6 opponens pollicis

c6 flexor pollicis brevis

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c6 flexor pollicis longus

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c7 palmar interossei