overview of basic neuroanatomy and cerebrovascular anatomy · overview of neuroanatomy and cerebral...
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Joey English MD PhD
Medical Director, Neurointerventional Surgery Service
California Pacific Medical Center Hospitals, San Francisco, CA
Stroke Medical Director Mills-Peninsula Health Services, Burlingame, CA
Overview of Basic Neuroanatomy and Cerebrovascular Anatomy
Overview of Neuroanatomy and Cerebral Vasculature
• Basic 3D relationships of central nervous system structures • Most clinically relevant pathway Corticospinal pathway: voluntary motor control • Cervical and intracranial cerebral vasculature
• Foundation for understanding acute ischemic stroke
Clinical stroke syndromes Stroke imaging Rationale for medical and endovascular stroke treatment Acute therapies, secondary prevention
Overview of Neuroanatomy
Brain Cerebral Cortex Deep Nuclei
Brainstem
Spinal Cord
Overview of Neuroanatomy – Orientation is Important
Overview of Neuroanatomy – Orientation is Important
The Fundamental Unit of the Nervous System: the Neuron
INPUT PROCESSOR OUTPUT
Overview of Neuroanatomy
Grey Matter vs White Matter
Overview of Neuroanatomy – Spinal Cord
MYELIN STAIN white matter = black grey matter = white
Spinal Nerve
upper cervical cord
medulla
pons
midbrain
Overview of Neuroanatomy – Brainstem
Brainstem
Spinal Cord
III IV
VI
V
VII VIII
XII
X
IX
II
XI
Overview of Neuroanatomy – Brainstem
M
MB
P cerebellum
T
SC
SC
M
P MB
cerebellum
T
Overview of Neuroanatomy – Thalamus
T T
SC
M
P MB
cerebellum
T
Overview of Neuroanatomy – Thalamus
pons
medulla
Overview of Neuroanatomy – BRAINSTEM AND THALAMUS
thalami
midbrain
Overview of Neuroanatomy – Axonal Highways
Overview of Neuroanatomy – Axonal Highways
basal ganglia
internal capsule
Overview of Neuroanatomy – Internal Capsule
Anterior
Posterior
Overview of Neuroanatomy – Internal Capsule
Overview of Neuroanatomy – Axonal Highways
M
MB
P cerebellum
T
SC
SC
M
P MB
cerebellum
Overview of Neuroanatomy – Corpus Callosum
CC
T
41/65
SC
M
P MB
cerebellum
Overview of Neuroanatomy – Cerebral Hemispheres
T
Cortical Anatomy and Functional Organization
LEG
ARM
FACE
Speech Production
Speech Comprehension
Visual Cortex
MOTOR SENSORY
Frontal Eye Fields
Leg
Arm
Face
Voluntary Motor Control: The Corticospinal Pathway
Primary Motor Cortex
Cell Body of UMN
Axon of UMN
Cell Body of LMN
Axon of LMN Synapse
of LMN
Target Muscle
cervical spinal cord
thalami
midbrain
pons
medulla
Motor Cortex
internal capsule
L A
F
Voluntary Motor Control: The Corticospinal Pathway
Primary Motor Cortex
Cell Body of UMN
Axon of UMN
Cell Body of LMN
Axon of LMN Synapse
of LMN
Target Muscle
cervical spinal cord
thalami
midbrain
pons
medulla
internal capsule
L A
F
Corticospinal Tract
Crossing of tract to contralateral side
Voluntary Motor Control: The Corticospinal Pathway Primary Motor Cortex
Cell Body of UMN
Axon of UMN
Cell Body of LMN
Axon of LMN Synapse
of LMN
Target Muscle
Motor Cortex
cervical spinal cord
thalami
midbrain
pons
medulla
L A
F
Anterior
Posterior
Voluntary Motor Control: The Corticospinal Pathway
internal capsule
Motor Cortex
cervical spinal cord
thalami
midbrain
pons
medulla
L A
F
Anterior
Posterior
Voluntary Motor Control: The Corticospinal Pathway
internal capsule
Motor Cortex
cervical spinal cord
thalami
midbrain
pons
medulla
L A
F
Anterior
Posterior
Voluntary Motor Control: The Corticospinal Pathway
internal capsule
Motor Cortex
Ventral Surface
cervical spinal cord
thalami
midbrain
pons
medulla
L A
F
Voluntary Motor Control: The Corticospinal Pathway
internal capsule
Motor Cortex
cervical spinal cord
thalami
midbrain
pons
medulla
L A
F
Voluntary Motor Control: The Corticospinal Pathway
internal capsule
Motor Cortex
Vascular Supply to the Brain
Cerebrovascular Anatomy
Cerebrovascular Anatomy
Cerebrovascular Anatomy
Cerebrovascular Anatomy
Cerebrovascular Anatomy
Cerebrovascular Anatomy
Cerebrovascular Anatomy
LEG
ARM
FACE
Vascular Neurology: Neuroanatomy and Vascular Anatomy
Speech Production
Speech Comprehension
Vascular Neurology: Neuroanatomy and Vascular Anatomy
cervical spinal cord
thalami
midbrain
pons
medulla
L A
F
internal capsule
Motor Cortex
cervical spinal cord
thalami
midbrain
pons
medulla
L A
F
internal capsule
Motor Cortex
Joey English MD PhD
Medical Director, Neurointerventional Surgery Service
California Pacific Medical Center Hospitals, San Francisco, CA
Stroke Medical Director Mills-Peninsula Health Services, Burlingame, CA
Overview of Basic Neuroanatomy and Cerebrovascular Anatomy
cervical spinal cord
thalami
midbrain
pons
medulla
L A
F
Voluntary Motor Control: The Corticospinal Pathway
internal capsule
Primary Motor Cortex
Cell Body of UMN
Axon of UMN
Cell Body of LMN
Axon of LMN Synapse
of LMN
Target Muscle
Motor Cortex
Cortical Anatomy and Functional Organization
LEG
ARM
FACE
Speech Production
Speech Comprehension
Auditory Cortex
MOTOR
SENSORY