Neuroanatomi - pharmguse.net

Neuroanatomi "Farmakologi, sjukdomslära och läkemedelskemi" Magnus Bengtsson Upplägg •  Översikt •  Hjärnhinnor och ventrikelsystemet •  Storhjärnan •  Mellanhjärnan •  Öga och Öra •  Hjärnstam och lillhjärnan •  Ryggmärg och Bansystem •  Blodförsörjning CNS •  PNS och ANS •  Insprängda kliniska fall Översikt Plan Afferens och Efferens Sensory input Integra1on Motor output Indelning CNS/PNS Hjärnhinnor Ventrikelsystemet Lateral ventricle
Septum pellucidum Anterior horn Posterior horn Interventricular foramen Inferior horn Third ventricle
Inferior horn Cerebral aqueduct
Lateral aperture (a) Anterior view
Fourth ventricle
Median aperture Central canal Lateral aperture (b) Left lateral view
Cerebrospinalvätska 4
Superior sagi=al sinus Arachnoid villus Choroid plexus Subarachnoid space Arachnoid mater Meningeal dura mater Periosteal dura mater 1
Interventricular foramen Right lateral ventricle (deep to cut) Third ventricle 3
Cerebral aqueduct Lateral aperture Fourth ventricle Median aperture Central canal of spinal cord (a) CSF circulation
Choroid plexus of fourth ventricle 2
1
CSF is produced by the choroid plexus of each ventricle. 2
CSF flows through the ventricles and into the subarachnoid space via the median and lateral apertures. Some CSF flows through the central canal of the spinal cord. 3
CSF flows through the subarachnoid space. 4 CSF is absorbed into the dural venous sinuses via the arachnoid villi. Lober FunkNonella centra Motor areas
Central sulcus Primary motor cortex Premotor cortex Frontal eye field Broca’s area (outlined by dashes) Sensory areas and related
association areas
Primary somatosensory cortex Somatosensory associa1on cortex Gustatory cortex (in insula) Prefrontal cortex
Working memory for spa1al tasks Execu1ve area for task management Working memory for object-­‐recall tasks Solving complex, mul1task problems Soma1c sensa1on Taste Wernicke’s area (outlined by dashes) Primary visual cortex Visual associa1on area Auditory associa1on area Primary auditory cortex (a) Lateral view, left cerebral hemisphere
Primary motor cortex Motor associa1on cortex Primary sensory cortex Sensory associa1on cortex Mul1modal associa1on cortex Vision Hearing FunkNonella centra Premotor cortex Primary motor cortex Cingulate gyrus Central sulcus Corpus callosum Primary somatosensory cortex Frontal eye field Parietal lobe Somatosensory associa1on cortex Parieto-­‐occipital sulcus Occipital lobe Prefrontal cortex Processes emo1ons related to personal and social interac1ons Visual associa1on area Calcarine sulcus Orbitofrontal cortex Olfactory bulb Olfactory tract Fornix Primary visual cortex Temporal lobe (b) Parasagittal view, right hemisphere
Primary olfactory cortex Uncus Primary motor cortex Motor associa1on cortex Primary sensory cortex Sensory associa1on cortex Mul1modal associa1on cortex Parahippocampal gyrus Homunculus Posterior
Anterior Sensory Hip Trunk Leg Hip Trunk Neck Motor lder Shou
Motor map in
precentral gyrus Foot Knee Brow
Eye Toes Genitals Face Lips Jaw Tongue Swallowing Sensory map in
postcentral gyrus Primary
motor cortex (precentral gyrus) Primary
somato- sensory cortex (postcentral gyrus)
Teeths Gum
Tongue Pharynx Kramper och epilepsi •  KorNkala urladdningar •  Sekundär Nll skada – 
– 
– 
– 
Stroke Tumör InfekNon Alkohol •  Kryptogen •  Symptomen följer anatomin Vit substans, banor Longitudinal fissure Superior Lateral ventricle Basal ganglia Caudate Putamen Globus pallidus Thalamus Corona radiata Fornix Internal capsule Gray ma=er White ma=er Third ventricle Pons Projection
fibers
Medulla oblongata (a) Frontal section
Association fibers Commissural fibers
(corpus callosum) Decussa1on of pyramids MulNpel Skleros •  Myelinskada à Plaque i vit substans •  InflammaNon –  Skovvist förlöpande –  Progressivt förlöpande •  EffekNva immunmodulerande läkemedel Basala kärnorna översikt Basala kärnorna 1 Basala kärnorna 2 Parkinsons sjukdom •  DegeneraNon SubstanNa Nigra –  ê DA •  Motoriska störningar –  Hypokinesi –  Rigiditet –  Tremor •  KogniNva och affekNva störningar HunNngtons sjukdom •  DegeneraNon Striatum och Kortex (främst frontotemp) –  ê GABA, é Glu •  Triad –  Dominant nedärvning –  Choreoathetos –  Demens •  HunNngNn, CAG-­‐repeat Djupa strukturer, limbiska systemet Limbiska systemet Psykiatri •  Cerebrala skador ger psykiska symptom •  Signalsubstanser påverkar –  Seratonin –  DA –  Na –  GABA –  Glutamat •  Starkt koppling kropp och skäl –  Descartes Diencephalon 1 Thalamus Dorsal nuclei Medial Lateral dorsal Lateral posterior Anterior nuclear group Pulvinar Medial
geniculate body Lateral
geniculate body Re1cular nucleus Ventral anterior Ventral lateral Ventral
postero- lateral Ventral nuclei (a) The main thalamic nuclei. (The re1cular nuclei that “cap” the thalamus laterally are depicted as curving translucent structures.) Hypothalamus Paraventricular nucleus Anterior commissure Preoptic
nucleus Anterior hypothalamic nucleus Supraop1c nucleus Suprachiasmatic
nucleus Op1c chiasma Infundibulum (stalk of the pituitary gland) Fornix (b) The main hypothalamic nuclei Arcuate nucleus Pituitary gland Dorsomedial nucleus Posterior hypothalamic nucleus Lateral hypothalamic area Ventromedial nucleus Mammillary
body Endokrinologi •  Saltbalans –  Diabetes insipidus •  Hungerkontroll –  Fet-­‐musen •  Cirkadianska rytmer –  Dygnsrytm •  Vakenhet –  Narkolepsi •  Thyroidea •  Binjuren •  FSH, LH •  GH •  Oxytosin •  Etc etc Örat Hammaren
Städet
Stigbygeln
Mellanörat
Ytterörat
Innerörat
Balansorganet
N. VIII
Hörselgången
Runda
Trumfönstret
hinnan Ovala
fönstret
Hörselsnäckan
(cochlean)
Örontrumpeten
KorNska organet Tectorialmembranet
Yttre hårceller
Tectorialmembranet
Retikularmembranet
Inre hårcell
Hörselceller
Basilarmembranet
Deitersceller
Figur 5.22
Fysiologi
© Jan Lännergren, Håkan Westerblad, Mats Ulfendahl oc
igur 5.10
Båggångaroch hinnsäcker Semicirkulära
båggångar
Temporalbenet
Subduralrummet
Utriculus
Sacculus
Hörselsnäckan
Endolymfa
Scala vestibuli
Scala media
Scala tympani
Perilymfa
Ovala fönstret
med stigbygeln
Runda fönstret
Ögat Pupill
Främre ögonkammare
Iris
Bakre
ögonkammare
Cornea (hornhinna)
Lins
Ciliarkropp med
ciliarmuskel
Glaskropp
Retina
(näthinna)
Choroidea
(åderhinna)
Sclera
(senhinna)
Synnervspapill
(blinda fläcken)
Fovea
centralis
Synnerven (N. II)
ANS och ögat Sympathetic activation
Nearly parallel rays
from distant object
Lens
Ciliary zonule
Inverted
image
Ciliary muscle
Parasympathetic activation
Divergent rays
from close object
Inverted
image
Brytningsfel Myopi
(närsynthet)
Korrigeras med
spridningslins
Hyperopi
(översynthet)
Korrigeras med
samlingslins
Synbanan N
T
T
N. opticus
Synnervskorsning
Synfältsbortfall i
vä öga
hö öga
1
1
Tractus
opticus
2
3
2
Laterala
knäkroppen
Synstrålning
Syncortex
Figur 5.34
3
Hjärnstam och kranialnerver Mesencephalon Dorsal Tectum Periaqueductal gray ma=er Superior colliculus Cerebral aqueduct Re1cular forma1on Oculomotor nucleus (III) Medial lemniscus Red nucleus Substan1a nigra Fibers of pyramidal tract Ventral (a) Midbrain Crus cerebri of cerebral peduncle Pons Superior cerebellar peduncle Trigeminal main sensory nucleus Fourth ventricle Re1cular forma1on Trigeminal motor nucleus Middle cerebellar peduncle Trigeminal nerve (V) Medial lemniscus (b) Pons Pon1ne nuclei Fibers of pyramidal tract Medulla Oblongata Hypoglossal nucleus (XII) Dorsal motor nucleus of vagus (X) Re1cular forma1on Inferior cerebellar peduncle Lateral nuclear group Medial nuclear group Raphe nucleus Medial lemniscus (c) Medulla oblongata Fourth ventricle Choroid plexus Solitary nucleus Ves1bular nuclear complex (VIII) Cochlear nuclei (VIII) Nucleus ambiguus Inferior olivary nucleus Pyramid Cerebellum Anterior lobe Cerebellar cortex Arbor vitae Cerebellar
peduncles Posterior lobe Superior Middle Inferior Medulla oblongata Flocculonodular lobe (b) Illustration of parasagittal section Choroid plexus of fourth ventricle Ryggmärgen Ryggmärgssegment Ryggmärg, gränssträngen Pyramidbanan Primary motor cortex
Cerebrum Pyramidal cells
Internal capsule
Midbrain
Cerebral peduncle
Cerebellum
Pons
Ventral
corticospinal
tract
Pyramids
Medulla oblongata
Decussa1on of pyramid
Lateral
corticospinal
tract
Cervical spinal cord
Skeletal muscle Lumbar spinal cord
Soma1c motor neurons
(a) Pyramidal (lateral and ventral corticospinal) pathways
ALS •  DegeneraNon av övre-­‐ och nedre motorneuron –  Centrala och perifera motoriska symptom •  Med Nden även korNkal degeneraNon –  KogniNva symptom Sensoriska banor Smärta, omkopplingar Huvudvärk Blodkärl, främre cirkulaNonen 1 Blodkärl, främre cirkulaNonen 2 Blodkärl bakre cirkulaNonen Blodkärl, ryggmärgen Hjärnans venösa system Stroke Cerebrovaskulär sjukdom med fokal ischemi •  Infarkt –  Lokalt; embolus eller lakunär infarkt –  Artär-­‐artär embolus –  Kardiell embolus –  Annat; venöst, dissekNon, etc •  Intracerebral blödning –  Hypertoniblödning –  Kärlskada •  Subarachnoidalblödning –  Aneurysm PNS Cervical plexus Brachial plexus Cervical nerves C1 – C8 Cervical enlargement Intercostal nerves Thoracic nerves T1 – T12 Lumbar enlargement Lumbar plexus Sacral plexus Cauda equina Lumbar nerves L1 – L5 Sacral nerves S1 – S5 Coccygeal nerve Co1 Dermatom C2
C3
C5 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L1 S2 S3 L2 L2 C4
T2
C5 C6
C6
C7
C8
L3
L4
L5
S1
(a) Anterior
view
T2
C5 C6
C8
L3
L4
L5
S1
C6
C7
Guillain-­‐Barrés syndrom •  Akut inflammatorisk demyeliniserande polyneuropaN (AIDP) •  Drabbar perifera nerver och nervrö_er –  Progredierande slappa pareser –  Parestesier –  Autonom dysfunkNon Myasthenia Gravis •  Autoimmun neuromuskulär sjukdom –  Ak mot ach.rec •  U_rö_barhet i muskler •  Thymom Smärta ut i armen anatomi. Smärta ut i armen anatomi Smärta ut i benen anatomi ANS parasympaNkus CN III CN VII CN IX CN X Ciliary ganglion Eye Lacrimal gland Pterygopala1ne ganglion Submandibular ganglion O1c ganglion Nasal mucosa Submandibular and sublingual glands Paro1d gland Heart Cardiac and pulmonary plexuses Lung Preganglionic
CN Postganglionic
Cranial nerve
ParasympaNkus Celiac plexus Liver and gallbladder Stomach Pancreas S2 Large intes1ne S4 Small intes1ne Pelvic splanchnic nerves Inferior hypogastric plexus Preganglionic
CN Postganglionic
Cranial nerve
Rectum Urinary bladder and ureters Genitalia (penis, clitoris, and vagina) SympaNkus Pons
Nasal mucosa Sympathe1c trunk (chain) ganglia
Blood vessels; skin (arrector pili muscles and sweat glands)
Superior cervical ganglion
Salivary glands Heart Middle cervical ganglion
T1 Eye
Lacrimal gland
Inferior cervical ganglion
Cardiac and pulmonary plexuses
Lung
Greater splanchnic nerve
Lesser splanchnic nerve
Celiac ganglion
Liver and gallbladder
L2 Stomach
White rami communicantes
Superior mesenteric ganglion
Spleen
Kidney
Sacral splanchnic nerves
Lumbar splanchnic nerves Adrenal medulla
Inferior mesenteric ganglion
Small intes1ne
Large intes1ne
Rectum
Preganglionic
Postganglionic
Genitalia (uterus, vagina, and penis) and urinary bladder
Synapser, skillnader Cell bodies in central
nervous system
SOMATIC
NERVOUS
SYSTEM
Heavily myelinated axon
Skeletal muscle
SYMPATHETIC
Unmyelinated postganglionic axon
Blood vessel
ACh
ACh
S1mulatory
NE
Lightly myelinated Ganglion
preganglionic axons
Epinephrine and ACh
norepinephrine
Lightly myelinated preganglionic axon
Effect
ACh
ACh
Adrenal medulla
PARASYMPATHETIC
Peripheral nervous system
Two-­‐neuron chain from CNS to effector organs
AUTONOMIC NERVOUS SYSTEM
Neurotransmitter Effector
at effector
organs
Single neuron from CNS to effector organs Ganglion
Unmyelinated postganglionic axon
Smooth muscle (e.g., in gut), glands, cardiac muscle
S1mulatory or inhibitory, depending on neuro-­‐ transmi=er and receptors on effector organs
Övre styrning ANS Communica1on at subconscious level Cerebral cortex (frontal lobe) Limbic system (emo1onal input) Hypothalamus
Overall integra1on of ANS, the boss Brain stem
(reticular formation, etc.)
Regula1on of pupil size, respira1on, heart, blood pressure, swallowing, etc. Spinal cord
Urina1on, defeca1on, erec1on, and ejacula1on reflexes