doc`Brain Storm` Neuroanatomy Refresher Course Overview
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`Brain Storm` Neuroanatomy Refresher Course Overview
‘Brain Storm’ Neuroanatomy Interprofessional Refresher Course Lecture Outline Cerebral Cortex Brain Structure & Function Ventricular System Meninges Blood Supply Cranial Nerves Clinical Cases Cerebral Cortex Parietal Lobe Frontal Lobe Temporal Lobe Occipital Lobe Cerebral Cortex Cerebral Cortex Cerebral Cortex Cerebral Cortex Cerebral Cortex Insula Cerebral Cortex Dominant Hemisphere Nondominant Hemisphere Language* Prosody Praxis Visual‐spatial analysis & attention Math Musical ability Sequential and analytical skills Spatial orientation * Left hemisphere is dominant for language in 95% of right‐handers and 60‐70% of left‐ handers Modified from Table 19.3 Blumenfeld Cerebral Cortex 1. Primary Auditory Cortex 2. Wernicke’s Area 3. Broca’s Area 4. Primary Motor Cortex 5. Cortico‐ bulbar Neurons What’s your name? Devin Cerebral Cortex Left Hemisphere Neglect Brain Structure & Function Brain Divisions 1. 2. 3. 4. 5. 6. 7. Telencephalon Diencephalon Midbrain Pons Cerebellum Medulla Spinal cord Brain Structure & Function Brain Structure & Function Brain Structure & Function Brain Structure & Function Brain Structure & Function Brain Structure & Function Brain Structure & Function Brain Structure & Function Long Tracts of CNS Brainstem Corticospinal tract • Anterior • Trunk muscles • Bilateral • Lateral • Limb muscles • Contralateral Upper Body Spinal Cord Lower Body Long Tracts of CNS Brainstem Medial Leminiscus • Fine touch • Vibration/Pressure • Proprioception Upper Body Spinal Cord Lower Body Long Tracts of CNS Anterolateral System • Crude touch • Pain • Temperature Brainstem Lissauer’s Tract Substantia Gelatinosa Upper Body Spinal Cord Lower Body Ventricular System Ventricular System Ventricular System Ventricular System Ventricular System Ventricular System Ventricular System Cerebrospinal fluid (CSF) • Buoyancy/Protection • Nutrition • Waste removal Ventricular System Cerebrospinal fluid • Made in Choroid plexus • Direction of flow (arrows) • 500 mL/day • Exit via • Luschka (Lateral) • Magendie (Medial) Meninges Venous sinuses • Separation of Dura • Not Veins Clinical Concept •Subdural Hemorrhage •Epidural Hemorrhage Meninges Dural Folds • Falx Cerebrei • Tentorium Cerebelli Meninges Venous Sinuses • Drain mainly via Jugular Vein Clinical Concept • Danger area of the face • Drain via cavernous sinus Meninges 1. 2. 3. 4. 5. 6. Vertebral Body Vertebral Spine Spinal Cord Dura Mater Epidural Space Catheter Clinical Concept •Epidural space is a real space in spinal cord. •Epidural administered at level of L1/L2 Blood Supply Blood Supply Blood Supply Blood Supply Blood Supply Blood Supply Clinical Concept • Aneurysm in PCA or posterior communicating can lead to ptosis, blown pupil and eye in down & out position Blood Supply Blood Supply Lenticulostriate Arteries • Supply lentiform nucleus, striatum, internal capsule Clinical Concept • Lacunar Infarct and hemiparesis Cranial Nerves Pure Motor • CN III, IV, VI, XII • Midline Pyramidal Decussation Cranial Nerves CN I Pure Sensory CN II CN III Olfactory CN I Optic CN II Oculomotor CN VIII Olfactory Sensory Optic Sensory Vestibulo‐cochlear Both Pure Motor CN IV CN V CN VI CN VII CN VIII CN III Trochlear CN IV Trigeminal Abducens CN VI Facial CN XI Vestibulo‐cochlear CN XII Oculomotor Motor Trochlear Both Abducens Motor Spinal BothAccessory Hypoglossal Sensory Mixed CN IX CN X CN XI CN XII Glossopharyngeal CN V Vagus CN VII Spinal Accessory CN IX Hypoglossal CN X Trigeminal Both Both Facial Motor Glossopharyngeal Vagus Motor Some Say Money doesn't Matter But My Brother Says Big Bucks Matters Most Corticospinal Tract Cranial Nerves Upper motoneuron • Cortex Lower motoneuron • Spinal Cord (ventral horn) • Cranial Nerve Nuclei • V, VII, IX, X, XI, XII Corticobulbar Tract • Articulation of speech • Dysarthria Cranial Nerves Jaw Face Pharynx Larynx Neck Tongue Cranial Nerves Facial Nerve Nucleus • Upper Face •Bilateral • Lower Face •Contralateral Clinical Concept • Forehead sparing is an upper motoneuron sign B B A A Clinical Case # 1 • Left arm, leg and facial weakness sparing the forehead • Hyperreflexia • Dysarthria (slurred speech) Where is the most likely clinical localization? Pure Motor Hemiparesis • AKA dysarthria‐hemiparesis •Corticobulbar and Corticospinal tracts • Possible Lacunar infarct Clinical Case # 2 • Left arm and leg weakness • Left decreased vibration and joint position sense • Right tongue deviation Where is the most likely clinical localization? Medial Medullary Syndrome Paramedian branches of the verterbral artery and anterior spinal artery Summary