CENTRAL NERVOUS SYSTEM

TRI INDAH WINARNI, MD, PhD

ANATOMY DEPT. FACULTY of MEDICINE
DIPONEGORO UNIVERSITY
1. Organogenesis and Ventricular System
Development
2. Macroscopic Neuroanatomy
3. Somatosensory System (Ascending &
Descending Tract)
4. Brain Stem, Nervi Cranialis and Limbic
system
5. Cerebral blood flow, Brain vascularization ,
Blood Brain Barier
 Ossa Cranii
• Basis cranii
– Outlets: Cranial nerves, jugular vein, brain stem
– Inlets: internal carotid artery, vertebral artery,
meningeal artery
• Calvaria cranii
– Sulci of Dura matric sinuses
– Foveola granulationess arachnoidea
– Sulcus arteriosus et venosus meningea media
A:1 – for.occipitale magnum; 2 - clivus; 3 - sulcus sinus petrosi inferioris; 4 -
canalis condilaris; 5 - sulcus sinus transversi; 6 - sulcus sinus sagittalis
superioris; 7 - protuberantia occipitalis interna; 8 - crista occipitalis interna.
B - outside view: 1 - protuberantia occipitalis exsterna; 2 - linea nuchae
inferior; 3 - condylus occipitalis; 4 - pars lateralis; 5 - linea nuchae superior.
 PROTECTION OF CENTRAL NERVOUS
SYSTEM – CRANIAL MENINGES
• Meninges - connective tissue membrane
external to CNS
– Cover and protect CNS
– Protect blood vessels (sinus duramater) and enclose
the venous sinuses
– Forms partitions within skull (falx cerebri/cerebelli/
tentorium cerebri)
• Composed of
– Dura mater (the outer most)
– Arachnoid
– Pia mater (the inner most, attached to the brain tissue
& follow the surface)
 DURA MATER
• Consist of 2 layer, periosteal and meningeal layer
(true). Meningeal layer will fold and form:
– Falx cerebri, separate 2 hemisphere and form superior and
inferior sagittal sinus (sinus venosus)
– Falx cerebelli, Diaphragma sellae
– Tentorium cerebelli, lies in between cerebrum and
cerebellum  incisura tentorii
• Dural sinus venosus, provide the principle return
from the brain
• Vascularization: middle meningeal artery (maxillary)
• Innervation:
– Supratentorial: trigeminal nerve  fronto-parietal pain
– Infratentorial: spinal nerve  neck rigidity (meningitis)
 SINUSES VENOUS DURAMATRIS
• Sinus venosus
– Sinus sagittalis superior (A) Sinus tranversus dextra
– Sinus sagittalis inferior – sinus rectus (B)  Sinus
tranversus sinistra
– Confluence sinuum: formed by A + B + sinus occipitalis 
sinus tranversus dextra et sinistra  sinus sigmoid
internal jugular vein
– Sinus petrosus superior dextra et sinistra enter the sinus
tranversus dextra et sinitra at point that the tranversus
become sinus sigmoid  internal jugular vein
– Sinus cavernosus: sinus venous lies lateral to the sphenoid
bone, it receives from emissary vein from face and neck
opthalmic vein, central vein of retina and middle and
inferior cerebral veins
• Pathway to spread infection due to slow blood flow
• Arachnoid layer
– Subarachnoid space contain CSF
• Cisterna cerebellomedullaris (magna)  CSF puncture
– Major distributing arteries of the brain run in  rupture
(aneurysm)  blood in CSF
 CLINICAL CONSIDERATION
• Intracranial bleeding
– Elevated intracranial pressure cause headache, nausea,
unconsciousness, optic disk edema
– Tentorial herniation, squeezing temporal lobe through the
tentorial notch  compressed occulomotor nerve with
signs:
• Loss pupillary constriction on side lession (early stage)
• Bilateral dilatation as continuing herniation involves contralateral
nerve
• Epidural hematoma: parietal/temporal bone fracture
will cause meningeal artery torn brain
compression in 2-3 H  consciousness (lucid
interval) called “talk and die syndrome” 
emergency craniotomy
BRAIN LANDMARKS
 FUNCTION OF THE LOBES
• Frontal lobe (anterior to central sulcus and lateral
fissure): serves motor function, speech, cognition
& high level of affective behavior
1. Precentral Gyrus (somatotopically arranged)
– Input: VA & VL nuclei thalamus convey modulating influence
from BASAL GANGLIA & CEREBELLUM
– Output: UMN project to pyramidal tracts & cross contralateral
LMN in brain stem & spinal cord
2. Area Broca at inferior frontal gyrus to coordinate the
muscles used in speech
• Parietal lobe (between central sulcus & perieto-
occipital fissure): somatosensory processing in
somatotopiccaly arranged
1. Primary Sensory Area (postcentral gyrus) receive general
sensation from CONTRALATERAL side through relay in
VPL & VPM nuclei of thalamus
• Temporal lobe (inferior to lateral sulcus)
involve in memory and audition
– Primary auditory area, caudal end of superior
temporal gyrus (41 &42)
– Auditory association area (Wernicke’s area/22) 
sensory aphasia
– Hippocampus
• Occipital lobe (posterior to parieto-occipital
sulcus) contain visual cortex
– Primary visual area (17) at either side of calcarine
sulcus
– Visual association area (18 & 19)
 WHITE MATTER TRACT
• Projection tract, extend vertically between higher and lower
brain and spinal cord centers, and carry information between
the cerebrum and the rest of the body. The cortico-spinal
tracts (pyramidal tract), carry motor signals from the
cerebrum to the brainstem and spinal cord (internal capsule)
• Commissural tract, cross from one cerebral hemisphere to the
other through bridges called commissures. The great majority
of commissural tracts pass through the large corpus callosum
• Association tract, connect different regions within the same
hemisphere of the brain. Long association fibers connect
different lobes of a hemisphere to each other whereas short
association fibers connect different gyri within a single lobe