The Brain or Encephalon

General Considerations and Divisions.—The brain, is contained within the cranium, and
constitutes the upper, greatly expanded part of the central nervous system. In its early
embryonic condition it consists of three hollow vesicles, termed the hind-brain or
rhombencephalon, the mid-brain or mesencephalon, and the fore-brain or
prosencephalon; and the parts derived from each of these can be recognized in the adult
Thus in the process of development the wall of the hind-brain undergoes modification to
form the medulla oblongata, the pons, and cerebellum, while its cavity is expanded to form
the fourth ventricle. The mid-brain forms only a small part of the adult brain; its cavity
becomes the cerebral aqueduct (aqueduct of Sylvius), which serves as a tubular
communication between the third and fourth ventricles; while its walls are thickened to form
the corpora quadrigemina and cerebral peduncles. The fore-brain undergoes great
modification: its anterior part or telencephalon expands laterally in the form of two hollow
vesicles, the cavities of which become the lateral ventricles, while the surrounding walls form
the cerebral hemispheres and their commissures; the cavity of the posterior part or
diencephalon forms the greater part of the third ventricle, and from its walls are developed
most of the structures which bound that cavity.

The Cranial Nerves

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 (Nervi Cerebrales; Cerebral Nerves) 1

There are twelve pairs of cranial nerves; they are attached to the brain and are transmitted
through foramina in the base of the cranium. The different pairs are named from before
backward as follows:
1st. Olfactory. 7th. Facial.
2d. Optic. 8th. Acoustic.
3d. Oculomotor. 9th. Glossopharyngeal.
4th. Trochlear. 10th. Vagus.
5th. Trigeminal. 11th. Accessory.
6th. Abducent. 12th. Hypoglossal.
The area of attachment of a cranial nerve to the surface of the brain is termed its
superficial or apparent origin. The fibers of the nerve can be traced into the substance
of the brain to a special nucleus of gray substance. The motor or efferent cranial nerves
arise within the brain from groups of nerve cells which constitute their nuclei of origin.
The sensory or afferent cranial nerves arise from groups of nerve cells outside the brain;
these nerve cells may be grouped to form ganglia on the trunks of the nerves or may be
situated in peripheral sensory organs such as the nose and eye. The central processes of
these cells run into the brain, and there end by arborizing around nerve cells, which are
grouped to form nuclei of termination. The nuclei of origin of the motor nerves and the
nuclei of termination of the sensory nerves are brought into relationship with the cerebral
cortex, the former through the geniculate fibers of the internal capsule, the latter through
the lemniscus. The geniculate fibers arise from the cells of the motor area of the cortex,
and, after crossing the middle line, end by arborizing around the cells of the nuclei of
origin of the motor cranial nerves. On the other hand, fibers arise from the cells of the
nuclei of termination of the sensory nerves, and after crossing to the opposite side, join
the lemniscus, and thus connect these nuclei, directly or indirectly, with the cerebral
cortex.
Stroke

Most strokes are caused by a blockage in an artery that carries blood to the brain. This
can cause that part of the brain to be damaged, and you may lose control of a function
that is controlled by that part of the brain. For example, you could lose the use of an arm
or leg, or the ability to speak. The damage can be temporary or permanent, partial or
complete. Doctors have found that if you get treatment right away after symptoms start,
there is a better chance of getting the blood moving to your brain, and less chance of
damage.

Symptoms Sudden weakness or numbness of the face, arm or leg on one side of the body

• Sudden dimness or loss of vision, particularly in one eye

• Loss of speech, trouble talking or understanding what others
• are saying
• Sudden severe headache with no known cause

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 • Unexplained dizziness, unstable walking or falling, especially along with any of
the other symptoms

Another warning sign of a stroke is called a transient ischemic attack (TIA). A TIA is a
"mini-stroke" that can cause the symptoms listed above and may only last a few minutes,
but should not be ignored. People who have a TIA are at greater risk of having a stroke
later. Call your doctor immediately if you think you are having a TIA.

Migraine Headaches

Migraine headaches seem to be caused in part by changes in the level of a chemical made
in the brain called serotonin. Serotonin plays many roles in the body, and it can have an
effect on blood vessels. When serotonin levels are high, blood vessels constrict (shrink).
When serotonin levels fall, the blood vessels dilate (swell). This swelling can cause pain
or other problems.
Many things can affect the level of serotonin in your body, including your level of blood
sugar, certain foods and changes in your estrogen level if you're a woman.
Possible symptoms of migraines

• Intense throbbing or dull aching pain on one side of your head or both sides
• Pain that worsens with physical activity
• Nausea or vomiting
• Changes in how you see, including blurred vision or blind spots
• Being bothered by light, noise or odors
• Feeling tired and/or confused
• Stopped-up nose
• Feeling cold or sweaty
• Stiff or tender neck
• Light-headedness
• Tender scalp

Classic migraines start with a warning sign, called an aura. The aura often involves
changes in the way you see. You may see flashing lights and colors. You may
temporarily lose some of your vision, such as your side vision.

You may also feel a strange prickly or burning sensation, or have muscle weakness on
one side of your body. You may have trouble communicating. You may also feel
depressed, irritable and restless.

Auras last about 15 to 30 minutes. Auras may occur before or after your head pain, and
sometimes the pain and aura overlap, or the pain never occurs. The head pain of classic
migraines may occur on one side of your head or on both sides.

Common migraines don't start with an aura. Common migraines may start more slowly
than classic migraines, last longer and interfere more with daily activities. The pain of
common migraines may be on only one side of your head.

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Epilepsy

Epilepsy is a disorder of the brain. People with epilepsy have brain cells that create
abnormal electricity, causing seizures. In some cases, a seizure may cause jerking,
uncontrolled movements and loss of consciousness. In other cases, seizures cause only a
period of confusion, a staring spell or muscle spasms.
A single seizure is not considered epilepsy. People with epilepsy have repeated episodes
of seizures.
Epilepsy is not a mental illness, and it is not a sign of low intelligence. It is also not
contagious. Seizures do not normally cause brain damage. Between seizures, a person
with epilepsy is no different from anyone else.
If you have epilepsy, you may want to share the following information with your family,
friends and coworkers. If someone near you has a seizure, use the following general
guidelines:

• Stay calm.
• Don't move the person to another place.
• Don't try to keep the person from moving or shaking.
• Don't try to wake the person by shouting at or shaking them.
• Remove items that could cause injury if the person falls or bumps into them.
• Gently turn the person on his or her side so any fluid in the mouth can safely
come out.
• Never try to force the person's mouth open or put anything in it.
• Place something soft (such as a pillow) under his or her head.
• Most seizures aren't life-threatening. You don't need to call a doctor or an
ambulance unless the person isn't known to have epilepsy or unless the seizure
lasts longer than 5 minutes.
• When the seizure is over, watch the person for signs of confusion. Allow the
person to rest or sleep if he or she wishes.

Cervical Spondylotic Myelopathy (CSM)

Cervical spondylotic myelopathy (CSM) is a compression of the spinal cord in the neck.
(When doctors say the spinal cord is "compressed," they mean it is being pressed and
squeezed.) CSM often affects older adults, but at earlier ages in men than in women.
In people with CSM, changes in the bones, disks and ligaments of the spine cause
pressure on the spinal cord. Sometimes bony growths called bone spurs add pressure to
the spine. Some changes are because of normal aging. Some changes are caused by
arthritis of the spine. CSM is the most common spinal cord problem in people 55 years or
older in the United States.
Symptoms of CSM may develop slowly. Some symptoms of CSM include:

• Neck stiffness
• Arm pain
• Numbness in the hands and weakness of the arms and legs
• Stiff legs

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 • Difficulty using your hands or walking steadily
• Loss of bladder or bowel control

Trigeminal Neuralgia

Trigeminal neuralgia is extreme burning, electric or shock-like pain in the face. The pain
can be so extreme that it can get in the way of normal activity. Even the fear of oncoming
attacks can be so stressful that performing day-to-day tasks is a challenge.

The pain may last a few seconds or minutes, then ease and then recur. Usually, these
cycles of pain occur for a few days or weeks, and then stop for days, weeks or even years
before returning. Over time, the cycles tend to recur more quickly, with shorter breaks in
between.

A flare sometimes is triggered by very normal activities, such as chewing, smiling,

talking, shaving or brushing your teeth. At times, even the wind on your face can cause
pain to start.

Some people who have trigeminal neuralgia notice numbness or tingling of the face in the
days leading up to an attack.
Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease that affects the nervous system.
Normally, antibodies produced by the immune system help protect the body against
viruses, bacteria and other foreign substances. In people who have MS, the immune
system destroys the substance that surrounds and protects your nerve cells – the myelin
sheath.

The job of the nervous system is to send electrical messages back and forth from the
brain to different parts of the body. Normally, the brain quickly sends signals through the
spinal cord and then through nerves that branch out to all organs and body parts. When
myelin around nerves is damaged or destroyed, the nerves can’t function properly to
deliver these signals in the right way. This can cause symptoms throughout the body.
MS affects women more than twice as often as men. White (Caucasian) people are more
likely to develop it than people of other races. If someone in your family--such as a
parent or sibling--has MS, you have a greater risk of developing it, too. MS can affect
people of any age, but it often begins between the ages of 20 and 40. If you have another
autoimmune disease, such as thyroid disease or Type 1 diabetes, your risk of developing
MS is slightly higher.
Common symptoms include:

• Vision problems, including double vision, blurriness, partial color blindness, eye
pain, partial or complete loss of vision in 1 eye
• Thinking and memory problems
• Fatigue
• Muscle weakness, dizziness or tremor

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 • Numbness or weakness on one side or the bottom half of your body
• Trouble with coordination and balance
• Loss of bowel or bladder control
• Sensations such as numbness or tingling, "pins and needles"
• Electric-shock sensations caused by moving your head in a certain way

Testing for MS
Blood test. Your blood can show signs of other illnesses that cause symptoms similar to
the symptoms of MS.

Neurological tests. Your doctor may want you to see a neurologist who can test how
well your nervous system is working. The tests will look for changes in eye movements,
muscle coordination, weakness, balance, sensation, speech, and reflexes.

Spinal tap (lumbar puncture). A small amount of fluid taken from your spine can show
abnormal amounts of blood cells or proteins associated with MS. A spinal tap can also
rule out a viral infection or other possible conditions.

Magnetic Resonance Imaging (MRI). An MRI can show detailed pictures of the brain
and spinal cord, and if there are any lesions present. However, lesions aren’t always
caused by MS.