2011 09 08 Spinal cord

1. Pain modulation . Pain modulation substania gelatinosa (Spinal cord Lamina II) . descending excitatory fibers enkephalinergic interneurons activate, postsynaptic inhibitory control pain impulse fiber . , descending inhibitory fibers spinothalamic projection neurons direct contact pain modulate . Gate control theory of pain , pain small c fiber fiber touch . touch neuron collateral axon s. gelatinosa interneuron interneuron inhibitory effects . (*)

2. Syringomyelia ? Syringomyelia cavitation of the central regions of spinal cord , frequent anterior white commissure crossing fiber . fiber bundle opposite side ALS (anterolateral syst.) enter fiber posterior horn midline cross fiber . lesion , fiber . bilateral spinal cord level , loss of pain and thermal sensations since ALS pain thermal sense convey . cervical region syringomyelia , cape mid and lower cervical level thermal sense pain sensation deficit . (* syrinx ant. horn ant.horn level extremity ipsilat. weakness . ant.horn bilat. weakness .) syringomyelia central canal hydromyelia.

3. Functional hemisection of the spinal cord (=Brown-Sequard Synd.) spinal cord , tract ?

4. Ascending and descending tract Spinal cord *substania gelatinosa: spinal trigeminal nucleus . *nucleus Z of Brodal and Ponpeino * ( ): Dorsal Column Medial Lemniscus syst.

Ascending SENSORY Pathway Pain & Temp 1. Spinothalamic = Anterolat. Syst. (ant. & lat.)

Descending MOTOR Pathway Pyramidal Syst 1) Corticospinal (ant. & lat.) 2) Corticonuclear

2. 3. 4.

Spinotectal 3) Corticoreticular Spinoreticular 4) Corticopontine Trigeminothalamic Extrapyramidal Syst

Proprioception (pressure, vibration, position) 1. 2. 3. 4. 5. Dorsal Column Medial Lemniscus Syst.

1) Rubrospinal 2) Tectospinal

Ventral Spinocerebellar 3) Lat. Vestibulospinal Dorsal Spinocerebellar 4) Medial longitudinal fasiculus Cuneocerebellar 5) Medial Pontine Reticulospinal Rostral Spinocerebellar 6) Lateral Medullary Reticulospinal

5. Spinal cord ; *High cervical level lesion: potential for total loss of sensation for the body below the lesion and of voluntary motor control. And also the phrenic nu. At central regions of ant. horn (c3-7) innervates diaphragm 6. Muscle spindle receptors 2 bag fiber, chain fiber stretch reflex (extrafusal muscle=skeletal m. alpha motor neuron intrafusal muscle of muscle spindle gamma motor neuron .) Muscle spindle skeletal muscle sensory receptor ( stretch length) CNS . Muscle spindle types of intrafusal fibers sensory function . Type Ia sensory fiber nuclear bag , noncontractile central region of intrafusal muscle

 , mechanorecceptor stretching . Type II sensory fiber , nuclear chain mechanical stretch activated muscle length . Intrafusal muscle gamma motor neuron , extrafusal alpha motor neuron . Stretch(Extensor) Reflex monosynaptic reflex, stretch intrafusal muscle afferent fiber . afferent fiber motoneuron , motoneuron efferent fiber . , Deep tendon reflex , patellar tendon tap primary sensory endings in the muscle spindles in the quadriceps femoris muscle stretch-> type Ia fiber DRG impulse dl afferent axons anterior horn QFm motor neuron synapse. sudden contraction of QF occurs and an extension of the leg at knees occur. Flexor(Avoid) Reflex; Sensory motor neuron interneuron polysynaptic reflex Receptor : free nerve ending Gamma Reflex loop: () muscle tone , gamma moto neurons . Descending tracts Gamma motor fibers Intrafusal muscle fibers (in muscle spindle) Sensory afferent fibers Alpha motor neurons Extrafusal muscle fibers 7. Upper motor neuron lesion and Lower motor neuron lesion Upper motor neuron cerebral cortex neuron soma brainstem or anterior horn somatic motor neuron n. fiber UMN. (ex: corticospinal corticonuclear rubrospinal reticulospinal) Lower motor neuron brainstem or spinal cord ant. horn motor neuron soma effector neuromuscular junct. n. fiber LMN. Symptom paralysis M tone M atrophy Decrease in mass Deep tendon reflex Pathologic reflex ++ +(: ) UMNL Spastic + no LMNL Flaccid _ yes

8. Decerebration and Decortication

Decortication -lesion in supratentorial region. - extended w/ toes inward - flexed agaist chest -head extended Decerebration - extended w/ toes inward - extended w/ fingers flexed -forearm pronated -neck head extended -back arched up off bed

decorticate decerebrate . (as lesion expands.)

Decorticate rigidity can be mimicked by transecting the brainstem rostral to the sup. colliculus (D). . This lesion leaves the rubrospinal tract intact while eliminating the cortical input to the red nucleus. Rubrospinal syst. can still be activated since excitatory projections to the red nu. from the

cerebellar nuclei are unaffected by the lesion. The rubrospinal tract influences primarily flexor mm. and most of this activity in human is limited to upper extremity. Upper extremities show an increase in flexor tone due to the intact rubrospinal syst. However the lower extremities exhibit extensor hypertonus for the same reasons as in decerebration. Decerebrate condition(A-complete transaction btw. Sup and inf colliculus this resembles supratentorial lesion that causes herniation of midbrain downward thru the tentorial notch-central herniation). All descending cortical systems are interrupted (corticospinal, corticorubral, corticoreticular) and rubrospinal tract transected, but excitatory and inhibitory components of the reticular formation are intact. Also the ascending somatosensory input to the reticular formation thru the ALS and reticulospinal syst. Flexor muscles are inactive due to the loss of descending corticospinal and corticorubrospinal input to flexor motor neurons. Conversely, extensor motor neurons are unaffected by the loss of descending cortical fibers b/c they are activated by descending reticulospinal and vestibulospinal inputs that are not involved by the decerebration lesion; thus these tracts remain intact.

8. Spinal cord 4 layer . Neural tube closed. , neuroepithelial layer . Neural tube groove (sulcus limitans). Neuroblasts . neuroepithelial layer mantle layer . (mantle layer: gray mt). Ant. and Post. Thickening . basal and alar laminae . Basal lamina thickening ventral horn , immature nerve cells vent. root. Alar lamina thickening dorsal horn . Mantle layer neuroblast nerve fiber marginal layer . fiber myelination white mt. . Spinal ganglion n. fiber marginal layer .

 doral and ventral median fissure . (* Sulcus limitans longitudinal groove. : mantle layer alar plate (dorsal) basal plate(ventral) .) <Neural tube layers> 3 (->): 1) ependymal layer(lining lumen, germinal cells, future vent canal) 2) mantle layer(layer that differentiates into gray matter, neuroblasts->neuron, spongioblasts->neuroglia) 3) marginal layer(consists of n fibers projecting from the cells in mantle layer and this layer differentiates into white matter.) 4 (->): ventricular zone(ependymal)->subventricular zone-> intermediate zone(mantle)-> marginal zone

Sympathetic (fight or flight) Nucleus Intermediolateral horn of spinal cord: T1-L2.3

Para (rest or digest) CN 3: Edinger Westphal nu. CN 7: Sup. Salivatory nu. CN 9: Inf. Salivatory nu. CN10: Dorsal motor nu. Of CN 10 S 2,3,4 sacral segment of spinal cord

Ganglion

-Paravertebral ganglion (sup. Mid. Inf. Cervical g., chain g. and g. impar) -Prevertebral ganglion: Celiac, SM, Aorticorenal, IM

CN3: ciliary g. (sphincter pupillae) CN7: pterygopalatine g. (lacrimal : ) Submandibular g. (subman and lingual gland) CN9: otic g.(parotid gland ) CN10: intramural g. S234: intramural g of pelvic pudendal n.

ganglion ** Cranial nerve functional component GSA: 5 7 9 10 GSE: 3 4 6 12 GVA: 7 9 10 GVE(parasym): 3 7 9 10 SVA: 1 7 9 10 SVE: 5 7 9 10 11(VE) SSA: 2 8

9. Blood brain barrier + BBB brain . : capillary endothelium tight junction (carrier mediation lipid mediation .) + basement memb. + Astrocytic process (glial perivascular feet) : brain fluid compartment chemical substance transport . **BBB : Circumventricular organs (POS MAN) Pineal body (melatonin), OVLT (organum vasculosum of lamina terminalis or supra optic crest), Subfornical organ and subcommissural organ, Median eminence of hypothalamus (pituitary gland ), Area postrema (obex of MO deep portion), Neurohypophysis (H~) 10. Common vascular disease(Haines 124 and 25) -Aneurysm: comes from Greek aneurusma dilation. It is a localized, blood-filled balloon-like bulge in the wall of a BV. When the size of an aneurysm increases, there is a significant risk of rupture, resulting in severe hemorrhage(). Aneurysm will cause the wall of the blood vessel to weaken. ** : bifurcation circle of Willis (Acom ACA, basilar a. bifurcate PCA etc.) *Haines: is the dilation of a vessel wall, usually in an artery, that extends from the lumen to the vessel surface and includes all layers of the vessel wall. Ex) cerebral aneurysm are frequently located at branch points of vessels or at points where the vessels may make an abnormally sharp abrupt turn on their course. (clip stalk off of aneurysm) -Cerebral embolism: is the occlusion of a cerebral vessel by some extraneous material. This occlusion leads to ischemia and if prolonged to infarction of the area served by the vessel. -Ischemia(): insufficient blood supply due to vascular occlusion. Infarction(): a localized vascular insufficiency resulting in necrosis. **ex) embolisms small cerebral vessels occlude TIA . TIA: a sudden loss of neurologic function that usually resolves within 24 hours. TIA 3 15% attack . => ischemic stroke () Embolic infarct(): plaque / ACUTE.

Thrombotic infart: , thrombus / CHRONIC -Transient ischemic attack (TIA): is referred to as mini stroke, it is a transient episode of neurologic dysfunction caused by ischemia (loss of blood flow) either focal brain, spinal cord or retinal without acute infarction (tissue death). TIAs share the same underlying cause as strokes: a disruption of cerebral blood flow (CBF). TIAs and strokes cause the same symptoms, such as contralateral paralysis (opposite side of body from affected brain hemisphere) or sudden weakness or numbness. A TIA may cause sudden dimming or loss of vision, aphasia, slurred speech and mental confusion. But unlike a stroke, the symptoms of a TIA can resolve within a few minutes or 24 hours. Brain injury may still occur in a TIA lasting only a few minutes. Having a TIA is a risk factor for eventually having a stroke or a silent stroke. -Arteriovenous malformation: a. v. malformation , rupture . AVM results when the communications btw. Major aa. And veins do not develop normally. 11. Cavernous sinus Internal Carotid A.

ICA 4 . 1) Cervical portion (carotid canal) 2) Petrous portion (temporal bone petrous portion ) 3) Cavernous portion 4) Cerebral portion ** 3)+4) carotid siphon . At the upper end of foramen lacerum, it enters the cavernous sinus, turns anteriorly, makes a hairpin turn, and enters the subarachnoid space.

*cavernous portion ICA , CN 3 4 6 5(V1&2), thus aneurysm n. . Cavernous Sinus The large irregular spaces lies on each side of the sella turcica, body of the sphenoid bone and pituitary gland that extends from the sup. orbital fissure to the petrous portionof the temporal bone. It is composed of network of intercommunicating venous channels enclosing neurovascular

structures. (lat. wall: CN 3 4 5-1 6 ICA .) It makes communications with ophthalmic v, IJV, pterygoid plexus, pharyngeal plexus, basilar venous plexus. *Danger Triangle upper lip: veins in this area communicate with the sup. and inf. ophthalmic veins which drain into the cavernous venous sinuses of the dura mater. inflammation, pterygoid plexus-> cavernous sinus-> pathogen . 12. Brain Blood Supply (Also .) ICA (ant. circulation) A.Ophthalmic arteries (central a. of retina) Vertebral a. (post. Circulation) A. Anterior spinal artery B. Posterior spinal arteries C. Posterior inferior cerebellar arteries (PICA) D. Basilar artery (BA) B. Anterior cerebral arteries (ACA) 1) Anterior inferior cerebellar arteries (AICA) 2) Pontine arteries C. Anterior communicating arteries (Acom) 3) Superior cerebellar arteries E. Posterior cerebral artery (PCA) D. Middle cerebral arteries (MCA) F. Posterior communicating arteries (Pcom)

Brain blood supply 1.Internal Carotid Artery cerebral portion (OPA, AM) -Major branches of ICA: Ophthalmic a (optic n. retina b supply)., Pcom (carotid siphon dorsal aspect ), Anterior choroidal a. (optic tract backward run temporal lobe choroid plexus), Ant. cerebral a. & Middle cerebral a. (terminal branches of ICA). 1) Anterior choroidal a. proximal portion of ICA MCA , supplies choroid plexus in the temporal horn of the lat. ventricle, and medial side of the temporal lobe and ventral part of

the cerebrum thus supplies lat. ventricle(inf. Horn-temporal) ~ a. to choroid plexus, optic tract, uncus, amygdale, hippocampus, globus pallidus, ventral part of internal capsule, LGB(lat. geniculate body), subthalamus, ventral thalamus, rostral part of midbrain. ** The lateral geniculate nucleus (LGN) is the primary relay center for visual information received from the retina of the eye. The LGN is found inside the thalamus of the brain. ***Ant. choroidal a. Synd. : ant. choroidal a. occlusion combination of visual deficits(optic tract) and weakness of the opposite upper and lower extremities (inf. Portion of the post. limb of int. capsule). : (thrombosis) . Proximal portion surgical occlusion: Parkinsonian tremor & rigidity : also this a. is long and slender thus easy to develop a thrombosis-> degeneration of the hippocampus or globus pallidus resulting from impaired circulation. (Binswangers synd: loss of memory and intellectual function and by changes in mood.) 2) Anterior cerebral a. (FORCP): Brain Medial aspect supply -optic chiasm ACA Acom join.->both aa. median cerebral fissure . -BR: frontopolar br, orbital br, recurrent a. of Heubner (med. Striate a.), callosomarginal a (pericall a. ), pericallosal a.( cor call) -: (homonculus!!) (A) ACA occlusion: direct lower limb -contralateral m. weakness (primary motor cortex corticospinal tract signal -> m. weakness . b/c ACA med. side of brain and homonculus ACA leg and foot lower limb.) -contralateral sensory loss (anesthesia or paresthesia): discriminative touch, proprioception, pain, temp, light touch (primary sensory cortex spinothalamic tract-pain temp dorsal column medial lemniscus syst.-proprioception b supply .

(B) ACA occlusion: Bilateral paralysis lower limb

3) Middle cerebral a. (LAO-PRAPP): supplies lat. view of cortex -enters into lat. cerebral fissure and funs posteriorly w/in fissure=> fanlike fashion over lat. convexity of brain. -BR: Lenticulostriate aa. (lat. striate a.), ant. temporal a., orbitofrontal a., pre-Rolandic a., Rolandic a., ant. parietal brs, post. Parietal brs, post. Temporal br. **MCA : , nonfluent aphasia (Lt-Brocas area), B ganglia( motor ), Hearing (Heschl area b supply) MCA occlusion -contralateral hemiplegia: upper extremity and face -contralateral sensory loss (cortical type): position, discriminative sensory loss -aphasia: dominant hemisphere (Lt) Brocas expressive aphasia/ Wernickes receptive aphasia 2. Major branches of Vertebral a. : Subclavian a. , cervical vertebrae transverse foramina foramen magnuum post. cranial fossa -> MO Pontomedullary junct. vertebral aa. Basilar a. . : 4 portion (Spinal aa.- ant. and post. vertebral aa., Muscular brs, Post. inf cerebellar a, Basilar a.)

1)Spinal arteries: vertebral a. ant. aspect ant. vertebral a.(1-sc ant. median fissure) vertebral a. PICA post. vertebral aa. (2 ) 2)Post. Inf. Cerebellar a. (PICA): PICA, AICA, Sup. cerebellar a. cerebellum. 3)Basilar artery (Ant.-Lab-Pon-Sup) ant lab pon soup -ant. inf. Cerebellar a. -labyrinthine br. : facial n. vestibulocochlear n. internal acoustic meatus ~ -pontine aa. -sup. cerebellar a. -: cervical seg of spinal cord, MO, Pons, Cerebellum, MB, thalamus post. part, post. and inf. Parts of temporal and occipital lobe, and body and membranous labyrinth -Basilar a. bifurcates into Posterior cerebral a. 4)Post. cerebral a. -at pons and midbrain junction the basilar a. bifurcates in the interpeduncular cistern and gives rise to the post. cerebral aa. -sends branches to midbrain, thalamus, ventral and medial surfaces of the temporal and occipital lobes as far as the level of the parieto-occipital sulcus -basilar bifurcation Pcom , Quadrigeminal and

thalamoperforating aa.. => med. & lat. post. choroidal & thalamogeniculate aa. & branches to midbrain=> temporal br., parieto-occipital a., calcarine a. ** -Occlusion of PCA: Contralateral homonymous hemianopsia (visual field defects) :hemianopic visual loss on the same side of both eyes. Hemianopsia occurs b/e the fight 1/2 of brain has visual pathways for eh left hemifield of both eyes and the left 1/2 of brain has v parts for the rt. Hemifield of eye. Lt. HH

***CIRCLE OF WILLIS***(7) -Circle of Willis is an arterial wreath encircling the optic chiasm, interpeduncular retion and tuber cinerum. (ICA-ACA-Acom-MCA-Pcom ICA brs-PCA-Basilar) 1) ICA 2) Ant. cerebral a. 3) Ant. communicating a. 4) Middle cerebral a. 5) Post. Communicating a. 6) Post. Cerebral a. 7) Basilar a. ** : Posterior Cerebral a. Superior Cerebellar a. CN3 . -Circle of Willis BR: central or ganglionic branches, choroidal aa., cortical aa. that spring off proximal portion of main aa. Of circle. Central/ Ganglionic BR (4 groups) A) anteromedial group: ACA & Acom , enter ant. perforated substance, supply ant., preoptic, supraoptic hypothalamic regions B) anterolateral group: striated aa from MCA and ACA., recurrent a. of Heubner-caudate & putamen, lenticulostriate a.-putamen & globus pallidus, A. of Charcot=A. of Hemorrhage: : the largest of the lat. striate aa.=> easily ruptured in hypertension patients. a. internal capsule blood supply . hemiplegia ** AAs that supply the Basal Ganglia: recurrent a. of Heubner (ACA), lenticulostriate a. (MCA), Ant. choroidal a.(cerebral portion of ICA). C) posteromedial group (=thalamoperforating a): PCA & Pcom, tuber cinerum, mammillary body, interpeduncular fossa ex: hypophysis, infundibulum, hypothal, thalamus,

mammillary body, subthal region, med. Nu. Of thalamus, midbrain (tegmentum), crus cerebri D) posterolateral group (=thalamogeniculate a.): PCA lat. , enter lat. geniculate body on post. Aspect of thalamus. : caudal 1/2 of thalamus, LGB, Pulvinar, Lat. nuclear group of thal, vent. Thalamic nuclear tier : Occlusion of thalamogeniculate a.- Paralysis, Paresthesia, Pain and hyperpathia in the contralateral face, body or extremity. contralat. Decussation level lesion! Choroidal aa. (ant. and post. choroidal aa.) a) Ant. choroidal aa.

b) Post. choroidal a. : PCA prox. part origin, med. & lat. , tectum (MB sup.- reflex center and inf-auditory relay nu. Colliculi), lat. ventricle choroid plexus Cortical aa. (ACA, MCA, PCA) 13. Watershed Zone brain damage zone (border zone infarction)=> cerebral cortex, int. capsule, basal ganglia. : branches , , ischemia . sudden hypotension(), hypoperfusion(decreased blood flow) of the distal vascular bed of a major cerebral a. zone ex) ACA-MCA: ant. watershed infarct (contralat. Hemi paresis of lower extrm, expressive language deficits or behavioral changes), MCA-PCA: post. watershed infarct (parial visual loss, variety of language loss) Blood Supply of Cerebellum/Brainstem/Spinal Cord + ~~ -Cerebellum Brainstem post. circulation Vertebral a. branches . Ex) PICA, Ant. Spinal a, Post. Spinal aa., Basilar a., AICA, Pontine aa., Sup. Cbll a., 1) Post. Inf. Cerebellar A. (basilar a. ) -inferolat. , MO posterolat. , Cerebellum posteroinferior and med. . -: MO (fascicule & nuclei of cuneatus & gracilis), caudal and dorsal portions of inf. cerebellar peduncle, NTS fasciculus, Vagal motor nu., Spinal trigeminal nu., nu. Ambiguus, area postrema -Anastomoses: AICA and post. spinal aa.(post. spinal aa PICA .) ** ~ motor decussation MO: contralateral Cranial n. ipsilateral Sensory ~!

Lateral Medullary Synd. (Wallenberg) -PICA Post. spinal aa. Occlusion -: 1) ipsilateral loss of pain and temp. sensation from face (trigeminal spinal tract & nu.) 2) hoarseness and dysphagia- difficult in swallowing (nu. Ambiguous) 3) contralateral loss of pain and temperature sensation from body (Spinal lemniscus anterolat.syst+spinotectal) 4) some vertigo () and (vestibular nu.) 5) ipsilateral 1/2 of tongue loss of taste sensation (NTS pars oralis) 6) Horners synd Lat. med. synd. !!

Med.Medullary Synd. (inf. alternating hemiplegia) -Ant. spinal a. rt. Lt. penetrating branches , med. medulla one side , med. medullary synd. Dejerine synd.. -: 1) contralateral hemiparesis: corticospinal tract/pyramidal (contralat.: decussation) 2) contralat. Loss of proprioception and vibratory sense: med. lemniscus (decussation @ lower MO) 3) deviation of tongue to ipsilat. sid when protruded (hypoglossal n. nu.) Hypoglossal palsy - ant. spinal a , bilateral .

-Horners Synd. (Lat. Medullary synd.) CONT. : MO posterolat. reticular formation

(hypothalamospinal fibers descending thru lat. side of MO) : 1) ptosis- drooping of eyelid (sup. tarsal mm.), 2) miosis- constriction of pupil 3) decreased sweating of face 4) loss of ciliospinal reflex

2) Basilar a. -pontomedullary junct. groove for basilar a. => pontomesencephalic junct. Lt Rt Posterior cerebral a. . -Branches (1) Ant. Inf. Cerebellar Artery (AICA) -inferolat. Pontomedullary junct. cerebellum inferior lateral . -: rostral MO, pyramid, ML, MLF, 12 nu, NTS, nu of CN10. -: -contralateral hemiplegia of arm & leg (corticospinal fibers in basilar pons) -contralateral loss/decrease of proprioception, vibration, discriminative touch (medial lemniscus) -ipsilateral lateral rectus muscle paralysis (abducens nerve fibers or nucleusCN 6) -paralysis of conjugate gaze toward side of lesion (paramedian pontine reticular <Middle Alternating Hemiplegia=Med. pontine synd.> -Pons level Basilar a. Pontine a. Ex) , : abducens n. => med. adduction/ : hemiplegia (2) Pontine a.: basilar a. branches on pons. (3) Sup. Cerebellar artery -pontomesencephalic junct. brainstem cerebellum . **CN 3 sup. cerebellar a. post. cerebral a. ~! Skull base surgery ! formation/pontine gaze center)

Midbrain!

1. Medial Midbrain (Weber) Syndrome/ Superior Alternating Hemiplegia (paramedian branches of P1 segment of PCA occlusion) -contralateral hemiplegia of arm & leg (corticospinal fibers in crus cerebri) -ipsilateral paralysis of eye movemt, oriented down & out, pupil dilated & fixed (oculmotor nerveCN 3) 2. Central Midbrain Lesion (Claude Syndrome) -ipsilateral paralysis of eye movemt, oriented down & out, pupil dilated & fixed (oculomotor nerve CN 3) -contralateal ataxia and tremor of cerebellar origin (red nucleus & cerebellothalamic fibers) 3. Benedikt Syndrome: includes both regions, both sets of symptoms from above

Sup. alternating hemiplegia: , hemiplegia and CN3 (lat. & inf.)

Meninges

CSF 1): lateral, third, fourth ventricle choroid plexus(vascular pia matter ventricle invagination ) 2):

3): dural venous sinus(, sup. saggital sinus & venous lacunae) arachnoid villi C.S.F venous blood *arachnoid villi cranial bone (=> arachnoid graulation )

Ventricle -neural tube lumen lateral ventricle -> 2 , cerebral hemisphere third ventricle -> (diencephalon) cerebral aqueduct() -> mid brain fourth ventricle -> medulla, pons, cerebellum medulla oblongata (spinal cord) ventricle central canal

Hemorrhages

Herniations

 brain 1 Vesicle 2 vesicle mature brain thalamus, diencephalon subthalamus prosencephalon cerebral hemispheres, olfactory system, telecephalon corpus stratum, cb cortex, white matter midbrain, mesencephalon mesencephalon cerebral peduncle myelencephalon rhombencephalon metencephalon pons & cerebellum medulla oblongata consisting of tectum & epithalamus, hypothalamus,

Neural crest origin DRG/ Sensory ganglia of CN 5 7 9 10 (semilunar, geniculate, sup. and inf. ganglia of cn9, sup. & inf. ganglia of cn10)/ Autonomic ganglia (sym. Chain g, parasym. G of CN 3 7 9 10: ciliary, pterygopalatine, subman., otic, intramural-auerbach meissners plexus)/ Intramural g of pelvic pudendal n. (s234)/ Neuralemmal cell of PNS Schwann cell/ Stellate cell/ Melanocyte of skin/ Ganglionic cell in the adrenal medulla (sym)/ Enterochromaffin cell (ADUP cell)/ Leptomeninges/ Part of skull (related to face) fissure & fibers

Papez circuit

Reticular Formation -reticular formation ? : a vest pool of neuron, more or lessly

arranged into nuclei

1)precerebellar nuclei: (cb cortex, thalamuse ) (spinal

cord) afferent fiber efferent fiber RF . 2)raphe nuclei: raphe neuron

serotonin synaptic transmitter , pain sleep . sleep: serotonin thalamus cb cortex sleep pain: serotonin dorsal horn pain ( ) 3)central group of nuclei -inspiratory center (central group nuclei gigantocellular nucleus ) -motor control -

( efferent fiber intralaminar thalamic nuclei -> intralaminar thalamic nuclei cb cortex ) => ARAS(Ascending Reticular Activating System) 4)cholinergic neuron -efferent fiber basal ganglia => (sterotyped) (ex; locomotion) 5)catecholamine nuceli -locus coeruleus -modulation of synapse between other neuron -spinal reflex alterness excitory . 6)lateral parvocellular reticular area -expiratory center ( acceleration, arterial blood pressure ) 7)parabrachial area -pneumotaxic center 8)superficial medullary reticular neuron -cardiovascular, respiratory regulation CORPUS STRIATUM 1. corpus striatum = lentiform and caudate nuclri 2. lentiform nucleus = putamen and globus pallidus (external div. & internal division .) 3. striatum = neostriatum = putamen and caudate nucleus 4. pallidum = paleostriatum = globus pallidus 5. basal ganglia(traditional anatomical usage) = caudate and lentiform nuclei, amygdala, claustrum 6. basal ganglia(clinical and physiological usage) = corpus striatum, substantia nigra, subthalamic nucleus.

 archicortex n etc.

Subiculum

 : area posterma gag?, tuberculum cinerum trigeminal,