NEUROLOGICAL SYSTEM PART II CEREBRAL ANATOMY AND PHYSIOLOGY

DENNIS STEVENS CRNA, MSN, ARNP SEPTEMBER 2008 FLORIDA INTERNATIONAL UNIVERSITY ADVANCED BIOSCIENCE IN ANESTHESIOLOGY II NGR 6145

CEREBRAL ANATOMY AND PHYSIOLOGY

 

OBJECTIVES Identify gross anatomical features of the brain. Discuss functions associated with membranes of the cranial meninges. Describe significant aspects of arterial cerebral vascularization. Explain cerebral perfusion pressure and autoregulation associated with cerebral blood flow. List divisions of the brain and specific functions related to each division. Discuss significant differences between gray and white matter.

CEREBRAL ANATOMY AND PHYSIOLOGY

INTRODUCTION Brain weighs ~ 1300 Gms Divided into four principle parts:  Brain stem  Diencephalon  Cerebrum  Cerebellum Brain is protected by cranial bones, cranial meninges, and CSF

 

CEREBRAL ANATOMY AND PHYSIOLOGY

INTRODUCTION Brain stem consists of the medulla oblongata, pons, and midbrain. Lower end is a continuation of the spinal cord. Diencephalon consists primarily of the thalamus and hypothalamus Cerebrum spreads over the diencephalon and occupies most of the cranium Inferior to the cerebrum and posterior to the brain stem is the cerebellum Cranial meninges surround the brain and are continuous with the spinal meninges

CEREBRAL ANATOMY AND PHYSIOLOGY



CRANIAL BONES Frontal bone forms the forehead, roofs of the orbits, and most of the anterior portion of the cranial floor Parietal bones form greater portion of the sides and roof of the cranial cavity Temporal bones form inferior sides of cranium and part of the cranial floor

CEREBRAL ANATOMY AND PHYSIOLOGY

CRANIAL BONES Occipital bone forms posterior part and significant portion of the base of the cranium Sphenoid bone is situated at the middle part of the base of the skull and articulates with all other cranial bones Ethmoid bone is principle supporting structure of the nasal cavities. Forms part of the anterior portion of the cranial floor, medial wall of the orbits, superior portions of the nasal septum, and most of the sidewalls of the nasal roof

CEREBRAL ANATOMY AND PHYSIOLOGY

CRANIAL BONES Four prominent skull sutures are immovable joints found only between skull bones and contain very little connective tissue:  Coronal suture  Sagittal suture  Lambdoidal suture  Squamosal suture

CEREBRAL ANATOMY AND PHYSIOLOGY

CRANIAL BONES At birth fontanels, membrane-filled spaces found between cranial bones, will eventually be replaced by bone:  Anterior (frontal) fontanel  Posterior (occipital) fontanel  Anterolateral (sphenoidal) fontanel  Posterolateral (mastoid) fontanel

CEREBRAL ANATOMY AND PHYSIOLOGY

CRANIAL MENINGES


Three membranes envelope the brain:  Dura (outermost layer)  Arachnoid  Pia (innermost layer)

CEREBRAL ANATOMY AND PHYSIOLOGY

CRANIAL MENINGES


Dura:  Tough fibrous structure containing an inner (meningeal) layer and outer (periosteal) layer  Most of the dura s venous sinuses lie between the dural layers  Dural layers are generally fused, except where they separate to provide space for the venous sinuses and where the inner layer forms septa between the brain portions  Outer layer firmly attached to inner surface of cranial bones; inner layer continuous with spinal dura

CEREBRAL ANATOMY AND PHYSIOLOGY

CRANIAL MENINGES


Arachnoid:  Delicate avascular membrane covers the subarachnoid space  Between the arachnoid and dura mater lies the subdural space  Arachnoid granulations project into the superior sagittal sinus  Subarachnoid space between the arachnoid and the pia is relatively narrow over the surface of the cerebral hemisphere and is much wider at areas at the base of the brain

CEREBRAL ANATOMY AND PHYSIOLOGY

CRANIAL MENINGES


Pia:  Thin connective tissue membrane that covers the brain surface and extends into sulci and fissures and around blood vessels throughout the brain  Invaginations of the pia form choroid plexuses of the ventricles Clinical considerations:  Various types of lesions, malformations, or pathology may present in one or more intracranial compartments

CEREBRAL ANATOMY AND PHYSIOLOGY

CEREBRAL VASCULARIZATION ~ 18% of total blood volume circulates in the brain Brain is responsible for 20% of total body oxygen consumption Constant flow of oxygen must be maintained:  Loss of consciousness occurs in less than 15 seconds  Irreparable damage occurs within 5 minutes Cerebrovascular disease occurs as a result of vascular compromise or hemorrhage in the central nervous system

 

CEREBRAL ANATOMY AND PHYSIOLOGY

ARTERIAL SUPPLY OF THE BRAIN Extra cerebral vessels; R carotid artery arises from R subclavian, L carotid artery arises from aortic arch Intracranial cerebral vessels; internal carotid artery divides into anterior cerebral and middle cerebral arteries Two vertebral arteries (arising from the subclavian arteries) join to form the basilar artery which gives rise to the posterior cerebral artery; supplying occipital lobes and brain stem

CEREBRAL ANATOMY AND PHYSIOLOGY



ARTERIAL SUPPLY OF THE BRAIN Circle of Willis is a confluence of vessels that gives rise to all major cerebral arteries It is fed by the paired internal carotid arteries and the basilar artery When the circle is complete, it contains a posterior communicating artery on each side and an anterior communicating artery Each major artery supplies a certain territory Sudden occlusion affects its territory immediately, sometimes irreversibly

CEREBRAL ANATOMY AND PHYSIOLOGY

REGULATION OF CEREBRAL BLOOD FLOW Cerebral perfusion pressure is the difference between mean arterial pressure and intracranial pressure CPP = MAP ICP CPP is normally 80-100 mm Hg CPP values less than 50 mm Hg often show slowing on EEG CPP values between 25-40 mm Hg typically flat EEG Sustained CPP less than 25 mm Hg results in irreversible damage

  

 

CEREBRAL ANATOMY AND PHYSIOLOGY



REGULATION OF CEREBRAL BLOOD FLOW Autoregulation:  CBF remains nearly constant between MAP of 60-160 mm Hg  Pressures greater than 150-160 mm Hg can disrupt the blood brain barrier Extrinsic mechanisms influencing cerebral blood flow:  Respiratory gas tensions  Temperature  Viscosity  Autonomic influences

CEREBRAL ANATOMY AND PHYSIOLOGY

VENOUS DRAINAGE Venous drainage of the brain and coverings includes veins of the brain itself, dural venous sinuses, dura s meningeal veins, and diploic veins Eventual cerebral venous drainage is the internal jugular vein Cerebral veins contain no valves

CEREBRAL ANATOMY AND PHYSIOLOGY

DIVISIONS OF THE BRAIN Develop from embryonic brain vesicles that form from the cranial end of the neural tube Consists of:  Brain stem  Diencephalon  Cerebrum  Cerebellum

CEREBRAL ANATOMY AND PHYSIOLOGY

BRAIN STEM


Medulla:  Relays motor and sensory impulses between other parts of the brain and spinal cord (some tracts decussate)  Reticular formation functions in consciousness and arousal  Contains vital reflex centers (heartbeat, breathing, and blood vessel diameter)  Nonvital reflex centers coordinate swallowing, vomiting, coughing, sneezing, and hiccupping  Contains nuclei of origin for CNs VIII, IX, X, XI, and XII  Vestibular nuclear complex helps maintain equilibrium

CEREBRAL ANATOMY AND PHYSIOLOGY

BRAIN STEM


Pons:  Relays impulses within the brain and between parts of the brain and the spinal cord  Contains nuclei of origin for CNs V, VI, VII, and VIII  Pneumotaxic and apneustic areas help regulate breathing Midbrain:  Relays motor impulses from cerebral cortex to pons and spinal cord and relays sensory impulses from spinal cord to thalamus  Coordinates movement of eyeballs and head and trunk  Contains nuclei of origin for CNs III and IV

CEREBRAL ANATOMY AND PHYSIOLOGY

DIENCEPHALON


Thalamus:  Serves as relay station for all sensory impulses, except smell, to cerebral cortex  Relays motor impulses from cerebral cortex to spinal cord  Interprets pain, temperature, light touch, and pressure sensations  Functions in emotions and memory Hypothalamus:  Controls and integrates the ANS, articulates with the pituitary gland, center for mind-over-body phenomena, rage and aggression, controls normal body temperature, food intake and thirst, maintains waking state and sleep

CEREBRAL ANATOMY AND PHYSIOLOGY



CEREBRUM Functional areas of cerebral cortex divided into sensory, motor, and association areas Sensory areas interpret sensory impulses, motor areas control muscular movement, and association areas function in emotional and intellectual processes Basal ganglia control gross muscle movements and regulate muscle tone Limbic system functions in emotional aspects of behavior related to survival Language; contained in the left hemisphere in 90% of the population, located in frontal (Broca s area), parietal, and temporal lobes

CEREBRAL ANATOMY AND PHYSIOLOGY

CEREBELLUM Second-largest portion of the brain, occupies inferior and posterior aspects of the cranial cavity Separated from the cerebrum by the transverse fissure and the tentorium cerebelli Controls subconscious skeletal muscle contractions required for coordination, posture, and balance Assumes a role in emotional development, modulating sensations of anger and pleasure

CEREBRAL ANATOMY AND PHYSIOLOGY

REFERENCES Morgan, G.E., Mikhail, M.S., and Murray, M.J. (2006). Clinical Anesthesiology. (4th Ed.) New York, NY: McGraw-Hill. Nagelhout, J.J. and Zaglaniczny, K.L. (2005). Nurse Anesthesia. (3rd Ed.) St. Louis, MO: ElsevierSaunders. Waxman, S.G. (2000). Correlative Neuroanatomy (24th ed.). New York, NY:McGraw-Hill.