Dr. Zul Izhar Mohd.

Ismail Department of Anatomy, PPSP MMed Surgical Based 21 September 2010

OUTLINE
Cerebral cortex Functional areas of the cerebral cortex Gross external features Internal features

Cerebral cortex
3 poles frontal, occipital, temporal 3 borders superomedial, inferolateral & inferomedial 3 surfaces superolateral, medial, inferior 4 lobes frontal, parietal, temporal, occipital

 Longitudinal cerebral fissure

separates the 2 cerebral hemispheres contains falx cerebri and anterior cerebral arteries

Corpus callosum connects the 2 hemispheres

Main sulci
Central sulcus Lateral sulcus
Anterior horizontal ramus Anterior ascending ramus Posterior ramus

Parieto-occipital sulcus Calcarine sulcus

Frontal Lobe

3 sulci precentral, superior & inferior frontal sulci 4 gyri precentral, superior, middle, and inferior frontal gyri Inferior frontal gyrus subdivisions: Pars orbitalis, pars triangularis & pars opercularis

Parietal Lobe

2 sulci - postcentral sulci, intraparietal sulcus 3 gyri - postcentral gyrus, superior and inferior parietal lobules Intraparietal sulcus Runs posteriorly from the middle of the postcentral sulcus Marks the borders of the superior and inferior parietal lobules

Temporal Lobe

2 sulci - superior & inferior temporal sulci 3 gyri - superior, middle & inferior temporal gyri

Occipital lobe

3 sulci lateral occipital, lunate & transverse occipital sulci 3 gyri superior & inferior occipital gyri, gyrus descendens Gyrus descendens a vertical strip just anterior to the lunate sulcus (Arcus parieto-occipitalis belongs partly to the parietal lobe & partly to the occipital lobe)

Insula
Surrounded by a circular sulcus The surrounding areas are called opercula
orbital operculum frontal operculum parietal operculum temporal operculum

The surface of the insula itself is divided into a number of gyri (anteriorly 3-4 short gyri, posteriorly
1 long gyrus)

Medial surface
Corpos callosum
largest commissure of the brain

Callosal sulcus
Separates cingulate gyrus from corpus callosum

Cingulate sulcus
Separates cingulate gyrus from superior frontal gyrus

Medial surface

Paracentral lobule
Area surrounding the indentation made by the central sulcus on the medial surface The anterior part is a continuation of precentral gyrus; posterior part continuation of postcentral gyrus

Medial surface
Precuneus
Bounded anteriorly by the upturned posterior end of the cingulate sulcus and posteriorly by the parieto-occipital sulcus

Cuneus
triangular area bounded superiorly by the parieto-occipital sulcus inferiorly by the calcarine sulcus posteriorly by the superior medial margin

Inferior surface
Collateral sulcus
runs anteriorly below the calcarine sulcus

Lingual gyrus
between the collateral and calcarine sulci

Inferior surface
Parahippocampal gyrus
anterior to the lingual gyrus terminates in front as the uncus

Medial occipitotemporal gyrus

bounded medially by the collateral and rhinal sulci and laterally by the occipitotemporal sulcus

Lateral occipitotemporal gyrus

continuous with the inferior temporal gyrus

Inferior surface
Olfactory sulcus
overlied by the olfactory bulb and tract

Straight gyrus
(gyrus rectus)
medial to olfactory sulcus

Orbital sulcus
H-shaped Divides the orbital surface into anterior, posterior, medial and lateral gyri

Development of the brain

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Structures within the cerebral hemispheres

Frontal lobe
Area Motor area (Primary motor area) Premotor area (Secondary motor area) Brodmanns area 4
(precentral gyrus, anterior part of paracentral lobule)

Function Carry out the individual movements of different parts of the body

6, parts of 8, 44, 45
(posterior parts of superior, middle, inferior frontal gyri)

To store programs of motor activity assembled as the result of past experience Programs the activity of the primary motor area Controlling coarse postural movements through its connections with the basal ganglia Movements of the contralateral limbs, but a stronger stimulus is necessary when the primary motor area is stimulated Its removal produces no permanent loss of movement Conjugate movements of the eyes, especially towards the opposite side Voluntary scanning movements of the eye and is independent of visual stimuli Formation of words by its connections with the adjacent primary motor areas; the muscles of the larynx, mouth, tongue, soft palate and respiratory muscles Make-up of the individuals personality Regulator of the persons depth of feeling Influence in determining the initiative and judgment of an individual

Supplementary motor area

6
(medial surface of middle frontal gyrus, anterior to the paracentral lobule)

Frontal eye field

Parts of 6, 8 and 9 (middle frontal gyrus)

Motor speech area of Broca Prefrontal cortex

44 and 45 (inferior frontal gyrus) 9, 10, 11 and 12

Parietal lobe
Area Primary somaesthetic area (Primary somatic sensory cortex, S1) Brodmanns area 3, 1 and 2
(postcentral gyrus, posterior part of paracentral lobule)

Function General sensory area (projection fibres

from VPL and VPM nuclei of the thalamus)

Most sensation from the contralateral side; some from the oral region to the same side; pharynx, larynx and perineum to both sides The body is bilaterally represented with the contralateral side dominant Many sensory impulses come from the primary area Function not understood Receive and integrate different sensory modalities, eg. Recognise objects, relates to past sensory experiences

Secondary somaesthetic area (Secondary somatic sensory cortex, S2) Somaesthetic association area

Superior lip of the posterior limb of the lateral fissure 5 and 7

Occipital lobe
Area Primary visual area Brodmann s area 17
(mainly on medial surface of occipital lobe, above & below calcarine sulcus)

Function Afferent fibres from the lateral geniculate bodies Superior retinal quadrants (inferior visual field) pass to the superior wall of the calcarine sulcus; inferior to the inferior wall Macula lutea represented in the posterior part of area 17 and accounts for 1/3 of the visual cortex Visual impulses from the peripheral parts of the retina terminate in concentric circles anterior to the occipital pole in the anterior part of area 17 Receives afferent fibres from area 17 and other cortical areas, and thalamus To relate the visual information received by the primary visual area to past visual experiences, thus recognising and appreciating what is being seen Stimulation produces conjugate deviation of the eyes, especially to the opposite side Reflex and associated with movements of the eye when it is following an object (compared with the frontal eye field)

Secondary visual area

(visual association cortex / psychovisual area)

18 and 19

Occipital eye field

Thought to exist in the secondary visual area in humans

Temporal lobe
Area Primary auditory area Brodmanns area 41 and 42 Function Projection fibres from medial geniculate bodies and from the auditory radiation of the internal capsule Anterior part reception of low frequency sound; posterior high frequency Unilateral lesion partial deafness in both ears, greater in the contralateral ear (medial geniculate body receives fibres mainly from the organ of Corti of the opposite side + some from the same side) Receives impulses from the primary auditory area and from the thalamus Interpretation of sounds and for association of auditory input with other sensory information Receives fibres from the visual cortex and the auditory cortex Understanding of written and spoken language Enables a person to read a sentence, understand it and say it loud (connected to Brocas area by the arcuate fasciculus)

Secondary
auditory area (auditory association cortex)

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Sensory speech area of Wernicke

Superior temporal gyrus, with extensions around the posterior end of the lateral sulcus into the parietal region

Functional localisation: other cortical areas

Area Brodmanns area Function Fibres from nucleus solitarius ascend to the VPM nucleus of thalamus, where they synapse on neurons that send fibres to the cortex Appreciation of the positions and movements of the head in space Taste area 43

Vestibular area

Near to the part of postcentral gyrus concerned with sensations of the face, opposite the auditory area in the superior temporal gyrus

Insula

Buried within the lateral sulcus and forms its floor

Fibre connections are incompletely known Planning and coordinating the articulatory movements necessary for speech

Association cortex
Primary sensory areas + primary motor areas form only a small part of the total cortical surface area The remaining areas have all 6 cellular layers = homotypical cortex (classically known as association areas) These areas have multiple inputs and outputs and concerned with behaviour, discrimination and interpretation of sensory experiences 3 main association areas:
Prefrontal cortex Anterior temporal cortex Posterior parietal cortex

Association cortex:

Prefrontal cortex

Associating experiences that are necessary for the production of abstract ideas, judgment, emotional feeling and personality Destruction does not produce any marked loss of intelligence Has a rich dopaminergic innervation Failure of this innervation symptoms of schizophrenia Frontal leukotomy (cutting the fibre tracts of the frontal lobe) and frontal lobectomy to reduce emotional responsiveness of patients with obsessive emotional states and intractable pain

Association cortex:

anterior temporal

Storage of previous sensory experiences Stimulation may cause the individual to recall objects seen or music heard in the past

Association cortex:

posterior parietal

Visual information from the posterior occipital cortex and sensory input of touch and pressure and proprioception from the anterior parietal cortex is integrated into concepts of size, form and texture (= stereognosis) Appreciation of the body image is also assembled here The brain knows where each part of the body is located in relation to its environment

Areas supplied by the cerebral arteries

Introduction
Length in adults: 42 45 cm Begins foramen magnum (C1): spinomedullary junction Ends L1/L2 vertebral level

Development

In embryos up to the 1st trimester : spinal cord length = vertebral column length Spinal cord grows slower than the vertebral column. Therefore, 6 months - S1 newborn L2 or L3 adult inferior border of L1

Spinal enlargements
Enlargement for innervation of the limbs 2 regions: 1. Cervical enlargement C4 T1 vertebral level (C4 T1 spinal segments) Ventral rami of spinal nerves form the brachial plexus Upper limbs innervation 2. Lumbosacral enlargement T11 L1 vertebral level (L2 S3 spinal segments) Lumbar and sacral plexuses Lower limbs innervation

 Cauda equina
the bundle of spinal nerve roots in the lumbar cistern (subarachnoid space) within the vertebral canal caudal to the termination of the spinal cord

Medullary cone/conus medullaris

tapering inferior end of the spinal cord which terminates between T12 and L3

Terminal filum:
Vestigial remnant of the caudal part of the spinal cord that was in the tail of embryo It is a prolongation of pia mater from the conus medullaris Its proximal end consists of vestiges of neural tissue, CT, pia mater and neuroglial tissue Leaves the inferior end of the dural sac, picks up a dural investment opposite S2 and the resulting coccygeal ligament passes through the sacral hiatus, and attaches to the dorsum of the coccyx Serves as an anchor for the end of the dural sac Dural sac = a long tubular sheath within the vertebral canal formed by the dura

External features
Ventral median fissure lined by pia mater Dorsal median sulcus composed of pia mater Ventrolateral sulcus attachment of ventral spinal nerve roots Dorsolateral sulcus attachment of dorsal spinal nerve roots Ventrolateral and dorsolateral sulci divide the white matter into ventral, dorsal and lateral funiculi (funiculus = white column) Dorsal intermediate sulcus appears in dorsal area superior to middle thoracic level

Structure of spinal nerves

Mixed nerves

Structure: spinal nerve

Dorsal roots of spinal nerves Contain afferent (sensory) fibres from skin, subcutaneous and deep tissues, viscera Ventral roots of spinal nerves Contain efferent (motor) fibres to skeletal muscle & presynaptic autonomic fibres Dorsal root ganglia contain the cell bodies of afferent axons Dorsal + ventral nerve roots unite at their points of exit from the vertebral canal to form a spinal nerve 50 % - C1 dorsal roots are lacking, and the coccygeal nerve may be absent

Structure: spinal nerve

Spinal nerves exit through the intervertebral foramina After exit, each spinal nerve divides into: 1. dorsal primary ramus Sensory & motor Joints of the vertebral column, deep muscles of the back and overlying skin 2. ventral primary ramus Sensory & motor Anterior and lateral trunk, UL, LL and skin Form plexuses (except T1-T11)

Internal structures
Composed of:
1. Gray matter 2. White matter

Gray matter
H-shaped Has 3 columns/horns: 1. Anterior gray column 2. Posterior gray column 3. Lateral gray column present only in the thoracic and upper lumbar segments. Contains sympathetic efferent neurons 4. Intermediate zone gray commissure + central canal 1 and 2 are united by gray commissure (anterior & posterior) The gray commissure surrounds the central canal The amount of gray matter is greatest within the cervical and lumbosacral enlargements

Gray matter
Consists of: Nerve cells and processes (multipolar) Neuroglia forms intricate network around the nerve cell bodies & their neurites Blood vessels Types of neurons in spinal gray matter: 1. Interneurons send impulse from afferent fibre to motor neurons or tract cells 2. Motor neurons alpha and gamma types. Send impulse to skeletal muscle 3. Tract cells send impulse to higher centres

Gray matter
Neurons are not uniformly distributed within the gray matter Their cell bodies are arranged into column, known as nuclei

Gray matter

3 neuron groups: 1. in the anterior gray columns 2. in the posterior gray columns 3. in the lateral gray columns

Neuron groups in the anterior gray column

3 groups

Most neurons
large and multipolar Their axons pass out in the anterior roots as alpha efferents (innervates skeletal m.)

The smaller neurons

are also multipolar Their axons pass out in the anterior roots as gamma efferents (innervates intrafusal m. fibres of neuromuscular spindles)

Neuron groups in the anterior gray column

Group 1 medial Nucleus Dorsomedial nucleus Ventromedial nucleus Distribution Innervation Present in most innervates skeletal mm. of segments of the spinal neck & trunk, intercostal + cord abdominal musculature C3, 4, 5 C1 - 5/6 L2 S1 diaphragm SCM & trapezius mm. unknown distribution

central Phrenic nucleus (smallest) Accessory nucleus Lumbosacral nucleus lateral Ventrolateral nucleus Dorsolateral nucleus Retrodorsolateral nucleus Onufs nucleus

Present in the cervical innervates skeletal mm. of the limbs & lumbosacral segments of the spinal cord Caudal lumbar & rostral sacral segments (S1, 2) Pelvic floor & perineal muscles, anal & urethral sphincters

Anterior gray horn

Cell bodies of motor neurons are arranged in groups Medially located neurons control axial muscles (neck and trunk) Laterally located neurons control limb muscles (cervical / lumbar enlargements)

Neuron groups in the posterior gray columns

4 groups

2 groups extend throughout the length of the spinal cord Substantia gelatinosa Nucleus proprius

2 groups are restricted to the thoracic and lumbar segments Nucleus dorsalis (Clarks column) Visceral afferent nucleus

Neuron groups in the posterior gray columns

Group/ nucleus 1 Substantia gelatinosa Location & distribution Apex of the posterior gray column throughout the length of spinal cord Anterior to the substantia gelatinosa. Throughout the length of spinal cord Constitutes the main bulk of cells present in the posterior white column Base of the posterior gray column. C8 T3/4 (Thoracic & upper lumbar segments) Lateral to the nucleus dorsalis T1 L3 Innervation Receives afferent fibres concerned with pain, temperature, and touch from the posterior root Reeives input from descending fibres from supraspinal levels Receive fibres from the posterior white column. Associated with senses of position and movement (proprioception), 2-point discrimination & vibration

Nucleus proprius

Nucleus dorsalis (Clarks column) Visceral afferent nucleus

Proprioceptive endings (neuromuscular spindles & tendon spindles)

Receiving visceral afferent information

Neuron groups in the lateral gray columns 2 groups

Group 1 Intermediolateral (Visceral efferent neurons)

Distribution Small lateral gray column T1 L2/3 S2,3,4

Innervation Give rise to the preganglionic sympathetic fibres - to organs and blood vessels

Give rise to the preganglionic parasympathetic fibres leave the spinal nerves as the pelvic splanchnic nerves to viscera in pelvis & abdomen Receives primary afferent fibres from dorsal root and has been implicated in visceral reflexes

Intermediomedial

Not seen in all cord segments

Laminae of Rexed

Nerve cells in the gray matter are grouped based on their cytoarchitecture and longitudinal arrangement in cell columns using Roman numerals 10 laminae

Central canal
Opens superiorly into the 4th ventricle of the brain Begins inferior half of medulla oblongata In the conus medullaris, it expands to form the terminal ventricle Ends below the terminal ventricle within the root of the filum terminale Lined by ependymal cells (ciliated columnar epithelium) Contains CSF Surrounded by gray matter, the gray commissure NO choroid plexus in it

White matter
Divided into: 1. Anterior white column/funiculus 2. Posterior white column/funiculus 3. Lateral white column/funiculus (2 + 3 = anterolateral funiculus) Anterior white commissure lies anterior to the gray commissure Posterior white commissure running transversely in the gray commissure, posterior to the central canal Contains: Nerve fibres Neuroglia Blood vessels White = due to the high proportion of myelinated nerve fibres

Ascending tracts in white matter

Descending tracts in white matter

Posterior white column

Posterior white column inferior to the lower half of spinal cord (T7-T12, lumbar & sacral) contains only fasciculus gracilis (i.e. sensory impulse from lower half of body) Posterior white column superior to the lower half of spinal cord (cervical & T1-T6) contains fasciculus gracilis & fasciculus cuneatus (i.e. sensory impulse from upper & lower half of body)

Spinal meninges
Spinal meninges: 1. Dura mater 2. Arachnoid mater 3. Pia mater

These membranes + CSF in the subarachnoid space surround, support and protect the spinal cord and spinal nerve roots

Dura mater
Outermost layer Separated from the vertebrae by the extradural/epidural space - contains adipose tissue + internal vertebral venous plexus Forms the dural sac Adheres to the margin of foramen magnum and continuous with the dura mater of the brain It is pierced by the spinal nerves and is anchored inferiorly to the coccyx by the terminal filum Dural root sleeves extension of the dura into the intervertebral (IV) foramina and along the dorsal and ventral nerve roots distal to the spinal ganglia These sleeves adhere to the periosteum lining the IV foramina and end by blending with the epineurium of the spinal nerves

Arachnoid mater
Delicate, avascular membrane Encloses the CSF-filled subarachnoid space Is NOT attached to the dura Surrounds the roots of spinal nerves as far as their exits from the vertebral canal Continuous rostrally through the foramen magnum with the arachnoid covering the brain Caudally, it ends on the terminal filum at the S2/S3 level

Subarachnoid space
(leptomeningeal space)

Between the arachnoid and pia mater Filled with CSF Surrounds the spinal nerves and follows them to the point where they leave the vertebral canal Arachnoid trabeculae delicate strands of CT that span the subarachnoid space

Subarachnoid space
(leptomeningeal space)

Lumbar cistern the enlargement of the space caudal to the medullary cone containing the cauda equina Extends from L2 to S2/S3 The subarachnoid space extends beyond the lower end of the spinal cord and invests the cauda equina

Pia mater
Innermost covering membrane of the spinal cord Closely follow the surface features of the spinal cord Covers the roots of the spinal nerves and spinal blood vessels The arachnoid and pia fuse with the perineurium of each spinal nerve at the point where they leave the vertebral canal Continues as the terminal filum inferior to the medullary cone

Denticulate ligament
A ligament that holds the spinal cord in the dural sac on each side They are lateral extensions from the lateral surfaces of the pia midway between the dorsal and ventral nerve roots The uppermost part attaches to the occipital dura immediately inside the foramen magnum The lowermost part spans between the T12 and L1 nerve roots

Spinal cord at different levels

The amount of gray matter is greatest in the region of the cervical and lumbar enlargements The amount of white matter progressively increase superiorly Lateral gray horns T1 L2

Cervical spinal segment

Oval White matter largest amount Anterior & posterior gray horns large at cervical enlargement (C4 C8) compared to C1-C3 Posterior white column fasciculus gracilis & cuneatus

Thoracic spinal segment

White matter less than that of cervical segments Anterior and posterior gray horns smaller Lateral horn T1 T12 Fasciculus gracilis throughout Fasciculus cuneatus T1 T6

Lumbar spinal segment

Lesser white matter Relatively large anterior & posterior gray horns (lumbar enlargement L2-L5) Only fasciculus gracilis

Sacral spinal segment

Relatively thin white matter Large gray matter Fasciculus gracilis only

Arteries of the spinal cord

From 3 longitudinal arteries:
1. Anterior spinal a. (x1) - supplies ~ 2/3 of the cross-sectional area of the spinal cord 2. Posterior spinal aa. (x2) - supply posterior 1/3 of the spinal cord

Reinforced by blood from the:

Segmental spinal arteries anterior & posterior radicular or medullary arteries