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Neuroanatomy
ThalamusandHypothalamus

Objectives
Toreviewaverycomplexareaofthenervoussystem andtoemphasizethatthethalamusliesatthecenter ofmanyafferentandefferentneuronalloopstoother partsofthenervoussystem Tolearnthelocationandboundariesofthe hypothalamusandthevariousnucleithatmakeupthis importantarea Toreviewthemainconnectionsofthenuclei, especiallytheconnectionsbetweenthehypothalamus andthepituitarygland Toreviewsomeofthecommonclinicalproblems involvingthehypothalamus

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Diencephalon
thediencephalon,orinbetweenbrain,iscompletelysurroundedbythe cerebralhemispheresexceptatitsventralsurface islimitedposteriorlybytheposteriorcommissureandanteriorlybythe laminaterminalis andtheforamenofMonro posteriorlimboftheinternalcapsulelimitsthediencephalonlaterally medially,thediencephalonformsthelateralwallofthethirdventricle dorsalsurfaceformsthefloorofthelateralventricleandismarked mediallybyabandofnervefibers,thestria medullaris thalami ventralsurfacecontainshypothalamicstructures agrooveextendingbetweentheforamenofMonro andtheaqueductof Sylvius (thehypothalamicsulcus)dividesthediencephalonintoadorsal portion,thethalamus,andaventralportion,thehypothalamus thetwothalamiareconnectedacrossthemidlineinabout70percentof humansthroughtheinterthalamic adhesion(massa intermedia) diencephalondevelopsfromthecaudalvesicleoftheembryologic prosencephalon

Dorsalsurfaceofthediencephalon.Thalamiarelocatedonbothsidesofthethird ventricle.Thestria medullaris thalamirepresentacomponentoftheepithalamus.

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Schematicdiagramshowingthesubdivisionsofthediencephalonasseenina compositecoronalview

Diencephalon
Thalamus
Ventralnucleargroup Lateralgroupofthalamicnuclei Medialgroup Intralaminar nuclei Midlinenuclei Ventralthalamus

Hypothalamus
Hypothalamicafferents Hypothalamicefferents

Pituitarygland(hypophysis cerebri) Epithalamus Subthalamus

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THALAMUS

Thalamus
attherostralendofthebrainstem functionsasanimportantrelayand integrativestationforinformation
cerebralcortex basalganglia Hypothalamus brainstem

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Generalappearance
large,eggshapedmassofgraymatterthatformsthemajorpartof thediencephalon twothalami,andoneissituatedoneachsideofthethirdventricle Borders
anteriorend ofthethalamusisnarrowandroundedandformsthe posteriorboundaryoftheinterventricular foramen posteriorendisexpandedtoformthepulvinar,whichoverhangsthe superiorcolliculus Inferiorsurfaceiscontinuouswiththetegmentum ofthemidbrain medialsurfaceofthethalamusformspartofthelateralwallofthe thirdventricleandisusuallyconnectedtotheoppositethalamusbya bandofgraymatter,theinterthalamic connection(interthalamic adhesion)

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Coronalsectionofthecerebralhemispheresshowingthepositionandrelationsofthe thalamus.

Posteriorviewofthebrainstemshowingthethalamusandthetectum ofthemidbrain.

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SubdivisionsoftheThalamus
Coverings
superiorsurface:thinlayerofwhitemattercalledthestratumzonale lateralsurface:externalmedullarylamina

Internalmedullarylamina
dividesthalamusintomedialandlateralhalves consistsofnervefibersthatpassfromonethalamicnucleustoanother anterosuperiorly,theinternalmedullarylaminasplits,resemblingaYshape

threemainsubdivisions
anteriorpartliesbetweenthelimbsoftheY medialandlateralpartslieonthesidesofthestemoftheY

eachofthethreepartsofthethalamuscontainsagroupofthalamic nuclei smallernucleargroupsaresituatedwithintheinternalmedullarylamina, andsomearelocatedonthemedialandlateralsurfacesofthethalamus

AnteriorPart

PartsoftheThalamus

containstheanteriorthalamicnuclei receivethemammillothalamic tractfromthemammillarynuclei alsoreceivereciprocalconnectionswiththecingulategyrus andhypothalamus functioncloselyassociatedwiththatofthelimbicsystemandisconcernedwithemotional toneandthemechanismsofrecentmemory

MedialPart
containsthelargedorsomedial nucleusandseveralsmallernuclei hastwowayconnectionswiththewholeprefrontalcortexofthefrontallobeofthecerebral hemisphere similarconnectionswiththehypothalamicnuclei interconnectedwithallothergroupsofthalamicnuclei responsiblefortheintegrationofalargevarietyofsensoryinformation,includingsomatic, visceral,andolfactoryinformation,andtherelationofthisinformationtoone'semotional feelingsandsubjectivestates

LateralPart
subdividedintoadorsaltierandaventraltier

DorsalTieroftheNuclei
includesthelateraldorsalnucleus,thelateralposteriornucleus,andthepulvinar haveinterconnectionswithotherthalamicnucleiandwiththeparietallobe,cingulategyrus, andoccipitalandtemporallobes

VentralTieroftheNuclei
consistsofthefollowingnucleiinacraniocaudal sequence:VA,VL,VP

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Threedimensionaldiagramofthethalamus.Majornucleargroupsaredemarcatedbythe internalmedullarylamina.Midlineconnectionofthalami(interthalamic adhesion)isalso Illustrated.

Importantthalamocortical projections.(Adaptedfrom
anoriginalpaintingbyFrank H.Netter,M.D.,fromThe CIBACollectionofMedical Illustrations,copyrightby CIBAPharmaceutical Company,DivisionofCIBA GEIGYCorporation.)

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OtherNuclei
Theintralaminar nuclei
smallcollectionsofnervecellswithintheinternalmedullarylamina receivefibersfromthereticularformationaswellasfibersfromthe spinothalamic andtrigeminothalamic tracts sendfiberstootherthalamicnuclei,whichinturnprojecttothecerebral cortex,andfiberstothecorpusstriatum influencethelevelsofconsciousnessandalertnessinanindividual

Themidlinenuclei
consistofgroupsofnervecellsadjacenttothethirdventricleandinthe interthalamic connection receiveafferentfibersfromthereticularformation.Theirprecisefunctionsare unknown

Thereticularnucleus
athinlayerofnervecellssandwichedbetweentheexternalmedullarylamina andtheposteriorlimboftheinternalcapsule afferentfibersconvergeonthisnucleusfromthecerebralcortexandthe reticularformation outputismainlytootherthalamicnuclei maybeconcernedwithamechanismbywhichthecerebralcortexregulates thalamicactivity

OtherNuclei
medialgeniculatebody
formspartoftheauditorypathwayandisaswellingontheposteriorsurfaceofthethalamus beneaththepulvinar afferentfiberstothemedialgeniculatebodyformtheinferiorbrachiumandcomefromthe inferiorcolliculus inferiorcolliculus receivestheterminationofthefibersofthelaterallemniscus receivesauditoryinformationfrombothearsbutpredominantlyfromtheoppositeear efferentfibersleavethemedialgeniculatebodytoformtheauditoryradiation,whichpasses totheauditorycortexofthesuperiortemporalgyrus

lateralgeniculatebody
formspartofthevisualpathwayandisaswellingontheundersurfaceofthepulvinar ofthe thalamus consistsofsixlayersofnervecellsandistheterminusofallbutafewfibersoftheoptictract (exceptthefiberspassingtothepretectal nucleus) fibersaretheaxonsoftheganglioncelllayeroftheretinaandcomefromthetemporalhalfof theipsilateral eyeandfromthenasalhalfofthecontralateraleye,thelatterfiberscrossing themidlineintheopticchiasma eachlateralgeniculatebody,therefore,receivesvisualinformationfromtheoppositefieldof vision efferentfibersleavethelateralgeniculatebodytoformthevisualradiation,whichpassesto thevisualcortexoftheoccipitallobe

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Corticalareasofthethalamicprojectionsonthelateralsurfaceofthecerebralhemisphere. Theseprojectionsarespecificsiteswherecertainsensoryand/ormotorimpulsesare Integrated.

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ConnectionsoftheThalamus
everythalamicnucleus(exceptthereticularnucleus)sends axonstospecificpartsofthecerebralcortex everypartofthecerebralcortexsendsreciprocalfibers backtothethalamicnuclei indicatethatinformationreceivedbythethalamusis alwayssharedwiththecerebralcortexandthatthecortex andthalamuscanmodifyeachother'sactivities animportantrelaystationfortwosensorymotoraxonal loopsinvolvingthecerebellumandthebasalnuclei
thecerebellarrubrothalamiccorticalpontocerebellarloop thecorticalstriatalpallidalthalamiccorticalloop botharenecessaryfornormalvoluntarymovement

Mainconnectionsofthethalamus.Afferentfibersareshownontheleft,andefferent fibersareshownontheright.

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Schematicdiagramofthemedialsurfaceofthebrainillustratingcortical projectionsofthalamicnuclei

Summaryofthemain afferentandefferent connectionsofthethalamic relaynuclei

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Schematicdrawingoftheafferentand efferent connectionsofthelateraldorsalnucleus

Simplifieddiagramofthemainprojections and afferentofthelateralposteriorthalamic nucleus

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Schematicdiagramoftheafferentsofthe dorsomedial nucleusofthethalamuswhich contributetotheformationofansa peduncularis

Schematicdiagramofthe afferentandefferentfibers ofthedorsalmedial nucleusofthethalamus. Notethattheconnection tothecorpusstriatumis bilateral.Theprojections ofthedorsomedial nucleustothemammillary body,tuberoinfundibular region,andpreoptic area comprisethe periventricularsystem

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FunctionoftheThalamus
madeupofcomplicatedcollectionsofnervecellsthat arecentrallyplacedinthebrainandareinterconnected vastamountofsensoryinformationofalltypes(except smell)convergesonthethalamusandpresumablyis integratedthroughtheinterconnectionsbetweenthe nuclei informationpatternisdistributedtootherpartsofthe centralnervoussystem olfactoryinformationisfirstintegratedatalowerlevel withtasteandothersensationsandisrelayedtothe thalamusfromtheamygdaloid complexand hippocampusthroughthemammillothalamic tract

FunctionoftheThalamus
anatomicallyandfunctionally,thethalamusandthecerebralcortex arecloselylinked fiberconnectionshavebeenestablished,anditisknownthat followingremovalofthecortex,thethalamuscanappreciatecrude sensations cerebralcortexisrequiredfortheinterpretationofsensations basedonpastexperiences
ifthesensorycortexisdestroyed,onecanstillappreciatethe presenceofahotobjectinthehand however,appreciationoftheshape,weight,andexacttemperatureof theobjectwouldbeimpaired

thalamuspossessescertainveryimportantnucleiwhose connectionshavebeenclearlyestablished
includetheventralposteromedialnucleus,theventralposterolateral nucleus,themedialgeniculatebody,andthelateralgeniculatebody

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FunctionoftheThalamus
Theventroanterior andtheventrolateral nucleiofthethalamus formpartofthebasalnucleicircuitandthusareinvolvedinthe performanceofvoluntarymovements.Thesenucleireceiveinput fromtheglobus pallidus andsendfiberstotheprefrontal, supplemental,andpremotorareasofthecerebralcortex. Thelargedorsomedial nucleushasextensiveconnectionswiththe frontallobecortexandhypothalamus.Thereisconsiderable evidencethatthisnucleusliesonthepathwaythatisconcerned withsubjectivefeelingstatesandthepersonalityoftheindividual. Theintralaminar nucleiarecloselyconnectedwiththeactivitiesof thereticularformation,andtheyreceivemuchoftheirinformation fromthissource.Theirstrategicpositionenablesthemtocontrol thelevelofoverallactivityofthecerebralcortex.Theintralaminar nucleiarethusabletoinfluencethelevelsofconsciousnessand alertnessinanindividual.

Clinicalcorrelations
SensoryLoss
usuallyresultfromthrombosisorhemorrhageofoneofthearteriessupplyingthethalamus damagetotheventralposteromedialnucleusandtheventralposterolateral nucleuswillresult inthelossofallformsofsensation,includinglighttouch,tactilelocalizationand discrimination,andmusclejointsensefromtheoppositesideofthebody thalamiclesionresultsindysfunctionofneighboringstructures,producingsymptomsand signsthatovershadowthoseproducedbythethalamicdisease
vascularlesionofthethalamusmayalsoinvolvethemidbrain,withresultingcoma,oralateral extension ofthalamicdiseasemayinvolvetheinternalcapsuleandproduceextensivemotorand sensorydeficits

SurgicalReliefofPainbyThalamicCauterization
intralaminar nucleiofthethalamusareknowntotakepartintherelayofpaintothecerebral cortex cauterizationofthesenucleihasbeenshowntorelievesevereandintractablepainassociated withterminalcancer

ThalamicPain
thalamicpainmayoccurasthepatientisrecoveringfromathalamicinfarct spontaneouspain,whichisoftenexcessive(thalamicoverreaction),occursontheopposite sideofthebody painfulsensationmaybearousedbylighttouchorbycoldandmayfailtorespondtopowerful analgesicdrugs

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Clinicalcorrelations
AbnormalInvoluntaryMovements
choreoathetosis withataxiamayfollowvascularlesionsofthe thalamus notcertainwhetherthesesignsinallcasesareduetothelossof functionofthethalamusortoinvolvementoftheneighboringcaudate andlentiform nuclei ataxiamayariseastheresultofthelossofappreciationofmuscleand jointmovementcausedbyathalamiclesion

ThalamicHand
contralateralhandisheldinanabnormalpostureinsomepatients withthalamiclesions wristispronatedandflexed,themetacarpophalangeal jointsare flexed,andtheinterphalangeal jointsareextended fingerscanbemovedactively,butthemovementsareslow conditionisduetoalteredmuscletoneinthedifferentmusclegroups

HYPOTHALAMUS

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TheHypothalamus
small(0.3%ofthetotalbrain) averyimportant partofthecentralnervoussystem isessentialforlife atthecenterofthelimbicsystem thesiteofnumerousconverginganddivergingneuronalpathways abletosamplethebloodchemistrythroughitsvascularsupply hypothalamusmakesappropriatecontrollingresponsesfollowing theintegrationofitsnervousandchemicalinputs controlbodyhomeostasis,throughtheautonomicnervoussystem andtheneuroendocrinesystem,andtoplayavitalrolein emotionalbehavior

Sagittalsectionofthebrainshowingthepositionofthe hypothalamus

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Hypothalamicnucleiandassociatedareas

Hypothalamus
Location
posteriortotheopticchiasma ventraltothethalamus betweenthethirdventricleandthesubthalamus connectedventrallytothepituitarygland dividedintolateralandmedialpartsbythefornix caudally,thehypothalamusmergesintothetegmentum ofthe midbrain lateralboundaryofthehypothalamusisformedbytheinternal capsule

relatedtothefollowingstructures,fromanteriortoposterior
opticchiasma tubercinereum andtheinfundibulum mammillarybodies.

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Inferiorsurfaceofthebrainshowingpartsof thehypothalamus.

HypothalamicNuclei
composedofsmallnervecellsthatarearranged ingroupsornuclei manyarenotclearlysegregatedfromone another functionallythepreoptic areaisincludedaspart ofthehypothalamus nucleiaredividedbyanimaginaryparasagittal planeintomedialandlateralzones lyingwithintheplanearethecolumnsofthe fornixandthemammillothalamic tract

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MedialZone
followinghypothalamicnucleicanberecognized, fromanteriortoposterior
partofthepreoptic nucleus anteriornucleus,whichmergeswiththepreoptic nucleus partofthesuprachiasmatic nucleus paraventricular nucleus dorsomedial nucleus ventromedialnucleus infundibular (arcuate)nucleus posteriornucleus

LateralZone
followinghypothalamicnucleicanbe recognized,fromanteriortoposterior
partofthepreoptic nucleus partofthesuprachiasmatic nucleus supraoptic nucleus lateralnucleus tuberomammillary nucleus lateraltuberal nuclei.

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Sagittalsectionofthebrain showingthehypothalamic nuclei.

A:Medialzonenucleilying medialtotheplaneofthe fornixandthe mammillothalamic tract.

B:Lateralzonenucleilying lateraltotheplaneofthe fornixandthe mammillothalamic tract.

Coronalsectionofthecerebralhemispheresshowingthepositionofthehypothalamic nuclei.

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LinesofCommunication
hypothalamusreceivesinformationfromthe restofthebodythrough
nervousconnections thebloodstream cerebrospinalfluid

AfferentConnectionsofthe Hypothalamus
Somaticandvisceralafferents
throughcollateralbranchesofthelemniscal afferentfibers andthetractus solitarius andthroughthereticular formation

Visualafferents
leavetheopticchiasma andpasstothesuprachiasmatic nucleus

Olfactiontravelsthroughthemedialforebrainbundle Auditoryafferents
havenotbeenidentified sinceauditorystimulicaninfluencetheactivitiesofthe hypothalamus,theymustexist

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AfferentConnectionsofthe Hypothalamus
Corticohypothalamic fibers
arisefromthefrontallobeofthecerebralcortex passdirectlytothehypothalamus

Hippocampohypothalamic fibers
passfromthehippocampusthroughthefornixtothemammillarybody neurophysiologistsregardthehypothalamusasthemainoutputpathwayof thelimbicsystem

Amygdalohypothalamic fiberspass
fromtheamygdaloid complextothehypothalamusthroughthestria terminalis andbyaroutethatpassesinferiortothelentiform nucleus

Thalamohypothalamic fibers
arisefromthedorsomedial andmidlinethalamicnuclei

Tegmentalfibers
arisefromthemidbrain

Sagittalsectionofthebrainshowingthemain afferentpathwaysenteringthe hypothalamus.

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Schematicdrawingoftheafferentandefferentfibersofthehypothalamus.Someof theseconnectionse.g.fromthehippocampalformationarebilateral

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EfferentConnectionsofthe Hypothalamus
descendingfiberstothebrainstemandspinalcordinfluencethe peripheralneuronsoftheautonomicnervoussystem descendthroughaseriesofneuronsinthereticularformation.The hypothalamusisconnectedtotheparasympatheticnucleiofthe oculomotor,facial,glossopharyngeal,andvagus nervesinthe brainstem.Inasimilarmanner,thereticulospinal fibersconnectthe hypothalamuswithsympatheticcellsoforigininthelateralgray hornsofthefirstthoracicsegmenttothesecondlumbarsegment ofthespinalcordandthesacralparasympatheticoutflowatthe levelofthesecond,third,andfourthsacralsegmentsofthespinal cord. Themammillothalamic tractarisesinthemammillarybodyand terminatesintheanteriornucleusofthethalamus.Here,the pathwayisrelayedtothecingulategyrus.

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Themammillotegmental tractarisesfromthe mammillarybodyandterminatesinthecells ofthereticularformationinthetegmentum of themidbrain. Multiplepathwaystothelimbicsystem

Sagittalsectionofthebrainshowingthemainefferentpathwaysleavingthe hypothalamus.

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Thevariousconnectionsofthehypothalamus.Someoftheseconnectionsformfeedback loopssuchasPapez circuitofemotion

ConnectionsoftheHypothalamus WiththeHypophysis Cerebri

hypothalamusisconnectedtothehypophysis cerebri (pituitarygland)bytwopathways
nervefibersthattravelfromthesupraoptic and paraventricular nucleitotheposteriorlobeofthe hypophysis longandshortportalbloodvesselsthatconnect sinusoidsinthemedianeminenceandinfundibulum withcapillaryplexusesintheanteriorlobeofthe hypophysis

thesepathwaysenablethehypothalamusto influencetheactivitiesoftheendocrineglands

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A. Hypothalamohypophyseal tract

B.Hypophyseal portalsystem

Hypothalamohypophyseal Tract
vasopressinandoxytocinsynthesizedinthenervecells
Supraoptic Paraventricular nuclei

hormonesarepassedalongtheaxonstogetherwithcarrierproteinscalled neurophysins andarereleasedattheaxonterminals

vasopressin(antidiuretichormone)isproducedmainlyinthenervecellsofthesupraoptic nucleus
functionistocausevasoconstriction antidiureticfunctionincreaseabsorptionofwaterintheDCTandcollectingtubulesofthekidney Oxytocinstimulates thecontractionofthesmooth muscleoftheuterusandcausescontractionofthe myoepithelial cellsthatsurroundthealveoliandductsofthebreast endofpregnancy,oxytocinisproducedinlargeamountsandstimulates laborcontractionsofthe uterus whenthebabysucklesatthebreast,anervousreflexfromthenipplestimulates thehypothalamus to producemoreofthehormone promotescontractionofthemyoepithelial cellsandassists intheexpressionofthemilkfromthe breasts

Oxytocinproducedmainlyintheparaventricular nucleus

supraoptic nucleus,whichproducesvasopressin,actsasanosmoreceptor
ifosmoticpressureofthebloodcirculatingthroughthenucleusbetoohigh,thenervecells increasetheirproductionofvasopressin,andtheantidiureticeffectofthishormonewill increasethereabsorptionofwaterfromthekidney theosmoticpressureofthebloodwillreturntonormallimits

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Hypophyseal PortalSystem
Neurosecretory cellssituatedmainlyinthemedialzoneofthe hypothalamusareresponsiblefortheproductionofthereleasing hormonesandreleaseinhibitoryhormones hormonesarepackagedintogranulesandaretransportedalong theaxonsofthesecellsintothemedianeminenceand infundibulum granulesarereleasedbyexocytosisontofenestratedcapillariesat theupperendofthehypophyseal portalsystem hypophyseal portalsystemisformedoneachsidefromthesuperior hypophyseal artery,whichisabranchoftheinternalcarotidartery arteryentersthemedianeminenceanddividesintotuftsof capillaries capillariesdrainintolongandshortdescendingvesselsthatendin theanteriorlobeofthehypophysis bydividingintovascular sinusoidsthatpassbetweenthesecretorycellsoftheanteriorlobe

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FunctionsoftheHypothalamus
AutonomicControl
hypothalamushasacontrollinginfluenceontheautonomicnervoussystem andappearstointegratetheautonomicandneuroendocrinesystems,thus preservingbodyhomeostasis hypothalamusshouldberegardedasahighernervouscenterforthecontrol oflowerautonomiccentersinthebrainstemandspinalcord

EndocrineControl
nervecellsofthehypothalamicnuclei,byproducingthereleasingfactorsor releaseinhibitingfactorscontrolthehormoneproductionoftheanteriorlobe ofthehypophysis (pituitarygland) anteriorlobehormonesincludegrowthhormone,prolactin(luteotropic hormone),adrenocorticotropichormone,thyroidstimulatinghormone, luteinizinghormone,andfolliclestimulatinghormone someofthesehormonesactdirectlyonbodytissues,whileothers,suchas adrenocorticotropichormone,actthroughanendocrineorgan,whichinturn producesadditionalhormonesthatinfluencetheactivitiesofgeneralbody tissues eachstageiscontrolledbynegativeandpositivefeedbackmechanisms

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FunctionsoftheHypothalamus
Neurosecretion
secretionofvasopressinandoxytocin

TemperatureRegulation
anteriorportionofthehypothalamuscontrolsthosemechanismsthat dissipateheatloss experimentalstimulationofthisareacausesdilatationofskinblood vesselsandsweating,whichlowerthebodytemperature stimulationoftheposteriorportionofthehypothalamusresultsin vasoconstrictionoftheskinbloodvesselsandinhibitionofsweating; therealsomaybeshivering,inwhichtheskeletalmusclesproduce heat thehypothalamussetsthebodytemperatureat98.0Fto98.6Fwhen measuredorallyand1 higherwhenmeasuredrectally temperaturesetcanbealteredinresponsetoextremes,suchasin environmentaltemperaturesorininfection

FunctionsoftheHypothalamus
RegulationofFoodandWaterIntake
lateralregionofthehypothalamusinitiatesthefeelingofhungerandresultsinanincreasein foodintake lateralregionsometimesisreferredtoasthehungercenter bilateraldestructionofthiscenterresultsinanorexia,withtheconsequentlossinbodyweight medialregionofthehypothalamusinhibitseatingandreducesfoodintake areaisreferredtoasthesatietycenter bilateraldestructionofthesatietycenterproducesanuncontrolledvoraciousappetite, causingextremeobesity

Experimentalstimulationofotherareasinthelateralregionofthehypothalamus causesanimmediateincreaseinthedesiretodrinkwater
areaisreferredtoasthethirstcenter supraoptic nucleusofthehypothalamusexertsacarefulcontrolontheosmolarity ofthe bloodthroughthesecretionofvasopressin(antidiuretichormone)bytheposteriorlobeofthe hypophysis hormonecausesagreatincreaseinthereabsorptionofwaterinthedistalconvolutedtubules andcollectingtubulesofthekidneys

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FunctionsoftheHypothalamus
EmotionandBehavior
functionofthehypothalamus, thelimbicsystem,andtheprefrontalcortex hypothalamus istheintegratorofafferentinformationreceivedfromotherareasofthenervoussystemand bringsaboutthephysicalexpressionofemotion canproduceanincreaseintheheartrate,elevatethebloodpressure,causedrynessofthemouth,flushing orpalloroftheskin,andsweating canoftenproduceamassiveperistalticactivityofthegastrointestinal tract. lateralhypothalamicnucleistimulationmaycausethesymptoms andsignsofrage,whereaslesionsofthese areasmayleadtopassivity stimulation oftheventromedialnucleusmaycausepassivity,whereaslesionsofthisnucleusmayleadto rage hypothalamus controlsmanycircadianrhythms,includingbodytemperature,adrenocorticalactivity, eosinophilcount,andrenalsecretion sleepingandwakefulness, althoughdependent ontheactivitiesofthethalamus, thelimbicsystem, andthe reticularactivatingsystem lesionsoftheanteriorpartofthehypothalamus seriouslyinterferewiththerhythmofsleepingandwaking suprachiasmatic nucleus,whichreceivesafferentfibersfromtheretina,appearstoplayanimportantrolein controllingthebiologicrhythms nerveimpulses generatedinresponsetovariationsintheintensityoflightaretransmitted viathisnucleus toinfluencetheactivitiesofmanyofthehypothalamicnuclei

ControlofCircadianRhythms

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Diagramdepictingthehypothalamusasthechiefcenterofthebrainforcontrolling theinternalmilieuofthebody.

ClinicalCorrelations
ObesityandWasting
severeobesitycanoccurastheresultofhypothalamiclesions generallyassociated withgenitalhypoplasiaoratrophy wastinglesscommonthanobesityinhypothalamicdisease severecachexiaissuggestiveofdamagetothehypophysis (pituitarygland) sexualretardationand,rarely,sexualprecocitywithhypothalamiclesions Afterpubertythepatientwithhypothalamicdiseasemayhaveimpotenceoramenorrhea hyperthermiacanfollowlesionsofthehypothalamus causedbyheadinjuryorfollowingsurgicaloperations inthe regionofthehypothalamus patientwithhyperthermiaisotherwisenormalandhasnosignsofmalaise,whichoccurswithpyrexia secondarytoinfections hypothermiaalsocanfollowalesionofthehypothalamus. resultsfromalesionofthesupraoptic nucleusorfromtheinterruptionofthenervouspathwaytothe posteriorlobeofthehypophysis patientpasseslargevolumesofurineoflowspecificgravity patientisextremelythirstyanddrinkslargequantitiesoffluids conditionmustbedistinguished fromdiabetes mellitus,inwhichthereisglucosuria eitherfrequentshortperiodsofsleepduringthewakinghoursorinsomniahasbeenobservedinpatients withhypothalamiclesions attacksofunexplainedweepingorlaughter,uncontrollablerage,depressivereactions,andevenmaniacal outbursts allhavebeenobservedinpatientswithhypothalamiclesions

SexualDisorders

HyperthermiaandHypothermia

DiabetesInsipidus

DisturbancesofSleep

EmotionalDisorders

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