The Brain and Cranial Nerves

Chapter 14 The Brain and Cranial
Nerves
Copyright John Wiley & Sons, Inc. All rights reserved.
The Human Brain
The Human Brain
The human brain, compared to all other animals brains, is marked by the highest ratio of brain to body size - thought
to directly correlate with our higher level of intelligence.

Most of the expansion is manifest in mans large
cerebral cortex. Especially expanded are the frontal lobes which are associated with higher (executive) functions
such as self-control, planning,

reasoning, and abstract thought.
Brain Development
During the first 3 weeks of gestation, the human embryo's neural tube flexes as it grows, forming the three primary brain vesicles colloquially called the forebrain, midbrain, and hindbrain. The 1st and 3rd
vesicles further divide forming

5 secondary brain vesicles in a process called encephalization.
Brain Development
The major parts of the adult brain are directly derived from the 2o brain vesicles: From the crescent-shaped cerebral hemispheres of the telencephalon to the inferiorly placed brain stem formed from the
metencephalon and
myelencephalon
Brain Development
The brain grows at an amazing rate during development; at times, as many as 50,000 neurons are added each second!
At birth, the neonatal brain looks very much like that of an adult and almost all
the neurons the brain

will ever have are
already present.
Brain Organization
The brain stem is the continuation of the spinal cord and consists of the medulla oblongata, pons and midbrain.
The cerebellum is the second largest part of the brain.

The diencephalon gives rise to the thalamus & hypothalamus.
The cerebrum is the newest (evolutionarily) and largest part of the brain as a whole.
It is in the cerebral cortex that perception, thought,
imagination, judgment, and decision making occur.

Brain Organization
The major parts of the adult brain are shown here
Protective Coverings
The cranial meninges are continuous with the spinal meninges and mirror their structure
and function they also bear the

same names:
a tough outer dura mater
a spidery arachnoid
mater
and a thin,
delicate pia mater

The cranial dura mater, however, has two layers an external periosteal layer and an internal meningeal layer; the spinal dura mater has only one.
In the brain, extensions of the dura mater form hard,
non-compliant membranes that divide the intracranial
vault in various ways:.

The 3 important dural extensions are the falx cerebri,
the falx cerebelli, and the tentorium cerebelli.
The falx cerebri is a strong sickle-shaped fold of dura mater which descends vertically in the longitudinal fissure and separates the two cerebral hemispheres.
The falx cerebelli is a
small triangular
process that separates the two cerebellar hemispheres.
Clinically, the tentorium cerebelli is important because

brain tumors are often characterized as supratentorial (above the tentorium) and infratentorial (below the tentorium). Most childhood tumors are infratentorial, while most adult tumors are supratentorial.
Since the tentorium is a hard structure, if there is any
brain swelling the brain can get partly pushed down
and herniate through the tentorium, which becomes a

life-threatening event.
Brain Blood Flow
The brain represents only 2 percent of total body weight, but receives about 20% of the bodys blood supply and consumes 20% of the O2 and glucose (even when resting).
Anteriorly, the internal carotid arteries supply blood to

the brain; the posterior blood supply is via the vertebral arteries.
The internal jugular veins are the venous return

Brain Blood Flow
The vascular endothelium around brain capillaries differs from most other organs of the body in that it forms tight junctions with the end-feet of nearby astrocytes.
As a result of this unusual architecture, a blood brain
barrier (BBB) is formed that serves to isolate the parenchyma of the brain from many substances in
the blood that would

normally be able to gain access.
Encyclopedia of Life Sciences, Wiley
Brain Blood Flow
The BBB protects the brain from some harmful substances

(like bacteria), but at a cost:
For one thing, certain molecules needed to meet
metabolic needs (such as glucose) must be actively transported across the barrier using specific transport
proteins and energy.

Another aspect of the BBB is that if a brain infection
were to develop, antibiotics (and many other drugs) have difficulty crossing into the brain tissues and reaching therapeutic levels.
Brain Blood Flow
The BBB can be used advantageously in certain

pharmacological situations. For example, it is well known that certain older antihistamine drugs readily cross the BBB and cause sedation. This makes these drugs not very good antihistamines, but very helpful in cough and cold medications
to induce sleep (NyQuil).

Drugs companies have devoted enormous resources to the
development of newer 2nd and 3rd generation antihistamines
that do not cross the BBB, and dont (usually) cause

somnolence they also charge you accordingly.
Production and Flow of CSF
Cerebral spinal fluid is a clear fluid that circulates through the internal cavities in the brain (called brain ventricles) and spinal cord (the central canal) and also flows over and around the brain and cord in the subarachnoid space. In
essence, the brain "floats" in it.

CSF absorbs shock and protects the brain and the cord.
It also helps transport nutrients and wastes between
blood and nervous tissues.

The Irrigation System of the fluid filled brain showing the circulating CSF.
The majority of CSF production - 80 to 150 mL at any given time in an adult - comes from ependymal cells in the choroid plexuses (networks of blood capillaries that line the ventricles).
The pathway CSF follows from the internal ventricles to

the SAS is given in the following sequence:
lateral ventricles interventricular foramina third
ventricle cerebral aqueduct fourth ventricle median aperture (of Magendie ) and the lateral
apertures (of Luschka ) SAS
The choroid plexuses can be seen in this superior view of a transverse section through the brain:
Once in the SAS, CSF flows continuously between the pia mater covering the brain and the arachnoid that is tightly adhered to the outer dura.
Pressure remains
constant in the head because the rate of fluid reabsorption closely matches fluid
formation at approx.
20 mL/h.
CSF __is _________ gradually reabsorbed __________ back ____ into ____ the ___ blood _____ through _______ the arachnoid ___ _________ villi (finger-like _____ projections ______ ____ that ___________ extend into
____ the dural ______ sinuses). ____ ___ _____ _______
In _ ____ this graphic, _______the ___ _________villi arachnoid _____ are___ ____ projecting seen __________ ____the into ___ superior ________
________ sagittal sinus. _____ A cluster _______ of __

_________villi arachnoid _____ is called __ ______ __ _________ an arachnoid granulation. ___________
Production _________ and ___ Flow ___of __ CSF
Failure of CSF to form and drain normally results in a buildup of pressure called hydrocephalus.
Hydrocephalus occurs with congenital abnormalities,
head injury, meningitis,

and episodes of bleeding into the brain.
Parts of the Brain
The Brain Stem
The brain stem is superior to, but continuous with, the spinal cord. Developmentally, it does not represent a single structure, but rather a group of anatomical components
considered collectively.
It is made up of
the midbrain, pons,

and medulla oblongata.
The Medulla Oblongata
It has two external bulges called the pyramids formed by the largest motor tracts in the body.
Axons from the left pyramid cross over to the right and
axons on the right cross over to the left (decussation of pyramids) so that the left hemisphere of the brain
controls the right

side muscles, while the right hemisphere controls the left side.
Vital functional centers regulated by the medulla include:

The cardiovascular center controls the rate and force
of heartbeat, and the diameter of blood vessels

The respiratory rhythmicity center controls the rate
and rhythm of breathing

The vomiting, coughing, and sneezing centers
The nuclei associated with 5 of the 12 cranial nerves originates in the medulla (CN VIII XII).
A portion of the 4th ventricle extends to the medulla.

Three cranial nerves emerge from the medulla.

The Pons
The pons lies directly above the medulla and anterior to the cerebellum (2.5 cm). It acts as a bridge connecting the spinal cord with the brain and parts of the brain with each other.
The Pons
Together with the medulla, areas in the pons help control
breathing (inhalation and exhalation).
The pontine respiratory group is normally inactive during quiet breathing. This group of neurons acts like an offswitch to terminate medullary inspiratory activity.
Early termination of inspiration leads to an increase in
the rate of breathing (which is why this center was

formerly know as the pneumotaxic center - taxic meaning fast).
The Pons
The pons contains the nuclei associated with 4 pairs of
cranial nerves: V - VIII

Cranial nerve V
emerges directly from the pons.

VI, VII, and VIII
emerge from the space between the pons and

CN V exits the pons, while 3 others come from the medullary pontine angle.
the medulla.
The Midbrain
The midbrain extends from the pons to the diencephalon.

The cerebral aqueduct passes through the midbrain
connecting the 3rd ventricle above with the 4th ventricles below (both locations of CSF formation and circulation.)
The Midbrain
On the anterior part of the midbrain are found the little feet of the cerebral peduncles.
The peduncles contain axons of the corticospinal,
corticobulbar, and corticopontine tracts which conduct nerve impulses from motor areas in the cerebral cortex to the spinal cord, medulla,
and pons,
respectively.
The Midbrain
On the posterior part of the midbrain are four rounded elevations known as the superior and inferior colliculi which serve as reflex centers for certain visual and
auditory reflexes,
and also the startle reflex.
It is the origin of cranial nerves III
and IV.
The Midbrain
The midbrain contains several other nuclei, including the darkly pigmented substantia nigra. Neurons that release dopamine, extending from the substantia nigra, help control subconscious muscle activities; loss of these neurons is associated with Parkinson disease.
The red nucleus
helps control
voluntary movements of the limbs.
The Reticular Formation
In addition to the well-defined nuclei already described, much of the brain stem consists of a netlike arrangement of neuronal cell bodies and small bundles of myelinated axons known as the reticular formation.
The ascending portion of this network is called the
reticular activating system (RAS), and consists of sensory axons that project to
the cerebral cortex.

The Reticular Formation
The RAS functions to maintain consciousness, a state of wakefulness in which an individual is fully alert, aware, and oriented. Inactivation of the RAS produces sleep, a
state of partial consciousness from which an individual can

be aroused.
It also prevents sensory
overload by filtering out insignificant
information.
The Cerebellum
The cerebellum, or little brain, is the second largest part of the brain and lies inferior to the cerebrum and posterior to the brain stem.
It is separated from
the cerebrum by
the transverse fissure (in which the falx cerebelli is located).
The Cerebellum
The cerebellums central constricted area is the vermis and
the lateral wings or lobes are the cerebellar hemispheres .

The cerebellum compares intended movements with
what is happening with skeletal muscles, and regulates posture, equilibrium, and balance.
The Diencephalon
The diencephalon is located near the midline of the brain, above the midbrain. Like the cerebral cortex, the diencephalon develops from the forebrain vesicle (the prosencephalon) - yet it is more primitive than the
cerebral cortex, and lies

underneath it.
The diencephalon surrounds
the 3rd ventricle and

contains the thalamic structures.
The Diencephalon
The thalamus functions as a relay station for all sensory impulses to the cerebral cortex (except smell, which belong to the hypothalamus). Pain, temp, touch, and pressure are all relayed to the thalamus en route to the
higher centers of the cerebral cortex.
While not precisely localized here (that occurs in the
cerebral cortex), all of these peripheral sensations are

processed in the thalamus in conjunction with their attendant memories and the emotions they evoke.
The Diencephalon
The epithalamus is superior and posterior to the thalamus.

It consists of the pineal gland (secretes melatonin) and
habenular nuclei (emotional responses to odors).

More melatonin is
epithalamus thalamus
secreted in darkness than light, and it is thought to promote sleepiness and help
regulate our
biological clocks.
The Diencephalon
The hypothalamus controls many homeostatic functions:

It controls the Autonomic Nervous System (ANS). It coordinates between NS and endocrine systems. It controls body temperature (measured by blood
flowing through it).

It regulates hunger/thirst
thalamus
and feelings of satiety.

It assists with the internal
circadian clock by
regulating biological activity.
hypothalamus
The Cerebrum
The cerebral cortex is the seat of our intelligence its because of neurons in the cortex that we are able to read, write, speak, remember, and plan our life.
The cerebrum consists of an outer cerebral cortex, an

internal region of cerebral white matter, and gray matter nuclei deep within the white matter.
The Cerebrum
During embryonic development, the grey matter of the brain develops faster than the white matter - the cortical region rolls and folds on itself. Convolutions and grooves
are created in the cortex during this growth process.

The folds are called gyri, the deepest of which are
known as fissures; the shallower grooves between folds are termed sulci.
The Cerebrum
The prominent longitudinal fissure separates the cerebrum
into right and left cerebral hemispheres. The central sulcus

further divides the anterior frontal lobe from the more posteriorly
situated parietal lobe.

Note the precentral gyrus
and postcentral gyrus of those two lobes.

The Cerebrum
The precentral gyrus - located immediately anterior to
the central sulcus in the anterior lobe - contains the

primary motor area of the cerebral cortex. Another major gyrus, the postcentral gyrus, which is located immediately posterior to the central sulcus in the parietal lobe, contains the primary somatosensory area
of the cerebral cortex.
The parieto-occipital sulcus separates the parietal lobe
from the posterior-most occipital lobe.

The Cerebrum
The lateral cerebral sulcus (fissure) separates the frontal lobe from two laterally placed temporal lobes, hanging like ear muffs off the sides. A fifth part of the cerebrum, the
insula, cannot be seen at the surface of the brain because it

lies within the lateral cerebral sulcus, deep to the parietal, frontal, and temporal
lobes.
The Cerebrum
The lobes of the cerebrum correspond to the bones of the
braincase which bear the same names.

parietal parietal frontal temporal occipital frontal
temporal occipital
parietal
frontal
occipital
temporal
The Cerebrum
Brodmanns areas are numbered regions of cortex that
have been mapped to specific cognitive functions.

Sensory areas of cerebral cortex are involved in
perception of sensory information.

Motor areas control execution of voluntary
movements.
Association areas deal with more complex integrative
functions such as memory, personality traits, and intelligence.

The Cerebrum
Brodmanns areas: Numbered Regions of Cortical tissue.

The Cerebrum
The primary somatosensory area (areas 1, 2, and 3 located in the postcentral gyrus of each parietal lobe) receives nerve impulses for, and consciously perceives the somatic sensations of touch, pressure, vibration, itch, tickle, temperature (coldness and warmth), pain, and proprioception (joint and muscle position).
Each point within the area maps impulses from a
specific part of the body (depending on the number of

receptors present there rather than on the size of the body part).
The Cerebrum
For example, a larger region of the somatosensory area receives impulses from the lips and fingertips than from the thorax or hip.
This distorted somatic sensory
map of the body is known as the

sensory homunculus (little man).
This allows us to pinpoint
(feel exactly) where somatic sensations originate.

The Cerebrum
The primary motor area (area 4 located in the precentral gyrus of the frontal lobe) controls voluntary contractions of specific muscles or groups of muscles.
The motor cortex also has a
homunculus map, with more cortical area devoted
to muscles involved in
skilled, complex, or delicate movement.
The Cerebrum
The 1o visual area is located at the posterior tip of the

occipital lobe mainly on the medial surface The 1o gustatory area is located just inferior to the 1o somatosensory area The 1o auditory area is
in the superior part of the

temporal lobe
The 1o olfactory area is in

the inferomedial temporal lobe
The Cerebrum
The cerebral white matter consists primarily of myelinated axons in three types of tracts.
Association tracts contain axons that conduct nerve
impulses between gyri in the same hemisphere.

Commissural tracts conduct nerve impulses between
corresponding gyri from one hemisphere to another.

Projection tracts convey impulses to lower parts of the
CNS (thalamus, brain stem, or spinal cord) or visa versa.

The Cerebrum
The corpus callosum is one of the three important groups of commissural tracts (the other two being the anterior
and posterior commissures) it is a thick band of axons

that connects corresponding areas of the two hemispheres.
Through the corpus callosum, the left motor cortex
(which controls the right body) is linked to the right motor cortex (which controls the left body).
The Cerebrum
The outer surfaces of the gyri are not the only areas of
gray matter in the cerebrum. Recall that the

telencephalon consists of the cortex, and also the basal nuclei.
The basal nuclei are conspicuous centers of cell bodies
deep in the cortex. The 3 basal nuclei help initiate and
terminate movements, suppress unwanted movements,

and regulate muscle tone.
The Cerebrum
The basal nuclei also control subconscious contractions of skeletal muscles. Examples include automatic arm swings while walking and true laughter in response to a joke.
The Limbic System
Encircling the upper part of the brain stem and the

corpus callosum is a ring of structures on the inner border of the cerebrum and floor of the diencephalon that
constitutes the
limbic system.
The Limbic System
The limbic system does not represent any one part of the brain it is more a functional system composed of parts
of the cerebral cortex, diencephalon, and midbrain.
The limbic system is sometimes called the emotional brain because it plays a primary role in promoting a range of emotions, including pleasure, pain, docility, affection, fear, and anger.
Together with parts of the cerebrum, the limbic system
also functions in memory.

Hemispheric Lateralization
Although the brain is almost symmetrical on its right and

left sides and shares performance of many functions, there are subtle anatomical and physiological differences between the two hemispheres.
Each hemisphere specializes in performing certain unique functions, a feature known as hemispheric lateralization. Despite some dramatic differences, there
is considerable variation from one person to another.

Also, lateralization seems less pronounced in females.
Hemispheric Lateralization
In most people, the left hemisphere is more important for reasoning, numerical and scientific skills, spoken and
written language, and the ability to use and understand

sign language.
Conversely, the right hemisphere is more specialized for musical and artistic awareness; spatial and pattern perception; recognition of faces and emotional content of language; discrimination of different smells; and generating mental images of sight, sound, touch, and taste.
Brain Waves
The
billions of communicating brain neurons
constantly generate detectable signals called brain waves. Those we can more easily measure are generated by neurons close to the brain surface,
mainly neurons in the cerebral cortex.

Electrodes placed on the
forehead and scalp can be used to make a record called an electroencephalogram.

Brain Waves
Summing waves of different frequency produces some characteristic, and diagnostic patterns.
Alpha (1012 Hz (cycles/sec) waves are present when
awake but disappear during sleep.

Beta (1430 Hz) waves are present with sensory input
and mental activity when the nervous system is active.

Theta (47 Hz) waves indicate emotional stress or a
brain disorder.
Delta (15 Hz) waves appear only during sleep in adults
but indicate brain damage in an awake adult.

Brain Waves
Electroencephalograms
are useful both in studying
normal brain functions, such as changes that occur during sleep, and in diagnosing a variety of brain disorders, such as epilepsy, tumors, trauma,
hematomas, metabolic abnormalities, sites of trauma,

and degenerative diseases.
The EEG is also utilized to determine if life is
present, that is, to establish or confirm that brain death has occurred.
Cranial Nerves The Twelve Cranial Nerves
How to Remember CN I-XII
Oh! Oh! Oh! To Touch And Feel Very Good Velvet! Ah Heaven!
I II III IV
Olfactory Optic Oculomotor Trochlear Abducens Facial
(oh) (oh) (oh) (to) (and) (feel) (very) (velvet) (ah) (heaven)
V
VI VII VIII IX X XI XII
Trigeminal (1-3) (touch)
Vestibulocochlear Vagus Accessory Hypoglossal
Glossopharyngeal (good)
Cranial Nerves
Spinal Designation Number Origin Number of roots Contents
C1-8, T1-12, L1-5, S1-5,
Co1 31 pairs
Cranial
Roman Numerals
I XII 12 pairs
Spinal cord
2 - a dorsal and a ventral root
Brain
Single root Most mixed; some sensory only All in the Head/Neck
Mixed
Target
Limbs/Trunk
(vagus n leaves)
Spinal and cranial nerves are compared in this table.

Cranial Nerves
The major functions of the 12 pairs of cranial nerves are
detailed in the
following slides.
This is a picture of a masterful dissection, showing the cranial nerves in-situ (as they are in place).
Cranial Nerves
CN I is the olfactory nerve
(sense of smell).
Cranial Nerves
CN II is the optic nerve (sense of sight).
Cranial Nerves
CN III, IV, and VI innervate the extraocular muscles that
allow us to move our eyes.

CN III also supplies motor
input to our eyelid muscles and facilitates
pupillary
constriction.
Cranial Nerves
CN V is the trigeminal nerve (the major sensory nerve of the face).

It has three large
branches, each of
which supplies an
area of the face:
ophthalmic maxillary mandibular
Cranial Nerves
CN VII is the facial nerve. It has 5 large somatic branches
which innervate the muscle of

facial expression. It also carries some taste sensations
(anterior 2/3 of tongue).

Paralysis of
CN VII is called
Bells Palsy and leads

to loss of ability to close the eyes and impairment of
taste and salivation.

Cranial Nerves
CN VIII is the vestibulocochlear nerve. From the inner ear, the vestibular component carries information on balance, while the cochlear component enables hearing.
Damage of CN VIII causes vertigo, ringing in the ears,
and/or deafness.
Cranial Nerves
CN IX is the glossopharyngeal nerve. This nerve carries
some taste sensations as well as ANS impulses to salivary

glands and the mechanoreceptors of the carotid body and carotid sinus (senses changes in BP).
Cranial Nerves
CN X is the vagus nerve (the wanderer), which
carries most of the

parasympathetic motor efferents to the
organs of the thorax

and abdomen.
Cranial Nerves
CN XI is the spinal accessory nerve. This nerve supplies
somatic motor innervation to the Trapezius and

Sternocleidomastoid muscles.
Cranial Nerves
CN XII is the glossopharyngeal nerve. This is a very large
nerve (a lot of resources) to be devoted solely to the tongue

it takes a lot more coordination than you might guess to chew, talk, and swallow without injuring our tongue.

The Brain and Cranial Nerves

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Chapter 14 The Brain and Cranial

Copyright John Wiley & Sons, Inc. All rights reserved.

The Human Brain

Copyright John Wiley & Sons, Inc. All rights reserved.

The Human Brain

to directly correlate with our higher level of intelligence.

such as self-control, planning,

vesicles further divide forming

Copyright John Wiley & Sons, Inc. All rights reserved.

Copyright John Wiley & Sons, Inc. All rights reserved.

the neurons the brain

Copyright John Wiley & Sons, Inc. All rights reserved.

The cerebellum is the second largest part of the brain.

imagination, judgment, and decision making occur.

The major parts of the adult brain are shown here

Copyright John Wiley & Sons, Inc. All rights reserved.

and function they also bear the

delicate pia mater

non-compliant membranes that divide the intracranial

vault in various ways:.

the falx cerebelli, and the tentorium cerebelli.

Copyright John Wiley & Sons, Inc. All rights reserved.

The falx cerebelli is a

Copyright John Wiley & Sons, Inc. All rights reserved.

Clinically, the tentorium cerebelli is important because

brain swelling the brain can get partly pushed down

and herniate through the tentorium, which becomes a

Brain Blood Flow

Anteriorly, the internal carotid arteries supply blood to

The internal jugular veins are the venous return

Brain Blood Flow

the blood that would

Brain Blood Flow

The BBB protects the brain from some harmful substances

proteins and energy.

Brain Blood Flow

The BBB can be used advantageously in certain

to induce sleep (NyQuil).

development of newer 2nd and 3rd generation antihistamines

that do not cross the BBB, and dont (usually) cause

Production and Flow of CSF

essence, the brain "floats" in it.

blood and nervous tissues.

Production and Flow of CSF

Production and Flow of CSF

The pathway CSF follows from the internal ventricles to

apertures (of Luschka ) SAS

Copyright John Wiley & Sons, Inc. All rights reserved.

Production and Flow of CSF

Copyright John Wiley & Sons, Inc. All rights reserved.

Production and Flow of CSF

Production and Flow of CSF

____ the dural ______ sinuses). ____ ___ _____ _______

________ sagittal sinus. _____ A cluster _______ of __

Production _________ and ___ Flow ___of __ CSF

head injury, meningitis,

Copyright John Wiley & Sons, Inc. All rights reserved.

Parts of the Brain

Copyright John Wiley & Sons, Inc. All rights reserved.

The Brain Stem

the midbrain, pons,

Copyright John Wiley & Sons, Inc. All rights reserved.

The Medulla Oblongata

the dural sinuses). _ _ ___

______ sagittal sinus. _ A cluster ___ of

Production _______ and _ Flow _of CSF