Post on 07-May-2015
Carlos Darcy Alves Bersot TSA.SBACarlos Darcy Alves Bersot TSA.SBA MD RESPONSÁVEL PELO CET H.F.LAGOAMD RESPONSÁVEL PELO CET H.F.LAGOA
Médico Anestesiologista do Hospital Federal da Lagoa-SUSMédico Anestesiologista do Hospital Federal da Lagoa-SUSMédico Anestesiologista do Hospital Pedro Ernesto-UERJMédico Anestesiologista do Hospital Pedro Ernesto-UERJ
animalanimalorganismorganism
animalanimalorganismorganism
Nervous systemNervous system
sensory sensory neuronneuron
stimulusstimulus reactionreaction
effectoreffectorInter-Inter-
neuronneuronreceptorreceptorMotorMotor
neuronneuron
Nervous System Nervous System stimulus and reaction stimulus and reaction Nervous System Nervous System stimulus and reaction stimulus and reaction
Nervous SystemNervous SystemNervous SystemNervous System
• Central Nervous SystemCentral Nervous System brain, spinal cord: brain, spinal cord: nervous tissuenervous tissue meninges, choroid plexusmeninges, choroid plexus: : connective tissueconnective tissue
• Peripheral Nervous SystemPeripheral Nervous System nerve, ganglion, nerve plexusnerve, ganglion, nerve plexus::
Nervous TissueNervous TissueNervous TissueNervous Tissue
Cellular ElementsCellular Elements
ŸŸ Neuron (Nerve Cell)Neuron (Nerve Cell)
ŸŸ Neuroglial Cells Neuroglial Cells central neurgliacentral neurglia
astrocyte, oligodendrocyte, microglia andastrocyte, oligodendrocyte, microglia and ependymal cellependymal cell
peripheral neurogliaperipheral neuroglia Schwann cell Schwann cell in nerve and ganglionin nerve and ganglion satellite (capsular) cell satellite (capsular) cell in ganglionin ganglion
NeuronNeuronNeuronNeuron
Neuronal MorphologyNeuronal Morphology
Neuronal Cell Body (Soma)Neuronal Cell Body (Soma)
ŸŸ Nucleus Nucleus
Neuronal ProcessesNeuronal Processes
ŸŸ AxonAxon ŸŸ DendritesDendrites
Diversity of Neuronal Size and MorphologyDiversity of Neuronal Size and Morphology
Diversity ofDiversity of
NeuronalNeuronal
MorphologyMorphology
NeuronNeuronNeuronNeuron
Neuronal FunctionNeuronal Function
CommunicationCommunication
Receptor - Neuron - Effector Receptor - Neuron - Effector - - Excitability (Irritability)Excitability (Irritability) - - ConductivityConductivity through membrane through membrane in intraneuronal conductionin intraneuronal conduction
via via synapsesynapse in in interneuronal conductioninterneuronal conduction neurotransmittersneurotransmitters
SYNAPSESYNAPSESYNAPSESYNAPSE
ŸŸ Presynaptic Portion: Synaptic Button Presynaptic Portion: Synaptic Button - synaptic vesicle- synaptic vesicle
- mitochondria- mitochondria - presynaptic membrane: tubulin- presynaptic membrane: tubulin
ŸŸ Synaptic Cleft Synaptic Cleft - 20-30 nm- 20-30 nm
ŸŸ Postsynaptic PortionPostsynaptic Portion - postsynaptic membrane: actin, fodrin, spectrin- postsynaptic membrane: actin, fodrin, spectrin
- mitochondria- mitochondria
SYNAPSESYNAPSESYNAPSESYNAPSE
Myelin Sheath - MYELINMyelin Sheath - MYELIN Schwann sheathSchwann sheath• formed by wrapped plasma membrane offormed by wrapped plasma membrane of OligodendrocyteOligodendrocyte in CNS in CNS Schwann CellSchwann Cell in PNS in PNS
• Node of RanvierNode of Ranvier - Saltatory Conduction - Saltatory Conduction - - conduction velocityconduction velocity
MyelinMyelinMyelinMyelin
MyelinMyelin
Structure of fast nerve conductionStructure of fast nerve conduction
Multiple Slerosis Multiple Slerosis – disease of the myelin– disease of the myelin
Jacqueline Du PreJacqueline Du PreJacqueline Du PreJacqueline Du Preoligodendrocyteoligodendrocyte
ORGANIZAÇÃO DO SNORGANIZAÇÃO DO SNORGANIZAÇÃO DO SNORGANIZAÇÃO DO SN
Central Nervous SystemCentral Nervous System
Gray MatterGray Matter Nucleus and CortexNucleus and Cortex White MatterWhite Matter TractsTracts
Peripheral Nervous SystemPeripheral Nervous System
Nerve (Peripheral Nerve)Nerve (Peripheral Nerve) GanglionGanglion
Nerve FiberNerve Fiber
Myelinated Nerve FiberMyelinated Nerve Fiber
Axon,Axon, Myelin sheathMyelin sheath, Schwann cell, Schwann cell
Unmyelinated Nerve Fiber Unmyelinated Nerve Fiber Axon, Schwann cellAxon, Schwann cell
Connective Tissue SheathConnective Tissue Sheath
EndoneuriumEndoneurium Perineurium – blood vesselsPerineurium – blood vessels EpineuriumEpineurium
SISTEMA NERVOSO PERIFÉRICOSISTEMA NERVOSO PERIFÉRICOSISTEMA NERVOSO PERIFÉRICOSISTEMA NERVOSO PERIFÉRICO
Receptor Receptor
EndingsEndings
TERMINAÇÕES EFERENTESTERMINAÇÕES EFERENTESSomatic Efferent EndingsSomatic Efferent Endings
Neuromuscular JunctionNeuromuscular Junction (Myoneural Junction, Motor End (Myoneural Junction, Motor End
Plate)Plate)
Autonomic Efferent Autonomic Efferent
EndingsEndings
Endings on smooth muscle Endings on smooth muscle
and blood vesselsand blood vessels
Somatic Efferent EndingsSomatic Efferent Endings
Neuromuscular JunctionNeuromuscular Junction (Myoneural Junction, Motor End (Myoneural Junction, Motor End
Plate)Plate)
Autonomic Efferent Autonomic Efferent
EndingsEndings
Endings on smooth muscle Endings on smooth muscle
and blood vesselsand blood vessels
NeuromuscularNeuromuscularJunctionJunction
(Myoneural Junction,(Myoneural Junction,
Motor End Plate)Motor End Plate)
NeuromuscularNeuromuscularJunctionJunction
(Myoneural Junction,(Myoneural Junction,
Motor End Plate)Motor End Plate)
NMJNMJNMJNMJ
MM
NN
Myasthenia GravisMyasthenia GravisMyasthenia GravisMyasthenia Gravis
• muscle weaknessmuscle weakness
• autoimmune disease autoimmune disease with autoantibodieswith autoantibodies against against Ach receptorAch receptor
• treated withtreated with AchT inhibitorsAchT inhibitors, , thymectomy, and thymectomy, and corticosteroidscorticosteroids
Defects in NMDefects in NM
TransmissionTransmission
before treatment after treatmentbefore treatment after treatment
Autonomic Efferent EndingsAutonomic Efferent EndingsAutonomic Efferent EndingsAutonomic Efferent Endings
Brain RegionsBrain Regions
1. Cerebrum
2. Diencephalon
3. Brainstem
4. Cerebellum
Cerebellum
CerebrumCerebrum• O cérebro humano
contém cerca de 100 bilhões de neurônios, ligados por mais de 10,000 conexões sinápticas .
• Corpo caloso• Massa Cinzenta e
Branca.• Giros e Sulcos
• Deeper grooves called fissures separate large regions of the brain.– The median longitudinal fissure separates the cerebral hemispheres.– The transverse fissure separates the cerebral hemispheres from the
cerebellum below.• Deep sulci divide each hemisphere into 5 lobes:
– Frontal, Parietal, Temporal, Occipital, and Insula
• The central sulcus separates the frontal lobe from the parietal lobe.– Bordering the central sulcus are 2 important gyri, the precentral
gyrus and the postcentral gyrus.
• The occipital lobe is separated from the parietal lobe by the parieto-occipital sulcus.
• The lateral sulcus outlines the temporal lobe.– The insula is buried deep within the lateral sulcus.
Where’s the insula?
Cerebral Cerebral CortexCortex
• 3 types of functional areas:1. Motor Control voluntary
motor functions
2. Sensory Allow for conscious recognition of
stimuli
3. Association Integration
Cortical Motor AreasCortical Motor Areas
1. Primary Motor Cortex
2. Premotor Cortex
3. Broca’s Area
Primary motor cortex
Broca’s Area
Premotor cortex
Frontal Eye Field
Primary (Somatic) Motor CortexPrimary (Somatic) Motor Cortex
• Located in the precentral gyrus of each cerebral hemisphere.
• Contains large neurons (pyramidal cells) which project to SC neurons which eventually synapse on skeletal muscles – Allowing for voluntary
motor control.– These pathways are known
as the corticospinal tracts or pyramidal tracts.
Panfiled?
Premotor CortexPremotor Cortex• Located just anterior to
the primary motor cortex.• Involved in learned or
patterned skills.• Involved in planning
movements.• How would damage to
the primary motor cortex differ from damage to the premotor cortex?
Broca’s AreaBroca’s Area
• Typically found in only one hemisphere (often the left), anterior to the inferior portion of the premotor cortex.
• Directs muscles of tongue, and throat that are used in speech production.
• Involved in planning speech production and possibly planning other activities.
Sensory AreasSensory Areas
• Found in the parietal, occipital, and temporal lobes.
1. Primary somatosensory cortex2. Somatosensory association cortex3. Visual areas4. Auditory areas5. Olfactory cortex6. Gustatory cortex7. Vestibular cortex
Primary Somatosensory CortexPrimary Somatosensory Cortex
• Found in the postcentral gyrus.
• Neurons in this cortical area receive info from sensory neurons in the skin and from proprioceptors which monitor joint position.
• Contralateral input.
Somatosensory Association Somatosensory Association CortexCortex
• Found posterior to the primary somatosensory cortex
• Synthesizes multiple sensory inputs to create a complete comprehension of the object being felt.– How would damage to
this area differ from damage to the primary somatosensory cortex?
Primary Visual CortexPrimary Visual Cortex
• Found in the posterior and medial occipital lobe.
• Largest of the sensory cortices. – What does this
suggest?
• Contralateral input.
Association Association AreasAreas
• Allows for analysis of sensory input.
• Multiple inputs and outputs. Why?
1. Prefrontal cortex
2. Language areas
3. General interpretation area
4. Visceral association area
Prefrontal Prefrontal CortexCortex
• Anterior frontal lobes• Involved in analysis,
cognition, thinking, personality, conscience, & much more.
• What would a frontal lobotomy result in?
• Look at its evolution
Phineas Gage’s lesion reconstructedPhineas Gage’s lesion reconstructed(H. Damasio and R. Frank, 1992)(H. Damasio and R. Frank, 1992)
Language AreasLanguage Areas• Large area for language understanding and production surrounding the lateral sulcus in the left (language-dominant) hemisphere
• Includes:– Wernicke’s area
understanding oral/written words
– Broca’s area speech production
NEGLIGENCIA
Basal NucleiBasal Nuclei
• Components of the extrapyramidal system which provides subconscious control of skeletal muscle tone and coordinates learned movement patterns and other somatic motor activities.
• Doesn’t initiate movements but once movement is underway, they assist in the pattern and rhythm (especially for trunk and proximal limb muscles
• Set of nuclei deep within the white matter.
• Includes the:– Caudate Nucleus– Lentiform Nucleus
• Globus pallidus• Putamen
ffff
Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components
Muhammad Ali in Alanta OlympicMuhammad Ali in Alanta Olympic
Parkinson’s Parkinson’s DiseaseDisease
Disease of mesostriatal Disease of mesostriatal dopaminergic systemdopaminergic system
PDPD
normalnormal
SYDENHAM’S CHOREASYDENHAM’S CHOREASYDENHAM’S CHOREASYDENHAM’S CHOREA
- Complication of- Complication of Rheumatic FeverRheumatic Fever- Fine, disorganized , and - Fine, disorganized , and random movements ofrandom movements of extremities, face andextremities, face and tonguetongue- Accompanied by - Accompanied by Muscular HypotoniaMuscular Hypotonia--
Clinical FeatureClinical Feature
Principal Pathologic Lesion: Principal Pathologic Lesion: Corpus StriatumCorpus Striatum
Clinical FeatureClinical Feature
Principal Pathologic Lesion:Principal Pathologic Lesion:
Corpus Striatum (esp. caudate nucleus)Corpus Striatum (esp. caudate nucleus) and Cerebral Cortexand Cerebral Cortex
- Predominantly - Predominantly autosomal dominantlyautosomal dominantly inherited chronic fatal diseaseinherited chronic fatal disease (Gene: chromosome 4)(Gene: chromosome 4)
HUNTINGTON’S CHOREAHUNTINGTON’S CHOREA
DiencephalonDiencephalon
• Forms the central core of the forebrain
• 3 paired structures:
1. Thalamus
2. Hypothalamus
3. Epithalamus
ThalamusThalamus• 80% of the diencephalon
• Sensory retransmission station where sensory signals can be edited, sorted, and routed.
• Also has profound input on motor (via the basal ganglia and cerebellum) and cognitive function.
HypothalamusHypothalamus• Functions:
– Autonomic regulatory center• Influences HR, BP, resp. rate,
GI motility, pupillary diameter.• Can you hold your
breath until you die?
– Emotional response• Involved in fear, loathing, pleasure• Drive center: sex, hunger
– Regulation of body temperature– Regulation of food intake
• Contains a satiety center
– Regulation of water balance and thirst– Regulation of sleep/wake cycles– Hormonal control
• Releases hormones that influence hormonal secretion from the anterior pituitary gland.
• Releases oxytocin and vasopressin
EpithalamusEpithalamus
• Above the thalamus• Contains the pineal
gland which releases melatonin (involved in sleep/wake cycle and mood).
CerebellumCerebellum• Lies inferior to the cerebrum and
occupies the posterior cranial fossa.
• 2nd largest region of the brain.• 10% of the brain by volume, but it
contains 50% of its neurons
• Has 2 primary functions:1. Adjusting the postural muscles of the body
• Coordinates rapid, automatic adjustments, that maintain balance and equilibrium
2. Programming and fine-tuning movements controlled at the subconscious and conscious levels• Refines learned movement patterns by regulating activity of both
the pyramidal and extrapyarmidal motor pathways of the cerebral cortex
CerebellumCerebellum
• The cerebellum can be permanently damaged by trauma or stroke or temporarily affected by drugs such as alcohol.
• These alterations can produce ataxia – a disturbance in balance.
Cerebellar Cerebellar AtaxiaAtaxia
ROMBERGROMBERG
a b c
d
PonsPons
The bulging center part of the brain stem
Mostly composed of fiber tracts
Includes nuclei involved in the control of breathing
Medulla OblongataMedulla Oblongata The lowest part of the brain stem Merges into the spinal cord Includes important fiber tracts Contains important control centers
Heart rate control Blood pressure regulation Breathing Vomiting
Spinal segment Spinal segment
C8, T12, L5, S5, Cx1C8, T12, L5, S5, Cx1
Anterior (Ventral) RootAnterior (Ventral) RootPosterior (Dorsal) RootPosterior (Dorsal) Root Dorsal Root (Spinal) GanglionDorsal Root (Spinal) Ganglion
Periosteum of VertebraPeriosteum of Vertebra
- - Epidural Space Epidural Space ----------------- ----------------- epidural anesthesiaepidural anesthesia
Dura Mater Spinalis Dura Mater Spinalis
Arachnoid MembraneArachnoid Membrane - - Subarachnoid Space --------Subarachnoid Space -------- Lumbar Puncture Lumbar Puncture
Spinal AnesthesiaSpinal Anesthesia
Pia Mater SpinalisPia Mater Spinalis
Periosteum of VertebraPeriosteum of Vertebra
- - Epidural Space Epidural Space ----------------- ----------------- epidural anesthesiaepidural anesthesia
Dura Mater Spinalis Dura Mater Spinalis
Arachnoid MembraneArachnoid Membrane - - Subarachnoid Space --------Subarachnoid Space -------- Lumbar Puncture Lumbar Puncture
Spinal AnesthesiaSpinal Anesthesia
Pia Mater SpinalisPia Mater Spinalis
Spinal Cord MeningesSpinal Cord Meninges Spinal Cord MeningesSpinal Cord Meninges
Arterial SupplyArterial Supply
- Spinal Arteries- Spinal Arteries
Anterior (1) & Posterior (2) Spinal ArteryAnterior (1) & Posterior (2) Spinal Artery
from from Vertebral arteryVertebral artery
- Radicular Arteries ----- Segmental arteries- Radicular Arteries ----- Segmental arteries
from from Vertebral, Ascending Cervical, Intercostal andVertebral, Ascending Cervical, Intercostal and
Lumbar Artery Lumbar Artery
Arterial SupplyArterial Supply
- Spinal Arteries- Spinal Arteries
Anterior (1) & Posterior (2) Spinal ArteryAnterior (1) & Posterior (2) Spinal Artery
from from Vertebral arteryVertebral artery
- Radicular Arteries ----- Segmental arteries- Radicular Arteries ----- Segmental arteries
from from Vertebral, Ascending Cervical, Intercostal andVertebral, Ascending Cervical, Intercostal and
Lumbar Artery Lumbar Artery
Spinal Cord Spinal Cord Vascular SupplyVascular Supply Spinal Cord Spinal Cord Vascular SupplyVascular Supply
anterior spinal arteryanterior spinal artery segmental arteries segmental arteries
5. Adamkiwicz artery5. Adamkiwicz artery
Spinothalamic TractSpinothalamic Tract Modality: Modality: Pain & Temperature Sensation, Light Touch Pain & Temperature Sensation, Light Touch
Receptor: Receptor: Free Nerve Ending Free Nerve Ending
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion) Posterior Root Posterior Root
2nd Neuron: 2nd Neuron: Dorsal Horn Dorsal Horn (Lamina I, IV, V)(Lamina I, IV, V)
Spinothalamic Tract - (Spinal Lemniscus)Spinothalamic Tract - (Spinal Lemniscus)
3rd Neuron: 3rd Neuron: Thalamus (VPL) Thalamus (VPL) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata
Termination: Termination: Primary Somesthetic Area (S I) &Primary Somesthetic Area (S I) &
Diffuse Widespread Cortical RegionDiffuse Widespread Cortical Region
Spinothalamic TractSpinothalamic Tract Modality: Modality: Pain & Temperature Sensation, Light Touch Pain & Temperature Sensation, Light Touch
Receptor: Receptor: Free Nerve Ending Free Nerve Ending
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion) Posterior Root Posterior Root
2nd Neuron: 2nd Neuron: Dorsal Horn Dorsal Horn (Lamina I, IV, V)(Lamina I, IV, V)
Spinothalamic Tract - (Spinal Lemniscus)Spinothalamic Tract - (Spinal Lemniscus)
3rd Neuron: 3rd Neuron: Thalamus (VPL) Thalamus (VPL) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata
Termination: Termination: Primary Somesthetic Area (S I) &Primary Somesthetic Area (S I) &
Diffuse Widespread Cortical RegionDiffuse Widespread Cortical Region
Spinal Cord Ascending TractsSpinal Cord Ascending Tracts Spinal Cord Ascending TractsSpinal Cord Ascending Tracts
Spinothalamic TractSpinothalamic TractSpinothalamic TractSpinothalamic Tract
spinothalamicspinothalamictracttract
anterior whiteanterior whitecommissurecommissure
posterior rootposterior root
decussationdecussation
- - contralateralcontralateral loss of pain and temperature loss of pain and temperature sensation sensation below below the level of lesionthe level of lesion
Spinocerebellar TractSpinocerebellar Tract
Modality: Modality: Unconscious Proprioception Unconscious Proprioception
Receptor: Receptor: Golgi tendon organ, muscular fuseGolgi tendon organ, muscular fuse
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion) Posterior Root , Posterior Root ,
2nd Neuron: 2nd Neuron: 1. Clarke’s column 1. Clarke’s column Posterior Spinocerebellar TractPosterior Spinocerebellar Tract
2. Accessory Cuneate Nucleus2. Accessory Cuneate Nucleus Cuneocerebellar Tract Cuneocerebellar Tract
3. Posterior Horn3. Posterior Horn Anterior Spinocerebellar r TractAnterior Spinocerebellar r Tract
Termination: Termination: Cerebellar CortexCerebellar Cortex
Spinocerebellar TractSpinocerebellar Tract
Modality: Modality: Unconscious Proprioception Unconscious Proprioception
Receptor: Receptor: Golgi tendon organ, muscular fuseGolgi tendon organ, muscular fuse
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion) Posterior Root , Posterior Root ,
2nd Neuron: 2nd Neuron: 1. Clarke’s column 1. Clarke’s column Posterior Spinocerebellar TractPosterior Spinocerebellar Tract
2. Accessory Cuneate Nucleus2. Accessory Cuneate Nucleus Cuneocerebellar Tract Cuneocerebellar Tract
3. Posterior Horn3. Posterior Horn Anterior Spinocerebellar r TractAnterior Spinocerebellar r Tract
Termination: Termination: Cerebellar CortexCerebellar Cortex
Spinal Cord Ascending TractsSpinal Cord Ascending Tracts Spinal Cord Ascending TractsSpinal Cord Ascending Tracts
FUNCTION?FUNCTION?FUNCTION?FUNCTION?
Corticospinal TractCorticospinal Tract
Origin: Origin: Cerebral CortexCerebral Cortex Brodmann Area 4 (Primary Motor Area, M I)Brodmann Area 4 (Primary Motor Area, M I)
Brodmann Area 6 (Premotor Area, PM )Brodmann Area 6 (Premotor Area, PM )
Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I)
Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule) Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)
Corona RadiataCorona Radiata
lnternal Capsule, Posterior Limblnternal Capsule, Posterior Limb
Longitudinal Pontine FiberLongitudinal Pontine Fiber
Pyramid - pyramidal decussationPyramid - pyramidal decussation
Corticospinal Tract - Lateral and AnteriorCorticospinal Tract - Lateral and Anterior
Termination: Termination: Spinal Gray (Rexed IV-IX)Spinal Gray (Rexed IV-IX)
Corticospinal TractCorticospinal Tract
Origin: Origin: Cerebral CortexCerebral Cortex Brodmann Area 4 (Primary Motor Area, M I)Brodmann Area 4 (Primary Motor Area, M I)
Brodmann Area 6 (Premotor Area, PM )Brodmann Area 6 (Premotor Area, PM )
Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I)
Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule) Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)
Corona RadiataCorona Radiata
lnternal Capsule, Posterior Limblnternal Capsule, Posterior Limb
Longitudinal Pontine FiberLongitudinal Pontine Fiber
Pyramid - pyramidal decussationPyramid - pyramidal decussation
Corticospinal Tract - Lateral and AnteriorCorticospinal Tract - Lateral and Anterior
Termination: Termination: Spinal Gray (Rexed IV-IX)Spinal Gray (Rexed IV-IX)
Spinal Cord Descending TractsSpinal Cord Descending Tracts Spinal Cord Descending TractsSpinal Cord Descending Tracts
- - ipsilateralipsilateral UMN syndrome UMN syndrome
atat the level of lesion the level of lesion
Corticospinal TractCorticospinal TractCorticospinal TractCorticospinal Tract
Corona Radiata Corona Radiata
lnternal Capsule, lnternal Capsule,
Longitudinal Pontine Longitudinal Pontine
Pyramid Pyramid
Pyramidal DecussationPyramidal Decussation
Corticospinal Tract Corticospinal Tract
- Lateral and Anterior- Lateral and Anterior
CR
IC
LPF
Pyr
PD LCST
ACST
Spinal CordSpinal CordSyndromeSyndrome
AmyotrophicAmyotrophicLateral SclerosisLateral Sclerosis
(ALS)(ALS)
Lou Gherig’sLou Gherig’sDiseaseDisease
Spinal CordSpinal CordSyndromeSyndrome
AmyotrophicAmyotrophicLateral SclerosisLateral Sclerosis
(ALS)(ALS)
Lou Gherig’sLou Gherig’sDiseaseDisease Stephen Haking (1946- )Stephen Haking (1946- )
British Physicist, A Brif History of Time