1 - Correlating Neuroanatomy with Patient.pdf

7/27/2019 1 - Correlating Neuroanatomy with Patient.pdf

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Correlating

Neuroanatomywith PatientPresentation


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Supratentoria Infratentorial

SupportStructures

Pathways

Overview of the Nervous System

above tentorium cerebelli - which contains the cerebrum

below - which contains

the cerebellum


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Tentorium

Cerebelli

Supratentorial

CorticalSubcortical

Infratentorial

BrainstemCerebellum


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Cortical

Outer gray matterLocation of cell bodies (neurons, glia)

SubcorticalWhite matter (includes the internal

capsule)Highways that connect cellbodies (axons)

Deep nuclei: gray matterBasal Ganglia motor control

Thalamus sensory, motor,consciousness

Hypothalamus homeostasis

Supratentorial


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Cerebral Cortex: 5 lobes: function1. Frontal:2. Parietal:3. Occipital:4. Temporal:5. Insula:

**GOOD QUIZ QUESTION

**

movement, decision making, higher lvl of thinking, motion and personality

sensory

vision

auditory, speech, language, memory, emotion

limbic response


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Neuroanatomy: Infratentorial

Brainstem: 3 areasMidbrainPons

Medulla

Neuroanatomy: InfratentorialCranial nervesCenters for eye movementCardiac, respiratory centers

autonomic: respiratory, HR, BP

relay station

vision, hearing, motor control, sleep/wake,

arousal/alertness, temp control


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Cerebellum:Lobes, Hemispheres, Tonsils

Functional divisions

Midline (vermis)-

Lateral hemispheres-

Neuroanatomy: Infratentorial

coordination and balance

axial coordination

(limb coordination)

most important for motor control

(of gait)

ant, post, and flocculonodular lobe


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Conduit for motor and sensorypathways

Lateral corticospinal tract (LCST) Upper motor neuron axons

Dorsal columns (DC)

Antero-lateral system (ALS)

Pain/temperature Anterior horn cells ( motor neuron)

Lower motor neuron cell bodies

Proprioception, discriminative touch and vibration

contralateral

limbs

signals coming from cerebral

cortex to brainstem

SENSORY PATHWAY


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DC

LCST

ALSAlpha

LE

UE


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Ends at

Cauda equina-..Nerve roots continue to exitrespective intervertebral foramen

C2-7: above respectivevertebra

C8: between C7-T1

T, L, S roots below

conus medullaris (L1-L2)

(L2-L5)


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Neuroanatomy: Support structures

Meninges

SpacesVentricles

Cerebrospinal FluidBloodArterialVenous


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Meninges

(outside-in)EPIDURAL

1. Dura MaterSUBDURAL

2. Arachnoid MaterSUBARACHNOID

3. Pia Mater

Venous blood: tornbridging vein

Normally containscerebrospinal fluid

(CSF)Arterial blood:aneurysm rupture

Arterial blood: tornmeningeal artery

(outer most)

When patient has hydrocephalus: monitor CSF


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Epidural space

A potential space inthe cranium

A real space in the

vertebral canal


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Ventricular system

Cerebrospinal fluid (CSF)direction of flow inventricular system:

Lateral ventricles (2) Interventricular foramen of

Monro (2)

Third ventricle (1)Cerebral aqueduct (1)

Fourth ventricle (1)3 foramen

Subarachnoid space (SAS)Intraventricularhemorrhagevs. subarachnoidhemorrhage


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Neuroanatomy: Support structuresVentricular system: CSF resorption

Arachnoid villi/granulations

Project from the SASinto the sinuses

Cerebral venous sinusesimportant for drainage


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Anterior Circulation 2 Carotid Arteries

Posterior Circulation 2 Vertebral Arteries


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Vascular Supply

MCA - MOST common CVA location

ACA

PCA


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Blood SupplyAnterior Circulation

Carotid Arteries (2)

Ophthalmic artery

Posterior communicating artery

Pcomm

Anterior choroidal artery

Anterior cerebral artery (ACA)

Middle cerebral artery (MCA


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Blood Supply

Posterior CirculationVertebral Arteries (2)Posterior Inferior Cerebellar

(2 - PICA)Anterior Spinal Artery (1 -

ASA)

Basilar Artery (BA)Anterior Inferior Cerebellar(2 -AICA)

Superior Cerebellar (2 -SCA)

Posterior Cerebral (2 -PCA)


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Blood supplyArterialThe Cerebral arteries (anterior, middle,

posterior) are terminal branches

Numbered segments (first, second, third

order branches)i.e. A1, A2, A3, or M1, M2, M3, or P1, P2, P3

The internal carotid also has segmentsCervical, carotid siphon, supraclinoid

(intracranial)


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VenousSinusesVein of Galen

IGNORE THIS SLIDE


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Three that are important to our patients!

1. Lateral Corticospinal TractVolitional movement, the upper motor neuron

2. Dorsal Column Medial Lemniscus SystemAKA large fiberProprioception/kinesthesia, discriminative touch,vibration

3. Spinothalamic Tract / Antero-lateral systemAKA small fiberPain, temperature, crude touch, itch, tickle

What are the differences in: pathways?

modalities?

originates in spinal cord and travels up and transmits info

to thalamus

crosses over at cervico-medullary

junction

crosses over at spinal segment

DESCENDING

ASCENDING

ASCENDING

crosses over at spinal segment


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What is the name of the 1o efferent track in the SC?What cells in the CNS give rise to this efferent track?What is the other name for these cells / track?What is the name for the analogous track for the CN?

Spinal Cord

lateral corticospinal tract

pyramidal cells

cross-pyramidal (OR lateral cerebrospinal tract)

subcortical bulbar tract


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Somatosensory / Proprioceptive Input

crosses over at the level of spinal

segment


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Somatosensory / Proprioceptive Input


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Anterior horn cell / lowermotor neuron pathology:LMN

Hemi-cord pathologyaffects touch andvolitional movement on

Lateral brainstempathology often affects.

Medial brainstempathology often affects.

ThalamusInfarcts usually affectOnly.

Internal CapsuleInfarcts affect

Pain, Touch,Volitionalmovement isperceived/controlled by.IGNORE THIS SLIDE


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Distribution of Sensory Impairment1. 2. 3. 4.

a. Dermatomalb. Hemisphericc. Polyneuropathyd. Segmental

dermatomal

hempisphericpolyneuropathy

involves many nerves at a time - both motor and sensory

1 - Correlating Neuroanatomy with Patient.pdf

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