Neuroanatomy Review for the SLP Handouts - · PDF fileNeuroanatomy Review for the ... •...
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4/3/17 1 Neuroanatomy Review for the Speech-Language Pathologist: From One Neuron to Another Andrea Hayes, M.S., CCC-SLP, BCS-S April 8, 2017 Disclosures • I have no financial disclosures to discuss • I have no non-financial disclosures to discuss • It has been decided that the new median salary medical Speech- Language Pathologists will be $3,141,592,653 for all that we are required to know and a separate bonus for every Qme we hear from our paQents “but there’s nothing wrong with my speech so why do I need Speech Therapy?” OR from one of our dear nurses that “they swallow fine, they aren’t coughing”
Transcript of Neuroanatomy Review for the SLP Handouts - · PDF fileNeuroanatomy Review for the ... •...
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Neuroanatomy Review for the Speech-Language
Pathologist: From One Neuron to Another
AndreaHayes,M.S.,CCC-SLP,BCS-SApril8,2017
Disclosures
• Ihavenofinancialdisclosurestodiscuss
• Ihavenonon-financialdisclosurestodiscuss
• IthasbeendecidedthatthenewmediansalarymedicalSpeech-LanguagePathologistswillbe$3,141,592,653forallthatwearerequiredtoknowandaseparatebonusforeveryQmewehearfromourpaQents“butthere’snothingwrongwithmyspeechsowhydoIneedSpeechTherapy?”ORfromoneofourdearnursesthat“theyswallowfine,theyaren’tcoughing”
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Course Outline
• EmbryologyandNeuralDevelopment
• NeuralProtecQon
• Neuroanatomy
• VascularSupplytotheBrain
• CranialNerves!
Early Mitosis
• Zygote• Blastocyst• Bilaminargermdisc• Trilaminargermdisc
• ectoderm• mesoderm• endoderm
Neurulation
• Flatneuralplateformed• Crest,folds,andgroove• Neuraltube• Primaryvesiclesform
• Prosencephalon• Mesencephalon• Rhombencephalon
h`ps://embryology.med.unsw.edu.au/embryology/index.php/Human_Embryo_Development_Movie
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Congenital Anomalies
• Anencephaly
• Spinabifida
• Microcephaly
• Agenesisofthecorpuscallosum
• Cleelipandpalate
Cephalic Structures • Prosencephalon
• Diencephalon• Thalamus• Hypothalamus
• Telencephalon• Hemispheres
• Mesencephalon• Midbrain
• Rhombencephalon• Metencephalon
• Pons• Cerebellum
• Myelencephalon• Medullaoblongata
Neural Migration • Neurons
• Unipolar,bipolar,mulQpolar• Pyramidal• Purkinje
• Neuroglia• OligodendrocytesandSchwanncells• Microglia• Ependymalcells• Astrocytes
• Synapses
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Central Nervous System • Cerebrum• SpinalCord
Peripheral Nervous System
• SpinalNerves(31pairs)• CranialNerves(12pairs)
Motor Pathway…..
Sensory Pathway…
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Defying Gravity….
• Brainweighsabout1400gramsinair• Ventricles,boneandmeningesprotectusfrombumpsandgravity
• Cerebrospinalfluidgivesbuoyancytothebrainsoitweightsonly50gramsintheskull
Ventricular System
https://www.youtube.com/watch?v=SDMO4vYkqdg
• InterconnecQngchambersinthebrain• Choroidplexus___________________• LateralVentricles_________________• ForamenofMunro________________• 3rdVentricle____________________• AqueductofSylvius_______________• 4thVentricle_____________________
Hydrocephalus • Enlargementoftheventricles• Dueto:
• ExcessproducQonofCSF• Blockagewithinsystem• FailureofCSFtore-absorb
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Bony Protection
• Skull• Cranialbones• Facialbones
• Spinalcolumn• Cervical• Thoracic• Lumbar• Sacral• Coccygeal
Skull
Skull • Foramenovale____• Stylomastoidforamen____• InternalacousQcmeatus____• Jugularforamen___________• Hypoglossalcanal_____• Foramenmagnum_____
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Spinal Column • Cervical
• C1______________________• C2______________________• C3• C4• C5• C6• C7
• Thoracic• Lumbar• Sacral• Coccygeal
Meningeal Protection: “PAD” the Brain!
• Pia
• Arachnoid
• Dura
Pia Mater = Tender Mother
• TissuepaperlikecoveringoftheCNS• Fibersanchorthearachnoidtothepiasothereisnomovement• Conformstothesulciandgyri• OnlyonecelllayerthickbutiseffecQvebarriertoinfecQon
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Arachnoid = Spider’s Web
• Givesappearanceofacobweb• Highlyvascularized• Subarachnoidspace
• CSFcirculatesthroughthespace• ArachnoidvillihelpdrainCSF
Dura Mater = Tough Mother
• Epiduralspace________________• Subduralspace________________• Falxcerebri___________________• Tentoriumcerebelli_____________
I the
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Vascular Supply!
• CaroQdsystem • Vertebrobasilarsystem
Carotid System
• InternalcaroQds• ACA__________________• MCA__________________
• ExternalcaroQds
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Vertebrobasilar System
• Vertebralarteries• PICA__________________________
• Basilarartery• PCA____________________• Anteriorinferiorcerebellararteries• Superiorcerebellararteries
Circle of Willis • ConnectcaroQdandvertebralsystems• AComm__________________________• PComm__________________________• Safetynetfordisruptedbloodsupplyifthelesionisbelowthecircle
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Cerebrum
• Hemispheres• Centralsulcus
• Motor• Sensory
• Longitudinalfissure• Corpuscallosum
Corpus Callosum • Rostrum• Genu• Body• Splenium
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Frontal Lobe • Precentralgyrus=__________• Damage….
• motorimpairmentstocontralateralside• cogniQveimpairments• non-fluentaphasiawithorwithoutacquiredapraxiaofspeech,transcorQcalmotoraphasia,Broca’saphasia
• **spasQcdysarthriaifbothhemispheresaffected• dysphagia• unilateraluppermotorneurondysarthria
• lowerfacialparesisoncontralateralsideofdamage• lingualparesisoncontralateralsideofdamage
Temporal Lobe
• Primaryauditorycortex• Damage…
• fluentaphasia• transcorQcalsensoryaphasiaorWernicke’saphasia
• memory• recogniQon• processing
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Parietal Lobe • Postcentralgyrus=_______• Damage…
• visualneglect• sensoryimpairments• conducQonaphasia• anosognosia• prosopagnosia• astereognosia• right/leediscriminaQon• agraphia• acalculia
Occipital Lobe
• Primaryvisualcortex• Damage…..
• corQcalblindness• a`enQon• reading• symbolicrecogniQon
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Cerebellum • CoordinaQon,balance• Damage…
• ataxia• dysdiadochokinesia• dysmetria• intenQontremor• disequilibrium• nystagmus• dysphagia• ataxicdysarthria
Diencephalon
• Thalamus• Hypothalamus• Epithalamus/pinealgland• Damage….
• thalamicpainsyndrome• sensoryprocessingdisorders• dysphagia
Limbic System • Amygdala• Hippocampus• Cingulategyrus• Damage…
• memory• encoding/learning• retrieval• emoQons• fear• behavior
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Basal Ganglia • Caudatenucleus• Putamen• Globuspallidus• Subthalamicnucleus• SubstanQanigra• Damage….
• Chorea• HyperkineQcdysarthria
• Athetosis• Ballismus• Tremor• Bradykinesia
• HypokineQcdysarthria
Brainstem • Midbrain(CNIII,IV)• Pons(CNV,VI,VII,VIII)• Medullaoblongata(CNIX,X,XII)• Damage
• sight,smell,hearing,taste• disequilibrium• nausea• coma• dysphagia• flacciddysarthria
Mnemonics
• SomeSayMarryMoney,ButMyBrotherSaysBigBrainsMa0erMore.• Olivertheop(mis3coctopustrotstriumphantlyaboutfacingaudiencesglossilyvaguelyspinninghippos.
• OnOldOlympus'ToweringTopAFinAndGermanViewedSomeHops
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CN I: Olfactory • Sensorynerve• Smell
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CN II: Optic • Sensorynerve• Vision
• Infofromleevisualfieldgoestorightoccipitallobeandviceversa
Sensory:NeuronOrder• Firstorderneuron
– PhotonsoflightconvertedtoelectricalsignalsinreQna.Thesephotoreceptorcellsaretherodsandcones.TheyinturnsynapsewiththeopQcnerve
• Rods• Cones
• Secondorderneuron– OpQcnerveleavesreQnaandjoinstheotheropQcnerveattheopQcchiasmtravelingthentorespecQvethalamicnuclei
• Thirdorderneuron– FromlateralgeniculatenucleusinthalamustotheoccipitalcortexforinterpretaQon
• LeeandrightopQcnervesexitviaopQccanalandjointogetherattheopQcchiasm
• OpQcchiasm– ½offibersfromeachnervecrossmidlineandexitchiasminoppositeopQctract
– ½offibersstayonthesamesideopQctract
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Visiondeficits• DamagetoreQnaornerveitself=blindnessinthatsameeye/ipsilateral
• Lossofperipheralvisionofbotheyes=damagetomedialaspectofchiasm=bitemporalhemianopia
• DamagetolateralaspectofopQcchiasm=decreasedvisionofoneeye’speripheralvision
• Damageposteriortochiasm=lossofinputfromcontralateralvisualfieldsofbotheyes
• DamagetoopQctract=lossofcontralateralvisualfieldsinbotheyes=homomynoushemianopia
CN III: Oculomotor • Motornerve• EyemovementandpupildilaQon
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CN IV: Trochlear • Motornerve• Eyemovement
CN V: Trigeminal • Bothsensoryandmotor• Somatosensoryinfofromtheface/headandmotorformasQcaQon
• Origin:Pons• TerminaQon:
• Opthalmicbranch• Maxillarybranch• Mandibularbranch
CN V: Trigeminal • Symptoms
• Facialnumbness• ReducedfacialsensaQon• Jawweakness/chewing
• Test• Close/openjaw• Lighttouchtopartsofface
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Sensory:NeuronOrder
• Firstorderneuron– Fromsensoryreceptorsinface(threebranches)
• Secondorderneuron– FromsensorynucleiofCNVinponstocontralateralthalamus
• Thirdorderneuron– FromthalamustoipsilateralpostcentralgyrusforinterpretaQon
Motor:NeuronOrder
• Firstorderneuron/UMN– Fromprecentralgyrustonucleiinpons
• Secondorderneuron/LMN– Exitsviaforamenovaletosynapsewithmusclesonipsilateralsideforchewing(masseterandtemporalis)
CN V: Trigeminal • UMNdamage-min.unlessbilateral• LMNdamage-wasQng,weakness,jawdeviaQon
• Trigeminalneuralgia
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CN V: Trigeminal
CN VI: Abducens • Motornerve• Lateraleyemovement
CN VII: Facial • Sensoryandmotornerve• ContralateralinnervaQontolowerface
• BilateralinnervaQontoupperface
• Facialexpression• Origin:Pons• TerminaQon:
• 5branches
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CN VII: Facial
Sensory:NeuronOrder
• Firstorderneuron– Fromchemoreceptors/tastebudsonanterior2/3oftongue
• Secondorderneuron– FromsensorynucleiofVIIIinponsuptothecontralateralthalamus
• Thirdorderneuron– FromthalamustoipsilateralpostcentralgyrusforinterpretaQon
Motor:NeuronOrder
• Firstorderneuron/UMN– Fromprecentralgyrusdownthroughtheinternalcapsuletoipsilateralandcontralateralforupperfaceandjustcontralateralforlowerface
• Secondorderneuron/LMN– FromnucleiinponsexiQngulQmatelythroughthestylomastoidforamentoallmusclesoffacialexpression
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CN VII: Facial • Symptoms
• Facialweakness• Decreasedtastetoanterior2/3oftongue
• Test• Smile• Puckerlips/whistle• Puffoutcheeks• Raiseeyebrows/wrinkle
UMN Damage
LMN lesion - Bell’s Palsy • Markedfacialasymmetry• Atrophyoffacialmuscles• Eyebrowdroop• Smoothingofforeheadandnasolabialfolds
• Droopingofmouthcorner• Cannotcloseeye• Poorlipseal
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CN VIII: Auditory • Sensorynerve• BilateralinnervaQon• Hearingandbalance• Origin:Pons• TerminaQon:
• AcousQc• VesQbular
CN VIII: Auditory • Symptoms
• Dizziness• VerQgo
• Test• Tickingwatch
CN IX: Glossopharyngeal • Sensoryandmotornerve• BilateralinnervaQon• Swallowing• Origin:Medulla• TerminaQon:
• Pharynx• Larynx• ParoQdgland• Tongue
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Sensory:NeuronOrder…• Firstorderneuron:Fromreceptorsinupperpharynxandposterior1/3oftonguetosensorybranchesofIX
• Secondorderneuron:sensorybranchesofIXinbrainstemuptothalamus
• Thirdorderneuron:FromthalamusuptopostcentralgyrusforinterpretaQon
• **Responsiblefortheafferentpartofthegagreflex• **MotorporQonofthegagismediatedbyVagus/X
Motor:NeuronOrder
• Firstorderneuron/UMN– FromprecentralgyrusthroughinternalcapsuletoipsilateralandcontralateralIXnucleiinmedulla
• Secondorderneuron/LMN– FromnucleiofIXinmedullaexiQngoutthroughthejugularforamentoinnervatethestylopharyngeusmuscleandsmoothmuscleglandsofpharynx,larynx,andvisceralofthoraxandabdomen
CN IX: Glossopharyngeal • Symptoms
• Dysphagia• IncreasedsecreQons• Tasteinposterior1/3oftongue• PressuretoEustachiantubes
• Test • Swallowing
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CN X: Vagus • Symptoms
• Velarweakness• Dysphagia• Hypernasality• Dysphonia
• Test• Uvula/palate• Swallowing• Voice
CN X: Vagus - Wanderer • Sensoryandmotornerve• BilateralinnervaQon• SwallowingandvisceralfuncQons• Origin:Medulla• TerminaQon:
• Pharyngealbranch• Laryngealbranch
Sensory:NeuronOrder
• Firstorderneuron:ReceptorswithinQssueofpharynxandlarynxgatherinfoandsynapsewithsensorybranchesofnerve
• Secondorderneuron:branchesofXfrommedullauptothalamus
• Thirdorderneuron:ThalamustopostcentralgyrusforinterpretaQon
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Motor:NeuronOrder• Firstorderneuron/UMN
– FromprecentralgyrusthroughinternalcapsuletoipsilateralandcontralateralXnucleiinthemedulla
• Secondorderneuron/LMN– Exitsviajugularforamenandthendividesintothreemajorbranches
• Pharyngealbranch(motoraspect/gagreflex,elevaQonofpalate,constricQonofpharynx)
– Superior,middle,andinferiorconstrictormuscles– LevatorpalaQnimuscule– Salpingopharyngeusmuscle– Palatopharyngeusmuscle– Palatoglossusoftongue(allothertonguemusclesareXII)
• Superiorlaryngealnerve– Externallaryngealnerve–cricothyroid– Internallaryngealnerve–sensorynerve
• Recurrentlaryngealnerve– Rightrecurrentloopsaroundtherightsubclavianarterythenupthroughgroovebetween
esophagusandtracheatoinnervateintrinsicrightvocalfoldmuscles– Leerecurrentloopsaroundthearchoftheaortaupthroughgroovebetweenesophagus
andtracheatoinnervateintrinsicleevocalfoldmuscles
CN XI: Accessory or Spinal Accessory • Motornerve• BilateralinnervaQon• Headmovement/shoulders
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CN XII: Hypoglossal • Motornerve• ContralateralinnervaQon• Tongue• Origin:Medulla• TerminaQon:Musclesoftongue
Motorneuronorder
• Firstorderneuron/UMN– Fromprecentralgyrusthroughinternalcapsuletocontralateralmedulla/LMN
• Secondorderneuron/LMN– Exitsviahypoglossalforamen– Extrinsicmuscles–genioglossus,styloglossus,hyoglossus
– Intrinsicmuscles–superiorlongitudinal,inferiorlongitudinal,verQcal,transversefibers
CN XII: Hypoglossal • Symptoms
• Dysarthria• Tongueweakness
• Test• Protrudetongue• Lateralizetongue• Elevatetongue• Depresstongue• LingualcircumducQon• DeviaQon?Atrophy?
