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NEUROANATOMY AND NEUROPHYSIOLOGY STUDY GUIDE

Neuroanatomy Learning Objectives


THE SPINAL CORD
The Gross Structure of the Spinal Cord in Situ
Lies within vertebral canal formed by foramina of vertebral column. Extends from medulla oblongata (lower half of brainstem). Spinal cord begins at occipital bone and ends between 1st and 2nd lumbar vertebrae. The diameter of the spinal cord varies as follows (thickest to thinnest): 1. Cervical. The cervical enlargement extends from C3-T2. It corresponds with the brachial plexus nerves, which innervate upper limb and 6th pair of cervical nerves. 2. Thoracic 3. Lumbar (note lumbar cord basically consists of the lumbar enlargement, which is thicker than thoracic cord). It extends from T11-L1, below which it tapers rapidly into conus medullaris. It corresponds to lumbosacral plexus nerves, which innervate lower limb. The enlargements are where sensory and motor neurons enter and exit. The spinal cord is divided into segments (31 spinal segments based on origins of spinal nerves): 1. There are 33 spinal cord nerve segments. Axons in CNS are grouped into tracts (not nuclei). a. Cervical (C3-C8): 8 segments 8 pairs of cervical nerves (excluding C1 and C2. C1 spinal nerves exit column between occiput and C1 vertebra. C2 nerves exit between posterior arch of C1 vertebra and lamina of C2 vertebra). b. Thoracic (T1-T12): 12 segments 12 pairs of thoracic nerves. c. Lumbar (L1-L5): 5 segments 5 pairs of lumbar nerves. d. Sacral (S1-S5): 5 segments 5 pairs of cranial nerves. e. Coccygeal: 3 segments 3 segments join to form 1 segment 1 pair of nerves (exit through sacral hiatus). 2. Motor nerve rootlets branch out of R. and L. ventro-lateral sulci. 3. Sensory nerve rootlets branch out of R. and L. dorsal lateral sulci. 4. Rootlets form nerve roots and are part of peripheral nervous system. 2 Ventral (motor) + 2 dorsal (sensory) roots= spinal nerve (one on each side of cord). Spinal nerves (except C1 and C2) form inside and exit through inter-vertebral foramen below corresponding vertebra.

Spinal nerves: 1. Upper part of vertebral column: Spinal nerves exit directly from cord. 2. Lower part of vertebral column: Spinal nerves pass further down column before exiting. Terminal portion of cord is called conus medullaris. The pia mater continues as an extension called the filum terminale, which anchors cord to the coccyx. The cauda equina is a dangling collection of nerve roots in the vertebral column that continue to travel through the vertebral column below the conus medullaris. The cauda equina forms because the spinal cord stops growing in length at ~4yo, even though the vertebral column continues to lengthen until adulthood. This results in the fact that sacral spinal nerves actually originate in upper lumbar region. Ganglia and Roots: Each segment of the spinal cord is associated with a pair of ganglia, called dorsal root ganglia, which are situated just outside spinal cord. Dorsal root ganglia contain cell bodies of sensory neurons. Axons of these sensory neurons travel into the spinal cord via the dorsal roots. Ventral roots consist of axons from motor neurons, which bring information to periphery from cell bodies in CNS. Grey and White Matter of the Spinal Cord

The Gross Structure of the Vasculature of the Spinal Cord


Three arteries run longitudinally along the spinal cord: 1. One anterior (ventral) artery 2. Two posterior (dorsal) arteries Spinal arteries arise from the segmental or root (radicular) arteries that follow dorsal and ventral spinal roots. They interconnect in the pial plexus which then supplies the deep tissue of the spinal cord. The other connections to the spinal arterial supply are: 1. Vertebral artery (cervical region) 2. Intercostal arteries (thoracic region) 3. Lumbar arteries (lumbar region) 4. Lateral sacral artery (sacral region) Venous drainage of the spinal cord occurs from veins running parallel with the dorsal and ventral spinal arteries and then into the large and complex epidural venous network.

The Internal Structure of the Spinal Cord

Internally, the spinal cord consists of:


1. White matter: Tracts of myelinated nerve fibres. Lies around outside of grey matter. Is divided into dorsal (posterior), lateral and ventral (anterior) funiculi. The white matter is located outside of the grey matter and consists of myelinated motor and sensory axons. Columns of white matter carry information up or down the cord. 2. Grey matter: Nerve cell bodies and their neuropil. Lies centrally in the spinal cord. In cross section looks like an H or a butterfly. Contains a central canal which is continuous with ventricular system of brain. The grey matter consists of interneurons and motor neurons. It also consists of neuroglia cells and unmyelinated axons. Projections of the grey matter (wings) are called horns. The grey horns and grey commissure form the grey H.

Neurons of the Spinal Cord


The Dorsal Roots of the Spinal Cord Bear the dorsal root ganglia (sensory). The Ventral Roots of the Spinal Cord: 1. Somatic motor fibres arise from final motor neurons in ventral horns striated muscle. 2. Autonomic preganglionic fibres arise from spinal preganglionic neurons. They are in the intermediolateral columns (below) and project to final motor neurons in peripheral autonomic ganglia: a. Thoracic and upper lumbar cord (sympathetic). b. Sacral cord (parasympathetic). 3. Paravertebral sympathetic chain ganglia are linked to the ventral roots by communicating rami.

Lateral Horn The lateral horn is found at thoracic, upper lumbar and sacral levels, which contain autonomic preganglionic neurons.

Descending [upper] motor tracts of the WHITE MATTER (all end in various regions of ventral horns)
1. Cortico-spinal (pyramidal) Tract a. Crossed = lateral funiculus. b. Uncrossed = ventral funiculus. 2. Extra-pyramidal Tracts a. Rubrospinal = descends in lateral funiculus Small and rudimentary. Responsible for large muscle movement and fine motor control. b. Medullary Reticulospinal = descends in ventral/lateral funiculus Excites anti-gravity extensor muscles. The fibres of this tract arise from caudal pontine reticular nucleus and the oral pontine reticular nucleus. Fibres of this tract project to interneurons of lamina VII and VIII of cord. c. Pontine (lateral) reticulospinal = descends in ventral funiculus Inhibits excitatory axial extensor muscles of movement. The fibres of this tract arise from the medullary reticular formation, mostly from the gigantocellular nucleus, and descend the length of the cord in the anterior part of the lateral column. This tract terminates in the grey spinal laminae. d. Vestibulospinal = descends in ventral funiculus Maintain balance and posture of body and head based on information from the inner ear (via vestibulocochlear nerve). The fibres of this tract arise from the lateral vestibular nucleus. This tract terminates at the interneurons of lamina VII and VIII.

Ascending [lower] sensory tracts of the WHITE MATTER (via the dorsal horns)
1. Fasciculus gracilis (carries information from below T6) = Ascends in medial part of dorsal funiculus Bundle of axon fibres in posterior column of cord. Carries proprioceptive information from middle thoracic and lower limbs of the body to the brain stem. Also carries deep touch, vibrational and visceral pain sensations to the brain stem. 2. Fasciculus cuneatus (carries information from T6 and up) = Ascends in lateral part of dorsal funiculus Nerves running in posterior column of cord. Sensation from spinal nerves in C1 and T6 dermatomes. Carries fine touch, fine pressure, vibration and proprioceptive information. Carries sensation to the brain stem. 3. Spinothalamic tract = Ascends in ventral and lateral funiculi Transmits pain, temperature, itch and crude touch information to thalamus. This pathway decussates at spinal cord level, not the brainstem. There are two main parts of this tract: a. Lateral tract: Pain and temperature. b. Anterior (ventral) tract: Crude touch. 4. Dorsal spinocerebellar tract = Ascends in dorsal part of lateral funiculus Transmits proprioceptive information from muscles to cerebellum. This tract runs in parallel with ventral tract. Transmits information from ipsilateral caudal aspect of the body and legs. 5. Ventral spinocereballar tract = Ascends in ventral part of lateral funiculus Transmits proprioceptive information from muscles to cerebellum. Transmits information from ipsilateral caudal aspect of body and legs.

The Relative Sizes of the Spinal Fibre Tract Varies with Spinal Level
Spinal Level Sacral Grey Matter Dorsal horn prominent. Lateral horn prominent. Ventral horn large. Dorsal horn prominent. Lateral horn small/absent. Ventral horn large. Dorsal horn slender. Lateral horn small. Ventral horn modest. Dorsal horn slender. Lateral horn absent. Ventral horn large. White Matter Small

Lumbar

Large

Thoracic

Large

Cervical

Large (especially lateral and dorsal)

The various sizes in the table above vary in accordance with the number of nerves that coverage on that area. ????????????????????????????????????????????????????????????????????????????????????????????

The Gross Structure of the Meninges


The meninges consists of three principal layers and enclose a space containing the CSF (superficial to deep): 1. Dura 2. Arachnoid 3. Pia The epidural space is external to the dura and carries the epidural veins of the spinal cord. The CSF itself is in the subarachnoid space. The spinal cord is suspended in the dural sheath by the denticulate ligaments that run from the inner surface of the dura between the dorsal and ventral rootlets.

Other Aspects of the Spinal Cord


Be able to identify: Dorsal sulcus Ventral Medial Fissure Conus Medullaris (tapering caudal end of spinal cord) Filum Terminale (pial extension beyond spinal cord) Cauda Equina (spinal nerves arising caudal to L2)

THE BRAIN
The Major Divisions of the Brain
Major functions of the brain have different embryological origins and different levels of function. The brain (excepting the cerebral cortex, which is highly homogenous) can be divided into a series of major division, each of which has a characteristic set of functions. Be able to identify: SECONDARY DIVISION Telencephalon Diencephalon Mesencephalon Metencephalon Myelencephalon MAIN STRUCTURE Cerebral hemisphere Thalamus, hypothalamus Midbrain Pons, cerebellum Medulla oblongata

PRIMARY DIVISION Prosencephalon (forebrain) Mesencephalon (midbrain) Rhombencephalon (hindbrain)

The midbrain + hindbrain = brain stem

The Cortex
You can identify parts of the cortex by anatomical or functional criteria. The major anatomical areas of the cortex are known as loves, the names of which reflect their location. Be able to identify: Frontal lobe Temporal lobe Parietal lobe Occipital lobe The two hemispheres of the brain are joined by a vast tract of nerve fibres, most of which are myelinated, known as the corpus callosum. You can see it in sagittal sections.

The Landmarks of the Cortex


The surface of the cortex is folded into ridges (gyri) and fissures (sulci) that are more or less constant between individuals. STRUCTURE 1 Frontal lobe Frontal lobe Parietal lobes SEPARATION STRUCTURE 2 Lateral fissure (or sulcus) Temporal lobe Central sulcus Parietal lobe Separated on medial side of cerebral Occipital lobe hemispheres by parieto-occipital fissure (or sulcus)

Be able to identify on whole brains, sagittal sections, cross-sections (real brains, CT and MRI): Deep within the lateral fissure is a region of the cortex known as the insula Cingulate gyrus Corpus callosum Parahippocampal gyrus Precentral gyrus Postcentral gyrus Superior, middle and inferior gyri of frontal lobe Superior, middle and inferior gyri of temporal lobe Lobules of parietal lobe (superior and inferior lobe, divided by intraparietal sulcus)

The Diencephalic part of the Forebrain- the Thalamus (inner room) and Hypothalamus
Thalamus + hypothalamus = lateral wall of 3rd ventricle inferior to corpus callosum. Pineal gland (circadian rhythms). Thalamic nuclei have connections with cerebral cortex, cerebellum and spinal cord. There is a topographic relationship between the thalamus and cerebral cortex. Y-shaped internal medullary lamina divides thalamus into lateral, anterior and medial nuclear groups. All sensory input (except olfaction) to the cortex is first relayed through thalamus. Lateral geniculate body (visual system). Medial geniculate body (auditory system). Hypothalamus (immediately superior to optic chiasm). Hypothalamic motor outputs to posterior and anterior pituitary. Links to brainstem. Links to cortical structures: amygdala, anterior cingulate and insula (visceral function, emotion, reward etc.)

The Midbrain
Tectum (dorsal surface). Tegmentum (ventral surface). Cerebral aqueduct. Periaqueductal grey (autonomic function and sensory processing). Superior and inferior colliculi on dorsal surface (visual and auditory processing respectively). Corticospinal fibre tract (main motor output from cortex to spinal cord and fine motor control). Corticobulbar fibre tract (motor cortex to brainstem areas involved in movement, balance and orientation). Corticopontine fibres, which terminate in pontine nuclei (in pons) that in turn project to cerebellum. Deep to fibre tracts is the substantia nigra. Deep to substantia nigra is the red nucleus (source of rubrospinal tract).

Be able to identify all these structure on whole brains on in brain sections.

The Hindbrain- pons and medulla oblongata)


Main external feature of pons are cerebellar peduncles (superior, middle and inferior pairs) on dorsum. Peduncles connect brainstem and cerebellum. Dorsal pons forms floor of 4th ventricle. Motor nuclei of abducens, facial and trigeminal nerves beneath floor of 4th ventricle. Most of pons is fibres connecting with cerebellum. Fasciculus gracilis -- sensory information gracilis nucleus. Fasciculus cuneatus -- sensory information cuneatus nucleus. Trigeminal sensory nucleus. Pyramids, which contain corticospinal (pyramidal) tract. Decussation of pyramidal tract. The Olive contains inferior olivary nucleus (connects to cerebellum). At the level of the Olive: Lateral and medial vestibular nuclei Nucleus tractus solitaries Dorsal motor nucleus of vagus Hypoglossal nucleus

Cerebellum
Involved with balance, coordination and learning. Vermis (muscle tone and position). Two lobes/hemispheres (coordination of muscle movement, trajectory, speed and force). Surface of the cerebellum folia (cerebellar gyri) Primary fissure separates anterior and posterior lobe. Deep surface of primary fissure flocculus and node (together form flocculonodular lobe) balance. Cerebellum connected to brain stem and midbrain by cerebellar peduncles.

The Cranial Nerves


Refer to attached document.

The Meninges (out to in)


1. Dura mater tough outer covering 2. Arachnoid mater soft translucent membrane underlying dura 3. Pia mater thin vascular membrane adherent to brain surface The arachnoid and pia is the subarachnoid space, which is filled with CSF. Subarachnoid cisterns (enlargement of subarachnoid space): Cisterna magna Interpeduncular cistern Two reflections of the dura partially divide cranial cavity and provide paths for major cerebral sinuses: Falx cerebri (between cerebral hemispheres) superior sagittal sinus Tentorium cerebelli (between cerebral hemispheres and cerebellum) transverse sinus Be able to identify: Meninges on brains and sagittal heads Subarachnoid space and main cisterns Relation between dura and bones of skull What happens to dura and the points where cranial nerves exit/enter skull

The Ventricles and CSF


CSF flows through: Subarachnoid space Ventricular system CSF is made by choroid plexus. Choroid plexus lines parts of: Lateral ventricle Third ventricle Fourth ventricle CSF is returned to circulation via arachnoid villi (lines superior sagittal sinus).

There are four ventricles: 1. 2. 3. 4. Right lateral ventricle Left lateral ventricle Third ventricle Fourth ventricle

The ventricles: Are interconnected Connect with the central canal of spinal cord Connect with subarachnoid space (via foramina in 4th ventricle)

Foramina of the 4th ventricle: 1. Median aperture (foramen of Magendie) Cisterna magna 2. 2x lateral apertures (foramina of Luschka) Cerebellopontine angle

Be able to identify on models and sagittal sections: Ventricles and interconnections Relations of ventricles to subarachnoid spaces and cisterns Relations of ventricles to major structures of the brain Choroid plexus

Getting Blood to and from the Brain


Internal carotid and vertebral arteries supply blood to brain. A small amount of blood gets to meninges via middle meningeal artery, which is the 3 rd branch of the 1st part of the maxillary artery, which is a branch of the external carotid artery. The internal carotid feeds into anterior and middle cerebral arteries, which supply major areas of the brain. The internal carotid and middle cerebral arteries also feed into: ARTERY Hypophyseal artery Branch of internal carotid BRANCHES Superior SUPPLIES Pars tuberalis, infundibulum of pituitary and median eminence. Posterior pituitary.

Ophthalmic artery Branch of internal carotid artery Anterior choroidal artery Branch of internal carotid artery Posterior communicating artery Connections to internal carotid via middle cerebral artery and anterior cerebral artery. Posteriorly communicates with posterior cerebral artery. None. None.

Inferior Internal carotid orbit Central retinal Lacrimal Posterior ciliary Muscular branches Supraorbital Ethmoidal Medial palpebral Terminal

Inner layers of retina. Lacrimal gland, eyelids. Posterior uveal tract. Extraocular muscles. Muscles and skin of forehead. Meninges. Eyelids. Forehead and nose. Telecephalon, diencephalon and mesencephalon. Part of structure of Circle of Willis.

Vertebral arteries: ARTERY Posterior inferior cerebellar BRANCHES Anterior medullary segment Lateral medullary segment Supratonsillar segment Internal auditory Lateral branch Medial branch Anterior vestibular Common cochlear proper & vestibulochochlear Perforating branches Lateral (marginal) branch Hemispheric branches Superior vermian Posterior communicating Medial posterior choroidal Lateral posterior choroidal Perforators Temporal branches Lateral occipital Medial occipital Splenial SUPPLIES Posteronferior cerebellum

Anterior inferior cerebellar

Labyrinthine (aka. auditory artery)

Anteroinferior cerebellum

Ear

Superior cerebellar

Superior cerebellum

Posterior cerebral

Occipital lobes and posteromedial temporal lobes

Be able to identify all branches and aspects of the Circle of Willis. What is the advantage in having a vascular circle at the base of the brain? One advantage to a circle is that there are redundancies in circulation. If one vessel is blocked, the brain is still perfused. At the base of the brain, the circle has the greatest and most immediate access to the most parts of the brain.

Dural venous sinuses: SINUS Inferior sagittal Superior sagittal Straight Transverse Sigmoid Cavernous DRAINS TO Straight sinus Becomes right transverse Becomes left transverse Sigmoid Internal jugular Superior and inferior petrosal Internal jugular vein

Dural venous sinuses are venous channels found between layers of dura mater. They: Receive blood from internal and external veins of the brain. Receive CSF from subarachnoid space. Ultimately empty into internal jugular vein. Clinical relevance of sinuses: Damage to dura mater may cause a thrombosis in dural sinuses haemorrhagic infarction Cavernous sinus is: Traversed by internal carotid artery Surrounded by CN 3, 4, 5 and 6 Important because: Thrombosis in cavernous sinus can affect CN 3, 4, 5 and 6 resulting in symptoms related to those nerves. Dural venous sinus: Drain into extracranial veins via emissary veins. Emissary veins have no valves, so pus can flow into skull through them and they are therefore a possible route for extracranial infection to enter the skull. One emissary vein communicates from outside skull through sphenoidal emissary foramen inferior to the zygomatic arch with the cavernous sinus on the inside of the skull. This is an important route for spread of infection because CN 2, 4, V1, V2 and 6 and internal carotid pass through cavernous sinus. Infection or inflammation in the cavernous sinus can damage any of the cranial nerves that pass through it, or meningitis. Rupture of the emissary veins will result in subdural haematoma.

THE BRAIN II
The Major Areas of the Cortex Involved in Motor Activity
FUNCTIONAL REGION Primary motor cortex Supplementary motor cortex Premotor cortex Brocas area (speech motor area) Frontal eye field (eye movements) Somatosensory cortex - Awareness of body position, joint angles, muscle force and touch etc. Parietal association cortex - Awareness of contralateral body, knowledge of object shapes, personal space etc. Hippocampus - Memory, spatial/temporal maps, emotional aspect of behaviour ANATOMICAL STRUCTURE Precentral gyrus Superior gyrus of frontal lobe, rostral to precentral gyrus Middle gyrus of frontal lobe, rostral to precentral gyrus Caudal part of inferior gyrus of frontal lobe, adjacent to lateral fissure Middle region of middle gyrus of frontal lobe Postcentral gyrus

Superior parietal lobe

Medial aspect of temporal lobe, deep to Parahippocampal gyrus

The Basal Ganglia and Corpus Striatum


Be able to identify all parts of the basal ganglia, corpus striatum and amygdala.

Inter-hemispheric Connections
On sagittal sections be able to identify: Corpus callosum Anterior commissure (information between temporal lobes) Association fibres connect various ipsilateral regions of the cortex. Be able to identify: Superior longitudinal fasciculus Inferior longitudinal fasciculus Cingulum (girdle)

Connections between Cortex and Subcortical Structures


These connections are known as projection fibres. Are input/output between cortex and thalamus, striatum, brainstem and spinal cord etc. These projection fibres are divided into: Corticospinal tract Corticobulbar tract These fibres are distributed radially as corona radiata, Thalamocortical tract which converge towards brainstem.

As fibres of corona radiate converge towards brain stem, they form the internal capsule. The anterior limb of internal capsule contains connections between thalamus and prefrontal cortex. The posterior limb of internal capsule contains: Corticobulbar motor tracts Corticospinal motor tracts Thalamus and somatosensory cortex connections Thalamus and motor areas of frontal lobe connections

THE SKULL
Gross Anatomy of the Skull
Looking at the base of skull you can see three main areas: Anterior fossae Middle fossae Posterior cranial fossae The floor of each fossa is traversed by foramina transmitting cranial nerves and/or blood vessels. Be able to identify: THE ANTERIOR CRANIAL FOSSA OF THE SKULL CRANIAL NERVE/S Olfactory nerves THE MIDDLE CRANIAL FOSSA OF THE SKULL CRANIAL NERVE/S Optic nerve Oculomotor nerve Trochlear nerve Abducens nerve Ophthalmic division of trigeminal nerve Maxillary division of trigeminal nerve Mandibular division of trigeminal nerve

FORAMINA Cribriform plate

BLOOD VESSLES

FORAMINA Optic canal Superior orbital fissure

BLOOD VESSLES

Foramen rotundum Foramen ovale Foramen lacerum Foramen spinosum

Internal carotid on floor Middle meningeal THE POSTERIOR CRANIAL FOSSA OF THE SKULL CRANIAL NERVE/S BLOOD VESSLES Vertebral arteries Spinal root of accessory nerve Spinal cord Hypoglossal nerve Internal jugular vein Glossopharyngeal nerve Vagus nerve Accessory nerve Vestibulocochlear nerve Facial nerve

Note hypophyseal fossa in which pituitary lies.

FORAMINA Foramen magnum Hypoglossal canal Jugular foramen

Internal auditory meatus

OTHER
Extraocular eye muscles.

The Auditory System

The Cranial Nerves


The cranial nerves emerge directly from the brain, in contrast to spinal nerves, which emerge from segments of the spinal cord. In humans, there are TWELVE PAIRS of cranial nerves. The FIRST AND SECOND emerge from the cerebrum, the REMAINING TEN PAIRS emerge from the brainstem. Mnemonic for the nerves Oh, Oh, Oh, To Touch And Feel Vagina, God Vaginas Are Hot. Mnemonic for the type of nerve
Figure 1 The Cranial Nerves and their Distributions.

S= Sensory, M= Motor and B= Both (sensory + motor) Some Say Money Matters, But My Brother Says Big Boobs Matter More. Mnemonic for the foramina C= Cribriform plate (Olfactory), O= Optic canal, S= Superior orbital fissure (Oculomotor), S= superior orbital fissure (Trochlear), S= Superior orbital fissure (Trigeminal Ophthalmic), R= Foramen Rotundum (Trigeminal Maxillary), O= Foramen Ovale (Trigminal Mandibular), S= Superior orbital fissure (Abducens), I= Internal acoustic meatus (Facial), I= Internal acoustic meatus (Vestibulocochlear), J= Jugular foramen (Glossopharyngeal), J= Jugular foramen (Vagus), J= Jugular foramen (Accessory), H= Hypoglossal canal (Hypoglossal). Carl Only Swims South. Silly Roger Only Swims In Incredible Jacuzzis. Jane Just Hitchhikes.

Cranial Nerve
Olfactory (CNI) Telencephalon Optic (CNII) Diencephalon Oculomotor (CNIII) Anterior Aspect of Midbrain Trochlear (CNIV) Dorsal Aspect of Midbrain

Foramen
Skull: Cribriform Plate Skull: Optic Foramen Skull: Superior Orbital Fissure

Branches
Olfactory Filaments None

Type of Impulse
Special Sensory (afferent) Special Sensory (afferent) General Motor (efferent) Parasympathetic Motor

Nucleus Name
Anterior olfactory Lateral geniculate nucleus Oculomotor EdingerWestphal Trochlear

Nucleus Location
Olfactory tract Thalamus

Symptom/Signs of Damage
Anosmia Blindness

Function
Smell and nasal mucosa. Vision and retina.

Superior and Inferior Divisions

Midbrain Midbrain

Eye deviates down & out Loss of pupillary/accommodation reflexes Diplopia, lateral deviation of eye

Eye movement (elevation and adduction)

Skull: Superior Orbital Fissure

Muscular Branches

Motor (efferent)

Midbrain

Eye movement (Superior oblique muscle depression of adducted eye)

Cranial Nerve
Trigeminal (CNV) Pons

Foramen
Skull: Superior Orbital Fissure

Branches
Meningeal, Frontal, Lacrimal and Nasocilliary

Type of Impulse
General Motor (efferent) General Sensory (afferent)

Nucleus Name
Principal Spinal

Nucleus Location
Pons Medulla

Symptom/Signs of Damage
Facial aneasthesia Loss of pain sensation

Function
Sensation from dura, nasal mucosa and beneath eye, side of nose, cheek, lip, upper teeth, hard palate and mastication

Mesencephalic Pons/midbrain Insignificant Motor Pons Weakness/loss of mastication

Ophthalmic (CNV1)

Skull: Superior Meningeal, Orbital Fissure Frontal, Lacrimal Other: Supraorbital and Nasocilliary Foramen, Anterior and Posterior Ethmoidal Foramina Skull: Foramen Rotundum Other: Inferior Orbital Fissure, Infraorbital Foramen
Meningeal, Infraorbital, Posterior and Anterior Superior Alveolar Branches, Zygmoatic, Sensory Roots to Pterygopalantine Ganglion and Greater and Lesser Palantine

General Sensory (afferent)

Maxillary (CNV2)

General Sensory (afferent)

Mandibular (CNV3)

Skull: Foramen Ovale Other: Mandibular Foramen

Meningeal, Auriculotemporal, Buccal, Lingual and Inferior Alveolar

General Sensory (afferent) General Motor (efferent)

Figure 2 Sensory branches of Trigeminal nerve.

Cranial Nerve
Abducens (CNVI) Anterior Margin of Pons Facial (CNVII) Pons (cerebellopontine angle) above olive

Foramen
Skull: Superior Orbital Fissure

Branches
Muscular Branches

Type of Impulse
General Motor (efferent)

Nucleus Name
Abducens

Nucleus Location
Pons

Symptom/Signs of Damage

Function

Medial eye deviation Eye movement (lateral rectus) (Abduction)

Skull: Internal Auditory Meatus Other: Facial Canal, Hiatus of Facial Canal, Stylomastoid Foramen Internal acoustic canal facial canal stylomastoid foramen. Skull: Internal Auditory Meatus via internal acoustic canal.

Greater Petrosal Nerve, Chorda Tympani (Auricular Branch), Facial Branches and Cervical Branches

Special and General Sensory (afferent) General and Parasympathetic Motor (efferent)

Motor Solitary Superior salivatory

Pons Pons Pons

Paralysis of facial nerve muscles Loss of taste (anterior 2/3rds of tongue) Dry mouth, loss of lacrimation

Facial expresssion Taste Salivation, lacrimation

Vestibulocochlear (CN VIII) Lateral to CNVII (cerebellopontine angle)

None

General Sensory (afferent)

Vestibular

Medulla

Dysequilibrium, Nystagmus Hearing Loss of taste (posterior 1/3rd) Insignificant

Balance

Cochlear Muscular Branches, Auricular Branch, Lingual Branch, Branch to Carotid Body and Sinus, Tympanic Branch and Lesser Petrosal General and Special Sensory (afferent) General and Parasympathetic Motor (efferent) Nucleus ambiguus Inferior salivary Solitary

Medulla Medulla

Hearing Taste

Glossopharyngeal Skull: Jugular Foramen (CN IX) Medulla

Medulla

Salivation

Medulla

Loss of gag reflex

Innervation of pharynx, sensation from carotid and aortic bodies and carotid and aortic sinuses.

Cranial Nerve

Foramen

Branches
Palatopharyngeal Branch, Superior Laryngeal Branch, Recurrent Laryngeal Branch, Carotid Sinus Nerve, Cardiac, Pulmonary, Gastric, Renal, Hepatic, Pancreatic, Small Intestine and Large Intestine Branches Muscular Branches

Type of Impulse
Sensory (afferent) Motor (efferent)

Nucleus Name
Nucleus ambiguus Dorsal motor vagal Solitary

Nucleus Location
Medulla

Symptom/Signs of Damage
Dysphagia & hoarseness of voice

Function
Swallowing & talking (palatoglossus)

Skull: Jugular Vagus (X) Foramen Posterolateral Sulcus of Medulla

Medulla Insignificant Cardiac, GI tract, Medulla Loss of cough reflex (larynx/pharynx), loss of taste (hard palate) Respiration, taste, sensation from carotid and aortic bodies and carotid and aortic sinuses.

Cranial Accessory (XI) Spinal accessory Cranial and Spinal Roots Hypoglossal (XII) Medulla

Skull: Jugular Foramen Other: Foramen Magnum

Motor (efferent)

Nucleus ambiguus Spinal accessory

Medulla

Insignificant

Pharynx/larynx muscles. Cranial branch overlaps with vagal functions. Neck & shoulder movement Tongue movement, except palatoglossus.

Cervical cord

Head turning/shoulder shrugging weakness Atrophy of tongue muscles, deviation on protrusion, fasciculaations

Skull: Hypoglossal Foramen via hypoglossal canal

Muscular Branches

General Motor (efferent)

Hypoglossal

Medulla

Trigeminal, glossopharyngeal and vagus derive from 1st, 2nd, 3rd and 4th branchial arches. Parasympathetic preganglionic pathways run with ciliary, glossopharyngeal and vagus nerves. In the head, the ganglia are associated with branches of the trigeminal nerve. GANGLION Ciliary Pteryogopalatine Submandibular Otic Vagal PREGANGLIONIC PATH Oculomotor Facial Facial Glossopharyngeal Vagus LOCATION Ophthalmic branch of trigeminal Maxillary branch of trigeminal Mandibular branch of trigeminal Mandibular branch of trigeminal Associated with target organs

Anatomy of the Cranial Nerves

Figure 3 Olfactory Nerve (CN I) passing through cribriform plate of ethmoid bone

Figure 4 Optic Nerve (CN II).

Figure 5 Oculomotor Nerve (CN III).

Figure 7 Trigeminal Nerve and its branches (CN V).

Figure 6 Trochlear Nerve (CN IV).

Anatomy of the Cranial Nerves

Figure 8 Abducens Nerve (CNVI).

Figure 9 Facial Nerve (CNVII).

Figure 10 Vestibulocochlear Nerve (CN VIII)

Anatomy of the Cranial Nerves

Figure 11 Glossopharyngeal Nerve and branches (CN IX)

Figure 12 Vagus Nerve (CN X).

Anatomy of the Cranial Nerves

Figure 13 Accessory Nerve with Cranial (joins Vagus) and Spinal branches. The cranial branch is often considered part of the vagus, while the spinal branch is considered the accessory nerve (CN XI) proper.

Figure 14 Hypoglossal Nerve (CN XII).

Anatomy of the Cranial Nerves

Anatomy of the Cranial Nerves (Inferior View)

LOCALISING STROKE LESIONS