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HUMAN NEURO ANATOMY
JAMES R. AUGUSTINE School of Mediane
University of South Carolina Columbia, South Carolina
AMSTERDAM • BOSTON • HEIDELBERG • LONDON • NEW YORK • OXFORD
PARIS • SAN DIEGO • SAN FRANCISCO • SINGAPORE • SYDNEY • TOKYO
ELSEVIER Academic Press is an imprint of Elsevier
Contents
V
Preface xv
Chapter 1: Introduction to the Nervous System 3
1.1. Neurons 4 1.1.1. NeuronaTCell Body (Soma) 4 1.1.2. AxonHillo,ck 5 1.1.3. Neuronal Processes - Axons
and Dendrites 5 1.2. Classification of Neurons 6
1.2.1. Neuronal Classification by Function 6 1.2.2. NeuronalClassification byNumber
of Processes 6 1.3. The Synapse 7
1.3.1. Components of a Synapse 8 1.3.2. Neurotransmitters and
Neuromodulators 8 1.3.3. Neuronal Plasticity 8 1.3.4. The Neuropil 9
1.4. Neuroglial Cells 9 1.4.1. Neuroglial Cells differ from Neurons 9 1.4.2. Identification of Neuroglia 9 1.4.3. Neuroglial Function 10 1.4.4. Neuroglial Cells and Aging 11
1.5. Axonal Transport 11 1.5.1. Functions of Axonal Transport 12 1.5.2. Defective Axonal Transport 12
1.6. Degeneration and Regeneration 12 1.6.1. Axon or Retrograde Reaction 13 1.6.2. Anterograde Degeneration 13 1.6.3. Retrograde Degeneration 14 1.6.4. Regeneration of Peripheral Nerves 14 1.6.5. Regeneration and Neurotrophic
Factors 16 1.6.6. Regeneration in the Central Nervous
System 16 1.7. Neural Transplantation 16 Further Reading 17
Chapter 2: Development of the Nervous System 19
2.1. First Week of Development (Fertilization, Free Blastocyst, Attaching Blastocyst) 20 2.1.1. Fertilization 20 2.1.2. From Two Cells to the Free Blastocyst 20
2.2. Second Week of Development (Implantation, Primitive Streak Appears, Three Layers of Cells) 20 2.2.1. Implantation and the Appearance of
Two Distinct Layers of Cells 20 2.2.2. Primitive Streak and a Third Layer
of Cells Appear 22 2.3. Third Week of Development (Neural
Plate, Groove, and Folds, Three Main Divisions of the Brain) 22 2.3.1. Primitive Node and Notochordal
Process Appear 22 2.3.2. Neural Plate, Groove, Folds and
Neuromeres Appear 23 2.3.3. Three Main Divisions of the Brain
Identifiable 24 2.3.4. Mesencephalic Flexure Appears 24
2.4. Fourth Week of Development (Neural Tube Forms and Closes, Neural Crest Formation Continues) 24 2.4.1. Formation of the Neural Tube 24 2.4.2. Rostral and Caudal Neuropores
Remain Temporarily Open 24 2.4.3. Neural Crest Cells Emerge 24 2.4.4. Neural Canal - the Future
Ventricular System 26 2.4.5. Neuropores Close and the Closed
Neural Tube is Filled with Fluid 26 2.4.6. Cervical Flexure Present 26
2.5. Fifth Week of Development (Five Subdivisions of the Brain Identifiable) 27 2.5.1. Simple Tube Transforms into
Complex Organ System 27
VI CONTENTS
2.5.2. Five Subdivisions of the Brain Appear 27 2.5.3. Brain Vesicles vs. Brain Regions 27
2.6. Vulnerability of the Developing Nervous System 28
2.7. Congenital Malformations of the Nervous System 29 2.7.1. Spinal Dysraphism 29 2.7.2. Anencephaly 30
Further Reading 31
Chapter 3: The Spinal Cord 33
3.1. Embryological Considerations 33 3.1.1. Layers of the Developing Spinal Cord 34 3.1.2. Formation of Ventral Gray Columns
and Ventral Roots 34 3.1.3. Formation of Dorsal Gray Columns 35 3.1.4. Dorsal and Ventral Horns vs. Dorsal
and Ventral Gray Columns 35 3.1.5. Development of Neural Crest Cells 36 3.1.6. The Framework of the Adult Cord is
Present at Birth 36 3.2. Gross Anatomy 36
3.2.1. Spinal Cord Weight and Length 36 3.2.2. Spinal Segments, Regions, and
Enlargements 36 3.2.3. Spinal Segments in Each Region are of
Unequal Length 37 3.2.4. Conus Medullaris, Filum Terminale,
and Cauda Equina 37 3.2.5. Termination of the Adult Spinal Cord [ 3.2.6. Differential Rate of Growth: Vertebral
Column vs. the Spinal Cord 38 3.2.7. Relationship between Spinal Segments
and Vertebrae 38 3.3. Nuclear Groups - Gray Matter 39
3.3.1. General Arrangement of Spinal Cord Gray Matter 39
3.3.2. Gray Matter at Enlargement Levels 39 3.3.3. Spinal Laminae 39 3.3.4. Dorsal Hörn 40 3.3.5. Lateral Hörn 40 3.3.6. Ventral Hörn 40
3.4. Functional Classes of Neurons 41 3.4.1. Four Classes of Neurons in the
Spinal Cord 41 3.4.2. General Somatic vs. General Visceral
Afferent Neurons 41 3.4.3. General Somatic vs. General Visceral
Efferent Neurons 41 3.4.4. Some Ventral Root Axons are Sensory
3.5. Funiculi/Fasciculi/Tracts - White Matter 42 3.6. Spinal Reflexes 43 3.7. Spinal Meninges and Related Spaces 44
3.7.1. Spinal Dura Mater 44 3.7.2. Spinal Arachnoid 45 3.7.3. Spinal Pia Mater 45
3.8. Spinal Cord Injury 45 3.8.1. Transverse Hemisection of the
Spinal Cord (Brown-Sequard Syndrome) 45
3.8.2. Syringomyelia 46 3.9. Blood Supply to the Spinal Cord 46 Further Reading 46
Chapter 4: The Brain Stern 49
4.1. External Features 49 4.1.1. Medulla Oblongata 49 4.1.2. Pons 51 4.1.3. Midbrain 52
4.2. Cerebellum and Fourth Ventricle 52 4.2.1. Cerebellum 52 4.2.2. Fourth Ventricle 52
4.3. Organization of Brain Stern Neuronal Columns 53 4.3.1. Functional Components of the
Cranial Nerves 55 4.3.2. Efferent Columns 55 4.3.3. Afferent Columns 55
4.4. Internal Features 57 4.4.1. Endogenous Substances 57 4.4.2. Medulla Oblongata 57 4.4.3. Pons 61 4.4.4. Midbrain 65
Further Reading 68
Chapter 5: The Forebrain 71
5.1. Telencephalon 71 5.1.1. Telencephalon Medium 71 5.1.2. Cerebral Hemispheres 72 5.1.3. Basal Nuclei 77 5.1.4. Rhinencephalon 79
5.2. Diencephalon 79 5.2.1. Epithalamus 79 5.2.2. Thalamus 79 5.2.3. Subthalamus 79 5.2.4. Hypothalamus 80
5.3. Cerebral White Matter 80 Further Reading 80
CONTENTS Vll
Chapter 6: Introduction to Ascending Sensory Paths 83
6.1. Receptors 83 6.2. Classification of Receptors by Modality 84
6.2.1. Mechanoreceptors 84 6.2.2. Thermoreceptors 85 6.2.3. Nociceptors 85 6.2.4. Chemoreceptors 86 6.2.5. Photoreceptors 86 6.2.6. Osmoreceptors 86
6.3. Sherrington's Classification of Receptors 86 6.3.1. Exteroceptors 87 6.3.2. Interoceptors 87 6.3.3. Proprioceptors 87
6.4. Structural Classification of Receptors 87 6.4.1. Free Nerve Endings 87 6.4.2. Endings in Hair Follicles 87 6.4.3. Terminal Endings of Nerves 88 6.4.4. Neurotendinous Spindles 90 6.4.5. Neuromuscular Spindles 90
6.5. Reflex Circuits 91 6.5.1. The Monosynaptic Reflex 91 6.5.2. Complex Reflexes 91
6.6. General Sensory Paths 92 6.6.1. Classification of Sensory Paths by
Function 92 6.7. Organization of General Sensory
Paths 92 6.7.1. Receptors 92 6.7.2. Primary Neurons 92 6.7.3. Secondary Neurons 94 6.7.4. Thalamic Neurons 94 6.7.5. Cortical Neurons 94 6.7.6. Modulation of Sensory Paths 94
Further Reading 95
Chapter 7: Paths for Pain and Temperature 97
7.1. Path for Superficial Pain and Temperature from the Body 98 7.1.1. Modalities 99 7.1.2. Receptors 99 7.1.3. Primary Neurons 100 7.1.4. Secondary Neurons 101 7.1.5. Position of the Lateral Spinothalamic
Tract in the Brain Stern 102 7.1.6. Thalamic Neurons 102 7.1.7. Cortical Neurons 103 7.1.8. Modulation of Painful and Thermal
Impulses 105
7.2. Path for Visceral Pain from the Body 105 7.2.1. Modalities and Receptors 106 7.2.2. Primary Neurons 107 7.2.3. Secondary Neurons 107 7.2.4. Thalamic Neurons 109 7.2.5. Cortical Neurons 109 7.2.6. Suffering Accompanying Pain 109 7.2.7. Visceral Pain as Referred Pain 110 7.2.8. Transection of Fiber Bundles to
Relieve Intractable Pain 111 7.3. The Trigeminal Nuclear Complex 111
7.3.1. Organization of the Trigeminal Nuclear Complex 111
7.3.2. Organization of Entering Trigeminal Sensory Fibers 112
7.4. Path for Superficial Pain and Thermal Extremes from the Head 112 7.4.1. Modalities and Receptors 112 7.4.2. Primary Neurons 113 7.4.3. Secondary Neurons 115 7.4.4. Thalamic Neurons 115
7.5. Path for Thermal Discrimination from the Head 116 7.5.1. Modality and Receptors 116 7.5.2. Primary Neurons 117 7.5.3. Secondary Neurons 117 7.5.4. Thalamic Neurons 117 7.5.5. Cortical Neurons 117
7.6. General Somatic Afferent Components ofVILIXandX 118
7.7. Trigeminal and Other Neuralgias 119 7.7.1. Causes of Trigeminal Neuralgia 119 7.7.2. Methods of Treatment for Trigeminal
Neuralgia 119 7.8. Glossopharyngeal Neuralgia 120 Further Reading 120
Chapter 8: Paths for Touch, Pressure, Proprioception, and Vibration 123
8.1. Path for General Tactile Sensation from the Body 123 8.1.1. Modalities and Receptors 124 8.1.2. Primary Neurons 124 8.1.3. Secondary Neurons 124 8.1.4. Thalamic Neurons 124
8.2. Path for Tactile Discrimination, Pressure, Proprioception, and Vibration from the Body 124 8.2.1. Modalities and Receptors 126 8.2.2. Primary Neurons 129 8.2.3. Secondary Neurons 131
CONTENTS
8.2.4. Thalamic Neurons 134 8.2.5. Cortical Neurons 135 8.2.6. Spinal Cord Stimulation for the
Relief of Pain 137 8.3. Path for Tactile I^crirnination from the Head 138
8.3.1. Modalities and Receptors 138 8.3.2. Primary Neurons 138 8.3.3. Secondary Neurons 138 8.3.4. Thalamic Neurons 139 8.3.5. Cortical Neurons 140
8.4. Path for General Tactile Sensation from the Head 141 8.4.1. Modalities and Receptors 141 8.4.2. Primary Neurons 141 8.4.3. Secondary Neurons and Their
Central Processes 141 8.4.4. Thalamic Neurons 142
8.5. Path for Proprioception, Pressure, and Vibration from the Head 143 8.5.1. Modalities and Receptors 143 8.5.2. Primary Neurons 143 8.5.3. Secondary Neurons 143 8.5.4. Thalamic Neurons 143 8.5.5. Cortical Neurons 143
8.6. Trigeminal Motor Component 144 8.7. Certain Trigeminal Reflexes 145
8.7.1. Mandibular, Masseter, or 'Jaw-Closing' Reflex 145
8.7.2. Corneal Reflex 146 Further Reading 146
10.1.3. Internal Ear 164 10.2. The Ascending Auditory Path 166
10.2.1. Modality and Receptors 166 10.2.2. Primary Neurons 167 10.2.3. Secondary Neurons 167 10.2.4. Tertiary Neurons 169 10.2.5. Inferior Collicular Neurons 169 10.2.6. Thalamic Neurons 169 10.2.7. Cortical Neurons 170 10.2.8. Comments 172
10.3. Descending Auditory Connections 172 10.3.1. Electrical Stimulation of
Cochlear Efferents 173 10.3.2. Autonomie Fibers to the Cochlea 173
10.4. Injury to the Auditory Path 173 10.4.1. Congenital Loss of Hearing 173 10.4.2. Decoupling of Stereocilia 174 10.4.3. Tinnitus 174 10.4.4. Noise-Induced Loss of Hearing 174 10.4.5. Aging and the Loss of Hearing 175 10.4.6. Unilateral Loss of Hearing 175 10.4.7. Injury to the Inferior Colliculi 175 10.4.8. Unilateral Injury to the Medial
Geniculate Body or Auditory Cortex 175 10.4.9. Bilateral Injury to the Primary
Auditory Cortex 175 10.4.10. Auditory Seizures - Audenes 176
10.5. Cochlear Implants 176 10.6. Auditory Brain Stern Implants 176 Further Reading 176
Chapter 9: The Reticular Formation 149
9.1. Structural Aspects 149 9.1.1. Reticular Nuclei in the Medulla 150 9.1.2. Reticular Nuclei in the Pons 153 9.1.3. Reticular Nuclei in the Midbrain 154
9.2. Ascending Reticular System 155 9.3. Descending Reticular System 158 9.4. Functional Aspects of the Reticular Formation 158
9.4.1. Consciousness 158 9.4.2. Homeostatic Regulation 159 9.4.3. Visceral Reflexes 160 9.4.4. Motor Function 160
Further Reading 161
Chapter 10: The Auditory System 163
10.1. Gross Anatomy 163 10.1.1. ExternalEar 163 10.1.2. MiddleEar 163
Chapter 11: The Vestibulär System 179
11.1 Gross Anatomy 179 11.1.1. Internal Ear 179
11.2. The Ascending Vestibulär Path 181 11.2.1. Modalities and Receptors 181 11.2.2. Primary Neurons 184 11.2.3. Secondary Neurons 186 11.2.4. Thalamic Neurons 187 11.2.5. Cortical Neurons 188
11.3. Other Vestibulär Connections 190 11.3.1. Primary Vestibulocerebellar Fibers 190 11.3.2. Vestibulär Nuclear Projections to
the Cerebellum 190 11.3.3. Vestibulär Nuclear Projections to
the Spinal Cord 190 11.3.4. Vestibulär Nuclear Projections to
Nuclei of the Extraocular Muscles 192 11.3.5. Vestibulär Nuclear Projections to
the Reticular Formation 192
CONTENTS IX
11.3.6. Vestibulär Projections to the Contralateral Vestibulär Nuclei 193
11.4. The Efferent Component of the Vestibulär System 193
11.5. Afferent Projections to the Vestibulär Nuclei 193 11.6. Vertigo 193
11.6.1. Physiological Vertigo 194 11.6.2. Pathological Vertigo 194
Further Reading 195
Chapter 12: The Visual System 199
12.1. Retina 199 12.1.1. Pigment Layer 199 12.1.2. Neural Layer 200 12.1.3. Other Retinal Elements 200 12.1.4. Special Retinal Regions 201 12.1.5. Retinal Areas 202 12.1.6. Visual Fields 202
12.2. Visual Path 204 12.2.1. Receptors 204 12.2.2. Primary Retinal Neurons 205 12.2.3. Secondary Retinal Neurons 205 12.2.4. Optic Nerve [II] 207 12.2.5. Optic Chiasma - the Union of Both
Intracranial Optic Nerves 208 12.2.6. Optic Tract 209 12.2.7. Thalamic Neurons 209 12.2.8. Optic Radiations 210 12.2.9. Cortical Neurons 211
12.3. Injuries to the Visual System 214 12.3.1. Retinal Injuries 214 12.3.2. Injury to the Optic Nerve 214 12.3.3. Chiasmal Injuries 215 12.3.4. Injuries to the Optic Tract 215 12.3.5. Injury to the Lateral Geniculate Body 215 12.3.6. Injuries to the Optic Radiations 216 12.3.7. Injuries to the Visual Cortex 216
Further Reading 217
Chapter 13: Ocular Movements and Visual Reflexes 219
13.1. Ocular Movements 219 13.1.1. Primary Position of the Eyes 219
13.2. Conjugate Ocular Movements 220 13.2.1. Miniature Ocular Movements 220 13.2.2. Saccades 220 13.2.3. Smooth Pursuit Movements 221 13.2.4. Vestibulär Movements 221
13.3. Extraocular Muscles 221 13.4. Innervation of the Extraocular Muscles 222
13.4.1. Abducent Nucleus and Nerve 223 13.4.2. Trochlear Nucleus and Nerve 224 13.4.3. Oculomotor Nucleus and Nerve 225
13.5. Anatomical Basis of Conjugate Ocular Movements 227
13.6. Medial Longitudinal Fasciculus 228 13.7. Vestibulär Connections Related to Ocular
Movements 229 13.7.1. Vestibulär Connections Related to
Horizontal Ocular Movements 229 13.7.2. Vestibulär Nystagmus 229 13.7.3. Doll's Ocular Movements 230 13.7.4. Vestibulär Connections Related to
Vertical Ocular Movements 231 13.8. Injury to the Medial Longitudinal Fasciculus 231 13.9. Injury to the Vestibulär Nuclei 231 13.10. The Reticular Formation and Ocular
Movements 232 13.11. Congenital Nystagmus 232 13.12. Ocular Bobbing 233 13.13. Examination of the Vestibulär System 233 13.14. Visual Reflexes 234
13.14.1. The Light Reflex 235 13.14.2. The Near Reflex 236 13.14.3. Pupillary Dilatation 236 13.14.4. The Lateral Tectotegmentospinal
Tract 237 13.14.5. Pupillary Pain Reflex and the
Spinotectal Tract 238 13.14.6. The Afferent Pupillary Defect
(Marcus Gunn Pupillary Sign) 238 Further Reading 238
Chapter 14: The Thalamus 241
14.1. Introduction 241 14.2. Nuclear Groups of the Thalamus 245
14.2.1. Anterior Nuclei and the Lateral Dorsal Nucleus 245
14.2.2. Intralaminar Nuclei 246 14.2.3. Medial Nuclei 247 14.2.4. Median Nuclei 248 14.2.5. Metathalamic Body and Nuclei 249 14.2.6. Posterior Nuclear Complex 250 14.2.7. Pulvinar Nuclei and Lateral
Posterior Nucleus 250 14.2.8. Reticular Nucleus 251 14.2.9. Ventral Nuclei 251
14.3. Injuries to the Thalamus 254
CONTENTS
14.4. Mapping the Human Thalamus 255 14.5. Stimulation of the Human Thalamus 255 14.6. The Thalamus as a Neurosurgical Target 256 Further Reading 256
Chapter 15: The Motor System: Part 1 - Lower Motoneurons and the Pyramidal System 259
15.1. Regions Involved in Motor Activity 259 15.2. Lower Motoneurons 260
15.2.1. Terms Related to Motor Activity 260 15.2.2. Lower Motoneurons in the
Spinal Cord 260 15.2.3. Activation of Motoneurons 261 15.2.4. Lower Motoneurons in the Brain Stern 261 15.2.5. Injury to Lower Motoneurons 263 15.2.6. Examples of Lower Motoneuron
Disorders 263 15.3. Pyramidal System 263
15.3.1. Corticospinal Component 263 15.3.2. Corticobulbar Component 270 15.3.3. Clinical Neuroanatomical Correlation 274
Further Reading 274
Chapter 16: The Motor System: Part 2 - The Extrapyramidal System and Cerebellum 277
16.1. Extrapyramidal System 277 16.1.1. Extrapyramidal Motor Cortex 278 16.1.2. Basal Nuclei 279 16.1.3. Äfferents to the Basal Nuclei 282 16.1.4. Cortical-striatal-pallidal-thalamo-
cortical Circuits 282 16.1.5. Multisynaptic Descending Paths 282 16.1.6. Common Discharge Paths 283 16.1.7. Somatotopic Organization of the
Basal Nuclei 283 16.2. Cerebellum 283
16.2.1. External Features of the Cerebellum 284 16.2.2. Cerebellar Cortex 286 16.2.3. Deep Cerebellar Nuclei 287 16.2.4. Cerebellar White Matter 287
16.3. Input to the Cerebellum through the Peduncles 287 16.3.1. Inferior Cerebellar Peduncle 287 16.3.2. Middle Cerebellar Peduncle 288 16.3.3. Superior Cerebellar Peduncle 288
16.4. Input to the Cerebellum 289 16.4.1. Incoming Fibers to the
Cerebellum 289 16.5. Cerebellar Output 289
16.5.1. Output from the Fastigial Nuclei 289 16.5.2. Output from the Globose and
Emboliform Nuclei 290 16.5.3. Output from the Dentate Nuclei 290
16.6. Cerebellar Circuitry 290 16.7. Common Discharge Paths 290 16.8. Cerebellar Functions 291
16.8.1. Motor Functions of the Cerebellum 291
16.8.2. Nonmotor Functions of the Cerebellum 291
16.8.3. Studies Involving the Human Cerebellum 291
16.8.4. Localization in the Cerebellum 291 16.9. Manifestations of Injuries to the
Motor System 291 16.9.1. Injury to the Premotor Cortex 291 16.9.2. Injuries to the Basal Nuclei 292 16.9.3. Injury to the Subthalamic
Nucleus 294 16.9.4. Injury to the Cerebellum 294 16.9.5. Localization of Cerebellar
Damage 295 16.10. Decorticate Versus Decerebrate
Rigidity 296 16.10.1. Decerebrate Rigidity 296 16.10.2. Decorticate Rigidity 296
16.11. Epilogue 296 Further Reading 296
Chapter 17: The Olfactory and Gustatory Systems 299
17.1. The Olfactory System 299 17.1.1. Receptors 300 17.1.2. Primary Neurons 300 17.1.3. Olfactory Fila and the Olfactory
Nerve 300 17.1.4. Olfactory Bulb - Secondary
Olfactory Neurons 300 17.1.5. Olfactory Stalk 301 17.1.6. Medial Stria 301 17.1.7. LateralStria 301 17.1.8. Thalamic Neurons 302 17.1.9. Cortical Neurons 302 17.1.10. Efferent Olfactory Connections 303
CONTENTS
17.1.11. Injuries to the Olfactory System 303
17.2. The Gustatory System 304 17.2.1. Receptors 304 17.2.2. Primary Neurons 306 17.2.3. Secondary Neurons 308 17.2.4. The Ascending Gustatory Path 308 17.2.5. Thalamic Neurons 308 17.2.6. Cortical Neurons 309 17.2.7. Injuries to the Gustatory System 309
Further Reading 310
Chapter 18: The Limbic System 313
18.1. Historical Aspects 313 18.2. Anatomy of the Limbic System 314
18.2.1. Olfactory System 314 18.2.2. Septal Area 315 18.2.3. Mamillary Bodies of the
Hypothalamus 315 18.2.4. Anterior Nuclei of the
Thalamus 315 18.2.5. The Hippocampal Formation 315 18.2.6. The Amygdaloid Body 316 18.2.7. Cingulate Gyrus and Cingulum 318 18.2.8. Cortical Areas 318
18.3. Cyclic Paths of the Limbic System 318 18.4. Synaptic Organization of Human
Limbic System 320 18.5. Descending Limbic Paths 320 18.6. Functional Aspects of the Human
Limbic System 321 18.6.1. Emotion 321 18.6.2. Memory 322
18.7. Limbic System Disorders 322 18.8. Injuries to Limbic Constituents 323
18.8.1. Septal Area 323 18.8.2. Hippocampal Formation 323 18.8.3. Amygdaloid Body 323 18.8.4. Seizures Involving the Limbic
System 323 18.9. Psychosurgery of the Limbic System 323
18.9.1. Drug Resistant Epilepsy 324 18.9.2. Violent, Aggressive, or Restless
Behaviors 324 18.9.3. Schizophrenia 324 18.9.4. Intractable Pain 324 18.9.5. Psychiatric Disorders and Abnormal
Behavior 324 Further Reading 324
Chapter 19: The Hypothalamus 327
19.1. Hypothalamic Regions 328 19.2. Hypothalamic Zones 329 19.3. Hypothalamic Nuclei 330
19.3.1. Anterior Hypothalamic Region 330 19.3.2. Dorsal Hypothalamic Region 330 19.3.3. Intermediate Hypothalamic Region 332 19.3.4. Lateral Hypothalamic Area 332 19.3.5. Posterior Hypothalamic Region 332 19.3.6. Posterior Nucleus of the
Hypothalamus 333 19.4. Fiber Connections 333
19.4.1. Medial Forebrain Bündle 333 19.4.2. Stria Terminalis 333 19.4.3. Fornix 333 19.4.4. Diencephalic Periventricular
System (DPS) 333 19.4.5. Dorsal Longitudinal Fasciculus 333 19.4.6. Anterior and Posterior
Hypothalamotegmental Tracts 334 19.4.7. Pallidohypothalamic Tract 334 19.4.8. Mamillothalamic Tract 334 19.4.9. Hypothalamo-hypophyseal Tract 334 19.4.10. Vascular Connections 334
19.5. Functions of the Hypothalamus 334 19.5.1. Water Balance - Water Intake
and Loss 334 19.5.2. Eating - Food Intake 335 19.5.3. Temperature Regulation 335 19.5.4. Autonomie Regulation 335 19.5.5. Emotional Expression 335 19.5.6. Wakefulness and Sleep
(Biological Rhythms) 336 19.5.7. Control of the Endocrine System 336 19.5.8. Reproduction 336
Further Reading 336
Chapter 20: The Autonomie Nervous System 339
20.1 Historical Aspects 339 20.2. Structural Aspects 340
20.2.1. Location of Autonomie Neurons of Origin 340
20.2.2. Manner of Distribution of Autonomie Fibers 341
20.2.3. Termination of Autonomie Fibers 342 20.3. Comparison of the Somatic Efferents
and Visceral Efferents 343 20.4. General Visceral Afferents 345
CONTENTS
20.5. Regulation of the Autonomie Nervous System 346
20.6. Disorders of the Autonomie Nervous System 346
Further Reading 347
Chapter 21: General Features of the Cerebral Hemispheres 349
21.1. Facts and Figures 349 21.2. Cortical Neurons 350 21.3. Cortical Lay er s 351 21.4. Cortical Columns (Microarchitecture) 352 21.5. Functional Aspects of the Cerebral
Cortex 353 21.6. Cerebral Dominance, Lateralization, and
Asymmetry 353 21.7. Frontal Lobe 353
21.7.1. Primary Motor Cortex 353 21.7.2. Premotor Cortex 354 21.7.3. Supplementary Motor Area (SMA) 355 21.7.4. Cingulate Motor Areas 355 21.7.5. Frontal Eye Fields 355 21.7.6. Motor Speech Region 356 21.7.7. Prefrontal Cortex 356
21.8. Parietal Lobe 357 21.8.1. Primary Somatosensory
Cortex (SI) 358 21.8.2. Secondary Somatosensory
Cortex 360 21.8.3. Superior Parietal Lobule 361 21.8.4. Inferior Parietal Lobule: Language
Areas 361 21.8.5. Primary Vestibulär Cortex (2v) 362 21.8.6. Mirror Representation of Others'
Actions 362 21.8.7. Preoccipital Areas Involved in
Following Ocular Movements 362 21.9. Occipital Lobe 363
21.9.1. Primary Visual Cortex (VI) 363 21.9.2. Secondary Visual Cortex 363
21.10. Temporal Lobe 363 21.10.1. Primary Auditory Cortex (AI) 364 21.10.2. Wernicke's Region 364 21.10.3. Temporal Vestibulär Cortex 364 21.10.4. Midtemporal Areas Related to
Memory 365 21.10.5. Anomia 365 21.10.6. Prosopagnosia 365 21.10.7. Psychomotor Seizures 365
21.11. Insular Lobe 366
21.12. Aphasia 366 21.12.1. Historie Aspects of Aphasia 367 21.12.2. Broca's Aphasia 367 21.12.3. Wernicke's Aphasia 368 21.12.4. Conductive Aphasia 368 21.12.5. Global Aphasia 368
21.13. Alexia 368 21.14. Apraxia 368 21.15. Gerstmann's Syndrome 369 21.16. Agnosia 369 21.17. Dyslexia 369 Further Reading 369
Chapter 22: Blood Supply to the Central Nervous System 373
22.1. Cerebral Circulation 373 22.2. Aortic Arch, Brachiocephalic Trunk, and
Subclavian Vessels 374 22.3. Vertebral-Basilar Arterial System 374
22.3.1. Branches of the Vertebral Arteries 375 22.4. Blood Supply to the Spinal Cord 376
22.4.1. Extramedullary Vessels 376 22.4.2. Intramedullary Vessels 379 22.4.3. Spinal Veins 380
22.5. Blood Supply to the Brain Stern and Cerebellum 380 22.5.1. Extrinsic or Superficial Branches 380 22.5.2. Branches of the Basilar Arteries 382 22.5.3. Intrinsic or Penetrating Branches 383 22.5.4. Classical Brain Stern Syndromes 385
22.6. Common Carotid Artery 386 22.6.1. External Carotid Artery 386 22.6.2. Internal Carotid Artery: Cervical,
Petrous, and Cavernous Parts 387 22.7. Blood Supply to the Cerebral
Hemispheres 387 22.7.1. Internal Carotid Artery:
Cerebral Part 387 22.7.2. Branches of the Internal
Carotid Artery 388 22.7.3. Posterior Cerebral Artery and its
Cerebral Supply 391 22.8. Cerebral Arterial Circle 392
22.8.1. Types of Arteries Supplying the Brain 392
22.9. Embryological Considerations 392 22.10. Vascular Injuries 392
22.10.1. Brain Stern Vascular Injuries 393 22.10.2. Visualization of Brain Vessels 393
Further Reading 393
CONTENTS xiu
Chapter 23: The Meninges, Ventricular Syst« and Cerebrospinal Fluid 395
23.1. The Cranial Meninges and Related Spai 23.1.1. Cranial Dura Mater 395 23.1.2. Cranial Arachnoid 395 23.1.3. Cranial Pia Mater 398 23.1.4. Dural Projections 398 23.1.5. Intracranial Herniations 399
23.2. Ventricular System 400 23.2.1. Introduction 400 23.2.2. Lateral Ventricles 400
23.2.3. Third Ventricle 401 23.2.4. Aqueduct of Midbrain 402 23.2.5. Fourth Ventricle 402
395 23.3. Cerebrospinal Fluid 403 Further Reading 403
References 406
Index 461
Recommended