Problem Based ApproachDr. Gregory Budiman

NEUROANATOMY

The aim of the lecture :To help instantly understood neuroanatomy

that is essential to this moduleTo give summary of clinically relevant

neuroanatomy with examples of medical cases.Stephen Goldberg : Most lecturers provide far

more detail than is necessary to applied anatomy. As a result student becomes confused by mazes of unimportant structures.

What to do :Before discussion : Watch and study the

DVD :Gross NeuroanatomyBasic Neuronatomical PathwaysJaras-jaras Neuroanatomi

During the discussionUse Basic Neuroanatomical Pathways

(Gregory) and Clinical Neuroanatomy (Snell) as references

How can impulse be transmitted in our body? (physiology)

What structures supports the transmission of the impluse in our body?

Central nervous system

BRAIN

Spinal cord

Ascending tracts

Descending tracts

Sensory nerve Motor nerve

Receptor effector

Peripheral Nervous System

Aff Eff

mesencephalon

pons

Medulla oblongata

Diencephalon (thalamus)

Telencephalon

What happen if your head got injured?Subcutaneus haematomEpidural haematomSubdural hameatomSubarachnoid bleeding/haemorrhage

Protection of CNS :

Extracranial protection :SCALP :

1. Skin :

2. Connective tissue: contains a/v/n

3. Aponeurosis (Galea aponeurotica): tendon of frontal and occipital epicranius

4. Loose connective tissue : enabling movement of the above layer

5. Periosteum

Intracranial protection : MENINGES

duramater

arachnoid

piamater

periosteal

meningeal

Epidural space (potential)

Subdural space (potential)

Subarachnoid space (actual)

What is the contain of subarachnoid space?

Sinus duramatris

Epidural Haematom : occurred when a.meningea media is ruptured. The blood will fill the epidural space

Subdural haematom : occurred when bridging vein (connects cerebral vein to sinus sagitalis superior) is ruptured..

Subarachnoid bleeding : occurred when an aneurism of large artery of the brain is ruptured. The blood fills the subarachnoid space usually no space occupying lesion (SOL)

Intracerebral haemorrhage (cerebrovascular accident) occurred when small branch of artery is ruptured.

Have you seen a newborn baby with a very big head? What do you think that cause this

abnormality?

Ventricles (located inside the brain)

Lateral ventricles are located in cerebral hemispheres and have several horns

•Anterior horn (frontal lobe)

•Posterior horn (occipital lobe)

•Inferior horn (temporal lobe)

Third ventricle : located in thalamus

Aquaductus cerebri Sylvii (cerebral aquaduct)

Fourth ventricle foramen luscha and foramen Magendie

Central canal : along the spinal cord but usually undergo obliteration

 

* On the wall of each ventricle there are choroidal plexus which produce cerebrospinal fluid/CSF

CSF circulation

Choroid plexus

V.I-II – V.III – V.IV

Subarachnoid space

Granulatio arachnoidales Pachioni

Sinus duramatris

Sinus duramatris

1. Falx cerebri

2. Falx cerebelli .

3. Tentorium cerebelli

4. Diafragma sellae5. Sinus sagitalis superior6. Sinus sagitalis inferior7. Vena cerebri magna Galeni8. Sinus rectus9. Confluen sinuum10. Sinus transversus11. Sinus sigmoid12. Vena jugularis13. Sinus perosus superior 14. Sinus petrosus inferior15. Sinus cavernosus16. Vena ophtalmica17. Menghub. Sinus sphenoparietalis18. Lacuna lateralis19. Vena emissaria20. granulatio aracnoidales

In case of meningitis or encephalitis we should examine the CSF.

How can we get sample of CSF?

The extension of subarachnoid space (cystern)

•Cisterna cerebellomedullaris (cisterna magna) – occipital puncture danger

•Cisterna pontis

•Cisterna interpeduncularis (basalis)

•Cisterna lumbalis – lumbal puncture (LIII/IV or LIV/V)

Homework:At what level of vertebral bone whould we

puncture to get CSF sample in a baby?

You know that if a patient get cerebrovascular accident he usually get paralysis. However, can you explain why patient A get arm and facial paralysis meanwhile patient B get leg paralysis only. How can it be?

a.carotis internaa.cerebri

anterior

a.communicans anterior

a.cerebri media

a.cerebri posterior

a.communicans posterior

a.basilaris

a.cerebelli superior

a.cerebelli inferior anterior

a.cerebelli inferior posterior

a.basilaris

a.vertebralis

L

A

H

Look at the picture of motor homonculus

LA

H

Homework :Can infection of orbital or facial region

affect the brain?Patient A got paralysis of arm, leg, and face

on the left side. What area was probably affected?

Mr. X fell down in the bathroom and got paralysis of his left arm and left leg. His facial muscles also got paralysis on the right side! Thus, the facial muscles got paralysis on the right side meanwhile the limb muscle got paralysis on the left side.

Where is the location of the affected area?Cerebral cortex – brainstem – spinal cord?

lesion

Mr. Y ride a motorcycle in a very long distance. After he got off his bike he found that his facial muscle was retracted to the left side. He couldn’t close his right eye. What happen to Mr.Y?

Homework :Mr. Z got cerebrovascular accident.

According to the attendant physician, he got an infarction at the area of left internal capsule.What limbs would get paralysis?Could he close his both eyes?To what side his face should be retracted?If he ordered to protrude his tongue, to what

side the tongue would move?

Mr. A, fell down the stairs and got a back injury. He complained that his right leg up to his right belly under the navel was numb. It was proven by the absence of pain when the doctor pinched the skin of the affected vigorously. When he was ordere to lift his two legs, he could only lift his right leg meanwhile his left leg was paralized.

According to the attending doctor Mr. Amir got hemisection of the spinal cord.Which segment of the spinal cord was

injured?Mention the injured pathways!What were the result of the reflect

examination of the patient?What were the results of the discriminative

tactile examination of his both leg?

One day, Anto watched a horror film. When he saw a murderer killed the victim, Anto’s face became pale, sweated very much, and his heartbeat increased.

Can you explain how the visual impulse can be interpreted and influence the autonomic nervous system?

Visual impulse

Primary visual cortex

Secondary visual cortex (association area)

Limbic system

hypothalamus

anterior posterior

Sympathetic division

Craniosacral outflow

Parasympathetic division

Thoracolumbal outflow

A physician found that Mr.Heru got pupillary constriction, slight ptosis, and decreased sweating. The patient had a history of pancoast tumor, tumor that affect the apex of the lung.

What do you think to be the cause of the symptoms?

Lecture on peripheral nervous system and its clinical aspects will be given in musculoskeletal module.

Thank You!gregorybudiman@yahoo.comhttp://scele.ui.ac.id fakultas kedokteran

modul neuroscience (neuroanatomi) by Deswaty F, M.Biomed