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Problem Based ApproachDr. Gregory Budiman
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
Sensory nerve Motor nerve
Peripheral Nervous System
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
Intracranial protection : MENINGES
Epidural space (potential)
Subdural space (potential)
Subarachnoid space (actual)
What is the contain of subarachnoid space?
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
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
V.I-II – V.III – V.IV
Granulatio arachnoidales Pachioni
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 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.cerebelli inferior anterior
a.cerebelli inferior posterior
Look at the picture of motor homonculus
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?
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?
Primary visual cortex
Secondary visual cortex (association area)
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!g[email protected]://scele.ui.ac.id fakultas kedokteran
modul neuroscience (neuroanatomi) by Deswaty F, M.Biomed