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Neuroanatomy Crash Course

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Neuroanatomy Crash Course Neuroanatomy Crash Course Jens Vikse ∙ Bendik Myhre ∙ Danielle Mellis Nilsson ∙ Karoline Hanevik Illustrated by: Peder Olai Skjeflo Holman ​ Second edition October 2015 The autonomic nervous system ● Division of the autonomic nervous system …………....……………………………..………….…………... 2 ● Effects of parasympathetic and sympathetic stimulation…………………………...……...……………….. 2 ● Parasympathetic ganglia ……………………………………………………………...…………....………….. 4 Cranial nerves ● Cranial nerve reflexes ………………………………………………………………….…………..…………... 7 ● Olfactory nerve (CN I) ………………………………………………………………….…………..…………... 7 ● Optic nerve (CN II) ……………………………………………………………………..…………...………….. 7 ● Pupillary light reflex …………………………………………………………………….…………...………….. 7 ● Visual field defects ……………………………………………...................................…………..………….. 8 ● Eye dynamics …………………………………………………………………………...…………...………….. 8 ● Oculomotor nerve (CN III) ……………………………………………………………...…………..………….. 9 ● Trochlear nerve (CN IV) ………………………………………………………………..…………..………….. 9 ● Trigeminal nerve (CN V) ……………………………………………………................…………..………….. 9 ● Abducens nerve (CN VI) ………………………………………………………………..…………..………….. 9 ● Facial nerve (CN VII) …………………………………………………………………...…………..………….. 10 ● Vestibulocochlear nerve (CN VIII) …………………………………………………….…………...…………. 10 ● Glossopharyngeal nerve (CN IX) …………………………………………….……….…………...………….. 10 ● Vagus nerve (CN X) …………………………………………………………..………..…………...………….. 10 ● Accessory nerve (CN XI) ……………………………………………………...………..…………..………….. 11 ● Hypoglossal nerve (CN XII) …………………………………………………..………..…………...………….. 11 Tracts of the spinal cord ……………………………………………….....................…………..………….. 11 ​ ​ Other high­yields ● Cranial nerve nuclei ……...……...……...……...……...……...……...……...………...…………..………….. 15 ● Innervation of larynx ……...……...……...……...……...……...……...……...…………………….………….. 16 ● Recurrent laryngeal nerve ……...……...……...……...……...……...……...………….………….………….. 16 ● Phrenic nerve ……...……...……...……...……...……...……...……...……...………..…………..………….. 16 ● Tongue innervation ……...……...……...……...……...……...……...……...……...….…………..………….. 16 ● Vagal (CN X) nuclei ……...……...……...……...……...……...……...……...……………………..………….. 16 ● Aqueous humor ……...……...……...……...……...……...……...……...……...………………….………….. 16 ● Paranasal sinuses and nasolacrimal duct ……...……...……...……...……...……….…………..…………. 17 ● Colliculi and geniculate bodies ……...……...……...……...……...……...……...…….…………..…………..17 ● Superior cervical ganglia ……...……...……...……...……...……...……...……..…….…………..…………. 17 ● Meninges and spaces ……...……...……...……...……...……...……...……...……….………….………….. 17 ● Structures associated with spinal cord ……...……...……...……...……...…………..…………..………….. 17 ● Cerebrospinal fluid ……...……...……...……...……...……...……...……...……...…..…………..………….. 17 ● Choroid plexus ……...……...……...……...……...……...……...……...……...……….…………..………….. 18 ● Cerebral circulation ……...……...……...……...……...……...……...……...………………………..………. 18 ● Common tendinous ring ……...……...……...……...……...……...……...……...…….………….…………...20 High­yield review questions ……………………………………………………………………………….. 21 ​ 1 THE AUTONOMIC NERVOUS SYSTEM (ANS) The ANS ONLY affects smooth muscle, cardiac muscle and glands (involuntary). ​ ​ EFFECTS OF PARASYMPATHETIC & SYMPATHETIC STIMULATION Parasympathetic (PSANS) Sympathetic (SANS) Eye Pupils constrict (miosis) Pupils dilate (mydriasis) Salivary gland Watery secretion Thick, viscous secretion Heart rate (HR) ⬇ HR ⬆ HR and contractile strength ​ ​ Lungs Bronchoconstriction Bronchodilation Liver/gallbladder Emission of bile Release of sugar Bladder Urination Urination blocked 2 PARASYMPATHETIC STIMULATION (Rest and Digest) ​ SYMPATHETIC STIMULATION (Fight or Flight) ​ 3 PARASYMPATHETIC GANGLIA 4 5 6 CRANIAL NERVE REFLEXES Afferent = sensory // Efferent = Effector (motor/parasympathetic) ​ ​ ​ ​ Afferent (sensory) limb Efferent (Effector) limb ​ ​ ​ Pupillary light II (optic) III (oculomotor)1 ​ Corneal (blink) V1 (ophthalmic division of trigeminal) VII (facial)2 ​ Jaw jerk V3 (mandibular division of trigeminal) V3 (mandibular division of trigeminal) Gag IX (glossopharyngeal) X (vagus) Cough X (vagus) X (vagus) 1 ​ Parasympathetic fibers from Edinger­Westphal nucleus of CN III (travels to ciliary ganglion → sphincter mm) ​ ​ 2 ​ Orbicularis oculi (innervated by facial nerve) closes the eye CRANIAL NERVES (CN) Nerve components: sensory (S) +/­ motor (M) +/­ parasympathetic (PSANS) CN I: Olfactory nerve ● Olfaction (smell): the only sense that is NOT relayed by thalamus ● Exits skull through cribriform plate of ethmoid bone CN II: Optic nerve ● Vision ● Afferent limb of pupillary light reflex ● Exits skull through optic canal (optic canal: optic nerve, ophthalmic artery) ​ ​ Pupillary light reflex ­ pathway ● Ipsilateral optic nerve (CN II) ­ afferent limb ​ ● Ipsilateral pretectal nucleus ● BILATERAL Edinger­Westphal nucleus (PSANS nucleus of CN III) ​ ● Bilateral oculomotor nerves (CN III) ­ efferent limb ​ ● Bilateral ciliary ganglia ● Bilateral short ciliary nerves ● Result: BOTH (bilateral) eyes constricts (miosis) ​ ​ 7 Visual field defects Eye dynamics ● Extraocular muscle innervation: SO4LR6R3 ​ ​ ​ ​ ​ ​ ​ ○ Superior Oblique = CN4, Lateral Rectus = CN6; Rest = CN3 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ● Oblique muscles (sup/inf) moves eye in Opposite direction (superior moves eye DOWN) ​ ​ ​ ​ ● Parasympathetic (PSANS) fibers cause constriction of the pupil (sympathetic: dilation) ​ ​ 8 CN III: Oculomotor nerve (CNs with parasympathetic fibers: III, VII, IX, X) ​ ● Eye movements: all except SO and LR (SO4LR6R3) ​ ​ ​ ​ ​ ​ ​ ​ ○ Superior rectus, inferior rectus, medial rectus, inferior oblique, levator palpebrae ● Efferent limb of pupillary light reflex ○ PSANS fibers from EW nucleus causes pupillary constriction ● Exits the skull through superior orbital fissure (SOF: III, IV, V1, VI, ophthalmic vein) ​ ​ ​ ​ ​ ​ ​ ​ ● Lesion to CN III: ○ Pupil looks down and out (unopposed lateral rectus (CN VI) and superior oblique (CN IV)) ○ Ptosis (loss of innervation of levator palpebrae) ○ “Blown pupil” (dilated pupil due to loss of PSANS fibers from EW nucleus of CN III) CN IV: Trochlear nerve ● Innervates superior oblique, which moves the eye DOWN (SO4LR6R3) ​ ​ ​ ​ ​ ​ ​ ​ ● The only nerve that exits from the dorsal aspect of the brainstem ● Exits the skull through superior orbital fissure (SOF: III, IV, V1, VI, ophthalmic vein) ​ ​ ​ ​ ​ ​ ​ ​ CN V: Trigeminal nerve (V1 = ophthalmic; V2 = maxillary; V3 = mandibular) ● Afferent limb of corneal (blink) reflex (V1) ● Afferent AND efferent limbs of jaw jerk reflex (V3) ● Innervates muscles of mastication (V3): ○ teMporalis, Masseter, Medial pterygoid Moves the mandible up ​ ​ ​ ​ ​ ​ ​ ​ ○ Lateral pterygoid Lowers the mandible ​ ​ ​ ● SENSATION from anterior ⅔ of tongue (V3) ­ (NB: taste = CN VII) ● SENSATION from face (V1, V2 and V3) ­ (NB: muscles of facial expression = CN VII) Mnemonic (where the divisions of CN V exits the skull): Scandale Royal Orgy ​ ​ ​ ​ ​ ​ ● V1 (ophthalmic): Superior orbital fissure (SOF: III, IV, V1, VI, ophthalmic vein) ​ ​ ​ ​ ● V2 (maxillary): foramen Rotundum ​ ​ ● V3 (mandibular): foramen Ovale ​ ​ CN VI: Abducens nerve ● Innervates lateral rectus (SO4LR6R3) ​ ​ ​ ​ ​ ​ ​ ​ ● Exits the skull through superior orbital fissure (SOF: III, IV, V1, VI, ophthalmic vein) ​ ​ ​ ​ ​ ​ ​ ​ 9 CN VII: Facial nerve (CNs with parasympathetic fibers: III, VII, IX, X) ​ ● Efferent limb of corneal (blink) reflex (orbicularis oculi mm) ● Muscles of facial expression ● TASTE from anterior ⅔ of tongue (chorda tympani) ­ (NB: sensation = CN V3) ​ ​ ● Innervation of all glands EXCEPT parotid gland (parotid gland: CN IX) ○ Submandibular, sublingual, lacrimal gland, nasal gland, palatine gland ○ Note: facial nerve passes THROUGH parotid gland, but does not innervate it ​ ■ In parotid gland, the facial nerve gives off its terminal branches ● Innervates stapedius muscle of inner ear ● Nerves in cerebellopontine angle: CN VII and CN VIII ● Path: internal acoustic meatus → facial canal → stylomastoid foramen ​ ● UMN lesion: contralateral paralysis of lower face ● LMN lesion (Bell’s palsy): ipsilateral paralysis of upper & lower face Terminal branches of facial nerve (from superior to inferior): To Zanzibar By Motor Car ● Temporal, Zygomatic, Buccal, Marginal mandibular, Cervical ​ ​ ​ ​ ​ ​ ​ ​ ​ Chorda tympani ● Path: facial canal (from CN VII) → between malleus & incus → petrotympanic fissure ​ ● Contains: ○ Preganglionic parasympathetic fibers (synapse on submandibular ganglion) ○ Somatic visceral afferent fibers from anterior ⅔ of tongue (taste) CN VIII: Vestibulocochlear nerve ● Nerves in cerebellopontine angle: CN VII and CN VIII CN IX: Glossopharyngeal nerve (CNs with parasympathetic fibers: III, VII, IX, X) ​ ● Afferent limb of gag reflex (efferent: CN X) ● Sensation AND taste from posterior ⅓ of tongue ​ ​ ● Innervation of parotid gland (NB: all other glands = CN VII) ● Exits skull through jugular foramen (jugular foramen = IX, X, XI) ​ ​ CN X: Vagus nerve (CNs with parasympathetic fibers: III, VII, IX, X) ​ ● Efferent limb of gag reflex ● Afferent AND efferent limb of cough reflex ● Taste and sensation from epiglottis ● Talking, coughing, swallowing ● Parasympathetic innervation to organs in thorax and abdomen ​ ● Sensation AND taste from epiglottis + sensation from carotid and aortic bodies ​ ​ ● Innervation of larynx (recurrent laryngeal nerve) ● Midline uvula (lesion → uvula deviates to contralateral side) ​ ​ ● Exits skull through jugular foramen (jugular foramen = IX, X, XI) ​ ​ 10 CN XI: Accessory nerve ● Innervates
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