The Human Brain and Spinal Cord The Human Brain and Spinal Cord Functional Neuroanatomy and Dissection Guide

Lennart Heimer, M.D. Department of Neurology University of Virginia

With 213 Illustrations Mostly in Color

Springer-Verlag New York Heidelberg Berlin Lennatt Heimer, M.D. Department of Neurology University of Virginia Charlottesville, Virginia 22908, U.S.A.

Sponsoring Editor: Marie Low Production: William J. Gabello

The figure on the front cover is Fig. 25. The venous sinuses and the veins of the head, (p. 40).

Library of Congress Cataloging in Publication Data Heimer, Lennart. The human brain and spinal cord. Includes index. 1. Brain-Anatomy. 2. Spinal cord-Anatomy. 3. Human dissection. I. Title. [DNLM: 1. Dissection. 2. Central nervous system. WL 101 H467m] QM455.H4 1983 611'.8 82-19665 ISBN-13: 978-0-387-90740-6

@ 1983 by Springer-Verlag New York Inc. All rights reserved. No part of this book may be translated or reproduced in any form without written permission from Springer-Verlag, 175 Fifth Avenue, New York, New York 10010, U.S.A. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone.

Typeset by Kingsport Press, Kingsport, Tennessee

9 8 7 6 5 432 1

ISBN-13: 978-0-387-90740-6 e-ISBN-13: 978-1-4684-0150-9 DOl: 10.10071978-1-4684-0150-9 To Hanne-Bjorg, Hakon, Mikael, Gosta, and Knut Contents

Preface ix

Acknowledgments xi

I. Introduction 1. Basic Design and Terminology 3 2. Development of the Nervous System 9 3. Meninges and Cerebrospinal Fluid 37

II. Dissection of the Brain Introduction 51 First Dissection 53 Meninges and Subarachnoid Cisterns; Superficial Arteries; Vertebral• Basilar System; Internal Carotid System; Basal Surface, and Cranial Nerves 53 Second Dissection 65 Midsagittal Section; Lobes, Sulci, and Gyri 65 Third Dissection 75 White Matter; Blunt Dissection of Major Fiber Systems 75 Fourth Dissection 85 Ventricular System, Fornix, and Basal Ganglia 85 Fifth Dissection 97 Fourth Ventricle; Cerebellum; Brain Stem 97 Sixth Dissection 111 Atlas of the Brain: Frontal, Sagittal, and Horizontal Brain Sections; Anatomical Correlation of Computerized Brain Tomography 111

III. Functional Neuroanatomy 4. Neurohistology and Neuroanatomic Techniques 127 5. The Spinal Cord 151 6. Ascending Sensory Pathways 165 7. The Lower Motor Neuron and the Descending Supraspinal Pathways 183 8. Basal Ganglia 199 9. Cerebellum 211 10. Brain Stem, Reticular Formation, and Monoaminergic Pathways 225 11. Cranial Nerves 237 viii CONTENTS

12. Auditory System 261 13. Visual System 271 14. Olfactory System 287 15. Hypothalamus and the Hypothalamohypophysial System 295 16. The Autonomic Nervous System 309 17. Amygdaloid Body, Hippocampal Formation, and "Limbic System" 321 18. Thalamus 331 19. Cerebral Cortex 337 20. Neuronal Transmitters and Modulators 353 21. Cerebrovascular System 357

Epilogue 375

Appendix 377

Index 391 Preface

This book was written to serve both as a guide for the dissection of the human brain and as an illustrated compendium of the functional anatomy of the brain and spinal cord. In this sense, the book represents an updated and expanded version of the book The Human Brain and Spinal Cord written by the author and published in Swedish by Scandinavian University Books in 1961. The complicated anatomy of the brain can often be more easily appreciated and understood in relation to its development. Some insight about the coverings of the brain will also make the brain dissections more meaningful. Introductory chapters on these subjects constitute Part I of the book. Part 2 is composed of the dissection guide, in which text and illustrations are juxtaposed as much as possible in order to facilitate the use of the book in the dissection room. The method of dissection is similar to dissection proce• dures used in many medical schools throughout the world, and variations of the technique have been published by several authors including Ivar Broman in the "Manniskohjarnan" (The Human Brain) published by Gleerups F6rlag, Lund, 1926, and Laszlo Komaromy in "Dissection of the Brain," published by Akademiai Kiado, Budapest, 1947. The great popularity of the CT scanner justifies an extra laboratory session for the comparison of nearly horizontal brain sections with matching CT scans. Since there is a tendency to rely heavily on expensive audiovisual aids in medical education, it seems especially important to promote the dissection of the human brain. No brain model or TV movie can match the efficiency of brain dissections in teaching the gross anatomy of the brain, and it is usually possible to secure a certain number of human brains at most medical schools. It seems important to emphasize, however, that a systematic description of the topographic anatomy of the brain is all the more important if brains cannot be obtained for dissection. With this in mind, the dissection guide has been richly illustrated and can be used as an introductory gross anatomy text without dissecting· the brain. Part 3 constitutes an illustrated account of the functional anatomy of the major parts and systems of the brain and spinal cord. Many of the schematic illustrations in part 3 have been modeled after the more elaborate drawings in Part 2, and they can be best appreciated on the basis of a reasonable understand• ing of the gross anatomy of the brain as outlined in the dissection guide. Consider• ing the clinical importance of cerebrovascular diseases, the blood supply of the brain is discussed separately in the last chapter. Physiologic, chemical and pharmacologic aspects have been briefly discussed whenever appropriate, but no effort has been made to introduce the basics of these subjects. The clinical relevance of neuroanatomy has been emphasized x PREFACE by including "Clinical Notes" at the end of each chapter, and some commonly seen disorders of the nervous system have been presented in the form of "Clinical Examples" in order to prepare the medical student for the practice of medicine. Many of the "Clinical Examples" have been illustrated with appropriate CT scans or angiograms. The reading lists at the end of the chapters do not pretend to be complete; they are presented as an encouragement for further studies, and they include some of the larger medical school texts, in which the various subjects are more fully discussed. Figures of the distribution of the peripheral nerve, finally, have been included in an appendix. It is my hope that the book will serve a useful purpose in almost any type of neuroscience education. It should fortify and complement related studies in basic and clinical neuroscience.

Lennart Heimer Acknowledgements

Many of my friends and colleagues have been kind enough to read one or several of the chapters, and it is with a great deal of gratitude that I acknowledge the help of Drs. Shirley Bayer, Theodore Blackstad, Anders Bjorklund, Irving Diamond, Bjorn Folkow, Ann Graybiel, Gunnar Grant, Gary Van Hoesen, Anders Lundberg, Eugene Millhouse, Enrico Mugnaini, UlfNorsell, Alan Peters, Jim Petras, Jan Voogd, and Torsten Wiesel. Colleagues at the University of Virginia, including Drs. George Alheid, Robert Cantrell, Fritz Dreifuss, John Jane, Ivan Login, Leon Morris, Edwin Rubel, and Richard Winn, have also been very helpful, and I would like to acknowledge specifically Dr. James Bennett, who was kind enough to prepare the "Clinical Examples" and Dr. James Q. Miller, who revised the "Clinical Notes." The carbon dustings in the dissection guide were prepared by Mrs. Florence Kabir, who spared herself no effort in preparing for the final artwork. Some of the other drawings were prepared by Mrs. Jane Gordon and Mr. Hnos Kalmanfi. The photographs from various planes of myelin stained sections of the human brain, which appear in the dissection guide, were taken by Mr. Paul Reimann and Dr. Gary Van Hoesen from material in the Yakovlev Collection at the Armed Forces Institute of Pathology in Washington. I would like to thank Dr. Paul Yakovlev for collecting this magnificent material and Mr. Mohamad Haleem for making it easily accessible. Drs. Victor Haughton and Michael Wolff of the Radiology Department of the Medical College of Wisconsin supplied most of the CT scans, whereas Dr. Leon Morris of the Radiology Department of the University of Virginia furnished the angiograms. It has been a great pleasure to collaborate with the competent staff of Springer Verlag in New York.