Unit 11 Cranial Nerves, Spinal Cord, and Reflexes
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Cranial Nerves
Cranial Nerves (1,5,7,8,9,10,11 and 12) Slides not included 9th and 10th Cranial 11th and 12th Cranial 8th Cranial Nerve 5th and 7th Cranial 1st Cranial Nerve Nerves Nerves Nerves (3,7,11,12,13,21,23,24) - (10,16) (12,23) Slides included: (14 to 17) *Slides that are not included mostly are slides of summaries or pictures. Nouf Alabdulkarim. Med 435 Olfactory Nerve [The 1st Cranial Nerve] Special Sensory Olfactory pathway 1st order neuron Receptors Axons of 1st order Neurons Olfactory receptors are specialized, ciliated nerve cells The axons of these bipolar cells 12 -20 fibers form the that lie in the olfactory epithelium. true olfactory nerve fibers. Which passes through the cribriform plate of ethmoid → They join the olfactory bulb Preliminary processing of olfactory information It is within the olfactory bulb, which contains interneurones and large Mitral cells; axons from the latter leave the bulb to form the olfactory tract. nd 2 order neuron • It is formed by the Mitral cells of olfactory bulb. • The axons of these cells form the olfactory tract. • Each tract divides into 2 roots at the anterior perforated substance: Lateral root Medial root Carries olfactory fibers to end in cortex of the Uncus & • crosses midline through anterior commissure adjacent part of Hippocampal gyrus (center of smell). and joins the uncrossed lateral root of opposite side. • It connects olfactory centers of 2 cerebral hemispheres. • So each olfactory center receives smell sensation from both halves of nasal cavity. NB. Olfactory pathway is the only sensory pathway which reaches the cerebral cortex without passing through the Thalamus . -
Intramedullary Cystic Lesions Ofthe Conus Medullaris
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.31.2.106 on 1 April 1968. Downloaded from J. Neurol. Neurosurg. Psychiat., 1968, 31, 106-109 Intramedullary cystic lesions of the conus medullaris SAMI I. NASSAR, JAMES W. CORRELL, AND EDGAR M. HOUSEPIAN From the Department of Neurosurgery, College ofPhysicians and Surgeons, Columbia University, and the Neurological Institute of the Columbia-Presbyterian Medical Center, New York, U.S.A. Intramedullary cystic lesions of the conus medullaris of the aetiology, these cysts may simulate the clinical are rare. Although an extensive literature describes picture of syringomyelia. syringomyelia as being a frequent basis for cystic The cases of cysts of the conus medullaris re- cervico-thoracic lesions it is apparent that this ported here simulated the clinical picture of does not occur frequently in the lumbosacral region syringomyelia, tumour, or lumbar disc disease. (Kirgis and Echols, 1949; Netsky, 1953; Rand and The radiographic findings in each case were inter- Rand, 1960; Love and Olafson, 1966). Poser (1956), preted as indicating the presence ofan intramedullary in a review of 234 cases of syringomyelia, found tumour. The correct diagnosis was made in each that the cavity extended into the lumbosacral region case only at operation. in only 12-6% and in only five cases were the Protected by copyright. cavities restricted to the lumbosacral segments. Some authors (Thevenard, 1942; Andre, 1951) CASE REPORTS question the occurrence of syringomyelia in the lower spinal cord. Nevertheless a high incidence CASE 1 (F.T., NO. 179 16 92) A 22-year-old negro male of constitutional defects has been noted among was admitted complaining of weakness and pain in the syringomyelia patients and members of their legs for three years. -
Gluteal Region-II
Gluteal Region-II Dr Garima Sehgal Associate Professor King George’s Medical University UP, Lucknow Structures in the Gluteal region • Bones & joints • Ligaments Thickest muscle • Muscles • Vessels • Nerves Thickest nerve • Bursae Learning Objectives By the end of this teaching session Gluteal region –II all the MBBS 1st year students must be able to: • Enumerate the nerves of gluteal region • Write a short note on nerves of gluteal region • Describe the location & relations of sciatic nerve in gluteal region • Enumerate the arteries of gluteal region • Write a short note on arteries of gluteal region • Enumerate the arteries taking part in trochanteric and cruciate anastomosis • Write a short note on trochanteric and cruciate anastomosis • Enumerate the structures passing through greater sciatic foramen • Enumerate the structures passing through lesser sciatic foramen • Enumerate the bursae in relation to gluteus maximus • Enumerate the structures deep to gluteus maximus • Discuss applied anatomy Nerves of Gluteal region (all nerves in gluteal region are branches of sacral plexus) Superior gluteal nerve (L4,L5, S1) Inferior gluteal nerve (L5, S1, S2) FROM DORSAL DIVISIONS Perforating cutaneous nerve (S2,S3) Nerve to quadratus femoris (L4,L5, S1) Nerve to obturator internus (L5, S1, S2) FROM VENTRAL DIVISIONS Pudendal nerve (S2,S3,S4) Sciatic nerve (L4,L5,S1,S2,S3) Posterior cutaneous nerve of thigh FROM BOTH DORSAL &VENTRAL (S1,S2) & (S2,S3) DIVISIONS 1. Superior Gluteal nerve (L4,L5,S1- dorsal division) 1 • Enters through the greater 3 sciatic foramen • Above piriformis 2 • Runs forwards between gluteus medius & gluteus minimus • SUPPLIES: 1. Gluteus medius 2. Gluteus minimus 3. Tensor fasciae latae 2. -
Split Spinal Cord Malformations in Children
Split spinal cord malformations in children Yusuf Ersahin, M.D., Saffet Mutluer, M.D., Sevgül Kocaman, R.N., and Eren Demirtas, M.D. Division of Pediatric Neurosurgery, Department of Neurosurgery, and Department of Pathology, Ege University Faculty of Medicine, Izmir, Turkey The authors reviewed and analyzed information on 74 patients with split spinal cord malformations (SSCMs) treated between January 1, 1980 and December 31, 1996 at their institution with the aim of defining and classifying the malformations according to the method of Pang, et al. Computerized tomography myelography was superior to other radiological tools in defining the type of SSCM. There were 46 girls (62%) and 28 boys (38%) ranging in age from less than 1 day to 12 years (mean 33.08 months). The mean age (43.2 months) of the patients who exhibited neurological deficits and orthopedic deformities was significantly older than those (8.2 months) without deficits (p = 0.003). Fifty-two patients had a single Type I and 18 patients a single Type II SSCM; four patients had composite SSCMs. Sixty-two patients had at least one associated spinal lesion that could lead to spinal cord tethering. After surgery, the majority of the patients remained stable and clinical improvement was observed in 18 patients. The classification of SSCMs proposed by Pang, et al., will eliminate the current chaos in terminology. In all SSCMs, either a rigid or a fibrous septum was found to transfix the spinal cord. There was at least one unrelated lesion that caused tethering of the spinal cord in 85% of the patients. -
Cranial Nerve Palsy
Cranial Nerve Palsy What is a cranial nerve? Cranial nerves are nerves that lead directly from the brain to parts of our head, face, and trunk. There are 12 pairs of cranial nerves and some are involved in special senses (sight, smell, hearing, taste, feeling) while others control muscles and glands. Which cranial nerves pertain to the eyes? The second cranial nerve is called the optic nerve. It sends visual information from the eye to the brain. The third cranial nerve is called the oculomotor nerve. It is involved with eye movement, eyelid movement, and the function of the pupil and lens inside the eye. The fourth cranial nerve is called the trochlear nerve and the sixth cranial nerve is called the abducens nerve. They each innervate an eye muscle involved in eye movement. The fifth cranial nerve is called the trigeminal nerve. It provides facial touch sensation (including sensation on the eye). What is a cranial nerve palsy? A palsy is a lack of function of a nerve. A cranial nerve palsy may cause a complete or partial weakness or paralysis of the areas served by the affected nerve. In the case of a cranial nerve that has multiple functions (such as the oculomotor nerve), it is possible for a palsy to affect all of the various functions or only some of the functions of that nerve. What are some causes of a cranial nerve palsy? A cranial nerve palsy can occur due to a variety of causes. It can be congenital (present at birth), traumatic, or due to blood vessel disease (hypertension, diabetes, strokes, aneurysms, etc). -
The Development of the Epidural Space in Human Embryos
Folia Morphol. Vol. 63, No. 3, pp. 273–279 Copyright © 2004 Via Medica O R I G I N A L A R T I C L E ISSN 0015–5659 www.fm.viamedica.pl The development of the epidural space in human embryos Magdalena Patelska-Banaszewska, Witold Woźniak Department of Anatomy, University School of Medical Sciences, Poznań, Poland [Received 25 April 2004; Accepted 25 June 2004] The epidural space is seen in embryos at stage 17 (41 days) on the periphery of the primary meninx. During stage 18 (44 days) the dura mater proper appears and the epidural space is located between this meninx and the perichondrium and contains blood vessels. During the last week of the embryonic period (stages 20–23) the epidural space is evident around the circumference of the spinal cord. On the posterior surface it is found between the dura mater and the me- soderm of the dorsal body wall. Key words: human neuroembryology, primary meninx, epidural space INTRODUCTION horizontal, frontal, and sagittal planes and stained The epidural space lies between the spinal dura according to various methods (chiefly Mallory, hae- mater and the periosteum of the vertebral canal. This matoxylin and eosin and with silver salts). In some periosteum is formed by the outer endosteal layer embryos graphic reconstructions were prepared at of the dura mater. The epidural space contains loose each of the stages investigated. connective tissue, venous plexuses and adipose tis- sue, which is particularly evident in the lumbar re- RESULTS gion [8]. There is some evidence that it is only a po- The primordium of the epidural space appears in tential space [2]. -
What to Expect After Having a Subarachnoid Hemorrhage (SAH) Information for Patients and Families Table of Contents
What to expect after having a subarachnoid hemorrhage (SAH) Information for patients and families Table of contents What is a subarachnoid hemorrhage (SAH)? .......................................... 3 What are the signs that I may have had an SAH? .................................. 4 How did I get this aneurysm? ..................................................................... 4 Why do aneurysms need to be treated?.................................................... 4 What is an angiogram? .................................................................................. 5 How are aneurysms repaired? ..................................................................... 6 What are common complications after having an SAH? ..................... 8 What is vasospasm? ...................................................................................... 8 What is hydrocephalus? ............................................................................... 10 What is hyponatremia? ................................................................................ 12 What happens as I begin to get better? .................................................... 13 What can I expect after I leave the hospital? .......................................... 13 How will the SAH change my health? ........................................................ 14 Will the SAH cause any long-term effects? ............................................. 14 How will my emotions be affected? .......................................................... 15 When should -
CHAPTER 8 Face, Scalp, Skull, Cranial Cavity, and Orbit
228 CHAPTER 8 Face, Scalp, Skull, Cranial Cavity, and Orbit MUSCLES OF FACIAL EXPRESSION Dural Venous Sinuses Not in the Subendocranial Occipitofrontalis Space More About the Epicranial Aponeurosis and the Cerebral Veins Subcutaneous Layer of the Scalp Emissary Veins Orbicularis Oculi CLINICAL SIGNIFICANCE OF EMISSARY VEINS Zygomaticus Major CAVERNOUS SINUS THROMBOSIS Orbicularis Oris Cranial Arachnoid and Pia Mentalis Vertebral Artery Within the Cranial Cavity Buccinator Internal Carotid Artery Within the Cranial Cavity Platysma Circle of Willis The Absence of Veins Accompanying the PAROTID GLAND Intracranial Parts of the Vertebral and Internal Carotid Arteries FACIAL ARTERY THE INTRACRANIAL PORTION OF THE TRANSVERSE FACIAL ARTERY TRIGEMINAL NERVE ( C.N. V) AND FACIAL VEIN MECKEL’S CAVE (CAVUM TRIGEMINALE) FACIAL NERVE ORBITAL CAVITY AND EYE EYELIDS Bony Orbit Conjunctival Sac Extraocular Fat and Fascia Eyelashes Anulus Tendineus and Compartmentalization of The Fibrous "Skeleton" of an Eyelid -- Composed the Superior Orbital Fissure of a Tarsus and an Orbital Septum Periorbita THE SKULL Muscles of the Oculomotor, Trochlear, and Development of the Neurocranium Abducens Somitomeres Cartilaginous Portion of the Neurocranium--the The Lateral, Superior, Inferior, and Medial Recti Cranial Base of the Eye Membranous Portion of the Neurocranium--Sides Superior Oblique and Top of the Braincase Levator Palpebrae Superioris SUTURAL FUSION, BOTH NORMAL AND OTHERWISE Inferior Oblique Development of the Face Actions and Functions of Extraocular Muscles Growth of Two Special Skull Structures--the Levator Palpebrae Superioris Mastoid Process and the Tympanic Bone Movements of the Eyeball Functions of the Recti and Obliques TEETH Ophthalmic Artery Ophthalmic Veins CRANIAL CAVITY Oculomotor Nerve – C.N. III Posterior Cranial Fossa CLINICAL CONSIDERATIONS Middle Cranial Fossa Trochlear Nerve – C.N. -
Acute Cauda Equina Syndrome Following Orthopedic Procedures As a Result of Epidural Anesthesia Lisa B
OPEN ACCESS Editor: Nancy E. Epstein, MD SNI: Spine For entire Editorial Board visit : Winthrop Hospital, Mineola, http://www.surgicalneurologyint.com NY, USA Case Report Acute cauda equina syndrome following orthopedic procedures as a result of epidural anesthesia Lisa B. E. Shields1, Vasudeva G. Iyer2, Yi Ping Zhang1, Christopher B. Shields1,3 1Norton Neuroscience Institute, Norton Healthcare, 2Neurodiagnostic Center of Louisville, 3Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA E‑mail: Lisa B. E. Shields ‑ [email protected]; Vasudeva G. Iyer ‑ [email protected]; Yi Ping Zhang ‑ [email protected]; *Christopher B. Shields ‑ [email protected] *Corresponding author Received: 29 December 17 Accepted: 15 January 18 Published: 10 April 18 Abstract Background: Cauda equina syndrome (CES) is a rare complication of spinal or epidural anesthesia. It is attributed to direct mechanical injury to the spinal roots of the cauda equina that may result in saddle anesthesia and paraplegia with bowel and bladder dysfunction. Case Description: The first patient underwent a hip replacement and received 5 mL of 1% lidocaine epidural anesthesia. Postoperatively, when the patient developed an acute CES, the lumbar magnetic resonance imaging (MRI) scan demonstrated clumping/posterior displacement of nerve roots of the cauda equina consistent with adhesive arachnoiditis attributed to the patient’s previous L4‑L5 lumbar decompression/ fusion. The second patient underwent spinal anesthesia (injection of 10 mg of isobaric Access this article online bupivacaine for an epidural block) for a total knee replacement. When the patient Website: www.surgicalneurologyint.com developed an acute CES following surgery, the lumbar MRI scan showed an abnormal DOI: T2 signal in the conus and lower thoracic spinal cord over 4.3 cm. -
A Cauda Equina Syndrome in a Patient Treated with Oral Anticoagulants
Paraplegia 32 (1994) 277-280 © 1994 International Medical Society of Paraplegia A cauda equina syndrome in a patient treated with oral anticoagulants. Case report l l l 2 l J Willems MD, A Anne MD, P Herregods MD, R Klaes MD, R Chappel MD 1 Department of Physical Medicine and Rehabilitation, 2 Department of Neurosurgery, A.z. Middelheim, Lindendreef 1, B-2020 Antwerp, Belgium. The authors report a patient who was on oral anticoagulants because of mitral valve disease and who developed paraplegia from subarachnoid bleeding involv ing the cauda equina. The differential diagnosis, investigations and treatment of the cauda equina syndrome are described. Keywords: cauda equina syndrome; anticoagulants; subarachnoid haemorrhage; mitral valve disease. Case report A 32 year old woman from Chile presented with a complete paraplegia. She claimed that the paraplegia had developed progressively over 8 months. Initially she had paraesthesiae in her feet, followed by progressive paresis of both legs, beginning distally, over a period of 3 months. Two months after the onset of illness she complained of bladder incontinence. There was no history of trauma or low back pain. Clinical examination in our hospital revealed a flaccid paraplegia at L1 level, and loss of sensation from the groins to the feet, including saddle anaesthesia. The knee and ankle jerks were absent. The anal sphincter was atonic. She had an indwelling urethral catheter, and she was faecally incontinent. Myelography and a CT scan were carried out, and a space-occupying lesion at the level of T12-L4 (Figs 1, 2) was defined. Surgical ex ploration was done to determine the cause. -
Lab #23 Anal Triangle
THE BONY PELVIS AND ANAL TRIANGLE (Grant's Dissector [16th Ed.] pp. 141-145) TODAY’S GOALS: 1. Identify relevant bony features/landmarks on skeletal materials or pelvic models. 2. Identify the sacrotuberous and sacrospinous ligaments. 3. Describe the organization and divisions of the perineum into two triangles: anal triangle and urogenital triangle 4. Dissect the ischiorectal (ischioanal) fossa and define its boundaries. 5. Identify the inferior rectal nerve and artery, the pudendal (Alcock’s) canal and the external anal sphincter. DISSECTION NOTES: The perineum is the diamond-shaped area between the upper thighs and below the inferior pelvic aperture and pelvic diaphragm. It is divided anatomically into 2 triangles: the anal triangle and the urogenital (UG) triangle (Dissector p. 142, Fig. 5.2). The anal triangle is bounded by the tip of the coccyx, sacrotuberous ligaments, and a line connecting the right and left ischial tuberosities. It contains the anal canal, which pierced the levator ani muscle portion of the pelvic diaphragm. The urogenital triangle is bounded by the ischiopubic rami to the inferior surface of the pubic symphysis and a line connecting the right and left ischial tuberosities. This triangular space contains the urogenital (UG) diaphragm that transmits the urethra (in male) and urethra and vagina (in female). A. Anal Triangle Turn the cadaver into the prone position. Make skin incisions as on page 144, Fig. 5.4 of the Dissector. Reflect skin and superficial fascia of the gluteal region in one flap to expose the large gluteus maximus muscle. This muscle has proximal attachments to the posteromedial surface of the ilium, posterior surfaces of the sacrum and coccyx, and the sacrotuberous ligament. -
Meninges Ventricles And
Meninges ,ventricles & CSF Dr.Sanaa Al-Shaarawy Dr. Essam Eldin Salama OBJECTIVES • By the end of the lecture the student should be able to: • Describe the cerebral meninges & list the main dural folds. • Describe the spinal meninges & locate the level of the termination of each of them. • Describe the importance of the subarachnoid space. • List the Ventricular system of the CNS and locate the site of each of them. • Describe the formation, circulation, drainage, and functions of the CSF. • Know some clinical point about the CSF MENINGES • The brain and spinal cord are invested by three concentric membranes ; • The outermost layer is the dura matter. • The middle layer is the arachnoid matter. • The innermost layer is the pia matter. DURA MATER ▪The cranial dura is a two layered tough, fibrous thick membrane that surrounds the brain. ▪It is formed of two layers; periosteal and meningeal. ▪The periosteal layer is attached to the skull. ▪The meningeal layer is folded forming the dural folds : falx cerebri, and tentorium cerebelli. ▪Sensory innervation of the dura is mostly from : meningeal branches of the trigeminal and vagus nerves & C1 to C3(upper cervical Ns.). DURA MATER Folds Two large reflection of dura extend into the cranial cavity : 1.The falx cerebri, In the midline, ▪It is a vertical sickle-shaped sheet of dura, extends from the cranial roof into the great longitudinal fissure between the two cerebral hemispheres. ▪It has an attached border adherent to the skull. ▪And a free border lies above the corpus callosum. DURA MATER Folds 2. A horizontal shelf of dura, The tentorium cerebelli, ▪ It lies between the posterior part of the cerebral hemispheres and the cerebellum.