Neuroanatomy: An Illustrated Colour Text [6th Edition] 9780702075087, 9780702075063, 9780702075070

Table of contents :
1 Introduction and overview

2 Cells of the nervous system

3 Peripheral nervous system

4 Autonomic nervous system

5 Coverings of the central nervous system

6 Ventricular system

7 Vasculature of the central nervous system

8 Spinal cord

9 Brainstem

10 Cranial nerves and cranial nerve nuclei

11 Cerebellum

12 Thalamus

13 Cerebral hemisphere and cerebral cortex

14 Basal ganglia

15 Visual system

16 Hypothalamus, limbic system and olfactory system

Glossary

Citation preview

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2015v1.0

Neuroanatomy AN ILLUSTRATED COLOUR TEXT

Cover image by Ben C『ossman, bas回 upon a 'time-of-flight' image of the a闹剧 supply of the brain in a living indMdual, cou「tesy of Professor P D G耐fiths, A臼demic Unit of R甜iolo町， University of Sheffield, Shef俑Id , UK.

AN ILLUSTRATED COLOUR TEXT

Sixth Edition Alan R Cr。ssman PhD osc Erne『itus Professor of Anatomy

The University of Manchester Manchester UK

David Neary MD FRCP Honorary Professor of Neuroscience Manchester UK lllustra幅d by Ben

Foradditi。nal

ELSEVIER

Crossman MA

online content visit StudentConsult.com

ELSE飞'IER 02020，日，阴阳 Umi阳i 必l

rights re阻四d. edition o Blamer Limited 2015 Fourth edition o Elsevier Limited 2倪。 咀世d editi。no Bis凹ier limited 2005 Second edition o Blsevier Limited 2000 Pint edition • PeaDon Proressional U皿ted 1995 F凶h

古ie right of .Alan Crossman and D町id Neaxy to be iden蝇d as au曲。”。f也ii work has bttn aaamed by 由m in accordance wi曲曲E C吨JYright. Designs and Patents Act 1988.

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and mearchers must al'Wa}'I my on 曲曲仰n eq>erienα 皿d knowledge in evalua由lg and us迦g any 姐也，rmation, m，础。由， compounds or ezperim四” deacribed her由. Because of rapid advan回事 in the medical aci.1四m inp缸咀α且也 ind叩end四t 四rifiation of dia伊创笛 and drug doaage1 should be made. 'lb 也缸llest 四ent of the law, no responsibility is assumed by El1evi饵 au血。”， editors or rontributors for a町 injury andfor 也ma萨 to persona 。E property as a ma饥er of products liab也跟 ne.gli伊m or 。therwis己 or from any use or 何用甜on of any me伽ods, product也恤机ructions, or id甜 contained in the material herein.

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a由ion d也E 血omb田uq>halon into 也emet回应脾alonand

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Fig. 1.10 Schematic repre ntatlon of'llWWV’””’ctlor嗣由rough 刷…酬』帽In’”“ral tube and (B) 1he a由民，，lnalcord. 陆l』ronal conr时dons v.ith per1川、自削 structures are Illus！闹剧。nlyon onesl幽．

myelenc甲halon.

The junction be阳e£D 由e la位E is marked by an additional 阳1d 扭曲e neuraxi岛 αlied 也e pontine 鱼a:ure.

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usually su附e. Ina回na blfld圃， the b帽制nal co闹剧 nerve roots are unden:抱唰oped and may lie unc肌顺回 by skin or the bony spine 阴阳 h阳＇t's beck (m制lngom”b侧，｝．＆』chin饱nts are left with wit闸red，闵rel归回 end ens倒thstlc lower lmbs t啕酣W with Ince扪咖朋ce d 甘、e bow回 end bladder. As the brain deveJ，句地 itJ central cavity d四 undergoes considerable chan阴恤，国缸id shape, forming a m阳n of chamb四 orv回国des (F悟， 1.13 and see Fig. 1.23), which con创n cerebrospinal tluid. Parallels have been drawn betw四1 由t embryo}。在al devdopm四1 of the bra扭曲d 也e majorchan隙，也at the brain h臼 undergone dur姐8 挡回lt of tl比 phylo缸’~c, or evolutionary, sc.ale from simple to more complex ani.mala. Al也础。由is 画 回tainly an ~plification，也E ooncept does have 由E educ回onal merit of introducing some of the principal parts of the brain, and their rel剧onships to one m创ier, in a graphic and memorable~ (Fig. 1.13). 四t simplest of chordate ani皿als （巳g.arn阱liell, lncom阳脚 dMde the cran阳l 08\llty 阳to compartn币，nts.

•The cren刷 dura mater con刷ns

• Ber酬’1 甘冒”回归10ld rr回圃， les 廿le 飘i阳回归M削句泪。e circula:国．

Is supplied w时I blood by the lntemel “删Id and

·刊， bran

鸭副司ebr回 arter阳s.

i8 suppled with blood by vessels th创町嗣阳m

•The 部>in副 cord

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rein岛rad by nd1cular 缸回tea derived 岳础1 吨m回回l v四剧’·

dural Yer峨眉刷nue”， which 四

by radlcular arteries dertvad

”。回nnale 旬'1f the venous

咀ie ar恒旭缸id 回naaa吼ng the CNS run 伽 p缸t of也dr 回回u

骨om911均m制”l m阁”Is.

drahlg，。『廿1e

with面也e aubuachnoid spare (Fig. 1.16）.四ie m四i!lFI are

supplied by a nwnber of 'ftlldιthe most lign温cant intracra皿al one being the 副“le mmingeal arte哼， which nunllies g阳11ively betMen 郎，1kull and dura ma恼。阳悖ing the lateral upectofth£ 田anal hemiapher巳

brain.

n

W削回庸””l8I U:I (C胡

Chapter

’ Introduction and overview •

13

Falxc:e帽M

Supe由：wsag嗣l Si削$

C假p!JSCI融路um

」一一－ Tentxrtum cerebelll

｛∞幽lnlngs圃’阳lnu吩

ca曾随llum

B『罩闹阳n

Fig. 1.18

Pllni嗣刨出I 回E髓。”’f惜冒， helld ahowing the disp回画画DnOf恤，伽bl cer9bri •nd mntorium e町，belli.

Anatomy of the spinal e。rd τhe If inal 田d h 回恤也ev町蛐ral u甲inal〕臼皿I of 趾

wrtebral column and is continuous rostrally (su阳iorly) wi也 the medulla oblongata of the b回nstem (Fig. 1.19）.咀四”inal CD时 receives in岛rmation from, and controL岛也e 往回业 and limb也田， is a曲ieved 曲。ugh31 严irs of 1p旭al Derftl 也at are a阳曲创 to 由e cord at in也rvals along its I四gthandwhi也 CODta皿 affeI四t and d阳回t nene fibres conn皿ingwi由阳uctur四凶由t 阳iph盯. Near to 也.e co咱也E spinal Del'响1:11 divide into clonal ＠但国ior〕 and v回国I (antEiior) mo钮，世tlch attach to the aml. alm唱 imdonola但ral and ventrola田al border!, resp缸曲曲 (Fig. 1.20）.四ie dorsal rootsαrry affer回t nm曹 fibres, the cell bodiea of which are located in dorsal root ganglia. 四le ventral roots 臼町 efferent nerve fibres, 也E parent cell bodies of which lie wi也in the 酬nal grey matter. Spinal ner咱 leave 也ever曲ral 但剧也rough amall apertures，也卫国恤也白宫tebral foramina, which 缸E le团筐d betWttn adjacent wrt曲mιBt!cause of the differ四ce in the E国 of grow也 of the 刷卫al cord and 咽钮阮al column during devel叩ment. 也e 酬nal cord in the adult does °'“ 四四d for 由E 缸11 l回回l of 也e 观血bralαnal, but 回dsat apprOiirnately 也e level of the i:r眠”回由百I discbetw民n L1 and L2 呢rtebra巳咀ielumbar 姐d 剑.cral 酬nal n町阳，世ierefore. descmd 旭 a leash-like arrangem皿t, 阴g.

called the cauda 吨u旭a

1.19), to rea血也曲目t foram且＆ 咀1e spinal cord is a relatively widifl自由白能d structutt 四mpared 明也也z brain. Cons呵u血句也E basic principles of orga皿皿on. es组blished ear抄 in embryonic de咀甸回回if. can 而11 be E回dily id四值ed e9回 in the adult human sp皿al cord (Fig. 1.20）.四ie 叩inal cord is appra厄matdy cylindrical in shape, αm回国ng at its 由1tre a v回世gial central canal The rda:咀.~

separ四.on

of cell bodies from nerve 6.brea conf白 a characteristic 'H' - or 'bu阳曲’－血.peto 由e central core of gr可 matter 由at

surrounds theαntralαnal. Fourpr咧配tions of the ren包al grey matter extend dorsolaterally and 观ntrolaterally towaI由 the 险m ofattachm回tof 也e doISal 阻d 顶盟国I roots of the spinal ner鸭盟， 四m projections are known as 臼 dorsal (p帽阳ior) homa and ventral （跑回ior) homa, respectively. 四e dorsal hom is 也耐 。f田mination of numerous a:ffer刨出四脯，由阳明ng im庐山es from s四1oryrec叩阳z throughout 由E K对y, and is the site of origin of ascending pa也.ways carr冽ng sensoxy impulses to 由E K垣n. 咀le ventral horn contains motor n四rones that 位mer咽:te skeletal musclιIn addition, at thoracic and upper lumbar I白白 of the cord only, ano伽ei; smallei; collection of 创I bodies comprisea 也E la能ral hom. 四” contains pre胆nglionic neurones belonging to 也e 句mpa也etic di司sion of the autonomic nerrous m国n (Chapter 4). 咀le 阳iphery of the spinal cmd consists of white matter that contains longi也dinally runni吨 nerve fibres. 咀iese are O事皿sed into ascending tr配ts and d皿andingtra血. Ascending 包缸ts carry information deriv回企om the trunk and limb1 to 也e brain. Desαndi:rlg tracts are the means by which 仕1e brain controls the activities of neuronea 旭 the spinal cord σ悔 1.21). The princi归i asαnding 刨出 are 也e dorsal colum皿｛阳ciculus 脾cilis 皿d faacicul四 cuneatllS), which carry fine touch and pri叩d侃甲tion, 也t a酬血。也alamic: 缸缸钮， whi出 canypa函，馆m伊咀缸盹 coarse tou血 mdpr回回-e,and 由E spinOCEl'Ebellar trac钮， which rany information from muscle and joint m叩甸回臼也e cerebellum. Among the deteending trac邸， one of the most important is 由e lateral cortlco1plnal 往配L which con田ls 剑lled volun钮’ movements.

14 • NEUROANATOMY 民nalcolumns 阳m曲m

句inoce唰lar t回la

Dorsal roots of

S回noU同由m跑 回由

sp阳J Ill，璐

Fig. 1.21

card llhawlng Ole nerve fibre ll'llc恤 A自卫1:1nding trac加 areonlyd酬cied on the left s1由 and descending only on 甘冒 right, although both occur bilat回回ly. Tra跚跚跚··刷刷’－ugh 阳刚nal

阳四””• al the prlncl回la翩翩dlngandd－抱回Ing

’

Anato111:ro the eplnal cord ·币18 spinalα>rd I嗣 W时li'l 甘w V町怕也『al 曲咽J.

pain; of spinal wh胁 It

It b瞄富 31

『l8M!6 thro咽h

receives fibres 膏。m

and 麟!l'ld8 砸到审sto，世19 pe~ery.

Sp1耐∞时

·陆a『阳 cord, spi帽I rl&IV回

divide to rorm do陪al and

vent耐『田恒； dorsal 『田Is 回町

Flg.1.帽 Donal 伽帽饵，b『，西哥”ct al the aplnal cord

In alb&. This is 伽－ mater h8\州E beenincis回 longttudinally to 回归回the spin副 cord and spinal ne『ver田恒 tyi咱 within t~回 sub苗苗圳、oidsp缸泊．

con刷ns motorn创ror四 and

the lat院咀l homαJnt副ns 阳啕甜电脑、le sympathetic neurones. ·晰thin 甘WI

white mat饱r run

创始end咱 and descandl咱 『lerVe 自bra tracts，时1剧协 the

spinal co则叫”’ the brah.

and v喧闹刨

·刊， princ回l a篇回ding

tractB

缸， the dor事al cclumr恼， the

锦州『创∞『eot g『W matter,

s回natha姐mic

阳帽ining 闹闹喇 b回i饵，

制noc刷刷lar tracts. The

tracls and tt商

and an outer 陶宵。I white matter contain同 nerw 明b阳．

∞刚U捕pr.al

tract Is an

lmpor田it des棚、ding t田t.

Anatomy of the brain Major 舶a阳＇res and landmarks The brain is dominat£d by the cerebral hemispheres (Figs 1.14, 1.15, 1.22). Th配 hm: a highly convolu时阴阳 mantle of grey m耐鸣曲e cerebral corta, and an inner core of white matter, wi创E 咽rich are loca艇dfur也.erm翩翩 of g可 ma忧也 Certain of 也e surface OODV。，Jutions of theα!ttbral he刷刷iere have sp国fie s四”ry or motor functions, aa desαibed below. 咀le 刷。但rebral h臼回spheres are 旭comple国y separated by a de叩 cleft. 由t ’四t lo吨豆刨出nal fig田e. 咀E a凰山E isoca明d by 也E falx

叫山 ~＼／ ~~＂－；－γ飞／乙乒~ ~＇ SD !(I {'I \' － 二 ,,.八I 、 Dinal 『阳ve -

＼＼气；. ）~－＼ I』

W刷刷＿＿；；.＿＝：；.，－～ 气？ 」工工 d印刷 m

nei.』ron酶，甘咀嚼rir回 horn

dorso创 root ganglia,

『回ts 倒即制阳明11 恤”8.

sames阳’cim回 as shown in Fig. 1.17. n胃 du『a mater/a阻d可noid

dorsal horn con凶m sensory

自阳rant 他『翩翩hoe阳回i髓的

·币回 spinal o田回 α，，sis恒 d a

ca回a 饲~na

·晰thin 甘冒B Iii用y mat阳，甘回

＼」一－ va刷 horn

飞

一－臼阳I canal

fig, 1.20 Sohematlo di啕ram “’ tra阐明”•••ctlonthro啕h a..

，回nel 回rel, sh’”Ing ’”“”由m删“”In刨帽”ero帽，ndthe emmgemant of grey•田d whll9mllt饲r.

cerebri and in it& d句地s lies 由t 四早us callosum, containing mmmiu山al nerve 盖脑四由at run between corre甲onding E唔ons of the two her旧，pher四． 哑ie bra姐，但m can be s配n cle.arly when 由t brain is vi酌”d from its in如ior a。缸L al也.ough the rel甜.onships d也E midbrain wi也。也er brain r唔ons are b倒诅.usuated in gittal Stttion (Fig. 1.148）.四.e brainstem. is 也e origin of 10 of 由A! 12 paim of cr.mial n町es (111-XII]. Donal (pas回阳） to 也 brains田1 画 lming out to form a 血allow.，由amboid-ahaped d叩回国m on the d佣al IU血re of the medulla and pons {the hindbrain p。而m of the braimtem) beneath the cerebellum. The cavity thus 伽med is the 岛”由四ntride.

Chapter

’ Introduction and overview •

15

Hypo伽ai.n1路

Fcur由 V911tride

时. 1.22

S.glttal m啕lltltlc reaor圃’回 Im町，刷刷，flhehi国d. Thethal町us and hypothalarm届阳mthe up因『 and b嗣rparts,respecl阳ly, of th回 the third ve呻ide. {Cot川回哩：yofPro恼sorAJa欧阳，阳胎m M础姐J/ar阳晒19C侧阔 UnNersity al M811Chss徊，刷刷酣御， uκj

国制唰l of

In饱阴回创α』lar旬ramen

Body d 阳.leralwn蚀却

Anle臼rhomof

幅幅剧”睛阁， ＝＝二

Pas饱阳 horn of M饱耐帽唰曲

Thhl ventr1cla 阳币自郎rhomof

CerabraI 叫四川

幅幅刚 va睛阔’

Fou『世1唰由icle

Fig.1.23 币” cerebl'lll ”刷biculara”tem.

且也t rostral border of the pons，也t walls

of the four也 a ruurow tube, 缸田由ral aqualuct. 币ie cerebral aqueducl 也Yea into the substance of 由E brainst田， running the length of the midbrain hen.ea:也 the inferior and superior co.监α.tli. At the junction of midbrain and forebrain伊 the aqueduct opens into the 也ird 驯皿住ide, a slit-Ilk£ chamber, IllllIOW 仕om side to side but a阳isi.ve in dorsarentral and E回也怕”也l dimensio皿 τhe la也ral w曲。f由E 也ird 回国de are formed by the 由alam.us 创ld 峙~由alamus of 也e diencephalon. Near 也.e rostral 四d of the 也缸咀嚼出创de, a small apert旧-e. 由ein缸”回国cular fora皿皿（foramen of Monro], 四m皿unj.臼teswi也 an S国lSive chambei; the h但ral 胃盟回d巳 wi也皿 each c:erebral b回亚spher巳咀ievmtriatl缸 m能mcontains m由ω庐tal fluid 〔C间，刷出 is seer冒ted by the 曲。roid plmu 回国de conveig巳岛m扭g once again

(Chap阳 6).

Brains归m 咀iel~ 四rebral

hemispheres obKUre many o由E structures

from view, but the brains恒m c.an be 隔四 d缸ly on both a median sagittal section and an inferior vi田 d the brain (Figs 1.14, 1.15）.咀ie brains但mco田姐”。,f the medulla oblonga钮， pom

and midbrain.

四ie brainstem forms o皿y a small w叩ortion d也t m幽 bra坦

but it is crucially important二四1r0ugh it 归” all of 也t uαruling 皿d des但I.di吨 nerve fibre 田eta linking 也 brain and spinal cord (Fig. 1.24）.咄咄 tra曲也rry 阻四ory information from, and oontrol 也E movem四t of; 也e trunk and limbs. The brains但m al回 oontain且也E sit£! of origin and 田mination of most of也e cra:r咀d nerves, through w扭曲 the brain innervates the h国d.Mor回鸭 within the brain，但m lie centres 也at control the vi刨缸nctions of brea也ing, 也E circ叫础。a of bl“对皿d 也e le叫 of consciousne侃

16 • NEUROANATOMY

Fourth m刨de

协副bl』larn山蚓

咽。g闹剧 nuc拟后 l响rior 剧由Ila『刚刚e

Medial 阳mnlsaJB

Pyr回nid

时.1.24 Tra跚跚幅幅ctlon through the bralnstem 剧” level oUhe medulla oblongeta. The 掬ctlon

has b翩翩n回 bytheW1啕制书J method. In narva fibres stan darkly，附lear回S 由h In 佣llbodl铺脚刚at嗣typelar. 刊epyremld 阳 a tract th回 contains d回回di咱 motor他明 runn网 骨。『nthece而b『alcor阳to the spinel oord. 有lEI 『n回lel lem nlscus 阳 a t瞄t consist!啕 of ascendng axons carr圳咱阳'9oryln币om唰on 阳nthellmbsto higher c刷刷 In 甘、e brain. The In制or cerebellar peduncle contains splnocerebel自由bresca即同 Information 骨om 』口lntsand m明cles to the oerebellum. The W部tb.』阳r nuclei are 甘冒E site oftermna四on of the vestibular nerve. which 臼刚回 Inf口m回on from the lnne『锦r 『啕ardlng the p阴阳nand mo叩n酬。f甘冒E 阳回. Thehy阳现los拥l nuc阳us Is the site of origin of hyp吨lossalne『W明bras that lnnerv田饵t晴 musc阳s of the tongue.

k回S rich

币ie medulla oblon酬a is con出.uous cau但卫y with 也e spinal

cord 姐d ex脑也 rostrally aa far aa the pons. 四t ponto-med叫lary

junction ca且 be 民回 dearly on 旭缸ior or sagittal view& sincr 也E \llrntml part of the pons fun田 a prominent bulge on the su血re of the brains皿. In sagittal section 但p l.14B, l.15A), the lumen of the four也把ntricle is apparent k阳晒1 由e po田 and medulla v钮回lly and theαrebellum dorsally; into the latte宜 of which iu ten岳阳pedroof a阳ids.

Cranial nerves 四ie brain directl歹 receives 阻四创y informa: ion

from, and αmttols peripheral structure岛严灿ripally of 也e h臼d 臼id n缸k Affer四t 甜d efferent n町e fibres run in 12 bila键因ly p笛red g扭扭l ner四s, which are 凶皿凶d byindi说dual names and by Roman numerals I-XII. Certain of the cranial nerves contain only sensory or only motor nerve fihII臼恤也e 叫ority contain a mixture, as i，也tα，e with spinal nerv鸭. The 缸，t t附 α四al n回·es 〔I olfact呵， E optic) a国chdh配tlyto 山西orebrain, 材世!st 由t others atta也 to the brainstem. Within the brainstem lie a number of nerve cell body group~’但且时由Eα扭扭I nerve nuclei. 四部ε 红t 由t sites of 田mination of s四aotyfibr盹曲d 也t ori归。f the motor fibres, 也at run 扭曲 α姐姐l ner咱（巳g. Figa 1.24, 10.2). 由E 缸tivi茵茵 of;

Cerebellum 四leC£1由ellum

is attached to 也e brainstem by a laige ma属 of nerve fibres that lie K国al to 也E b田也回1刨出 on either side (see Fig. 9.1). The mass is split nominally into 也reeparu：由E inferio鸟 middle and superiorαrebellar peduncles.τbeseαny nerve fibres betw四n 也e med叫la, pons and midbra姐， resp回ivcly, 曰“让leαrebellum. The 田d划lum consists

of an outer I句er of grey matter, 也e surrounding a 阻ttml core of white mat阳 。lg. 1.14B）.τbe 回国cal SU血aia h胁ly convoluted to 阳m a E唱tlarpa包em of nanow. parallel folds, or folia. The cerebellar white matter consists of nerve fibres running to and from the 回回bellar oorta. The white matter has a characteristic bran由盐tg. tree-like man萨ment in section, as iu ramifications reach towards 但由ellar corra,

the surfa阻四eαrebellum is conαmed 明白也.e coo硝nation of ma略m四t 皿d it Ope.I富国 at 阻四也ely unconscious level. 如由al to the pons is lo也能d the relatively small midbrain. On its dorsal sw也u 臼n bese四由e rounded emio曲创 of 也e superior and in缸ior colliculi, ben，但也 whi由 runs the cerebral aq田d田t {Figs 1.13, 1.14, 1.15].

Diencephalon and cerebral hemi:叩heres Rmtral to 也E brains回dies 也e forebrain, which mnsists of也E diencephalon and theαrebral hemispheres. 四iedien＇αphalonand c.erebral hemisphere on 刨出 side of the brain are to a I吨e extent phy.ti田ly separate from 曲曲 counterparu on 也ea也e sid己 al也oughimpo白血tα唰-connectiom do exist, aa desαibedbelow. 咀恕”。画des of也t di回应phalon are 能para时 bythelwn四 d 幽幽dven创de. ofwhi曲曲句倒四Wte 由t lateral w也． 币ie di四αpha』on

consists of four main di由ions: in a direction, these are 也E q>i由ala皿田，也.ala皿UI, 四b也ala皿.ua and hypo由d且mu1. The 甲i也alamw is small and iu m伺t notable compon回t is the pineal gland, which lies in 由e midline, im皿ediately rostraJ to the SU阳ior colliculi d由E midbrain (Figs 1.1钮， 1.15A). TI腿也alamus is by far the h咱自t part of the diencephalon and it forms much of the lateral wall of 也e 也int ventrid巳咀爬山d剑nus p问s an important P皿 in senso町， motor 四dα事utive 缸nctions and it baa exte田ive E回prow connections with 世ie rerebral cortex. 咀iesub也alamus is a small region lying deep to 也e ventriatlar wall It contains 也e sub也ala皿ic nucl四，， which is closely 时ated 句nctionally to the basal 伊nglia (ChaP'田 14）.τbe hypo也alamus forms the l阴阳 rt of the w咀la, and 也e tl.ooi; of the 由irdven刨de. It is a complex and hi由ly 恤1严血nt r唱on because of its in·四lwm四t 扭曲t autonomic n町阳刚回（Chap田 4），也e limbic m能m 缸咀由t neuroer埠。αine m田n (Chapter 16). From 也E 呢ntml a吨配t of the 峙po由alam田 in the midline 缸茵自由e infundibulum or pi回国y 血lk (Fig. l.15A),” which is attarhed the pi伽it.uy gland. 币le 四rebral hemisphere is by far the largest part of也e brain. Like 也.e cerebellum, it consists of an ou田间町 or carte.:岛。·fgrey dor回vmttal

”

Chapter

’ Introduction and overview •

17

臼闹剧∞阳E !Mli岭 mat恒r G陪al longitudi闭l

R剧』m

Lateral ＂＇细bide

Fig. 1.25 Coran.i ••cU。n lhn”’hthe 四”bl'lll h田”’Bphllnl.

Lalal回’”u

Hypothalamus

’”IJ corr回ponding to Ag. 1.25. (Cour阳1yof仰。阳”。rAJackscn,

F阳.1.21 Coron创 magne11c ruONmee Im咽’刷RI) of 曲， head, approxlm Wol阳m M加α啕r阳a供19α如何， U础l9fS/t'J of胸ncl瞄仰， Men仿制阳， UK.)

ma缸r and an inner mass

of white mat田（Figs 1.25, 1.26, 1.27, 1.28]. In addition. partly h1皿d wi也in the subcortic.al white matter lie several masses of cell bodiES, c.ollectively referred to as the basal ganglia. The twoα~her皿sph眩目脚’叩arated in the sagittal plane by a deep midline cleft, the great longitudinal “四m σ耶 1.25, 1.26), whi血 accommo甸回也efah: 也rebri, a 血eet of dura mater reflec时 from 也 in恒malsw也ceof 也 aanium. In 也t depths of也E S槌ure lies 也.ecorp山 c.allo皿m O幡 l.15A, 1.挡， 1.26), a Jar萨曲ttt of tr.msv四ely runni咱 nerve fibrEB (mm皿issural 6brES）由at link c.orresponding ar回IS of the 的帽但rebralα>rtica.

Them咖alcor回 is higt世y oonvolu毗哑由 M the d国 of m回mi由i.g the oortiαI SU血ce area, whi由 is about 1 m1 缸 each hem坷址阳也回ie convolutions

are called gyrl （由鸣叫ar. gyros) and

也E furrows k阳回1 也.emaresu挝｛曲唱ular. sulcus). Some gyri and suki ~ a relati叫.ymruistmt 田nfiguration between

individuals and 也eymarkthe b硝on of important 旬nctional

areas. On the la艇ral sw:faαof the hemisphere, a de叩 deft, the 1.25, 1.29），姐姐 important landma血哑也

lateral 缸剧” σigs

togetherwi由出tain suki,

forms bou且也ri臼由at di说de 由E

hemisphere into 如田 lobes 阴g. 1.29]. The lobes bear 也t names of the bones of the skull beneath which 由ey Ii巳 咀le E田tan但rior p缸tof 也E 但rebral hemisph田:e is called 也e 告。ntal lobe, 也e molt an国ior convexity of咐iich ill the fron组I pole.τbepos能rior boun也.ry of the 企ontal lobe is the cen往回 9ulcwl，世世ch 阳回由nes occurs as a singl巳 continuous 缸rrow runningo咱也e entire la:回alsu血ce of 伽 hemisphere 量。但也

阳”阳『

＠明t 阳牌1dinal伽创re

Frallal lobe

互~~ （）；杰在

臼udalenudeus

Pi翩附，n

像lbusp副剧UI

民揭Ce巾rhom of 阳18raJ v阳怕幅

,,,

,

－飞 ’ I I

‘、＿＿

•

t

‘

’ II

I

~

. -·

队， 飞【

点俨＼ ..r' ／』

I/

J

、L

..

f

、t ‘

-

λ r-＿＿／去 -

一『飞 －~ 7' ‘

阳抽血宵 horn of lalllral 鸭ll1lricJ8

T&rrfOral lobe l晴野田l C8pal』le

R回1811lJS

问楠怖”“ of

由pl8 臼JI甸回

Fig. ’E ”“'lzont翩翩翩翩’”而咱h the cerebral he刚刚”他

In饱m1lc:ap1曲一一一气飞

Thalalu

Fig. ’.28 缸a.I m1gnetla remn1n翩翩－’”Al) af the hRd, 1用m画lmmlyconwpondlng 幅 Fig. 1.27. ＇臼u巾町d丹田民sorAJe帽白， Woll坦m

M湘cular Imaging Cer，同 U刷刷歧yofMancl四伽，蜘ncl田伽， uκj

Chapter

阳回l 割lcus Precen抽J gyrus (p~mary motor cor刨

’ Introduction and overview •

19

,,- Paa回ntral gyrus

l

/

伽irnary somatDse阳阴阳｝

向阳nlnll gyrus

「－Par刷刷 向阳bocc:i回恒l s咀四S

Frontal lobe 阳m甜y

Fmn刨 lobe

vis叫 ∞伽z

臼阳rine

sulcus

＼」~Occfp阳l lobe

@)

「’正〉 ·.· 问. 1.21

Principe! g:wrl, eulcl end functlonal .,...• of the cerebral co同胞刷 U帽”l 四”“； m mediaI 四”“－

g四t longitudinal

fissure to 恤 lateral fissure. Po阳iorto the

αntral sulcus lies the 归由国 lobe,

which is separated from the tem ral lobe below by the la回回I M山巳咀ie tip of the 也皿阴阳l lobe is called 由t temporal pol巳 The p曲回ior p缸t of 由t her回sphere i，也.e oa:i回国 lobt，四ding in 由e ocripital pole. 四ieboun也ri臼 betw配n parietal and 回nporal lobes and 也E oa主pital lobe 臼E indistinct m 由E K恒ral Ill[也a of the h回回刚回巳血α 也可 do not con四pond to 缸typar笛mlarmlci. 臼1 the medial m鱼岛 h0Wf!9el; 由e parietal and 配ri1抽回 lobes are s叩ara胆d by a deep parie徊。cdpttal 1ulcus. On 由e medial aspect of the 但由raJ. hemispher略也e d11g1曲，te lulm1 runs parallel to 也E up阳 margin of the co甲us callosum.ηUs delinea＂坦 a E唔on of cortex 由此 t甸回ierwi也 p缸ta of也E medial a再配t of the temporalα>Ikx, is sometimes referred to u the Ii皿hie lobe. The 缸nctions of the cerebral cor皿 are desαibedin more detail in Chapter 13. It w诅 be useful at the 0\阳吼 haw阴阳， ω identify 旬田国阴阳川岛nctional areas of corta, one in 侃出 lobe ｛问. 1.29).

”

• lo the frontal lo民 thegyrus 皿mediately in front of the central sulrusisre阳red to anatomical坊 as the 伊民entt菌lgyrua. Functionally，也is comprises 由E 严恤uy motor cortu. which is 也.ebi由estlevd 扭曲t 阮血 for 阳 control ofvolun田y m~t. Here, in each hemispher电由E oppo曝k half ofthe body is rep11自由能d in a highly precise fashion. 咀1e 呵『(JOSitehalf of the b呻 i，呻resented bec:aU1e也e newones situated here 也at control movement have axons thatσ翩。即（d刷刷:te) to 由阴阳osite side ofthe brains阳n and spinal co吨 to control 也e motor neurones b四时也a巳τhehi~ypr四” representation of也t body isαlied ’somatotopic', which means 也atp缸ts ofthe body 也at 缸ed曲etogether 缸E represented in p缸”。f也ecortrx that are close together [see Fig. 13.20]. •In 甜ie parietal lobe. facing the 回m町 motorcar恒x:across 也E 回itral sulrus, lies 由哇”’缸回归画1 gyrua or primary somato，钮’“~cor缸瓦四由 is the site of阳minationof pathw旬， carrying 也E modalities of touch. pressw巳 pain and 忧mperatwe from 也e opposite halfofthe body and it is the E唔on where 也句are consciously per倒时. Analogous to 也t 缸ran萨mentin 由eprim缸ymo回 cort凰山 opposite half of 也e body is repr四ented in the prim缸ysomato阻四orymr回 b回国E也E aldlv刷刷 Into the me由le 曲lo咱酬， pons and cerebellum.

•The•，饱ce of 甘l&cereb唰 hem阳phara cons阳ts of oor四”l gray ma他宵， which 阳币。M回 m form gyrl and sulcl. Ben回th 甘冒E

masses of the corona 『回国阳 西回 the internal capsUB. 有1日缸，饱m 幅 divi曲，d into

b刚附tern. 1l、a foreb刚·n con剧创sot 甘冒自

the

阳lamus and hy阳Iha脑mus) and 廿'18 cereb刚 hemis防W嗡．

lol泪s:

• Frontal lobe con回InIng 甘le primary 『rotor cortex · 同rie刨 lo国∞瞄in同 tt隐

• Within the cerebral hem即here

primary somatoeenso『y

l阳 S剧唱rel l筒，e nuc阳i cal恼d 甘、， 回回 ganglia.

•

corpus calo虱』m.

SU『徊。elie t咱也随e 由bre

• The m副ulla, pons and mldbraln cor四tltute the

dienc句型halon 伽inci间ly

hemispheres

are lin阳d by the comm恒剧叫 他田 d the

and 阳由『ain.

•

more detail dsewh但也

·节1e twocereb『回I

a s归temof C自由醋。r ventricles con恒·ning CSF, which is w回回国 by the choroid pl酬JS. 1l回 bra'n con恒ins

• The brain PossaE梅” 12 p副rs of cranial neM器．酬耐1 佣rry affe帽、t and d幅rent ftbres,

配置幅K

•

T＇田1por回 lobe con恒j『li『lQ 伽， primary 副ditory co『幅K

•

Occip刷刷自 con1凶ning

the

primary 叽剧创 cortex

• Umblc lobe contain！咱 regions for memory and amotion剑”pects of 嗣同刷刷F

princip副ly 恒 and 阳m

strucb.Jres of the head.

Major sens。市 pathways S四aoi:y in阳mation 曲创且也t intanal. 缸td extmlal envir回回四”

is carried m 也E CNS in affer四I nerve fibres running in cranial

and spinal ner观a. Sensory information can be d甜甜d under 也E h倒也Dg'J of ’,pecial senses' and ’general 阳uei.τhe special senses are all 田ried in cra皿al ner咱 and are comp由d of olfaction (cranial nerve I), vision （呵， taste (VII and IX) and hea且吨 and

ηle 伊leral 阳1帽 include the mo由H扳回 of touch, 伊四sun鸟 pain and temperature （时句d from ex但m饵”。” in the sk扭扭d interoceptol'B 扭曲e 咱也啡，血d aw.u:四ess of 萨)qJ恤配皿d mavein四It(齿。m propri。但ptors 旭 joint岛 tendons and muacles). Ga田al sensory in缸mationfrom 也E trunk and limbs is carried in spinal ner咱；量m 由E head, it is carried in 也E 由ige皿inal n田VE (cranial D＇町’E 叼． For all modali世es in the 田吨。ry of general sensation, there is a S叫uenceof 也ree neurones betwftn the sensory receptor loca剧 in the periphery and the per呻由·D of sensation at the 1erel of阳

回由ral oor回（Fig. 1.31）.四le 缸'St n四rone （缸，t『ordernem创le orpri皿町幽nnt neurone〕四阳也E spinal cord 也rough a spinal ner鸭 or 也E brains惚m 也rough 也t 国萨minal ner吨。n 由e same side of the body as its peripheral m甲甸E is located. 咀le cell body of也e 缸吼叫order neurone is lora也d outside 也E CNS, either in 也e donal root ganglion of a spinal nerw, or in 也e “伊1inal 院nglion.V归创n the C邸， the axon of the 盖酬。，nfer neurone remai皿 m 也esameside （刷出阳al) and synapses upon 山川农ond neurone （跚跚d-order a础。ne）.回E 揭四nd-0rder neurone has it& cell body i且也e spinal cord or brainstem, the exact locai由E dept!nd.ing on 也E m口dality 00DC£1I1ed. Its axon 四”ea ewer （也~回国） to 也e other side of 也E CNS and 画面idil to the thalamus, where 拉国mi回国. The third neurone 扭曲e 叫uence （也ir归rder neurone) has its cell body in the thalamus and its awn projects to the so皿a阳四”ry corta, loca时 in 也E 萨就回国i gyrus of the parietal lobe of the cerebral hemisphere. Moreη回fican如 prim町 sp旭al affet四.ts 也rry讪g coarse touch/ pr1甜U岛 pain and temperature information from the limbs 血d trunk 田mina但 near 也eir k叫 of四町 into 由t spinal cord. 四1句 句E平回 wi曲回回nd-mder neurone鸟也E axo皿 of which decuaaate within a few s电men.ta 缸td ther四ftcrform 也E 昭inothalamic tract. In contrast, primary spinal afferents cm归g propri民写对W! inform甜.on and discriminative （缸e) touch 倒四id unin回rupted on the same side of the cord as their 回町， forming the dorsal

Chapter

’

Introduction and overview • 21

- Fl憾。nlern剧院lll98

… s“:ond-创唱~er … n审峰。rd er

Venlnll po翻1or nucleus of thalamus

Pons 明白睛1自1

sensory nucl自U8

翩翩翩

”“ialle!m阳αIS

阳rsalc划umnnuc拟 。创唰 columns

相nolhalarnlc 棚。t

问副 root ganglion －气气 ；；画飞

「：Touct咿qirtoce附n ••••• Typlcal spinal斗 nerve 」－ Pain/I由mp倒胃也Jl9•• …

Spinal 棚世

Fig.1.31

0咧时棚。f份， major pa伽way，伽疆翩翩1 翩翩俑栅．

columns （阳ciculus 阴cilis 姐d fuciailus cuneatus). They column nuclei (nuclei gracilill 姐d cuneatwl) loca时 in the medulla. From here, 1£C.Ond倒order neurones decussate and asrend to the that且mus as a fibre tract known 划 the medial lmmi110111. 阶回ny afl'a四t neurones that 姐.terthe bra凶stem in the 缸igeminal nerve terminate ipsilaterally 泊位e 创伊四iDal ”naory nudms, one of the a部世al nerw: nuclei. From her巳悦ω民的rder neurones d阻挡sate 拙d a秘:mdto the 创皿.us as the 啕u血。由alamic tra.c:t. Seam的rder 阳1阳ry neurones, of either spinal cord or bra坦s阳n origin, ∞川职 upon the 鼠me z唱on of the thalamus (the vmtr.al m阳ior nucleus), synapsing upon third-order neurones that proj创 to the somatosensoiy cone: in the pa1优entral 8YrtJ$ of the par阳al lobe. Throughout the 础惚草Ip硝ections of the 串omatosensory system, there is a high d咿·ee of spatial s咿啼硝on of the m创rones represen由l8 different pans of the body ｛仲创lled 串omatotopic o耶nisation）.施is is most dramati·创ly demons阳ted at the le叫。·fthe 也刷刷刷惚｛see Fig. 13.20). Here 也e somatosensory area occupies a 削p of cor惚也就 “础ds from the m甜al aφ仅t of the hemisphere (11句很随） to the in缸。ilateral aspect of the parietal lobe {head area). 回mina能 in the dorsal

Major motor pa恤ways The motor neurones that diredl.y innei:v葛优 skeletal mu&cle have cell 以:>Cliea lying in the grey matter of the spinal card and braiDstmJ. 姐d are oftm refared to as lower mota霄 neurones. 四ey CODI岱tute the 嚣。咀11.ed ’＇final common pathway' by w记ich the nei:vo嘟”’temamtrols m。”回回t In contraat, the neurones 也很 control the ac制ty of lower motor neurones are themael.vu

”’ motor

a四.rone1. The latter form that nm through 位1e brainstem and spinal cord. Among the m倒t important of these are the m描coapinal 姐d c:orticobulbar (or conironuclear) tram (Fig. 1.32). These tradll o蝴M能归rtly from neurones in the motor a础。fthe 优rebral cort属 where the whole body i& repx四entEd in a precisely o耶nised. or somatotopk. 烛bion （附 民g. 13.20). 岱1edescen1也ngaxona 阴as through the internalα阴山四d into the brain跚地 where most of them d刷刷re to the otha sid怠 切也 means 也atmCJ\lall1四ta of one side of the body are conuolled by the opposite 础曲ral. cmt配 c.o民icobulb~ or co民iconudear. fibres control the activity of motor neurones I侃atedinα也世al nerve nuclei of the brains能笛，叫tich innervate skele饱I muscles of the h创d 姐d n但k throu庐也eαanial ner赠。ulb' is 姐 a1'也aic 甜d little-used term for the m础必.a, in whi命”me of the motor neurones Ji件 Cortico，仰al fibres control the activity of motor neurones in the sp汹al co划， which inneivate trunk 础d limb muscles. Desαnding cor岱cospinal fibres fonn a pro皿nent ridge on the ventr划靠山face of the med叫la. This is called the pyramid and, b四ce the corticospinal. trad is also known as

collecti'Rly referred to as up

anumberofd创倒也g tractl

thepyrami伽I tract 四e placewh侃侃ese fibre3α。”伺W

to the oth，衍 side isαlled the d刷刷刷。n of the pyrami曲 (see Fig. 9.4). The m必n 缸nction of the corti.co队tlbar and oortiα呻inal pa1也，ways is the (.0础。11 of skilled, voluntary mσ陀ments. A laI怒e proportion of the motor cortex. and its descending pathway3 an鸟 therefo11巳 devo能d to tho1e parts of the body capable of deliα饨 so-called ’＇&actiona时’， movements such as the muscles ofψeech and t边也I exp哑ession 姐d the muscles rontrolling the hand.

22 • NEUROANATOMY

M口torαw阳z

l『1lemalC81*』la

且 11.f:烟r币brea

……·

同)l'IS

11.tc*>r cranial nerv

M创ulla

h也翩翩阳1 of the pyram副S

阳也自由pinal/pyrami也l 恼a l阳l 制

T)l)ical s阴nal nerve •w

…·

’

Fig. .32 Overv阳w of the mll,lor m。”’ pa恤~”－

Caudate nucleus Motor nuclei d伽－阳nus

Midbrain Pons

”’dul阳

F阳.1.33 Overv阳w“’”’由剑”“咽棚， ot the basal ganglla.

NumeroUI brain 罩住uctu:r鸭 apart from the corticol]>inal, or 胃ramidal，哪位m are 国volved in 也e control of movement,

院础ue and mll8de tone. These are sometimes coll配曲曲 ref回回 ωω 也eem:吨厅m皿1dal m也mand 由自由配endi鸣 projections a晶 exttapyra皿也l pa由ways. Included in this definition are 回回in nuclei in the bra旭S植m. such as the 嚼蜡bular nuclei, the reticular nuclei (mimlar 伽E副司， the rm nucleus and 曲otheb画al 伊nglia 扭drela“d ’ubcortiαI nuclei t。α回 in the 旬rebr罩in. 咀 喃sti趴:Ua耳配uα血r 田1d E时 nuclei 恤flu皿.cel]>i田Im“or E四z回1es

阴z世y也rough d”αruling 田m回ions 扭血t 胃g“.bulOBpinal,

retiml回pinal and rubrospioal tracts. They are impo血ntin 也t control of mll8de 刨1雹姐dth哇”由m of也.e body. The basal ganglia aert 也eiractions m 伽l阴阳 motor neurones of阳 brains回1 and spinal cord of也 con田h眩目1 side 也ro~ 臼mpl圃，旭溢血tpa血.ways {Fig. 1.33）.四幽 include projections via 也e 由也mus to the m。”rare徊。f也ecaebr直loor皿皿d pn:喝缸:tia田”由E ret:imlar formation of也ebrains阳n. The baaal ganglia are important in the C'Ol1trol of muscle tone and posture

m叫， importan句也e facilita咀onofap严甸回础 m例。r bebav阳U

and the inhibition of unwan时 movements (Cha阴er 14).

Chapter

’ Introduction and overview •

23

陈锦由u阳『 nuclei

Splnocerebeller lrac旭

Sl*!al co叫

Fig. 1.34 OV.rv阳w “the com剧目donsot 曲’“即“”Hum. 咀1e rerebellwn is an im严mant 回回E in which programmes of movement, ger田atedin 也e motor region of the c.erebral cor眠 aR comparedwi也 senJOIY feedback conαmi吨位espeedand direction of active movements of the limbs, head and neck 恒 spa阻 四山 is 倒四tial for accurate, coordi且也d, purpo配M movement. The arebellum re咀咱 affer四t connections from the spinal co时 说且也eapinoc:四由ellar tradl. It a1ao rec踵咱 input from 也e

Ventrt~

I

,r:~r:.T~γ~~~：~I脚

=1~、 问（谷 ”唰 , :

r『，... j、／旬吃了四川a

vestibul缸哼配皿 and from 也emotorcor回（the lat恒 indirectly 说a nuclei in 也epons〕． τk dR:r四t oonn£Ctions of也E但d>ellum

are mmpl.a but are prim缸ily 恒 the form of Cudback to the motor m四a说a 也e 曲创缸nus (Fig. 1.34). Afferents to ea，由 side of the αrebellum come 岳阳1 the ipsilateral half of the spinal cord and brains也m 皿d 岳阳1 由eco曲回ateral cerebralαm阻四Jerent

出曲ellarpro阳tions aRdir回国 ω 也econtrala忧国也alamUB 皿d m由alcor回也rough ad回皿础。n in 也e midbrain.

Because of

由函， and the d配us阻don of cortical descending motor patbw可E

F匍.1.揭四，回睛，I and pe巾heralner回国甸回ems a闹 ””lb旬

ea曲目deaf也e rerebellum 田ordinates the mO\咫皿四ta of the

，胁， otpa曲。旬，l回I leelon.

ipsila1回I 盹 of the body (Chap阳 11).

Basic clinical diagnostic principles A knowledge of neuroanatomy is 皿 essential 伊回叫回site for 由e clinic:al diagn倒也 of disorders of 也e nervous system. The procras of reaching a d唔回白严octtds by his阳cy咀king. 也回 n四rological e坦mination and, finally. by m面nnatmy investig甜ODS {Fig. 1.35). History」taking 归回des clues to 由e aetiol呗worcauseof 曲ease,. wherea，也e clinical examination pinpoints 也E 剑te oftb世 lesion {Fig. 1.36). A pathological lesion 缸也l8 at a spttilic loc甜m within 也e neuromuscular 皿s forms a 扭曲胆isable syn缸。IDE马 in咱tiga咀on of which leads to establishing 也E aetiology or diagnos也

C豆D

G豆E

~

任~ （勋1dron唱 anal归is)

任亟~ 时.u＆ τM W，。”’“ cllnlcaldl啕””la.

号豆E

Aetiology of neurological disease 刀iedi四时eB of the neuromusa血r sys田1 are d卸ur major types F也 1.37)

in relation to causation or aetiol吨y.

F缸 each major cause of di跪倒e there are appropriate types of invea咀gation, leading to specific forms of tr四unent. 咀le four causes are ranked in order of di皿臼I prio曲曲曲at 倒tditiona 由at are com皿on, po圆白lly life..曲回国ing and reversible with prom严缸回国ent are either established or acluded fimt. Conditions 也at 缸t rare, chronic and incurableαn be consider回 1面能r.

ca蝠’

阳”’田”“”哨”’”””t

自刨nalc

h』阳回归Y

栩栩睛

M“闹市

W剧』ler

臼rdlava翩翩

缸”＂naic

Neu刚啕V

Flg.1.37 四”’our m咖re翩阴阳eotdl”时，m d曲，

田uromu1111刷阳’””’m.

24 • NEUROANATOMY

Extrinsic disorders Enrinsic 幽幽rders lead to com阳也sion of 也ebr沮血， spinal cord, l1eIYe

m础皿d 阳iphEral ner咽（Fig. 1.38）皿d are. 也a曲m

四晤cilly remediable. hr帽幅画oru,

IUCb aa radiologicil im晤吨

。f 由e CNS, must be promptly canied out prior to neurosu唱团l 恒馆”四.tion. Del町 in

decompressive neurosurgery can lead to

perman回t paral}'I~，侃nsory I。” and incontinenc怠 ’Ibe brain, spinal cord 缸td peripheral na晒 m be compressed by di能础。f adjacent S刨出ues. 四t brain may be com严四d on its OU田 surface~bl“对 clots 伽ematomaa), absα剧创td tum0UI1 arising wi剧E the skull and αNerings of the 四rebrum. Al阳nati四i郭世ie fluid-filled 咽ntricles may comp圃，也E brain from within when bloc如~to 也E fl.aw of CSF lea也 to a rile in F四sure and 呵缸lSion of the ven创des (h：帅民叩balUI). The spinal cord may be co皿阴阳d by disease of the 币2己 IUCb as z也ri白。”ndylosis), prolapsed in也rvertebral discs and bone tum.ows, as well as by tumO\lIS of 也t meninges (m皿ingio血’）. The cmtral 也nalof 由E spinal co地削mal与 a minut£ V四tigial spac:r. may expand into a cavity {syrinx), compres曲唱也e nerve fibres i且也e CEO:田 d 也ecord (syringo町曲｝． 咀e aanial ner棚 emerging from 也阳回回阳n maybe comp睛”d,

as they course 也rou拚命eαanium and leave 由t foraminaof 也t 位叫L by tumoUIB and swollen arteries （皿四rysm1）.’Ibe S阱tal nerve roots le町ing the sp旭al cord 姐也e n仅k and back may be trapped by tumours 甜d 伊olap能d in缸”四由ral 曲a, causing pain, W回kness and sensmy lo画面 由eir region of distribution (radiml句“hy). The peripheral ner晒 may become trapped at vi血erable presmre 1i回 in the limbs by ribs and tough fibrous bands, leading to 阴h weakness and semory loss in their distnbution （回回pm回t E四m阳也对． Investi.伊tions for ex回nsic disorders are chiefly n四roradiological {e.g. com归国 tomo胆.phic （叼 brain scan and ma胆创ic resonance im唔吨（MRI)) to delineate 也e disorders (lesions) for n四IOSUllPcal deα>mpr四ion. 趾gerym勾 be E明国red u喝四.tlyto pre晒lt permanent disabili可 and 也at is why extrinsic disorden should be 由E 鱼'St diagnostic consid四tion.

cardiorespiJ:atoi:y, liv略 renal and 四d民rine function. Trealment of 也e systemic disease by 也e approp血.te sped.aliat can lead to 四re of the n四川咱.cal disorder.

Vascular disorders Vasrular disord四（Fig. nervm皿阴阳n

1.40）归nage 由z dra血tion to 也E

in a nwnber of ways:

• Occl国ion ofthe 回础（由om.be血） Res回国.on of由e blood and oxygen supply (infarction)

•

．四嗣同 into 也enervous 伽阴阳回orrhage) 咀ie rapid development of a

vurular lesion is called a stroke.

Co吨胆ital swdlin&'J of ar阳ies (aneurysms｝缸”mours of bl。“

vessels （皿gioaw) can com”剧创nial ner晴四d 也e brain itself. In田咿tions for vasrular disorders are aimed at m:ludi吨 abnormal d。“咱也随时础。f也t drculati吨 blood, 阳出lg 也t valves and muscles of也 h出t (ech·民ardiography, electrocardiography and rardiac angi1唔aphy), and di甲1却ing 也E 呢细ell of 由E nedcand k回n by angiography. The treatment of vascular disorders may be haematol唔αl or canliological and may require SU写~ to the heart or art回es in the neck 缸id 位叫1.

Intrinsic disorders Intrinsic disord四（Pig. 1.41) are priowy di刷dersofthe E町ous system itself. Intrin&iιprimary neurological disordm are uncom皿on, but when 也eyα:cur 也ey are oft£Ii chronic and

,’s ”””mic dieorders of 怕”’阳romu1”ula’”’tem.

fig

Exlracarabral haem口nhage

时.1.揭 E庸”le dlaorde.,. of the newomuecular 叼咽睛，m.

Flg.1.40 Vi’”ulsdlaor由”’Uhen刷rom帽cularav咧am.

…’…

Q ntrinsic di9orde兮

性叩~

也豆E

G豆〉

||

r= Q叫哩~~函叩l付 。”自由m邮心

II

σ~）

阴阳d…雨雨~

G二局面画

,’ ’

fig A lntrtn•lc dlso肉””’f伽eneurom晴佣阳”’”m. Colour事附阳协 句s 1.42-46.

irreverlible. Many navom S}'I'恒m d.ilord£I1 田1! UI叫E petic

influcnca (ha蝇。dq四enltion). Inborn errors of m幽bolitm

lead tom剧创 subnormality and disability in chil也en and are

,.. _ '.......-'

_

l.JJ _ t.:J .!.__ Prin町 lymphoma

ω咀l抄嘟”d by dtficie:r国n of sp回k 四写mes. Par啕mW

dUorcltta comilt of episodic l。”。f comciousnesa （制冲刷， aaaaiv哩，1句（nan:ol句，y) and headache (mi阴阳｝．阳回 缸’回回.ODa 阴g. 1.42) ocmr in ym血 and old 咿 and lrad to thep置四跑回 doth （自鸣曲·） of a:rta画 oeurom.usmlar com归田E钮， w恤’归自1gof oth四. When ，血m 也p.er画。国 民m in )'OUth, 由eyoftm have m 。bvioUI bered阳yor 萨netic 侃”也缸 eD.111肉也t muecular 甸恼。phla,

the her回ltuy

S四”dm。”z ’”叫地血烟， baedltary ”“缸”m归Z咽，， cerebellar u皿uandH皿.tlngton’， dilleaK. Whm 也ey occur h田 in lifr. 由ey att mott oft血，poradic: e.g. m·创orneumne 也钮’r. Puldmon’I diaeue and Al血ei.ma'1 也钮’e.τhe m回1 d唔阳回atiom aR rmw:kably selective as to the ner E cells 由at are affect£d. For ellllD1pl~ in motl:贸 D£111tlne disea舅也ere is para!归ii of mwde but no abnormalitiea of temation, 喇回回sin

’

’

Fig. .43 N”’阳翩创棚”“romuacular.,._.,.

Alzheimets di’”’己也m bee陀~amn回a but no par划”is.

” ues

Neoplulare缸， toez阻，sive, uncontrolled grow曲。f ti

forming ab白帽l or mall扭扭t tumour. Primary n四plasms 缸ise 扭曲t oeuromUICUlar ti8IU份由四Jelvea (Fig. 1.43); secondary nee略地UIWI sprud in the circulation from 创her prim町 0串且 1ite1 (e.g. lung or bruat). Rar曲， 也mours at distant 岳阳也皿咿 thenemn皿 m回1 by humoral or immune mechanisms and 也E multing 也orders m 阳mednon-m翩翩.tic or paraneopla回C

syndromes （邸， 1.“｝．

阳帽幽问 m”蝴蛐Y ElllDn-也翩1”『t叩咱tll1T­ Fn揭叫m冒｜ 由imenlia

Po加明蝠’

－二2立1

刷刷唰『削 「 阳刚唰呻拙y

_ \1 ｜」／主再

？二r

"

L向 …

J

－「y

u d 鼠

F『回刚ch'sl剧，

I

\ -

闻.1M ’刷刷刷翩咽le syndrome• of ti. newommculer ”翩翩．

lnftammatioo of neuromUIOJlar ti”四 may result from

in缸划m bym阳。。耶n凶ru (Fig. 1.45) and can a佳ct a

variety

of础旺tum, for 也mple 也t menin阴（皿姐ilJ8C)COαal meningltia），也t brain (viral enc叩ballti也 oeur。”抖世间 or 阳ipl田alna咱 (leproey). Alterna曲曲，也.flamma植m can 优ur

He『晤tlry spastic 阳酬阴阳

Mu刷刷归trophy, rnyo阳ic阳同忡，

me刨地｜怆 myope问

Flg.1 础。”帽”阳 di”’“”“··”刷romu刷lar ..，蜘m.

in 皿皿.une diaorden 阴g. 1.46), in 由e 血阻四 of 也fectlon. The molt common l.mmun£ disorder of the CNS i1 multiple Kleroli凰 Immune diaordm may al.lo ~ peripher田I nena (acute inflamm刷ryomro阳甜， or Guill由－Buri lflldrome), 也t neuromuacular junction (mya抽回旭萨田ta〕 or mu副e

26 • NEUROANATOMY multiple sclerosis). ~co呢ry from immune 曲orders takes w民ks ormon由量，“ it is incomplete. Moreov略 immune d皿rders oft四 m且 a rela严ing 皿d remi创吨臼山盹 wi由副耻 E咽lts

Fig.1.45 In伽ctiana af 恤， neuramuacul’”’幅m.

superimposed on chronic decline o晒 IDOil由aandymra. 咀is pare町mial course is hlghly rbarac田istic of multiple sclero1i1 · hence the name of 也e di刷隙，伽tern d吨~tions, by contrast, talre many 如m to d阴暗fop (chr01让c) and 也e on剧 is often difficult to 由他甸回ally 血t:r. 阴阳阳缸四皿n。但也 slowly to 也eir accumulating disability. In muscular 句础。＇Phy, h自edi国y semorimotor neur叩a血i筒， Parkinson’sand Alzl回mer's disease鸟也t di四men may I笛t from 5 to 30 y回皿 Neoplas皿S (tu皿m皿｝四ually develop over mon也s or如a玩 wi也町mp甸回E such as 明1甲缸，eizurel and h但也ch巳由tly rarely do hi民ly mal毕18Dt tumOUI'I 阔iomasand 优con也ry tumoun) declare themselv四 over days or w回b.

…

le cllnlcal di啕”ostlc ’”nclpl••

•H阳也口『y·恒脑咽， clinical 自相nina:tion 町d i刚回ligations

跑回 to

the diagnc划s of the

阳回｛副olo时 d 翩翩． ·币市e

site d甘冒E lesion(s)

由termi'田 tr晒。In饵l

E翩·nsic, s归temic, VII!归U恤『 or intrin副c.

•I『rtrlnslc disorders oonslst of

system d唱阳市eratlons (atroph捕， Inborn errors of me阳bollsm, parox归m副 d陆orders,

叩ldrome r回国Jed ~the

neap园”菌， infections ar回

n四rologi田I examin硝on.

immune d酷ordera.

·四剖>rders of the

nervous

system 帽n be c脑d’edas

Chronic polyradlcu崎础沪－「

I

G~n-也arr卤

f

Site of the lesion and clinical syndromes

J

Wha:但四r the cause

咂吁，

W晴回1自－－－：；－－τ／ 1

阳W脚阳J 飞斗：Myasthen恒酬，

Ea胁也mberts川mme

Fig. 1.48 lmmuM dlsardtlni af 世圃， neuromuscular~归”m.

S 霍SHE bBSaw 柿 、h

Trauma, vascu阳

Aa.119 S曲，ω恒 除缸”i『啕 Chronic (i附tan!) （唰世1in1w”k) WJd 19mi由啕（over mo呻胃口r”’陪｝

Dne Flg.1.47 H阳”’yf锢，，t)llmltapo”．翩翩，，l啕嗣． (pol归刷刷. Inflammatory disorders

are inv回回国 by

microbiolo脾al and 1erological 阳ts of the blood 缸id CSF.

Treatment of infection with 血也tiaobial a伊its and suppression of immune re叩onses by drugs such as corticosteroids mayαm or control these 姐fective or immune 也eases. Tlme-c。urse of disease 四story-taking can be wluable 伽 SUggeB由18 也E likely 臼.use of illneas, by determining the rate of 衍。lution of the disorder, which is often charac田is缸。f the di:ffeI四t aeti.ologio笛（F:也 1.47). Dilord田 of sudden (acut啡，由l!IJl.aDC OI四t are 臼wed by z田nal in问｛田uma）田 a vasa血r acrident （血。Ice). When the condition devd响阴阳 days (subacute) to become m回malin about one week, 也is is strongly au回回咀:ve of an inftammatory disorder, wbi也 maybe 旭fective (e.g. men皿gi也） or immune (e.g.

of a lesion may b己 its site in the neurommcular 阴阳n leads to a charac田istic syndrom已回is is defined clinically by careful examin甜on of the cranial nerv田，由E motor sys惚m, refla盹回回.tion 阻d coordination. In 也is boo.比 由e fun面。nal sta1US of由创e systans is d叩i.cted diagrammatically (Fig. 1.48) 80 也at 由t syndromes produced by particul缸 types of lesion can be ill回国国回ctorially in a way that links n四JIOana旭E吧F wi·也 clinical signs. In approp由te chap缸冒，也E desaipti.on of也e ana1a町 and basic functions of 也e nervous m饭m is aa:ompanied W 盖.gures, based upon 也e prototypical Fig. 1.48, that summarise the principal clinical syndromes in terms of semory 皿d motor deficits. In order to understand 伽即 由E relatiOI回lip betw四n neuroanaton弯曲d clinical signs, it is n配essary to know 由t IOU恼。f也e major sen四ry 姐d motor pa也w酬，也e significance of leaions of 也e 1ower motor neurone' and ’ upper motor n四rone' and the general 鱼皿ctiona of the 回由ellum, basal 伊nglia and r.erebral mrta. 咀u: neuroanatomical in伽mation contained h 由is ch叩ter m萨四四”也e min皿al and easen由l knowledge r明uired before 也E clinical approach to 也.e neurological patient. Without 也is know~鸟 it is im~sible to interpret 也.e si胆ificance of the si伊s elicited on examination of the ner鸭山耶回1 豁 described in the 皿缸咀aid texts on ’ clinical methoda'. Theαmtinual prac咀ce of由E exam坦ation of也z nervo四”Z恒n through experi团团 and 由E de叫吨mient of clinical acnn田L permit 由E hi民ly accurate

l民对isation of lesions wi创n the 回回回1 and peripheral nervous m能ms. The site of 阳 lesion ~be 由ictly focal, 伽 example a tumour in the left cer曲ral hemisphere; or may E叩臼能nt 10也.alamic 田d leads to passing, 剖且也t 也alamus.

”’ ”’

and a contialateral lou of pain and temperature 11eI11ation 扭曲E tmnkand l阴阳恤nba below 也e levdof 由el回.OD.Jn a ition, u daaibed below.， 也m i1 an ip1ila恒埠 ’＇pyra皿也·~·＇ of 也t Im晒且mb. Coller.ti陀忡， thae aR known u a hemimrd or Bnnm-S句wd m曲。me (tee Fig. 8.25C). Sele咽，e l创on in the bl'linsum of 也 medial lemniKut leadl tok翩。.fto昭l aemation. whereaa lesion of 也e u胆niDo阳lamictt回国da to loa of归旭 and tml:阳血配 翩翩欲地 iD the fa毡’n田-doll己 the dinical findi吨。f幽幽ociated 阻llOIY l·。”皿阱iu 也 pIDence of扭 intr画画c 岛cal lesion 明创n 由e 1pina1 oord or brainstem. Because of the dea刷蚓on of all ucending lell90JY pathways in either the spinal cord or ~巾曲，回n, lesions of the up阳 M割且’回norαrebral bemispbe:r冒 lead tol。”。fall sensation on 也叩萨源ite (contrala回al) side of the K吻. (See abo spinal cord l创锢， in Fig. 8.25』L M回皿国n leaioos in Fig. .9.17 皿d m幽幽al cerebral hemisphm! lesions in Fig. 13.18.).

“

~＂＇ •

Pmtlenlll

“......,.... In伽吧

Unllate刚陆slons o1 the s回naJ cord or b嗣rbraln嗣m lead to

dissociated sen90ry 阳8. • Lesions of the upper 阳In制m or cerebral hemisphere lead to loss of all sensation on the oontralateral side of the 以刘y

28 • NEUROANATOMY

Major motor pa协ways

由t lower brainst臼n means 也at a

Motorneur回国由at origin.a也 in cranial nerve nuclei of 由t

bet回sphett (see Fig.

braiDI'阳E or 由even臼al

αm国la胆菌I 严m均由 of the limbs.

horn of 缸咂nal card are called I阴阳

囚。”r n田lIOI田 and 也可 inner回.te 甲回k groups of skele饵1

muacle fibres. Damage to I阴阳皿例。r n跚跚跚 l倒也 therefore, to weakne3s （阴阳ii) orpu啕由 and wuting of individual muacl臼. The muscles shaw d叩m”eds回忆h （伽don) reflexes (hyporeB回啡时也er lose their tone (hypotcmia). Spontaneous contractions of 也t muscle fibru 幽socia阎明也 a 画ngle mo回 nave (motor unit）町urwb四缸 muscle fibres are denerv苗时 皿dares回E as faaci.a血tions, i.巳 ripple-like mσ四四四”。f muacle hen.ea也由e 副n. 曲ice all 1阳E mo细E R四rones innervate muacles on 也e same side of 由E body as the le四.tion of 也E n~ cell body, the effects of Im阳 motor neurone lesions are seen ipsilateral to 也e lesion. The detceodi吨 motor pa:也W町，也很 control the activity of lower motor n四rones are tt如red to as upper motor neurones. 四er 红iae from 由t 田ebral cor阻四d brain&田n.'lbe m咀cospinal 阳IilIIl划al）皿d antiαmudear／回国四bulbar

F由ways are particularly imp回国1t 但g. 1.32）.咀配也出1曲唱 m例。rpa由ways are highly m阴ni时四m嗣topic.ally but are 曲。 concerned wi也 CODα血d rnovem四”。fthe Ii皿.bs. Damage to the m植cospinal pa曲W町（upper mo伽 neurone lesion) leads to I。” of individual mo回n四”。fthe digits 血d a breakd俩相 in mo呢mentsof回回aion and abduction of the upper limb and of flmon of 也e lower limb. 咀1ia charac回istic W回h幽 of mo呢mentll is clinically referred to as a pyrami也l weakness.

ri'D

Lower •nd upper llllOtar neurone I跚跚

阳mage to low曹r motor neurones is 槌soc剧创 W讪 a number of motor signs and symptoms that distinguish t 阳m upper motor na.rone 阳阳回. The distinction Is c阳M In neuro问刷刷mlnatlon and

d问nos幅． Lowerm创。r neurone syndrome • W1回阳ess 阳resls) or par冉冉 ω同l剑。f lndlvldual mu剧”· • W1臼ting of muscles. • Visible spontaneous contractions of motor unts O阳sci凶lation). • R国u国d resist町、ce to passive st刚出1ng (hypoton峭． • Diminution or lo锚 of st阳tch (!er回on）阳阳帽 (hyprticonuclear/co副cobulbar 皿dco副.cospinal tr配ts decu剧tein

unilateral lesion M 也e cerebral

13.18) or brains回1 (see F地 9.17) l.eada to

币1£ 田e of the 恒田’阳ami也I’” describe 也E effec:ls of upper motor n四rone I臼ions implies that these clinical futtures z四ult solely from damq霞 to 也.e pyramidal or cortico酬nal nact. H侧穹帽， individual 田cts are rarely damaged 恒 isolation and, therefon:马 it is often 必flirult to attribute clinical deficits to involvement of p缸tiwlar pathways. D缸nage to 也e 凹rami也l tract itself 严。ibably 部:counts for 也E loss of diacre能 mm咽nents and 由z appe缸anαof the Babinski reflex. H归田:ref(国a and spastidty are d田 to the a甜itional invoMln四t ofo由自 pathw苟且

Ce陪bellum 咀1£ CUI田rt concept d但由ellar 缸nction is 也且也 as

movement is CErebral m缸瓦也epa阳mof in阳ided movement is 往回1S1I1itted simultaneowily to the E自由ellum 由也e pom (Fig. 1.34). At the sa皿.e time, after回t im严血es from sensOI)' E悦甲ton in muscles. joints and tendom』 conπy in阳mation 曲。ut 也E O鸣P凶s m回白血nt thro咀gb peripheral nerv四旭ω 也E spinal 倒咀皿d ascend in 也t sp也.oc:er由ellar tmcta to 由E 田由ellum. 币1£ cerebellum. therefore,. is in a uniq田 position to 四mp缸E the in但ruled m。”E四t with 也E a由ial mo阳n四t V由.en there is a discrepancy be的帽回也ese,. theαrebellum is able to correct deviant mσ陀皿四”. Thil is a由ieved by a征:ending cerebellar efferent pa曲ways travelling 由 ini由时 by 也e mo阳归血。f the

也E 也alamusto 由E m悦。rcor皿皿4 世ten鸣曲rough detceodi吨

fibres pa提问 ω 也E bra坦stem 皿d spinal cord.τ'here are 曲。 direct cerebellar connections to the 咱咀bular 血d reticular nuclei of the brainstem, w扭曲曲回1时四s give ri民 to descaid.ing pa也W可E 面fluendng ton巳 p田lure and balancL l.aions of the rerebel.lu皿田 its OODD配咀.onsl四d to a cerebellar syn也回1e comprised of inooordination of 句t m回回1ents (DJStagm\11), s~配h (d”町白白），也e upper limb1 (in阳筐。n tremor）四d gait （.刷血｝，姐也e absence ofw回kness or ！。”。f S咀sation. The symptoms and 画胆S 田E山 OD 也.esame 画de as (ipsila田al to) the lesion 凰山 αttbellum. A lesion 旭能rrup由1g cerebellar connections m勾 lie in the m由ellu皿 itself, in 也E braim回1 or in 也E 回回叫ing spin低班由ellar tr配佩 U国la回回I lesions of也ecuebellum l锦d to ipsila忧国 I。” of coordination. Simil缸坊， a unila阳al lesion of也t bra皿回1 姐回饵bly destI呵，由Eαrebellar connections to 也e αrebral hmllsphett and s阱ial cord and leads to ipsilateral incoordina筒。n 姐d, as desαibedabo鸭 a cootrala田al pyramidal W四knesa of the limbs.

F亭 ，嗣n1...耐 lh•oerwb•lluln Cerebel阳r 阳阳ns cause:

•

N归恒gmus.

•

D归arth阳（s国nning 哥>each).

•

Inter啦。n甘冒π)Of.

• Ataxia. Tu自 slgr回 and 珊nptomsα:cur psi阳阳回 to the

lesion.

It is someti.m四 mistaken与也OU曲t 由at 扭曲ordination of 也t limbs ia syno町mous with a disor咀aof 也tαrebellum. 四山 is not the 但盹 wher臼lS it is 回ue 也at lesions of 由e. cerebellum do lead to inαxmlination. A pati四t wi也 a short l电 and an ar也ritic hip joint,. for aampl己 W诅 ~an inroordina也 gait. Moreova, W回h棚。f the limbs due to di剧院 of the c:entral or peripheral nervo时，Item w诅 cause incoordin甜on. Dam.age to 也E 阳1”teral aensory ner晴 or to 也e dona! columns of the spinal

Chapter cord d叩d咱也 brain of proprioc甲由-e information from w 且mbs，也回但且也lg lack of COOI也nation of 也e arms and an at.aidι gait. 咀由 is known 菌’lmllO哼 ata垣a~ When patient& wi血腥nsory a钮:xia do院也ai: 句昆曲ey readily lose their balanαand 也is is kn侧E 组 Romberg'a aign. This does not happen 回thl回回回 of wα:rebellar pathw句/S.

B仅awie of these problems of in能甲retation, it is con:顶:ntional to carry out taaks of coord画剧。·n at the 四d ofwneurolo脾al aamina出几 in order to 幽幽幽 contribution of or也叩aedic d由rmiti”， n四rological w田kneas and sense町 l幽 ω 也e d嘈tt of inooordination. If 由eae prior deficits can be excludm on aamination, Wn iru:omdination can reliably be blamed on lesions of 由E 但由ellar pathw句， themsd晚且 This can some由nes be adi组.cult ererci盹伽 eKail'l.J此画 di键倒”’uch as multiple sderosi岛也m are multiple lesions in the cerebellu血， brains艇m and spinal cord, each making a contribution to 也e nature 皿d d咿e:e of neurological di抽出协

也yro«Wcosi.s

’ Introduction and overview •

29

- or slow and pment at mt (res由gtremo吵， u in

Parkinson’s 幽幽且 。”m conai血 of rapid，坦鸣叫ai, un严时ict血l鸟’“萨叨’－likl!! mo胃menu.

It is uaually most markal in 也E head. neck and 曲也1 limbs ando伽盟 E但mbl幽幽回回也d fragments of 阴up田eful mσ，em四”，。lOI回 mmifests in Huntington’s di就ase and also as a long－能rm complication of the treatm回t d 阳rkinson's dis创篇 幅也 L-DOPA, 晒m it may comst with d归阳由｛L-DOPAinduced 句喇nesia).

D归”Dia consists of rela.tivdy fixed abnormal po血imand slow 臼由出gm.oπm四” that may occur in 由.e face 缸id.mouth

(orofadal dyatonia），由E n缸主｛ω币四His），也E m皿k or the linlbs. h 也e latter E盹 it ten1也 to be most marked prt回mally. Dystonia manifests in here祖国yneurod申iera.tive 也ease 阳edi町 d”阳由.） and in L-DOPA-indu时咖阳由” a complication of 也e trea皿.ent of Parkinson’，也副已 ’na are brief involuntary mov也nen钮， which may be simple or compla 曲d which remain stereotyped in the otherwise normal indi世dual. 四ey 田国llycomm四ce in childh创xi oradol也centt and remain characterislic of the adult, ~at ti皿es ofs缸四 四daI回ety. In children wi由 Tour回te's syn也ume, a E可田抽出 d di最nm.t complex tics d罚d叩’阳ially over time in 恒也吼duals who often display obsessional behavioun and somet回es utter involuntary obsceni阳（coprolalia).

Basal ganglia 四le baaal gangli也 lying deep wi也且也eα~bralhen咀刚回巳

receive S幽幽ry 皿d motor in缸mation from wid.臼.prea.d regions of 由E 但由ral car国（Fig. 1.33）皿d al抽血严t 岳阳也

braim回l. 咀icy are involved in d理由itrol of mo晒nent. pc:班”R and muscular tone （也叩田 14). Lesions or di四，nfers of the b血l ganglia do not lead 阳 1田a of 1£11.1ation, power or coordination. Ins徒刑， there ii a lo”。fco曲。I ofvolun:田ymo阳nent and 归础E电 increase 皿 muscular tone (rigidity）皿d 也E 由自萨nee of involun钮rym·町ements (d ldnesia). Unilater菌I I创.ODS of 也t bual 伊.nglia lead to a contrala阳al motor disorder. Impaired motor con宵。11 manifesta as del句d ini由tion and slowness of ma晒tent 〔副m划M句挝nuia），甲isodic burr”吨位耐nant 伊益）缸td sudden Ito阳， causing 削.b. Posture is :flem:l or; less commo吻，但阳uiedand 由m is anabaenαof ann-swingi吨 whenwa国ng. The face lacks apress10n. We’“tyis an ina圃，e in muscular tone 也atmani他ts 笛 resistance to passive movem四t throughout 缸回entof 也E mm-'ml.ent. It may be smooth (lead pi严） or jerky (cog－·咱国〕 in typ巳咀由 mntraau wi也耶astidty. where 由m is an initial E回血nee to passive ma陀mentat 也em田tof 回国a血E stI回曲， 币。llowe:I ~ relnation. Tremor is a to-and-fro, al也ma·也池，in:田oidalmo阿mentofthe limbs. It may be rapid and pre阳it while m画nta旭ingposture ＠饵”ral tremor) - for eum.pL己扭曲e out&tretched 缸ms 笛 in

霄 ，ieordersof由.......唰i•

”

Basal gangla disorders cause: •

Slowlnlt阳1tlonand 似ecu田。n of movement 伽四”eruleus in the pons. Llpofusdn is a yellow-brown pigm四t that aαumula田 in some neurones wi也 a萨 Each nerve cell is a s叩arate p峙富国1 四.tity with a limiting ceU membrane. In order for in缸mation processing to occur 画 networks of neurones，也erefor骂 in缸mation has to p四 be伽ttll neuron臼．咀由 oca皿 at l}'Jl3.J>Sel. 币ie basic strw:ture of the ’回叩，e bas been outlined in Chapter 1. 四e most common location 岛r synapse forma植.on is between 也e 回minal amnal arborisation of one neurone 缸:id 由t dendrite d皿other (a皿der咀rltic synapse）.。由a loca1由ns att also possible and 由ey give uosomatiιuo坦onal 四d d曲曲。d曲曲itic 句nap阳． Neurotransminion betw四n neurones occurs by release of 叩国k chemical agents from 也e presynaptic en.占ng 由at 缸tupon receptors in the pos田naptic membran巳

N叫剧us

Nucleus

Neurotransmit恒rs N四mtraruJ皿阳｛田m回由） chemi四1s are rtm:咀 in 四des

Myelin shealh N山以J8 of Schwarm

eel 时.2.3 At,回国t neuron1比Thed啕ram ilustra刷刷ieint陆倒IYa『

。咱anel阳. See also Fig.

1.3.

wi也in 也e presynaptic er回国忌 A 也igle neurone is thought to release the 掘me transmit田 at all its synapses, and all neurones of a 归rticular type, 姐回ms of origi几 ter田nation 缸u:l 缸皿tion. utilise the same transmitter. Numerous transmitter substances have b能n identified at 四riot』s sites 凶也t nervous system. It has long b田iknown 由础， in 也E periph町， amylcholine (ACh) i1 也emu田ni也g be阳回n motor neurones 皿ds回ated muad巳 It ia also an import且nt transmit也r 画 the autonomic nervous 句15tem (Cha阴er 4 ), being released by preganglionic neurones of ho曲也e sympathetic and pa:r叼m阴ithetic di悦sion岛四d hypos耶nglionic paruym归血.etic neurones. Fur由.ermore, ACh is a transmitter at

neurones. Numerous microscopic dumps of Nilll granules {Nissl 以对胞， Niss! subst皿α） can usually be 舱钮 in nerve cell bodies Sta旭ed 明白 b幽句也ilic dyes. Nissl granules cons画tofrough 也埠。阳mic retiatlum 幽d associated ribosomes. The ribosomes contain RNA (which 缸回国.ts for 也e ba叫池ilic 幽ining 严可>erties〕皿dare 也e si圆。fprot血可nth臼is. Nave ceUs are hi由』y m也.bolical』y ac:t:M and, 也erefore. 由E Nini granules are

AChas 由eirtr皿smitter are

础回阳ypro皿nent

G血Aergic synapsa) and are the p血cipal excitatory 扭d

(Fig. 2.4).

Neurones conta扭 a compla.: meshwork of structural 萨。回n strands called neurofilam四”， which are as悦mbled 皿.to la鸣~

numero圃， widespread si剧时也in the CNS. 每回严a 也atuae

called cholinergic. Some simple amino acids act as n四rotransmitters.τhe most important are glutamic: acid (gluta皿血〕 and p皿皿4皿inoln呵ric add (GABA),whi血 ocx:ur 响曲（forming glutamateq豆cand

inhibito可 transmitters, re叩回ively, in the CNS. 囚，cine is an inhibitory transmitter 扭曲叩inal cord. Sereral monoamines are

34 • NEUROANATOMY important transmi忧四.Nora也ena1旭.e (nor哩pinephr旭.e) is relea能d by 阳西盼ngliOI血 sympa也.etic n四跚跚 peripherally aa wrll. 笛 at some si圆明也in the CNS. Dopamine and aero抽血in (5-hydm巧tryp1B皿凰巳 5-H叼 d皿 act as 缸llllllmit国z in 由e brain and spinal mrd. Most neurones 也at u创ise monoamine!I as their neurotransmitter have th由国l bodiea loca时 in nuclei M也in 也e brains回l, e.g. the loCUllα田uleus (nora，也回aline), the sub民组1世a 皿g田（dop缸旧ne) and 也t raphe nuclei (5-H可． Some small molecule transmi出rsub阳nces, particul曲曲t u旧no acids and ACh, are often ref回回 to as fast transmitters bea田e 也町 b出18 about rapid chan伊 inpos町naptic membrane 阳meab血ty t。但国E ions (no由，Jy N矿， IC', ea:it and Ci-), resulting in chan厚望 ω 也e pos町naptic membrane 归国1世al. Other transrni臼m IDM! a slow自四an because 由eyact 由rou吕h the in能rmedi町 d a sa-called 随即id m倒回鹏则由 as cytlic adeno由iemon咐10sphate (cAMP). D叩amine 缸b into this 四魄。1ry.

are stored 皿d d跑回 P, chol町stokin画，四皿atosta也句no甲bin 皿d o由四. These peptides are o位四 found oo-localised in 由esameneur回圆圈 ACh, amino acid or monoamine n四rotransmitters and are sometimesαlied cc-transmit阳事. In ma町 instances』 their precise functions are poorly under冒tood. It is believed that some neurop甲tides modulate the rel倒也卧uptake 皿d 萨双tsynaptic effects of o也a 往回smitten 皿d they a略。1erefore, 0缸白血缸red to as neuromodulators. In order 如也.ere to be effid回国皿mission of information between neurone11, 也E E曲ct of a neurotransmi筐z mlllit be 值minated once it has acted upon the pom归.aptic membran已 回由 is achieved either by e四mic demuction of the transmitter or by its active re-uptalm into nei:w en曲!PaDd 酬.a. For eKalilple, at the n剧romuscular junction （：跚 地 3.6) and at 也.Oline晤E synapse鸟也t action of ACll is termina时也rough E可也啕sis by the 四zyme acetylcholin但恤ue (ACbE). In contrast, monoamine- 四d a皿ino add-mediated transmission is usually 阳minated by a re-uptake mechanism. although d电rading enzymes also 国.st. N四rop叩＇tides 缸E d电;raded by

and chemical 田说ronm四t 伽 neurones. 驰rious types of n四m副al cell are recognised：阳回归卫y astrocyt筒， oligo缸咀rocy田（oli伊d曲曲oglia）四d m阳回国＆

Astrocytes AstroS8Cl'BI p恒泪』s In

tts course through tt回国市. C8l』sing pan, and wasting of t陆 muse胞s and numbness of the l啕（略， with I bl缸Kier and bO¥帽l incontiier盲目’－ I

W回阳1ess

I

42

……

|

Cranial nerv阴 and

~

motot句幽m

.-

Senealion

C刷dinalicn

－立之

+

+ +

+

+ ,,,

+ ++

+I f ' +'

ML幽幽嗣础m”und

+

II L幽of

除:wmal

咽”咱

Flg.1.12

~

I)

La阳帽，．．．”副刷刷例GUS 伽阳回 CCII'鸣。，』·TIJ. 陆驷 elsoto 同.

1ll 111naallon

1.48.

Femoral n1rw Ob阳帽”『帽W

Sdatlcn1rv1

” Hnlpluul.

肉’.3.13 The 旬’t lumb

心

" 帐，mal

……In…system 咽

C7·

CT

L5

lJM，阳隘的Ill a*"8ou8 cf .....

Liii制鼠翩翩’“阳明m Mee制a阳阳帽 d伽帽m 阳制

Ulnar

”“l1l111d In怡nnadl幽 cutan副局d同

t

LI恼，a aJtan翩翩 of thigh

『，

“

M i1n

q

－LH ．，

,..

lJpj:圃，国·回国 α翩翩醺且a of 81111 Medalaill翩翩•darm

ktmnop

』目 CJqeaFau

..

陈崎刷

α血m幽

匈灿灿 t翩翩 a翩闲” d同 a脚旬’“阳回回（rn.刷划翩翩1eOUS) ω．，阳Ullll 民刷阳ω恒neoua of forearm R刷阳ω恒neouaoflh胁

”“l1la』阳”Ulof 航协 副唰

Fig. 3.14 币”’闹””田di嗣以刷刷。”阳’嗣同”｛曲”ll8t0m•，四”med ，，目，...ine”“.Axl副 l~nlnbo刷．

｜

44 • NEUROANAT。MY

4忐乒7~，

乙4歹'-y!j＼、＼「

也哇二、~J . . C7,8

(\\ i

,\\

， 即

＇~J d手工＿）＿＿＿二 、 CB

\\

, 仁＝

、7

门 、 l .\4u

j

,

h

~

,

……nervous刷刷 l..al8倒也血”。..

’”

ll'llrn

Mo!Dr

S翩翩y

45

,...,. of Ille.协 M幽r

SenlOr)'

SmaD musc:les at 骨，E hand

None

组cep曲创buctor酬l崎阳酬 Ulnar阳rm af Diiie ar叫“ng 偷嘲，rand 回，世

Common 闵Rlnl8I nerve

Median nerve 伽刷V

M口IDr

Se『wy

蜘切r

Abductor阳lllcls brev恒

Toad耐tle>!Drs Foot 阳军阳阴晴 F倒到阴阳回事

R9c凰”闸

“n帽Y

MolDr Fi『可e『 extensors

Thumb 翩翩nand a以1u::lus

Wrist倒”nsora Bract自radial阳

“”

Fig. 3.11 Sena

nd m创圃， detlcb 8190Cl8恼dw胁，lll'lphenil nerve 嗣Ion•.

。 如甲 」3“－～ζ二五...............

’.tpl蛐”“阳时朝” •

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a 19α』mbant llmb) and to ch町、b antrapm酬 by normal or di””“ eneto州”l st阴阳，部副阳刷饲甘iem. Then回t commone:田nples 翩翩Jle '9dlal .,..,,. compr唱sslon In 廿18 spiral groO\州E d 甘冒E humerus and chronic entrapment d 苗、e t*-'...wat the elbow er咽’ of 晴、E m -.nn...皿 the wrist ~α~tumel 叩ldrome} in th& upper lmb. Chronic er审理阳酬。r the lataral

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饱回E圃， d nerv喃自阳”－ •TI冒E 内e睛’bres are e晴h凶thed

in th1'811 oonnllOI惘田”ue 回到，ings：，回:loneurium, pems』riim g回叩lneurium.

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, commDn ’”’naall*帽 at the h回d d 怕自由bu恒 occur in th& l阴阳

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Autonomic nerve

via 也t white

Sympathe回c dlvisi。”

47

ramua c.ommunican鸟”“lied because 阳 are rn)"l!lina时．

倒四”四t fibres

咀lOK fibres concuned with innava由D of structures in 民啕anglionic aympa也~c neurones

are located m:l~y in 由t

也t h组dand 也or.u 田minate in synapticαmtactwith

也倒四z and uppu two or 也m lumbar aegi:田Dtl of the spinal

萨M咖nslionic ttll bodies in

oord (Fig. 4.2）. 四iey lie in the la阳咀l homof 也e 1Pinal grey matterwb油 ia, tber曲盹创y 阴aent at~ le¥da (aee Pip ”， 8.9B｝. 民咿.oglionic uons I钮，e the cord in 阳刚回l nerve rootl and join the 酬nalnaw. Poi耶nglio皿c l}'Inpatht.tic neurones~ 世ieir cdl bodies in one of ”。 locatiom: either the aympatbd:lc 由翩。，但nglia that liet d也er side of 阳刚由al oolumn, or the plellllel (coeliac. superior m倒四阳ic, in缸ior maentl'lic）也at 1UITOUDd the main bran曲”。，f the abdominal aorta. In order to aa.cb. any of thae le回阳1鸟”咱~ionic amnsin 也e 1pinal naw 四tEr 由E 却mpa血me chain. n，倒E 酬nalne凹白血at contain lf0lpa1hetic outflow are linked to 伊吨lia of the l)'IDpatht.tic chain by 旬帽 small ner昵鸟也E rami 四mmuoic:antn {Fig. 4.3). Pr甲nglior山 fibres 归11 into the chain

阳喃喃ionic fibres return to 也 spinal

the sym阴阳配 chain. The

nerve via 也 grey ramua are

communica凰” called btt.ame 他 constituent 曲m

~sled. ’Ibo能 prega唰沁园c l)'lllP•thetic fibres concaned with innervation of pelvic and abdominal vi筑m PUI 阳也iterru”’d 也rough the sympathetic chain and tmel to the plameswh自 由eir co田，pond皿gpos电anglior山倒l bodies are l阳ted. The neurotranamittel' releued by pr咿nglio盹 aymp仙etic neun:>nes ii acetylcholin也岱ietrammit恼。r p嘟嘟nglionic aym阴伽etic Wla is ger皿allynora·也回al恼t (nore回n甲ihrine), although the ttlls innavati吨阳回 glands are cholli回牌’lbe a也四d medulla is 姐 a即tional organ, in 由at 扭扭曲回ly innemlled by p眩，ng1io血 1)'111~由etic nc田onm.

Eye U创n回 g阳叫 M山XJU，町略mbr酣睡$

of noee and pll幽 P翩翩 gland

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48 • NEUROANATOMY Preganglio『1icn1浏阳市’

in 凰”ral hem Sympa伽剖k chat1

Spinal net晦

问啕ar嚼阳icneu阳酶

White rarr阴阳nmu『阳m 臼9'J l'lll1US comm1S1i甸回

“

Flg.4.3 R，』剧’1>nehlpa b ween a tJplcal 曲。”clc •plnal ner四 end the ”mpathe回cchaln.

The d剧， of 句m阳也etic nervous 句晦m activity are most apparent under conditions of 盹哇’也 mi但也由t or fear 扭d are classically ref回回 to as 由t 咀ght m 副ght' 阳.pons巳咀1e K缸tra但 and blood pressure are incuased.ηie bronchi are dilated to incr回se airflow to and from 也E lung且咽，odilatation in 业eletal mwcles alltn帽，也e inaeased blood flow E呻tired for 回.ergetic K由i够 while gastroin伽tinal blood flow and mo创ity are d回国sed. Metabolic changes oca岛民JChas 姐 increase in blood ~UCO盹 to support high energy u剑”a山n andswe甜ng 忧Ul'8 to inα'ease h且I lo”-

l~

….,.....

LMlomof1M.,..........cn

Parlpheral •曲”“nl岳阳HUN 嗣dsto 阳htlng through 削lure to control the h倒rt 附te and bl以刘 presMe 伽”11.!ral Qncope), urinary and bowel Incontinence er回 Im阳tence. 似嗣nomlc 闹Ul'Q阴晴旬，旷阳、 com~I回协 acute and chror晦 跚跚ymotor 晴m阳llhles, but r四ly manl嗣t es chronic 饱mllsl n刷red饵”nera伽帽 d阳q由用口if the 阳rtpher刨剧tonomlc neM揭． Homer's 町nclrorna 用怕E b口 d『ooping

of the 句elid (ptosis) end

(miosis) ca山田 by 由mage 恒甘回叩n田.thstic and tt回阻di副 协刷lodilato『）他圃 of the i由．节18 叩叩甜回忆 neuror圃，。『甘1自 由scendi啕阳lhways corr1roll同 them, may be dam啕回 a a number cor胃回ction 口f 白白 pupil

inn町回首on of 世16 阳ator palpeb甩， superioris m崎cie

of I即由：副啕由scendin 阳 brain幽m 脚甜翩。『 illm叫 and t情 spinal co叫脚创锹阳、d回阳ity or 酬时， as 甘ieyem宵”的廿附

thoracic nerve root (by tumour of the apl叫 lung) and as they In the symp础elk: p阳山 91'()1.』nd the carotid arter回脚 脚ellng of the arter1 In a mlgn副nous 创tack).

加t

”棚d

”

Parasympa·甜，etic

division

“ in the

R鸣曲nglionic para巧mpathetic neurones are locat

bra皿回1 四dthe 刚nal cord 但g. 4.4）.明白姐也e brains倒也

such cells lie in 值皿al nerve nuclei associa能d wi幽幽E oculomot01; facial, g1，幽咐wyngeal 曲d 四gus nerves 血d pro说de innerva世on f町由U血E四 of 也E head，也oraxand abdom四. The parasympa:也eticαmiponenta

of these nerves 缸E

described in Cl呻值 10. Wi也M the m礼 preganglionic P缸圃’回阴阳tic neurones lie in m ”rond，也ird and 岛u抽 saa划”gm回ts

and pro悦de inner明白n for pelvic 由cera.ηle cell

k划ies ofpos耶nglionic para句mpa·也etic neurones lie 画院ng1扭 曲at 红E located close ω 也.e

structures which 也町 innerva~巳

W』由扭曲e alimentary 臼nal，世Iese

町回国ic （扭曲ach's)

neurones coa回1bute to 也 and submumaal (Meissnei:’,) plexus四．

哑iese pl.£Jtuses are 血o ref届国臼翻白e'en田k Itel咽回

”配m~

Such a wncept has arisen bea.we 也epl皿蝇 additionally conta扭曲ffer回t neurones and in能rneurones. 咀le rich l侃al in田ronnec植ons of these 创ls are ca归hle of sustaining the mo创ityof 由t 伊础。凰”stinal tract in the absence of input from 由t CNS.Furth四non鸟 these cells cannot simply be 叫回也dwi血 由eparasym严也etic nei:vous 阴阳nas 田di由nallyd曲时，血1但 也句 are known also to receive aynap缸 input from pos唱唱ionic sympa由etic: neurones. 咀le DJ四mtransmitter released by both preganglio国candpos毕ngli。因cparasympa也etic n四rones acetylcholi皿

is

…… ”

E

L.aalmal 恤M

蛐后ouamar惜1111181

dnc翩翩阴阳”

问”“回削 ＆翩咽，回lblmllld

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臼toph啕us 5'Jm回1

Small inllllltine

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Ad181回 gland

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F胁”。

on at the’”””’曲de d阳i.1an or the aulDnomlc n•”四””lllft.

5

Coverings of the central nervous system

S阳II 50 Anterior cranial k怒领 50 M1剧le cranial fc跑回 回

Po剖eriorα町l创 fossa

Cranlal menlng” Dura m回er 52

回回 central nervous 制em （＇创S)

is supported 副 protected by bone and membranous 由呢rings.τhe brain is lo惶惶d wi由in 也E cra皿al ravi.ty of 也E 由ill and 由E spinal cord li臼 in 也E vertebral, 。r 酬nal, canal 明白扭曲E 呢rtebral column, or spine. Wi也扭 曲曲 bony covering岛 the brai且也d spinal cord are in咽sted by three concen创ιmembranous 皿ivel.op创. The outermost membrane is the dura ma:陋， the middle l句自 is 也t arachnoid ma:阳缸鸣曲e innermost l句-er is the pia ma:田． τhevmebral column and sp皿al m四nges are described 姐 Chap田 8; mns叫出itly, only 也E 血ll and cranial m皿ngea are considered here.

Skull 四ie brain Ii.es on 也t ftoor of the cranial 钮，ity, which. 旬萨也er

50

Arachnoid m副er and p阻 mater 54

坦

e

Theoptk 也nal is located medial to the an也rior clinoid process

and oommunica恼回由也eorbit. 四m咄 it阳E 也E叩世E 归） nerve and the ophthalmic缸阳y (a branch of也ein阳nalαm“ 四町）.

• The superior orbital fissure lies betw白血也E S回国 and l四ser wings of the sph四oid bone and also commm咀αteswiththe orbit. It carries 也.e oculomotor 但I), tr配blear(IV〕皿dabducens (VI) nerves 血d 也e 叩h由almic d世sion of由t 国萨minal 〔V)

nerve. • Theforam回 rotundum 叩ens into the pteryg。”la由le fossa. and carries 也e muillary di词，ion of也.e trigeminal oerv巳 •The 缸ramen ovale carries 由e large mandibular 世vision ofthe 回geminal nerve. • Theforam钮，.pinoaum is the point of en町 of the middle meningeal anery.

wi由也E bones of 由e aanial 四.ult.

provide& suppon and physical h如ry. 咀ie 8oor of the cra皿al ravity consi翩。f 由ree f。”盹 Each of 也ese aa:ommodatel 阴rtia血r 归rta of 他 brain and posseaes 伽amina 也rough which cranial nerv四 and blood 咄咄四固自id leave 由e cranial cavity pro缸tion from

〔F电~

5.1).

Anterior cranial fossa 四iean也riorαanial k剧a is

formed by the frontal, eth血。id and sphenoid bones. It aa:刀mmodates the 企ontallob四 of the M祖n. 四ie greater part of the floor of the anterior cra皿al fossa consists of the frontal bone and it also forms the roof of the orbit. The 归rt of the 击回国 bone 也a:t 缸ms 也e an恒ior wall of the 也m contains the frontal air sinu1. 咀1e medial part of the floor of the 血也rim cranial fossa is compo蝇d of the eth皿oid bone. In the midline, a 也缸p ridgi鸟也e aista 醉m. is 血e an田iorpoint of attachment of the dural fab: E由i. In a narrow, elonga:时 d叨’因sion on either side of the 由饵”lli lies the aibriform pl础。f由t ethmoid bone, upon which lies 由E olfadoly bulb. 四ie bone of the cribrifonn plate is pq咱？ered wi由 small perforations 也rough which the fascicles of the ol缸torynerve 回阳也ea回国由rityfrom 也t nasal cavity to atta血 to the olfactoty bulb.

Middle cranial fossa 咀ie middle cranial

foasa is fanned by the sphenoid and temporal bones. In 也e mid.line, the body of the S冉enoid forms a d四P depr1四ion, the 峙P句也归国I 恤盹曲创mp幽d by four spws of bone. the an恒rior and pos恒ior clinoid pnx军sses. The

国pophyseal. fo嗣叙:comm＇以k胞也e 崎p。p峙，姐， or pltui钮’ gland. Lateral to the body of由t sph曲。“，也e rest of 也t middle

cranial fossa holds the 能皿萨>ral. lobes of 也e c.ei:由ral hemisphere. 咀te middle cranial 旬，a contairu numerous points of en町 ω，

and mt from，也e cranial ravity for 由nial nerv跑回d blood In partiall缸

础scls.

p。s恒ri。r cranial f。ssa 咀尊严部阳ior cranial fo酬 is 阳med~ 也eoa:制回 and p由剧’ 回nporal

bones. Anteriorly, in the midline, it forms a sk甲， smooth slope （由t cllvu1）由at isαm由:uous wi由阳 body of the sphenoid bone, posterior to the 句p叩峙seal 岛帆’The bra圆圆1 rests upon 也e d叽~，也emedullapa篇面g 也rough 也E foremen magnum to become continuous wi也由e spinal co此 τbe forant四 magnu皿 also ad皿its 由E 胃口ebral z回国 and 由E

spinal root of the aαessory (XI) ner陀 In the la能ral wall of the fora皿m magnum lies 也e 峙pogl饵”l canal 也rough which the hypoglossal （泪I) nerve b咱也口anialcavi可. Bet响扭曲E 。因.pital and p由阳阳1poxal bones lies the large 如gular foramen 也rough 咐rich 归”也e internal jugular vein 皿d 也e 自1幽ophacyn胆I 隅，咽胆S (X) and aαessory (XI) ner晒. In 也t 回tical wall of the petrm皿阳nporal bone is located 由E M恼nal auditory (acoustic）皿倒”” whim transmits tl眼睛tibulocodtlear (VI用血.d facial (VII) nerves. 四四 αrebellum rests on 也e fioorof the F览馆rior cranial f。“a.

A•pe四··帽，pPtg

”

t Ion Is an e>φandI咱旬cal leslon such as a Since the cranial c刷ty 阳 ciO!踊d and un嗣ding, the brdi 阳 distort回 and displaced d时nwards, towards 阳阳租men m啕num，创阳阳咀cranl创 p刷刷m d锦S 归g. 5.2). The 阳回ant compl创ns of headache, vomit阔， bur~咱 of 喇on and dro响in幽．刊e optic d恼CB 刷刷。l胁’&pill曲翩咱创d 啕na or b『面附tern dys仙nction are ro町、d. Coma and d回th Bl』P自W冒商『甘冒自 P『eseue is not 闹剧回 by n剧rtl8llQ町（aaniab町呐. Benign lntrac111nlal hypert回回阳n is 臼峰回 by general回d 田Wiiing d 甘回 brain in 阳 a国朋臼 d a b臼l sp也a-occupying lesion. It a伽1α:clES in ob院妇 young women; the 町ndrome of raiSE四 h国crani副 pr，白血18 mimi臼 a brain rumour - h田ce the old d臼啕nat阳＇· 'p回udo tumour tumour，~回matoma or ab9CE嗣.

佣rebt1’．

… c………~~ Fron幅la曲，in~捕

~

剧’mαw嗣k棚”

I,

主矗

:t'..

。恤” Clllr食ITft pl幽

~

·• :;;:

飞＿，，＿， 1 飞

’

｝悯10ph归”l 他幽

M刷l’”唰 folll

αM』’

,

.

」 t . .比

,.

I)

~

,

,

也＇

一一一－－

严和〔

. ’

」，、气，

..，＿，

f飞 L

'

气

..

、

I

Foran睛’曲”um For回阳11鹏rum

\i:\ Fonunan magnum

肉，leriorc而幽lb”

INan回lloc鸡翩 阳翩翩回

Fmn恒lualnua

c~幽 galll

飞飞 吨、

Crlbr快m pl幽

Supe阳刷刷阳回

Optic e1n1I

Fonmenl1”吼町1

For回啊＇＂ o测le

N阳阳『 clinoid

process

｝一一一－－－－－－＼－ Fonunen 咖ndwn 于『』－』－－－

－－－『－－－－ 向steriordil'll币d proc捕’

α阳，

k陶押回...糊Jtlcmea邸’ A刷，ro.wn.i

””啕l。”“”nil

Fig, 5.1 Floor of1he 1阳ll1hawin1 ’”曲”’由冒ni1lfa”－ ind plincip•I 伽nimin•.

阳，wim筒，um

51

I

52 • NEUROANATOMY

F副x cerabrt

Space唱刷酣啕 l臼阳1

Temporal lobe

Tonsil of care切也m

阳raman m啕num

”

’”

”

F幅.S.2 ASPll ..。剧附Ing leslon IHcl’”“”l’”m刷tot 曲， brain and ral lnl:nlcrulal Pl9 ure. 1: Herniation of c:ortEIX b阴阳th falx 091'9b『l 2: Hemllrtlon of temporal lobe Into posterior cranl副 fossa. 3：臼mp『白白n ofmldb『田lneg副nst tentortumα曹由eHl.4:H町也回onofce甩出liar tonsils through foran冒en magnum.

•"1'

Cranial meninges

Fonlmln.. .,..drolMS

of the ski.』II r叩『esent si国 d p口t回国 extrinsic of structu『回阳nni『可甘1rough 甘、em, by diso『I恼E such as bony deformity and 阳m凶币。，f bone, meninQE览。r blood vessels. n币B parlicu恒『回回ial nerves dam甸回副伽g 田t site 国d 怡’foraminal

The 西Dial dura mater is

叩1drom由＇， e.g. of 甘币e..,.rior ，而ibll fia剧”。『 jugular 旬帽lntll'I.

as 也e floor

In 廿1e forwnan

roo£，也e

有回回t f口『国『nine E田npres副on

magnum 11J11Some the spinal co时， lower b耐用tern and tonsls of the ce『曲创lum are compromi创划．

Dura ma阳r 四sh甜由因也e brain

a tou庐， fibrous membrane that

like a lo创e-fi创ng bag. In some regiom』 such

of the era皿al 四ity 姐d 也e m挝line of the era皿al dura is tightly a曲但回.t to d能 in时or surfac£ of 曲

曲曲， while els四her巳 m血画也E fmn臼parie恒I area. 由E two

are

呻血恒d by a

Skull •

1l冒e bone量。f 甘冒E skull and

the

meni咱酷 provide prot倒roon

• Su阳lo『白白阳l 侮副陪 (oa』lom口恒几 troch抱ar,

for

the brain.

abduc窟回 and 叩hthalmic

• The brain lies on t喃自由or of 甘冒’ cran刷刷Mty，附胁 oonsl跑。f 甘、『回 fos串倒．

div画ion of trigeminal nerve画｝ • Foramen rotur田dim(m副llary d闹剧。f trigeminal n町ve) • Foramen o回跑 (mandibular

• The anteriorαanlal foesa con刨ns lhetlln刨恤es d 甘冒B

div恒阳， d trl阴min创 nerve)

• Foramen splnoSLm (mldd脑

oerebr刨 hemispheres.It forms

roof of t闸，bit and Is Clo倒y assoclel回 with the 匍ntal a~ shus. 廿ie

• The c~brttonn plate admits 廿回 d触ctory n8MIS to the cran阳l C刷lty

and accommodat倒 the

d饱ctory bulb.

•

menlng嗣J · 币、e

a.coommod眠”甘18 W刨帽tam

and cerebellum. • Anum恒『 d Important strucllles 田SS through the 怕町ina of the p臼terior t揭sa:

• Foramen m啕num(medul恒

ll、emidd脑 aani创仅焰sa con刨ns

oblor咆曲， var幅bral arter酶，

the temper刨 lcbe. In

Sflinal 『回t

t回『nldllri白， the hypoph归捕“ 阳sa holds 阳刚tu阳ry~and.

•A numbarof 伽田niia pro咐’ 自nt『y 苗、d 部E b『 imper恼nt

n町vs) Hypoglos剧创nal

•

J啕uarfo阳nan

阶yp啕b嗣l 闹闹）

Pntemel

Jugularv刨「I, glos8ophary啕锦I,

n81V88 Ond阳.tad In

vegusend

m铺町 n自晦｝

parer咄翩翩｝；

ophthalmic artery)

of 1t田部2棚ory

•

blood 咽部副自由Is and 臼回．剧

． 。因E canal~叩tic

artery)

postertor c阳削 fos锦

• nerve,

In恼nal 副d阳『y m回tus

但cial

and VI嚣tibulococ刺ear

n町晦｝

nanow em咀山al space Two large folds，。r rdlection岛 d duraa阳id into theα四al 四ity 缸idocc吨，也E fissures between major components of the k回n (Figs 5.3, 5.4). In 也e midline, a w阳I sheet of dura,, 也e falx cer曲d，回ends 伽n 也t 四nial roof into 伽t g回t lo也gitudinal fissure betw四D the 出曲ral hemisphe:r凰咀e fah.. therefore, has 血 a国ched bord自 由at adheres to 由e inner SU血a of 由E skull and a fr四 border that lies ab.:m: 也e cmpuaall田山n.Anteriod票也e falx is attached ω 由E ha町 ridge d由e crista galli. Plliruli. 咀le simpl＇马 tuln血r configur甜m of 也tαrebral aqueduct. in comparison to 也e rest of the 但由ral π血icular 阴阳n. refiecta 也e relatively UI咀iffer四.tiatro na阳re of the midbrain in comp缸iaon to the furebrain. At the ros缸al margin of 也e midbra缸， the cerebral aqueduct opcna into 也E 也inl 呢ntride. This is a mid监te, nan圳， sli凶h cavity,，也e lateral walls of which are formed by the 血alamus and hypo曲创amus on d也e side (Fig. 6.2 and see Fig. 12.2). The roof of也e 也mt 罚B刨出 is formed by pia-ep四伽na, which spans betw阳1 臼啊。 nave fibre bundles, the S创ae medullaria 也ala皿i, which are situated along 由e dor四medial border of 由e 由也mus on eith.er si也 In 由E m血al part of也e 也ird 咽ntricle lies an aperture. 由E 姐回曹四.trirular fora皿田，田 fora皿皿 d Mom口， which is J,。但也d betw田E 由e column of the 卸mis: and 也e anterior pole of 也E thalamus.

「一 Int阳明细胞ular 伽冒m制

Body of 阳”而lwn创de

.，，，....－ 除idyof

恒恒ral wn创de

。由曲ral 啤』educt

In自eriorhomof 恼恒ral ven刨eta

民躏阳homof

(i :· Fig. 8.1

A帽阳帽，tofth’”『唰刷lar9Pt9m. 问 Lateral v饱w; (B) poeter1o『飞~ew.

.r，气 . u

letaral ventricle

56

…

NATOMY

I 刊创emus

α10刚d pl饵”

“协m peHucidum

__....---s抽 m础......时

αxputcallOM』m

臼同也ral 饲ueduct

Superior medul阳y velum 阳u仙 ven协le

加悔”阴阳icul• 伽amen

C旨”m1m句na

~u 盼侧’翩翩·”’a ”e铺””··阳”n tllowlng . .WI阳晴刷刷阳”现刷n.

Superior 锢睛创脑

网unda

-- s阴阳m回ull1ry 唰um

阴阳 Ballara而町

Choroid plexus

Fae割『酬W

and a阳”’ d fourth 唰啤掉’

Fig.U Dore剑”’lclof笛，•brain’”mehow画，伽…·’“伽－

fou睛”川同cle. The cerebellum has been removed by 棚arlngtha

帽畸创larpedunc阳．

M创uli.

Olive

Ce『ebellum

Fig.IA Cera””。”时勘··”gle. The poiit 时continuity betw明m the 凰，taral re。”softhe 似」『伽 ventricle and the subarachnold S萨比e Is Indicated by a small tuft of cho刚d p刷』s,whl由 pr协'Udes through the lateral a阳tura.

Chap幅r6 Vent『icular s拥阳m

币1世姐tervmtri.c叫arfor割nen provides commu皿catio儿回1

也扭曲ttt 咿皿s betw院n 也.e

• 57

corpus calloswn and fomiit in the lattral

d也er side,. wi也出t 回回.sive la佳时霄’2刨出 h佳时明白in the

midline 血d separa倒也t 姐也riorhoms of也e two

出由al hemisphere （目岛 6.6 皿d 阳 Fig. 16.15）.咀ie la国'al ventricle is a阳回m回y C也aped. It consim of an an回or (fron国） horn, a k吻， p回国ior 〔occipital) horn and an in缸or ｛阳nporal) horn. 咀iean回ior horn of the lateral 咽回de is that p刷刷ngant回.or to 也ein缸”阳市icul缸 foramen.τhe la能ral wall of the an能rior ham is formed by 由t head of也t caudate nucleus and its roof is 也.eco甲m callosum （眼 Figs 13.3-13.η．四t medial wall is formed by 也即“m pelluddum (Fig. 6.2）.咀Us

咱也挝笛．咀ie body of the la坦国咽1tricle 缸国tds b剧时也t h缸”田1臼icular foramen. ha:讯卫g as

it& floor 也e 也alamwi and 也E

tail of the caudate nucleus. More p回国阳市， a small poi田ior

horn g但ruJs t跚缸巾 the O回pital pole but the 回ncipal r.oune of 也e ven回clesw创ps downwards and fon阳时， to 伽mthe 但优naive inferior horn, which lies in 也E temporal lob巳 In the floor of 也t in阳ior born lies the hipp创丑皿阴JS, while in its roof runs 也e much attenuated tail of the 倒idate nuclei路（眼 Figs 13.9-13.12 皿d 16.15).

To”’raphl四I •1111幅my of vantrlcul•，”’恒m • The vant~Cl』lar w创佣1

•

cons阳ts

剧时 ventr1c阳 becorr嗣

d甘1e lateral ventrld筒，廿1~

contn1拟』s

ventrlde, a霄，b刚 9QuedUct and fou时1 ventricle.

叫I.IE翩翩． •The 臼嗣W剖 aqueduct ext田'£18

throl啕hout the mldbr划n, Inking the third and fo四”、 ventr1c悔8.

Tt陆恼脑画l 瞻仰ic幅幅 lo饵led

within 锦ch c嗣br刨

hemlsph919 and 阳 apprmdm就脚。-shaped.

It

commun刷刷，咖 1啕 lnterv审ntrtculer foremen, with the th~ 唰回r刨a •The th~ 幌刷刷， lsamldlhe,

8111-llke c时ty. I饱恒.taral 响’s consist of the tha脑mus and

with the ce用b刚

•

Thefou时1 怕自由icle 画 loca:回d

国tween the

brainstem l四”s the

andm回ull司 and α，回:ielum.

A med阳、 aperture

and two lateral apertures comm111阳.ta with 廿l9 sub刷窜。mold

space

surrour回Ing 廿19

brain.

h部JOthalamus. 臼A剧曲， the

Cerebrospinal fluid 咀le 咽1tricular sys恒姐， together with theα皿ial and spinal

M晦n aperture of阳r由唰时曲

subarachnoid spaca, contains cerebra早nal fluid(Cam.pus. Wi由in each intanal

α理~bral hemisphere, 也.ese 胃部damergeto 缸m 也e

阳”『阳

α盯阳帽JloalSTI ｛创t剧巾铺｝

Antarlar horn "

阳回回l ventrlcla

cau曲阳阳claus

Th幽mus

l『1恒『nalce睛『罩l vein

Third win刨cle G帽tee睛闭l vein

R施国ior

Fig. 7.8

T惘 d跚帽”bnd veins. The brain 阳 v刷刷闹m above and 甘18CO巾us E副losum f回 b倒n remov回 tor趴刷I the third end 阳阳刨 ventrlc嗣．

m

…

I

NATOMY ＆』阳回『啕i翩翩us In伽阳组a翩翩nus

G~ce睛”l

vein

S桐峭瞌翩翩

Super恼l 『唰伽

Con’唰ce of the

C8ll曲创 vein

Cor币’uence of

阳自inu”’

(!) Fig. 7.1 VenDU• dl"llinllg• of 笛，．”’i比例国幅ral 飞risw;(B) 啕it旭l明酬．

car也泪I veins

TranSY9rse sinus 剑”rlors句lllal8"1us

Sigmoid ainus 句nald 伽ω

Grntca呻『田I ...., 就刚1gl畴，inus Trar.v明，esinus

α，喇uenc:e

or sin睛”

Fig. 7.10 Ph•””nt,...MRwn叩..，•• The 制nsw阴阳阳m创 m a3.0TMR 能酬’·刷 Later刨 view：，阴阳t翩翩．阳L刷刷f阳棚。rPD ＠附，s, Act幽mlc Unit of Radh掬1gy,

Unlvetslty ofShe熊剧， Std剧， U句，

gbE aF$5SEESSEE 民gR 昏昏 RZE ‘ 宫ES ’也同邑 SS · 昏 ggga 四百嗣同需 目 2 岳 ag －－ E也 EEB 也需昌昆－ VH 3E 奋圃喝‘鹰益 营－ EBB －SSZS 且盲目 HS 昏同冒冒目－ gEHMa S 回国 。 但 － 钮’2 －· 『4· ss 民昌EF 唱吕号BB 〔s gmu· c －zgZBFEES 西 跑 去 E E g 善 耳 【 百 鱼 。a ER邑qsE 42军 8··zag 幅gsea － ‘ EES 。PEBBSHazgHESSE 负泣ZEZRE gE 缸里’乱昏 F 冒 SEas 自 gug 自Eggs 昏昏再也曾 o－g主ggas －－ SERgs －HP巳gaaEF雹 Z霄 C EF 宣 g 曹 ERB巳－

明 389

3

－ g 『

pa 呈蕾 「

唱aEs

1l

『宫岱邑·

4133g 蕃氢 dg Z恤 S ’s ’ aa83 亘古巴go －a45σZ 黛是言筐 －Z gaS 筒压自 ZEE －。ZESEn36 币 ag ganuSEa－ a－ a 帽nE me革 dE房 ggsa 皇县 a － E 也gsgss E旨 a － gan － aE 胃 eSEa －O噶BE 且自由自由自 aa8 3曲同司司’ － 民ZBE g 『 BBEMZB宫自 ZSOS －量 dd0332雷 g 民吕 E

虱雪’＝司 g· 『 S 鸣 MW － 言’’画2·s·a － 532EE ”－ － m民巳SEE 国EE 皿－－n 且＝ 5g Egan 且 z － zae 再四ag 丑驾贡革雪8ZEgoEapqgm

se －44EES －－－E－ －a 2· 咱4 ES匾’3， E

－seS

雪重『哥『蛋 g

33

E’ EED gE岳宫”’昏旨是

白宫目臣也 SE4SEER

雪富量 ssg

-”=’

ESS 自己 8822ES

国－一S 量

E --

dw ggaeggsg

嗣咱哥回F 去OR－HS民aERE－PH 昏而且岛昏 RRZ且昆国 民ERBUE EESEZPmEEE －－看冒昆主吕昏mm SER 宫 gE ESSA 冒SEEM22ES （量咎由 zzea 翠吕gES$58EREZERggESE ES －－ 旨 SSEZ 同EREHSbz － ERSEZ 唱吕H 茧HP卧 MEa EaERES ）·苦苦昆 SBE H －aggaE 而BSE － ｛

TES· －A画

a－ E 臼胃’

EFEES 昏号。导。『昏同 ｛ 囚币 2 3 －

> vazoa

EB －

J

BEE

-

国同日

鱼 E··

，『 gs ’as ···s －2ES －－－旦 JEgg帽每兽a ，氢Egg －S 崎RE

－

－『Z

gzssgsg 蕃 aESha

蕃去苔’葛 ggpn

Eau－ E 皿画 ZS 瞥’ s·

gma ’也组gm 慧副且每

鲁是再葛 es3EaHE 当ggage

岱 eg

－

响33 哼624 ，‘gn2a 可FBg马饵’阳 ZEaa＝a· 困筐番，·革章’宣蜀’ 霉画＠ d恩 0·a 只骂毒 u’ ma ahFK草 m 莓d 哼量’奥『皿‘昆唱西哼’可创耐量a 霄a圈 ’6 · 每 aEEFEEZ 町雪温 EE罔莓’

－

－mEBaEaag喜 － ’『 E 『西E 2－ SZEBE 自由军且’ 3E回 －国3巳言，。哩’『灵皿酶 ’3ε，．

8

Spi『、

I

Ex幅mal 饵”阳”. of 由e aplnal cord T叩啕raph阳l anatomy

Spin创 nerv幽

68

幽

88

Spinal men闻自s 70 In幅malst阳ctura of 由espinal c阳唱’

Grey matter of the splnal cord

咀ie spinal

cord and its 础。dated spinal n回es are of imm.回8e functional importance. These struc伽res act to: • Receive afferent fibres from sensory rehalin is via opiate rec叩ton le回国 on the 田min血。fnocirf阴阳 primaJy atferm也咀理皿d萨，k

pr叫回回aof 叩iateagonis饵”dias m。•Ip恤1鸟拇归rtly a result

of their action at 削，，it巳 Deeper 面 the dorsal horn. lamina VII con回ns a number orf important cell groups. A1 cord le叫， C8-L3 lie the 创ls of 。缸n” colum皿｛也m回t nuclma』 nucleus dorsalis), which are the~orfuc:四ding fibmi of the dorsal apinerate to main阳in muscles at a constant len回E in 叩position to imposed 础宫时i. they are impo血nt i且也eco血ol of body 萨施旧也 By 也由 action, 缸剧ty i• maintained in 00:丸 trunk and low缸 limb ex国iaor muscles ｛皿ti-gr田ity muacl臼）也at support an upright k均 pD1ture 串inst the 自由rce of gravity and are 跑回ched 叫m these body parts bemme flaed..

E坠

”’饵”

mUSt:梅他隅

In国b刷 刷刷排，自bra

Garn『nam由万『刷阳市

Fig.I

Tendon 附彻xes (deep tendon 咧似es or ten阳市 jerks) a附 mono叩叩，tic stretch 翩翩， d比阳d du向 clinic翩翩mlnatlon, by 阳l'CU8剖on of the ten由n of a m啤cl自．刊阳凶U蹦阳刚d,b而ef

stlmulatlon of dynamic stretch 瞅湖Jtors. 自国ch tendon 用匍x Is 剧阳『V回 by specific spinal oord s暗nants: Cord aegmenta

Reflex Bic每到s r回阳x (b阳psje叫 Bra阶ioradial路时ex

(supinator j酬。

Tri凶阳刚睐。rice阳同时 Quadr1回psre刊以伽ee

jerk)

Achlll倒 tendon 刚ax~町、kle Jerk)

C5/C6 C5/C6 C6/C7 L3/L4

81182

In addition to alpha motor neuron战 which innervate extrafuaal the ventral horn of 也e 昭nal cord (and mo阳 田园al nerve nuclei) contain an additional population of ef.趾回t neurones －醉mma motor neurones - which innervate 也t polai; mu副e fibres,

四B国ctlle elem四.ts

of in国fusal muscle fibres 【目.g. 8.13）.四E of gamma motor neurones is 甸回1田I the 阳15j·由ity of the S缸E时E receptors. 四1us,wh四 gamma motor n四E田1es 缸E actiw.时， the resultantαm田.ction of the intr曲lSal muscle fibre applies 阳uion to the ，但Jory ending队 η也 I顶帽rs the threshold of 也t s田蛐阻碍tors to e2:阳tally applied stre时l ar盹也U鸟 ina回剧也e sensitivity of 由t stretch refla. This mecha皿m is ref回回 tou 也e gamma reflex loc可P 阴g. 8.13). 咀回宦缸~ two types of gamma motor n四阳也 So-called ’电mamic' gamma m。”r neurones innervate nuclear bag fibre属 while ’血画r! gamma motor neurones 垃mer咽te nuclear chain 缸nction

盖脑田，

Like alpha motor neuror圃，院mma m侃。r neurones are m咀er 也t influence of descend画g pathways from 也e brain 扭d 也e 伽U

types of motor a四ronecan be 忧para凶y controlled. Abnormal

76 • NEUROANATOMY 缸tivity of 由ese desαncling pathw句玩 which OCCUD

in many pathological condi由鹏也a由re indu幽幽幽伊始也 S四aitivity of 阻四血 rdlex四．’Ibis ia evid四ced by abnormaliti四凶 能ndon reflex西 and in muscle toI皿 When upper motor n田lIDn臼 缸E 由ma，也伽 aample in 1troke. 由is results in a阳缸副tyof 句namic gamma motor neurones. As a r.on幌quenc鸟阳idon rdla£S are 均penensitm: (I亨阳rdlena) and muscle to田 is inαeased during initial muscle 跑时l (sp创city). In disoxdm of 由E basal ganglia. such as h面naon’s disease （~ter 14），也配 is ov臼缸tivity of 阳缸 gamma motor neurones.τbi& results in hypert。因且 of muscles 也roughout 由E extent ofp笛si~ movement (rigidity), while 也E 恒ndon rdlEXeB remain no口回I. 咀1e 回idorn1 of skeletal muscles contain m缸hanorecq>甸回 αlled Golgi 回叫on o咽DS. 四i.ese give rue to cia” Ibaf趾回t fibres 也at enter 也t spinal g叮 matter and，由 an interneurone, inhibit alpha motor neurones rum由18 to 由t m田de of origin. 咀lisammgem四t is 也OU胆 tofu皿I a 伊'OteCtlve function and it underlies the abrupt rduation 由at occu鹏也H佣iDg initial contraction. on rapid passive s田础 of a spastic muscle （由t cla甲－knife

reac:t:i.on).

When a 阳也 reflex: is elicited （吨位申adriceps rdla, by tapping the pa回Jar 阳咖啡， prim缸ya岛四t fibres 岳阳 the mu副t spindle ercite not only the alpha motor neurones of the stretched muscle but also inter田urones 世iat inhibit the al庐a motor neurones of 皿tagonistic muad臼（e.g. 也e knee flew略 目g. 8 .12). This illustrates 由E 院neral 严ind.pie of redpro臼l innerv甜。D of agonist and 皿tago旧st muscle groups.

po与synaptic rellu, in which one or more 面能rneurones are interposed betw民n aff町四t 缸td effeJ:四t neurones. 阶回ary aH自由t fibres acti回.te intemeurones wi由扭曲t spinal gr町 m甜.er. which in tu皿 excite alpha motor neurones inneiva由ig the limb flemr muscles 但g. 8.14]. Flex:ion of a limb about aeveral joints E同uir圈也.e ooordina也d action of more 也an one spinal segm四t and this is achi~ by colla能ralisation of prim町 d虹回ts and 扭teme缸。nes.

A皿 forms of cu国ieous st皿.ulation hav哩也E potential to elicit the flm>r rd饵 but this is normal抄 prev四ted by descending pathways from 由e brain, UD』幽由t stimulus is pain缸I.

抽回1ding influ四ce ii t帽t 〔吨.

rdla: is re醉rded as path吨:nomonicof 也mageto 也e corticospinal tract. Acti四ion of 也e flm>r rdla in a weight-bearing limb (e.g. by standing OD a 阱｝ aimul皿eoualy causes reflex extension of 也t contralateral limb 甸甸k 由E weight of 由E K对y. This is c.alled 由E crosaed memior rdo: (Fig. 8.14). It is media:臼d by axon colla能rals that cross 由e midline of 也e cord and ercite the alpha motor n四rones of contralateral limb mensor muscles.

Noxious a血E回国 stimulation of也E limbs a田a flex:ion from the ofreriding 况imulus. 切由 is mediated by a

Lumbar cord

l瞄mall"Ona

mu甜”

Fig. 8.14 Flexor reflex and croued ex棚”’川lf'I也

~

following a 础。Ice in the in阳回1

αpsule) the a:temor plantar refit'X re-emer萨a Aposi由e E曲＇inski

with命awal

＝一..＿＿.

”

stimulation can cause limb 回thdrawal The men r plan·钮E response (B由inski reflex）扭曲m幽ised by el[回回m {dors诅回on) of 也e 萨回.t toe and 酬aying of the other toes in response to 甜m叫“on of 也e sole of the foot. Physiologically, it is a S臼~rrefl但由d is present 姐 infants b由re mydination of theα览咀α>Spinal ttact has taken pl缸巳’Ther回fter, the rdlex: is abamt, being suppressed by descending cortico早nal influ团圆（stim叫回on of 缸四，Je of the foot 由四但山inga flemrplan恼 respon跑回也 curling of 缸 toes). Wb回也

Flex.or reflex

_/’

In E四ainpa也olo脾alcondi世on鸟也E deso曲也ng is lost and evm innoaw田 cutan回回

M曲itory influence

\1

Chapter 8 Spinal cord • 77

四iett is

Splnal re伺翩翩帽 crganlsa11on of the number al Im阴阳nt reftax functions.

• The nternal

moto『阳刚回lion to 伽e Spindle

α刷刷隘捕阿咽e a

自bras.

·节19 stratch 帽’ex is m每泪n国b阳

for maintenan四 d ml勤恒 tone a回 p四lure and is cl同回Hy t笛t创铺甘冒9d锦p tendon

• Theπ'ICln四”1aptic E圆圆、闸’回

in to st附阳”。f muse陆

m回t剧创 muscle ccntr回国on

res似万回e

喇nd嗣． ·币'198町1sltivity d 甘回 stretch

a s呵U四ce of也ree neurones between 也e pmpher革I

Z配叩tor 幽d 也j? cerebralα>rtex.

附自由湖8.

•The M归~icl阳阳『刨缸

gamma motor niuones, which p酬由 『曲IX 阳啕uat回 by

White matter of the spinal

m回ates 11『『lb w时回『awal 骨om

『剧。us stimuli.

cord

四lE! g可 matter of the spinal

cmd is c.omple:时YSUIWl皿dedby wbite matte!; which mruisu of 细cending and descending nerve fibres. 咀ie white matter of 四曲，ddeca且 be roughly divided into donal, lateral and 呢ntral columns or 旬nlculi (sing., funiculus), separated by 也e dorsal and 咽1tral horns （囚g. 8.8). Nerve fibres 油E鸣 ω皿non origin岛阳minations and functions are 。耶nised into 往缸”。r fasdculi （：血~.， fasciculus: Latin for small 队皿die). Some fibres in阳connect adja田1t or di血ntcord segments and mediate intersegmentalαxmlination, while other fibres are longer and BeIVE to join 也e 酬nal cord with the hr垣n The intera唔mental (or proprio酬nal）伽m ocx:upy a narrow band immediately peri抖ieral to 由e g町 matter. TI由 is kn侧E 倒 也e fasdculus prop血”（~ 8.15). Ner甲E fibres running between 由E sp迦alα时四d 也e brain mnstitute the ucending 缸id d臼倒回恒8 回础。f the spinal cord {8.15-8.17 and 8.19-8.24).

Ascending spinal trac阳

·四le 缸百tn四m配｛缸，，t-ordern四rone or primuy affer四t

neurone) enters 由e spinal cord 由m咱E也e dorsal root of a spinal nave and its ed.! body lies in a domal root ganglion. The central proc四 may collateraliae extenai叫y and make synaptic connections that media艇，pinal reflan and in缸”嘈nental coordination，咀lE! m创nfib陀remains on the ipsila键时 side of the cord and termina阳 in synaptic contact wi曲曲esecond neuronιwhi也 is located d也er in 也espinal~ma饥er or in 也t medulla oblongata of the brains国n, depending OD the modality being served. ·四iesecondne田one ( KCOud-onier Dmrone) baa ita cell body in the cord or medulla oblongata. Its axon 囚田晒 aver (d皿皿幽） to 也e 吨’因ite side of the CNS and ascends to the 由alamus, where it tennina阳upon the 也ird E四zone. ·四le也ird neurone （由ird。rder neurone) has its cell body in the thala皿.us. Its 缸。n pas附 to 也.e somatosensory cor回 in the 严rietal lobe ofthe ipsila.teral cer曲ralhez旧spher巳 ’l'wo m血 tract sys也ms in 也E sp旭al co时缸 into 也is pa·民em: 由t domal 〔pos削or) columns 皿d 也酬m也alamic tractB.

Don姐I columns 白ie clonal

columns are loca:回d hE白帽回也E domal median sula皿 are com同aed of 回E饵 incompletely separated by a 也in 呻缸E the 也回皿lus gradlis，翩且时 medially and the 阳dcu.lus cuneatwl，翩翩d la能rally. The tracts carry im阴且ses concerned with proprioαption (mi阴暗ment and joint posi由n sense）扭d di阳回国tive (fine) tou血． 四ie domal

Ascending tta＇曲也rryim阴山es from pain, 也ermal, tactile. mUllde and joint 阻碍阳回 ω 也e brain. Some d也is information e晒1tually reaches a conscious level （也e cerebral cort时， while some it des由d for subcon9ciou，但ntres (e.g. the c.erebellum). Pathw叼s thatαrry infonna咀on to a conacio田 level share α血in common charac阳istiα． A翩翩ding Ira幽

l Fascicul”’前ii丽

””

and 也E domal horn. 咀ie domal colu皿ru

columns con国n 由euo皿 of primary affa四t

neurones 也at have 回国也d 由e cord 也rough 出t dona} IO础。f

spinal DeIVES (Fig. 8.16）.咀E 』ciatlua gracilis 田naim d伽回 也at join 也e cord at sacral, lumbar and lower thoracic lev由四d, thU.8, includes those from the h阳 hb. 自阳-es of the fasciculWJ cunea饥皿回阳市u the upper thoracic and cervical domal roots 皿4 也.us, include those from the upper limb. Since 也e domal 国”endi咱阅幽

J. Fudculus proprius

F创ciculuscun锦阳 U锦翩翩~·tract

Doraal s回m帽咽tielier 国d

Lateral co而即向副阳t 盹』brosl*!a陆目t

M阴阳l spl阳嚣’由自Har 国ct

”“lal longlludlnal 饱民如l嘟 ”“ulll町闹剧”pinel ll1lct

S曲曲曲mic 国d

Lat嗣l vestlbuloaplnaJ lract P阴阳e 时也邮pinal tr事ct Tee田pinaJ 国民 阳回l 耐cospi唰 M

Fig. 8.1’ Aa剑”Mfing and d”。”叫ing tr幢幢创甜”’ apin•I cord. 剑l ascending and d幽幽nding tracts 嗣 present bi阳W剑ly. In this figura, ascer回同 国翩翩唱a emphasised on the 阳n side and d翩翩ding t缸:tsa阁制phaslsed on the light side. In addl田。『1, the b四tlon of Ussauer” stract and 廿'19 阳clculus proprk.ls 伽hlch co阳In both ascending and descendl咽他阳：） are shown.

78 • NEUROANATOMY Sensoryαlltex

l..iM阉， lirr由 Thill-order『酬『’晴

回 Second-order neurones Fl耐q由rn自L1t1n1捕

“”阳，a hlmisph.,.

Medi自l lemnlaa』S R剧 nuc椒』S

Crus 翩翩

Middle 帽ebellar 阳dunc:le

M创ial lemn＇瞅划’

Nucleus g阻cllla

””’ulll

Nucleus cuneatua lntamal an:ua”他隅

M国ial le『『11跚跚

时ramid F副比阳lus~i帽

F剧时culuaα』n锺M c.咧Cll cord

Fig.8

mlumnaαmtainpr垃llllY affer四t n四皿圃，出ey CllllY information relati.吨 to the ip1ila恒al side of the Ix由. Fibres aac.end without in国ruption to 由t medulla oblonga钮， where 也ey termina:也 upon second-order neuron饵，也e cell bodies of 抽ich are loca也d in the nucleus g四lb 扭d nudeu1cu画”.tua (see al曲 目g. 9.6). The uons of the S缸ond『order neurones decussate in 也e medulla as 画回nal an:uate fibra and. 由g回岛町 ascmd 由rough the brains恒m a 也E medial lemnilcwl. The medial lem皿SOJS 阳回m国扭曲E 回国l pas回or (VP) nucleus of 也.ethalam皿 upon 也ird叫order thala皿配ortical neurone1. The随 in tumpn:功ect to 也e10mato阳uory cortex. loca旬d h 也t pos也回国l gynu of 由t 归rietal lobe.

Sp.的Otha阳mic 如'8Ct 咀lelp恤s曲曲mk tract (sometimes referred to

as the lies la阳菌I 幽d 回ltral to 由ev四.ualhom of 也E sp旭al 伊y ma出Z It carries in阳mation related to 归in and thermal sensations and also non-di回国inative (coune）刨出 皿d pres皿皿 Some authorities identify di皿net lateral and 晒1tral spinothalai:回E臼缸ts COD现~pain and 能mperature or touch and 血恒rola眩目1 刷出n)

r曹 Lalo”“’”donlll 翩翩嗣 Tab帽 do'8811• Is a late mar巾拭目tlon of syphllltlc l响ctlon of the CNS. II chiefly affe晦 the lumbc刷刷l dor踊l 酬nal r回ts and the do陌刨

colmns of the 酬n副 cord. The 阳s of propr陆即！Ion 阳ds toe high 副ep田ge and uns幅画~ g副（＿，sarya皿l叫. which is 跑回b回国 ”胃、甘回叼咀16 are cbsed (Ramb•咱＇••111时． Subact翩国mblnmcl d饵””’四m of the 串In副 cord Is e. 町stemle disease result同 from a d自由阴晴yo! 由町1in B,. (cyanoco国lamin), which also a且』揭s pernicious anaemia. The d啕町1日ration of the dorsal col.Jmns produc因回恼。『y at四a. 有回回国alcoh』『nns d 甘冒e spinal ∞『咀幽幽O rwolved (combi圳，刷S闯唰阳1瞄删 sp植t剧y

of the limbs. Th自 d阳ord吼叫甘lOUgh l』nco『11mon, Is an lmporlant one 剧由 P『呻自f k回怕阳t with 咽蚀min ~2can 阳d to comp阳le 啊盹恻蚓．

In ml翩酬， acl’”19, an mmune d幅幅弱， spedftc damage to t陶 to loss of pr叩rioceptionin 甘、E hands and fingers, c剧目ng prof四nd loss of d回erlly end In曲曲 to Ider世fy the shape end n回ure of o阔前ts by f团副culus cun帽tus of 由eαiMcal sphal co刚回ds

以曲曲ne (1’lltaniogn幅幅｝．

Chapter 8 Spinal cord • 79

• Thi嗣同，阳刚瞄 圃 Seccn卧倒自rneurones

First.order neuronea

C邸’饵”阳i

＼主／

Midbtain Spi帽l lemnisa.is

Midd协 cerebellar 附则，

Pons Faaclcl髓 d α别以111Plnal 回b1'88

”“ull1 即amid

Splnothelamlc阳d

臼Meal co耐 V阳市面I white COlll111串串回审

F幅.8.17 Spine洲回lamle 怕也有ie central psthw阴阳阳In, temper刷闸， touch and pressure are must阳刚．

严四山e. resp回ivdy; but 也ere

appeaill to be little evidence for

由is in man and fibresαn抖鸣曲，e modalities are 严曲曲ly in能rmingled,

咀iesp皿。由.alamic 田.ct con也in’”αmd。，derneurone岛也E 创l b叫ies of which lie w诅ely dis回buted

in the contt也.teral donalhom 曲d z缸rive input from primary affer四t fibres 也很 困min血泪也U E唔on ｛地 8.17). Afu!r le町i咱也E 严rent cell bodies, s阳othalamic axora decussate to 缸吨’由it£ side of 由t mrdby 归.ssing 也rough the vmtral white commi画盹咄i出 lies ven回 ω 也e central canal of the m吨阻d, thus.，四.ter 也E 倒1包划ateral spino也alamic tract. AmnsαE归s pain and temperature d刷刷.te promptly wi也in one segment of their origin, while 也.ose 也rrying touch 皿d pressure may ascend for U咱al Segal•四.18 beforeα田sing.

the spino由且Jamie fibres run in dosε known aa 也E spinal lemniams. 咀ie majority of fibres 阳minate 面也E vmtral In 也t bra且S位m.

pm由li守 ω 也z medial lem血口皿 and are

pas阳iornudeu，。fthe 也alamw』 contacting third呵。rder α览馆L

Itis M阱ly O耶niaed 1omatotopically;

com呻lentfy，也e location of sensory stimuli, ”rticularly those to

at l倒tto aomea腿nt

也alam配回世cal neurones 也at 严oject to

咀ie spinothalamic 田d is aometimes referred 阳画也E

’neospino也alamic sys键时

the somatolenso可

也E bodysur岛屿但B be id四tified wi也 very high accuracy. 也ought to be 也t route via which 也arp，严i面ng 归in

It is (sometimes

called ’她r pain) is cond配时．

The spinothaJamic tract can be 酬前lively dan啕回 inay巾，Om,eii圃， In which 阳帽1回l 凶nal becomes en阳＠回 to 阳m a cavity compress同制如帽ll netVe 明b『铺. lhe second-order n创附唰 SU闽西rh唱 p副n and temperab.』附即回 dam剑”d 俗世Yi1t decussate In tha vent『al wh阳 α:mm国ure, clo隔 to 伽a car四rel canal, ceusl咱 a 翩翩闹 loss of pain and tempera阳re 由NSren民蜡 In 廿19 up民W limbs. This Is tann回且 dlnocl翩翩翩lnlC町阳’， sin佣 light t口uch and P『叩『bα制ve 回吉凶。n ere 田园ned. 有回回归「rt ln]ur白自回 l:lllns 甘E hends 四川踊ly, and 1he 如Irr幅 d 由时lmbs become dlso咽ens国 wHhout discomfo『t (Charca1’. Jc*tlB). Selecli闹剧咆ical 曲曲uction ot the spinolhalamic t『副｛四rdotamy ortrac恒ton咽。 is s田nsli'nes PE贸阳med for 骨、e neu『田U咆ical 『回1ef of intr部恒ble pain 骨001 a variety of E副回6.

80 • NEUROANATOMY

D啕晴uagm 。闺白pt啕UI

H锦此 臼Jlbladder stern勘h

Liver

Int橱窗1’

Ap阳ndbl:

刷『时回脚

Blad:“r F崎.8.18 P剖nclpalbody 明Iona 翩翩＠恤.ted with l'8阳，edpalnfrom 由•vie“ra.

τbe 1pinom:ladothalamk: 1J1tem re阴阳晦扭时刷刷L

phylogenetically Olde!; IOl血 by 咱i曲曲ciare剖s with hy阳r翩翩 and 以tensor p脑ntar resp阳回阂， but with 部副ng

at sens翩。n and bladder function.

Approxima能ly 55%

of corticospinal 时won.es 出mina也 at 25% at lumb蹦出I le\'els. Fibres 田minate ex阳sivdy 扭曲t spinal grey mat国.Ma町 d those fibres that originate from the mo臼r mrta 回minate 扭曲t 呢ntral horn，四me making monoll}'Il3.ptic contact wi由 motor 由世cal l倒也 20%at 由.oracle and

neurones.

nuclei situated in 也E pons and med曲， in and near 也E floor d也E fourth 观E刨出〔Fig. 8.24). The ve甜b时ar nuclei receive input from 也e la阳归也扭t system by way of 由e vmibular nerv冒阻d also from the cer由ellum. A皿ns from cells of the I世ral ”stibular nudeua (Del恼’， nucl四a) descend i回h阳ally 幽幽 k阳al v四伽Jlo1pinal ttact. which i1 loca·时 in 由E 咱也lll funiculus. La阳lll v四咀b叫。甲inal tract fibres media能 pmYa也l acitatory effects upon a国1SOI' motor n四rones. 咀icy 民rve to con缸ol E皿ms田 mmde tone in 也e anti也mitymaint回anceof p。”山巳 哑ie medial ”四bularnucl剧’ contribu阳 d倒也nding fibres to 也E ipsila田lll medial longitudinal Casdad田， also known as the

mecllal ft&伽llosplnal 国a. which is l侃础d ad!acmt to 也E -m1:田l m甜甜缸sure 缸ld descends 幽 far as cervical l.ev由．四le

Rubrospinal tract 咀亚 rubr田pinal tract origina国 from 由e

rm nudewi of the

8.22]. It eerts con缸。l m眩 the tone of being excitatory to the mσtor neuronea of 由ese muscles. Amns leaving 也e cells of the red nud肌JS COUISe ventromedially and cross 国 the '9e.D四”但回国 dealssatlo也 after which th町 des但ld to 也e spinal cord where 由町 lie 咽1trola键时凶，姐d partly in恒rmingled wi也也t la国lll m时ms庐tal tract. 咀1e red nucleus m望iv四 afferent fibres from 也E ma田 001回 阻dfrom theαrebellum. 咀ie rubrospinal tract, 由自由吗 midbrain 但gmen缸m (Fig. lir由 flewr muscles,

爬萨四四” a non-pyrami.也1 rou能 by which 伽t matorcor回 and m曲ellu皿也n influenαspinal Tee曲叩inal

’k

decuasation. In the 酬nal OOI址，幽幽幽鸣阳回pinal fibres lie n倒也E V回国l median fias0tt 缸id 也eytermi国.te predomin副市 in 但吼叫 segments. The superior co血αtlus re国.ves visual input and 也t 也ctospinal tract i自由副咀11 to mediate reflex mo阳n四.ts in respome to 由ual 回muli.

”’pin

motor activity.

tract

al 位act.fibres 缸ue 企om the su.perior colliadua of the

mi曲mo 〔Fig.

8.23). Axons p跚跚ttmmedially around the periaqueductal grey m副er and cross in 世ie dorsal 钮，nm刨

medial longitudinal fascicuJ.皿 contains fibres 由at link 也E nuclei innervating 也E E国E叫E muscles (orulomotor, trochl四 and abduceru nuclei) and ill, th111, impo血皿 in coordinati吨 h臼d and eye movmients （由叩田 9, p 93; Chap阳 10， ” 103-104).

嘀嚣tibular nuclei 回也由z

R由ticulospinal tracts

咀iere咀皿1ar formation

of the pons and med叫lagi愧， d皿 to reticulospinal fibres. Axons eris画g from the pcm由e reticular formation descend ipsila回lllly as the medial (or pon也e) reticuloap恒al 回ct. A皿nsfrom 也e med叫la descend bila国咀ly in 也 la回理I (or m.edull町） rd扭曲，例nal tracta. Both 世酬， are located in 由t 哑nttal 缸皿cul山． Rdi.cul皿pinal fibres influence voluntary mo哩血四L reflex 缸tivity and muscle tone by mntrolling 也e activity of bo由 alpha and gamma motor neurones. 哑可由omedi础萨嘟”rand d咿翩。r effem upon the circulatoiy m阳n and are involved in 也e control of breath吨

向“ II.IC以』’

＆’阳也鸣” 阳』， cerebrt

翩翩’”n1bell1r pedunda

/ Pon•

”“ul幅 时阳“

。”ic.lco耐

l.Ynblr

”“

F幅. 8.22 AubrosplMI 田ct.

.......翩翩’“刷刷...翩翩唱’z prlnolp9I ··“酬din…幽 ·伽t阳”lnal tract con怕自B d崎C唰’，’刷刷刷幌llT18"t8, 阳tlcull附 ot1hed制 回嘟”旬’. It W幢回回 tom 『鸭阳 and 帽l90rY 倒也因．

’”

同ll'eS des棚，d ltvoL

阳帽”田。晦Jlllle,on捕。，筐，i

IS1d Yllf1tral pans to ra四、阳 πl8dUlay pyrsr削.M饲t 缸’－

σ5%-(1()%）侃cuseata to fonn 甘w lateralαy由:oephal tract, the m晴刚帽，阳睛啕甘ie lpslat刷 vantr回倪育御用啕禽l8I

”喃阳翩翩 auperlor oc蝇u削

g回阳回 aossln 阳 dorsal

·阳翩捕俯咽’剧创剧目lls 曲曲

钮’回回国由拟. . .幽m

角棚， ITUIClea et回 a蛐回嗣

唰吭唰旬，晴T刨甸嘟”由1

mec翩翩＠也阳阳1 ot ..，.也

It W晴、“”曹om the

tracl

饥m 甘冒ued ru粗.. of the w也岛而＊＇－ Fllr回 α。88 In 曹啕

ortglnates 曲。m thelpe刷刷 阳”ral ....削以应rnud割路，回

•Ti四”plnal tract 抱 lnvo阳d In 即伽IXl9鸣”r嘟” to 呐创d k拟』t.

•

Vest队指瞒田’act8 侃侃糊回

axter丽0/( muscl侃

•

Ret阳凰捕阔咽圈’act8 deac:er圃’

“町、甘田’院，l8 81'唱cl mac1幽L

The¥ 81"6 ln¥OM副tU-1 ’随 αX11rOI

flam 廿'1814191以启富 ru:lll. The

of F哪怕剑英刷串串，『n.自由 W啕

lalnl 晴，ttJulos防田园”ct

g圃’嗨al f1.r1c怕也

…句in叫

”“”’~n .Subal;幽幽啕白白

阳回＂＂＂翩翩匈臼瞄lion

Pone

”·由Ila 向阳“

甸、4倒”而

Fig.8.23 h胁””llnle也

二， 叫 d伽喇喇时 I

Foe刘国ions

of t闸 spinal cord and the nerve r田恒 p『回U国 clinical in 2 w匈唱：

manifus旭t阳is

1. The leslon deetroys 仙阳tlon at the s啕mer闹闹唰． 2. The leslon Interrupts descendlrci rr刚1or and ascer回Ing sensory t『acts. Dem甸， todlf旬附咣阳tta of the 制nal cor吼 th惆fora」 1悔

” companied by distinctive

clln阳I syndrorr嗣 同.8.26).

刷刷刷Ions of 伽e spl唰 oord followαx:luslcn of 刷刷刷or spinal

g回y end 前四ma， “凶Ing 青回归res d 由e sl*le.αuonlcαimp尼锚Ion d 酌’ spinal oo州西、deme咱ing

nerw roots isαrused by in旬clion and and ne『w roots g咽’ by prol司骂回 . interver饱bral dis比 Sub能U饱挝、d 由ronic 国阳盲 of the spinal cord are I I刃而mcnlydue b 阳 immune disorder of mu峭pie 回erosis. tumours d甘、esp阔，

meninges

Lllllal VI揭tib哑arnudl民IS Mlddl’”rabellar pedunda

印制id

”“ul胁（cau侃”

” plnaltn”’·

F幅. 8.14 Vestlbul

era啕l 阳vesand

Rella闹’

－宵”’偏m

Ser咽allon

Coordl『翩。”

、

~t-

/

ll ll

‘--

飞 Mu蚓ew喃自阳1融串串 ar阁 制sting

i：昼

”

翩翩1t tendon and

abdomi闭l ”’倒踹

E 阳ofall 倒叫

lnooo网inat，衍脚，ment, a四a

lncontine愤怒

Fig.US 刷 LumbDUCl'lll aplnal cord

le81an. A lumbosacral cord lesion ca幅幅W回阳鹏， wa副ingar回饱sciculation of mu副部， a邸’锁国 of the lower 1.48.

l阳bs 伽wer motor neurone I酬。吟， incor喝nence，”nsoryloss 刷刷 the ltMll of the 嗣ion 则＇senso旷翩翩．阳饱『 also to Fig.

…句in叫

Crwlial nervea and

.

陆. . .

mot白’”’”m

+

+

t I:/

α剧由'l8lion

Se” lion

I

＇

‘ 气

飞

+ +

,+++

圄 Spullc呻翩

-

Abeel1l抑制向

． 叫all 111翩。n

l 扭曲n幽 moveme而

+++ Iner阔”d阳唰””“E

lllCOI曲，眩’

t

： ~·

恤丽p阳帽晴阳瞩

Fig. 8.25, canl'd (8) Thoracic 111in•I 四rd 1. .ion. A tho鹏ic cord lesion causes a spastic 阳apar回s, hypamillmda and 田回lSor plantar 晦阳盲目S (upper motor n刷刷，阳io吟， incontinanca, sensory loss below the I酬。f the lesion and 'sens盯＇ a·国阻．阳饱『刨”也o Rg.1 ”－

Cranial 帽晴 and

棚”伽

Ra伽跟随

motorsy由m

头L +

rfS

+ +

+

+

+++

l 飞＋

+++

+

臼ordlnaUon

JJ_ 气

~

··’

II s附响曲锦 ，..；；：、 ι，

+++ Iner四”d 刨啤m m伽

1 胁叫附r睛”帽

“”

I

I

U嗣ofpnipric嗣ption and 。ouch

t 曹

lncoordlna恼 movem翻L ataxia

囱 LOii of pain and tlllmpe181ura

时. 8.25, canl'd (CJ Heml协剑”。，the tholWClc 111lnel cord three to the 曲，嗣4榈阳刚”时””•· This ls charac栩栩回 W l闵llaterel loss al proprioception and upper moto『 neu町、eslgns 阳m刷啕lalmonop同l崎 pk.ls central幽ral loss of peln 四棚阳ature sensation. 阳也『副soto F均.1.48.

C帽啕l ner睛，则

..

Rel甸回

m陶rry骗酬

。m曲回配m

Senlllon

飞 气

/

+++{ : +++!

+++

‘r

W 叫叫

.

Inc泊”’nance

（~j

Abl帽咀画ndonand

-

a烛阳市回国用缸”·

II Le时川灿

~ =rdlna脑 m喇喇

＋＋＋ 阳m翩翩翩翩用阳

f

自自回归啸，m阳晒

Fig. 8.25, cont'd (D) Law.，帽rvlC81 spln•I cord Inion. A IOI阳oerv国loo闹闹Ion E剧描 W回阳瞄．明sthgand 饱剧创恒.tlon af muscl臼， and are’以旭 d阳 U阵庸 limbs ~ower motor neurone 悔。咱. In 甜甜。n，阳阳 is spastic parapar四后， hyperrel恒xia and extenso『 plantarr揭阳1ses (upper motor neurone

l筒阳时 in 阳 lower limbs, inα>nlinert08, senso『y loss below the 闹剧。f the lesion and 'sen倒町’翩翩.R响ral邸’0 Fig. 1.48.

·.

。，n画l ”网”’回 rrdor system

”j孔

Senaa也n

Rellllll88

＋斗＋ +++ +++

~＋＋

Cαll'dlnatlon

气

+++ +++

++++++

＋忡 ｜

t ． 怕也嗣翩翩 Ince:翩翩回

：号，

-

＋忡

t

Absent abdominal 咖．

． 闹。f山脚

~ =rdl蛐阳叫

+++ Iner四”“回don 18伽

t

B阳帽阳嘟嘟阳嗣

Flg.8.25, 伺nt'd 伺 Upper 惕”比“..”’l 髓’d 阳Ion. A high cervtcal cord lee刷刷’es epeatlc te回p问la with hyperrafte>da，似闹翻p阳阳『 respon888 (1ψperm伽r刷阳、， lee刷， lncontlnen俑，侧回W 阳S below the 阳回 σf刷刷栩栩d •seneory’ ata>da. R翩翩Oto F旬. 1.48.

Brainstem

External feab.lrea ot 由a brain’”’m 89 Dorsal sun缸:e of the brains恼，Tl 89 Ventral a』r抽回 of th自 b国ns恼m 90 Internal structure ot the brain•幅m 刷

Midb『审in

caudal medulla 91 Mid-medulla 91 Rostral m副ulla 91 Pons

9

94

Reticular form甜on 96

凶

四le b国ns能m consi础。f the medulla oblOI耶路 pons and midbrain. 四le 缸由此也m 岱ulb'’ is

applied to 由E brains监min compound 缸atomical names given to nerve fibres originating from, or 阳mina由电 in，也z brainstem (e.g. ’由币四bulbar' re缸E ta axons that arise in the rerebral cortex. and 阳minatein 也e brai回国i). It is also used clinically 旬缸。但 the medulla in such terms as 'bulb缸 palsy' and ’阳udobulbar 阴Isy’， which d臼aibe

cranial nerve nuclei. with the 四ebdlum. 皿d wi也 brainstem and a庐ial motor mech四总!Ill』由rough which it in.flu四.ces mo惚m四L P倒也re and muscle 协皿 τhebr诅由国neon姐姐s the cells of origin of impo血nt monoaminergic (dopamineI在 nora曲回ergk. 驱m恤w:gic) neurones that ha:哽咽d呵read pre加tions 也roughout the CNS and are important in sen皿哼， motor; autonomic and cogni~ functions.

m伽mes associa阔前th medull町 dysfunction. 咀ie bnrinstem lies upon the basal portion of the 创:cipital bone (di吼叫， b donal as严u being 1啕dy covered by 也e

cerebellum 明白 which it h组 rich 祖国mnnectiona. Caudally. the medulla is 四n由iu.ouswi也由E 咂nal cord j四t below 也E foramm magnum. RDlltrally. 由E midbrain is continuous wi由世1£ di回回卢alon of the forebrain. 咀ie bra函，但m contains numerous ascer回ingand d cending fibre 回侃 Some of 由僧””由roughout its whole !en制L

”

h町恒g 由.eirorigi且 in thesp恒alα时 or cerebral hemisphel略 respectiv由10也m h却冒也e:ir origin or 回minati.on within 也e nuclei of the brains恒m itaelf. Some of 也.esebra旭stem nuclei rea司:ve affi:r四t fibres from, or 阳ul effa四t fibres into, cr.u咀d nerves, 10 paim of which （田－XII) attach to 由E m也a d由E brai回国i; these are known as 也ecm皿d D~nuclei （阻 地 10.2). In addition, the brains阳i contains a complex and heterogeneous ma回x of neurones known as the reticular formation. within which a number of individually identified nuclei aist. The retiαtlar formation has se呢ral important 也nctiow』 including control over 也e level d倒四m皿回鸟也e pen::ep咀m of pain and 吨由lion of 也e cardiovascuJar and m阱atory m国ns. It also has g国~co皿配世onswi曲曲e

自幅mal features of 由e brainstem Dor踊l surface of 由e brains幅m 咀redonal. su血ce of the brah四temcan be vi四帽d if the CJveI持ing αrebdlu皿 is E四1oval by Cll国ngthe 血E四 pairs

of nerve fibre on ea出 side (Figs 9.1, 9.2). On the dorsal m血ce of the medull匾，也e mid.line is marked by a dorsal median suku岛四n也uouswith 阳I of the spinalα时. In the 饵”也l part of the med叫Ia. 也z dona! columns (fudαllus g回lil and faadculUI CUD倡“1, conta皿ing first-order 阻1刷y neuron·叫 contln啤 rostrally from the 甲inal cord to 曲曲 阳mination 扭曲E nude&且s gradlis 皿d nucl四l8 cuneatus，也t 1。但.lions of which are marked by 棚。 small d四甜。但也由e gracile anda.m国te tuherd£s. 回leαudal two-thi巾。f the medulla con回m the m跑回1 con位iuationof由t 田1田l canal of 由e s庐tal cord 缸id i鸟 也回efore, sometim臼 ref回ed to as the ’dosed’ portion of the medulla. Passing rost.rally，也Eαntral canal m例es pre嗨胞的由 more dorsal m础， in the roattal medulla, it opens out into 也E lumen of the four也 V回国de. 咀Wi portion of the medulla is 回回国mes referred to aa 也e ’吗阻’ medulla. The floor of 也E bundl筒， orpeduncl饵， by which. it is attached

- - - Thalamus

同川

「Ill－ttt！ t』

L 阴M

MmHN m

Pons

-- Su阴阳coIiicul晦

,-- - Mlddle cerabeller peduncle

Inferior 饲rabl曲r 阿duncle ,, ------ La恼ral re铺” andap自由m of fourth vantr1c抱

M创ulla

”

F cla.ilue cunaati』S F笛ciwlus gracils

’

Fig. .1 Do1'981 ”’翩。fthe brain翩『，．．

90 • NEUROANATOMY

Crus cel9bri

Supe~or colllculus

Mi“腼锢，bellarp回unde

αIve

时IWllid

Fig.

’a

”’m.

M刷』 upect ot the brain

four曲回回cle 缸nns

a shallow, rhomboid d句>ression on 由E

咀1e transition from medulla 旬 pona is

clearly delin回国 on 也e

donal 阳也re of 也e rostral med旧la and 世tepo皿 ηte transi由n

阳市al SU由αof the brains能m. 咀te 呢ntral part of也e poru is

from medulla to pons is not cl国rly delineated on the dOISal surface of the brains惚m but, 叩pre皿na剧，也e caudal third of 由E floor of 由efour也 V四.tricle co皿titu阳也e donal aspect of the K擅自al medulla, while the rostral two－由irds of 也E 观盟.tri.cular floor is made up of 也E dmsal aspect of 也epona.τk four也 田园de is widest at 也e level d由epontomed曲If junction. Hen鸟 a h但ral rec回a of the v四.tticle a恒nds 阳也t k键时 ma咂ns of 由E brainstem. At this point, a small la忧思l 甸回ture (fomnen ofl.uKhlra) pre闸des pa岱age 恼。E wi由in the fo田址E wntricle to reach 由t subara血且创d space S山roundlllg 也E brain (Stt Fig. 6.4). Th世 la田al walls of 也e m阳al p皿 of the fo山曲 回ttricle are made up of也e superior 皿d inferior ttttbellar pedm世帽， connec由lg the brainstem wi由也Eαrebellum. In 由t E回回归鸣曲t walls con陀事田1til, at 由e pontomesencq>halic junction, the fo田由 m缸icle becomes mn由lUO田 wi也 a small chann乱也e cer曹bral 叫ueduct, which p棚”由roughaut the length of 由e midbrain. The dorsal a年ect d也E midbrain is marked by four paired elevations, 也e superior and in缸ior colli四且｛归思血r: colliadus; Latin for ’little bill’), which are 归rta of the via国1 and auditoiy m能Dll, respa:tiv由．咀ietro由lear DerYE (era皿al nave IV) 四1e咱es immed且.tely caudal to the inferior 田Uiculua.

dominated by a transverse system of fibres (the trannene pon出E fibres or pontocerebellar fibres）也at or增皿ate from 创h 扭曲t 观ntral pons （严mtine nudei) and which, after decussation. 归晶晶由rough the contralateral middle cerebellar peduncle to 四阳也e cerebellar hemi币tere. 咀e pon由ie nuclei E在函，E “四四pan由ie fibres 叠。m 也E ipsilateral cerebral oortex (incl叫ing the motor corta) and oonstitute an important connection b眈W使E 田d>ral andαrebellar co副α， involved in 也e coordination of m例回nent. 四ie massiv哩阴阳n of国nsv町，e pon也.e fibres obsc:uM 也e m回自蝴ngcortico酬nal 田.ct. 四tev四.tral SU血re of由e midbrain consists, on d也a sid巳 ofa large column of d刨出lding fibres，也e aua cerebri or basil pedunaill. In the midline. the t附 aura cerebri att se归rated by a depl'四ion called 也E in也rpeduncular fuasa. The crua 但由i is mrr血llOUS IC陆缸世ly with the in但mal capsule of the cerebral h刷刷田~（see Fig. 1.30) and co四sta of mrtimbulbar ai叫 corticospinal fibres that have left the cer由国 hemisphere 由 the in也rnal capsule on 也.eir way to the brainstem and sp姐alco此 回沈阳，e fibres descending through the aus are primuily motor 扭缸nction.

Ventral surface of the brainstem

Ex抽回回幅atures “ thebrainste”

臼1 世1e 咽E缸aJ SU血a of 也E medulla. prominent longitudinal mlumns, the pyramid!』 run on either side of the 咽E缸al median 咀阻四 但gs 9.3, 9.4). The pyramid S田 ib name to the underlying pyramidal or cordα凋ipinal 国ct,. which C01回’” 。f des但ndi吨 fibres originati吨阳n the ipsila幅画I cerebral 四r皿 In 由E caudal medulla, 75-90% of 也倒 fibres cross o回扭 曲E de四”甜”。f也E pyram蝇， 例gs 9.3,’.4, 9.5），归nly

•Tl'咽 b『aln就阳n oc育部阳ts

ob缸田ing t}比咱1国I media且也割ire as 也eydo 曲， to form 由e h险阻1 cortiαl&p也al

tract of the spinalαml. la阻菌l to the pyramid lies an elonga锺d elevation, the olive, wi也in which lies 也E inferior oliv町 nudeua (Stt Fig. 9.7）.四is has connections primarily with the 四时，ellum and is involw.d in the control of ma明阻lent

of the

m回ula oblon庐恤， po晴 and

mklbraln. ·臼阳 dor割l a自pect

of the branstem can be 挺楠、甘18 dorsal cok.lm闸， the 四oor of the 触」时1 ventrlcle ar币d the 瓢刷剖or and In饱『tor colllcull.

·币、自由rsal

aspect of the rost恼l m回ula and the 阳胃l8 to何TI 甘M自 由oor of the 拟』同h w翩翩斟酌， later创 and median apert\188 al the 触，th vant~cle permit 甘、自

P腿”。e of CSF Into the

subarachnold sp’”. The cerebral 伺U回uc:t 阳ns thn.iugh the mldbr回n,b阳帽tn 廿m colb.111. •On t愉 van回I asp创t oft愉 W刨nstem

can be 树”阿甘回

wemlds，甘回凯18l'lHI pontl闸

’bres and

1~市E C阳阻 α首曲同．

•Thein他而r,

middle and

supel1orcen血ellarp副uncles conn创t

the cerebel11n to the mldbn.n,

medulla，阳ns and 晴和部队耐y

Chapter 9 Brainstem • 91

Ma.mmillary body 。ua cerebri

刷刷in

Pons Middlec:咽rebellar peduncle

。llve

Pyramid

”’dul除 0日创ω自由。nof pyra脯’

’

Fig. s Ventral

”’

ect ot the bral””“”-

也E spinal cord. 四is h徊， α回al part of 缸’增m皿d

nuclem is

R皿mlarly uaodated wi也 the m。但litie1 of 归in and 健mperature. 白眼回事minal Daft attaches to 由E ponaand,

Pons

Micldlecer曹bella『

pedLl'lcle

Olive 时ramie!

。“划asaUon

of pyramlcls

Fig. 9A Ventral 棚pectot 锁， br11instem 刷刷ing 筋，， d阳翩翩tionot the pyramlde.

也erefor巳 fibre，也at 田minate 迦由eparta of 也t 回geminal

nucleua ca叫al to 由is I~ deacmd in a tract (the spinal tract of 也etri萨minal), which lies 汩11nediatdy super面dal to 由E nucleus. In 由t 观B田l medulla. 由e majority of fibra of也e pyill皿id m缸p deculaation and 曲回归m h田曲， donally and caudally ω 伽m 也e M恒温lcor阻，spinal 田总

Mid-medulla 臼1 thevmtral m血ttoftbe m挝－med旧la the pyramids are ”。因nent. abcwe their deems甜on. On the donal 剧由唱“t ascending 鱼阳”。，f the clonal columns rea曲 th＇由能rmination in 也e gracile 姐d cuneate nucl画， whi曲 appearben倒也 th＇由 respective traces (Fig. 9.6）.哑ie donal columm cor闹，t of 缸，t叫order 1e1四”y neurones; 也t 创l b叫iel of these neurona lie in 也t clonal root 伊nglia of 1pinal n缸”’四d hav哩 cen·缸圃l 阴阳跚组也at asRst。但句Jinal αmi. The E刷er originate from 世:ae nudeul m.抖~ m唱m1Sof位:ae medulla and are invol观d in 岱e mod回ation of nocimandlbU脑r

Sl4Ml1'1orae阳回nry llJC椒路

S副阳回dion 81回恒C伽回阳1

V田园Dular nucl画， coc到hlaer

V回国bular san植.lion

and w阳『ygopereane

gangl恒

VIII

Vestibulococh阳.

S阳回ory

Vestibu恤rapper咀.!us; ooc归脑血

nucl副

民

Glosaophlryr唱“

Ser回ry

同审-,nx, pc揭剧，世1hj

of ton1J.1e,

(position end h88111

m111耐nant d暨堕圈’）＿

T电emn翩翩翩ynucl鹏

Ganer罩l s冒商atlon

N1蚓凰』880阳时U8

Taste; chernor四ieptlon,

Nucl-arnb踉I.I&

S幽l阳Nlng

Eu曲曲lan'llDI, ml幽B 圄町 Poshlrb，剧时 d W唱回；因IOltd body, 铺即回d

X

Vagus

Sll'IJS

baror赋精3也m

Motor

~o闹剧n归us m幽幽

H甲归回国民

PertJtid seli-..町’｜田回，回回缸 gqlion

lnlai口『圈ivBID叩『U相s

S副阳lllion

Ser田，y

问~.laryr咀鸟”d回·”soplwgu也

Trlgsnnal aenaory nucl鹏

嗣同aral aer唰Ion

里堕回重塑旦 lhonllclc end abdomn副咽ooera; aortic

Nl刷eussolltarlus

阴阳ierel 甜圃’on. chernor田ieptlan,

Nucl凰aamb踉皿

Sp嗣白h，翩翩翩蝴

以刘幅膏， aortic 田t相

berol唱cep蚀m

Motor

SOft 闵阳饱＇ phar)nx，阳yro乌 U阁”ar

Par圃咿npalli回le

Thoracic 81回 abdaT曲回l 唱团嚣E

捕。由啤』自 Dor回l m啤宵 nucleus

of

回吨’』S

Inn田咽lllon

of cardiacπ'f.JSCle.

nrwvation of smooth muse幅 and g阳、ds of 凶，司由国剧A恤， 匈现自响．『由略”凶『y 由、d gestroin田tnaitr回怡

XI

/Ice田”’y 偶到nal

泪l

H归>Og阳幡a

Motor

S睛”m四old and ’”回us muse!酷

Spnal cord

Mα~ent af head a'ld st回uder

Motor

E削nslc 町回嗣同nslcmusd帽 of tnn9u11

l-IYPOE’”回l llJC幅us

M刷町1ent al

roo时 Tiieα>mponents are co以』『·α刘翩翩:ordl『啕 to th御街11Jr阴闹剧口rlgln (s”a嗣 Fig. 1.11

incl叫ing taste 6br跑回min世扭曲e nurleua

aoliblriua of the

medulla.

Efferent nuclei 臼l the basis of their embryological deriva蚀。＇°＇ the efferent aanial n町E nuclei

can be di说dedinto 也m groups, ea血 l列ng 恤 a

也continuous longiwdinal column.

Nuclei of 曲e somatic e偏1rent cell column 耻，omaticdfer四t cell column Ii臼 near to them剧neand 由1岳阳 ofthe nuclei 也at s四dmotorfibr四 into the III, IV; VI and XII ne:r响骂. The oculomotor nucleua lies in the 'VI回国l apex: ofthe periaqueductal g可ofthe midbrain at the le\赳 ofthe superior colliculus (see Fig. 9.13]. Its ef』回t fibres run in 世ieoad佣1otor n回·e to innervate the levator 归lpebr悦 superio由 muscle 缸id all of the emaocul缸muscles, except 由t superior oblique and lateral 配阳s. The 往配hi田r nucleus also lies 扭曲emidbra尬， at 也E venttal border ofthe periaqueductal grey, but at the level of the inferior colliculus (att Fig. 9.12). Fibres leave in 也e trocblear ner鸭 to innervate the superior oblique muscle of也E 句皂白ieabducma nucl四E ia located h 也eαud.al pons benea也由e ftoorof也E four也 ventricle (see Fig. 9.8). Its effer白白 run in the abducerui nerve and 也ey innervate the lateral rectus musd巳 In the medulla lies the

torc:iue

and R目. 10.2).

hypogt明”1 nudewi (see Fig. 9.7〕， whi，由 innerva阳也ein回nsic and extrinsic muscles of也e tongue via the hypogl”’alner陀

Nuclei of 拍e branchiomotor cell column 四ie branchiomotor cell

column innervates stria能d muscles derived from the embryonic branchial (pharyn伊1) arches. In 也e t嗨mentumof也e mid-pons is loα时也.e trigeminal motor nucleus, which 剧.pplies fibres to the trigeminal nerve and innervates 也E E田des of mastication. ten四E 吵mp皿L 田lSOI 咄i pala由li, 町loh归id and 也ean田ior belly of the diga血ic m四de. h 也.erau也l pon由e tegmen'Wm lies the facial motor nudeu1. 白白 innervates the muscles of 旬cial apre割ion and the stapediwi muscle via the facial ner呢 Within the medulla lies 也t nud四s amb与UUI. 四is long nucleus sends motor fibr四 into 也e gl。”。pba巧ngeal, vagus and cranial part of the 缸笛”。ry n四eto innerva1e 也刷品cl.es of the 抖wy阻四d la1')'皿 Nuc，阳·of the parasympa由etic cell column 四le 归且可mpa由~c cell colwnn

consista of preganglionic

parasympa也etic E四ron倒也at 阻id axons into 也e III, VII,

IX and The mo皿 m血al cell group am皿旬国 the Edinger-W饵，bal nud饵”， which lies in the midbrain periaqueductal grey matter adjacent to 由eo四lomotor nucleus (see F拖 9.13). Its axons leave the brainstem in the oculomotor

Xcra皿al n~.

Chapter 10 Cranial nerves and cranial nerve nuclei • 101

CCL』b町阳tornuc椒』S

T抽出l晒阳曲UI

T啕画睛副跚跚y nuck蝇』8

F翩翩l m糊， nucleus

Su阳ior-,

Ves也』la' aid

_,,..•./ '

m曲learnuclel

Nuck到samb幅uus

N山’“saoH臼~us

Dorsal rnotir nucleus of the vegua Hy陶口b嗣l nucleus

时·’”百四”－.atem W嗣dfromthe 由，... ..回回. Thedi咂'8IT1 illus！回回 the lex剧ons of the at伽町laanial 帽w nuclei ~EJll) and 1he 冒雨『剧 C翩翩lnervem刷I~咱ht). 。、 the 啕时， nl脯l shaded in the 翩me 倒our sh嗣 acommonemb明问阳l o啕1n ~嗣创so F阳.

neni:and p酬 to the cilia:ry ganglion b 也E orl>it, wi:也in which they synapse; from here pos增nglionic fibres innervate the sphinc恼阳:pillae and cilia:ry muscles wi血面也E 句t

In the pcm也况也gmen也m lie two parasym归也etic 创i group也

1.11).

Fibres leave in 也eva伊s neni: and are widely di由ibuted to abdominal viscera.

也oracic and

Cranial nerves

由e superior 四d inferior aaUvatory nuclei. 咀e superior

salivatmy nucleus supplies pr咽nglionic fibres to 由E facial nene 由at 阳minate in the pteiygt耶alatine and submandi队tlar ganglia. Pos耶nglionic fibr回击。m the p田ygop曲曲ie ganglion innervate 由e lacrimal gland and 由e nasal and oral mu回国 membran四． 四10se 岳阳n 也esubmaI回ibular ganglion innervate 也e submandibular and sublin思Jal salivary glands. 咀le in缸ior 锦livatory nucleus 阳晒 preganglionic fibres into 也e g1。”。1pba.ryn萨al nerve. 四ieae terminate in the otic ganglion, which in tum a姐ds p值增nglionic axons to 也归rotid salivary gl皿d. 咀le K电est pr电imglio皿c parasympathetic aill group lies 面也E medulla and cons由l回 the doraal mo阳 nucleus of 也eva酬’ ｛跚 地 9.η. Its rostral 阴rtion lies immediately beneath the floor of the four由呢ntrid鸟 la也ral to the 峙院昭0嗣I nud田’·

Ill: Oculomotor nerve 咀ie oculomotor nerve carries 由e majority of somatiιmotoruon1 也at iru阻四.te the extraocul.缸 muades responsible for mo由igthe eye. It also contains pr甲nglionic parasympa也etic ne田四le& whi曲， via 由E in国mediaiy of the ci1iary ganglion, control 也e

sm.oo也 muscle 回thin the 句巴 咀ie motor neurones ser世ngthe 回raoa由r muscles

have their

创l lx对ies in 伽E 。adomotor nuclew』 which lies at 也e base of 也t periaqueductal grey of 由t midbrain at the le叫“也t superior collicul田（Fig. 10.3）.民唱imglio皿ιparasympathetic E四1I0nes ari民 from 也E neaxl:亨田ingu'-W国甲hal nucleus (Fig. 10.3; see 山 自g. 9.13). Pi.bra 企om both SOUial mune ventrally 由rough 也E midbrain 也gm回归m,

many of也回1

trav回ing 世1e red nucleus, to 回I on 也e medial asp回 of 也ecrus

巴些…~ SUpe阳晒lic:ulua

a四”’－ ’

I

,,,

－，.＿「

阳i剖u创u幽l g明 自量nger-Wes抽al mm』串

Cer曲帽l aqu蝇』ct

。culamolor nuc椒』’

Medial long阳dlnal faack:ulua

阳d nuc阳』S

Subl坦ntla nlgra

伽』阳notorne隅

Fig. 侃3 T,.n””’翩翩翩’－ugh them蛐，.in.tth，阳velofth• 剧””『回lliculu‘有ied闻四n sh口晒 the origin and cot』1'88 of oa.』lomoto『 nerve 自bras within th国 brains饱m.

也rough contraction of 也虐，pbioaer pt』p迦ar muacle of the 胞 也回 mlucing 也z amot.皿 of light miching 也E E由Ia. 咀i山 known 笛 the clira:t light reflo: (Fi岳 10.6). Evm if only one

Olfa幽rybulb

Rtina is illuminated (1巳g. d\lling d皿αI ex:amin甜叫“四 pupils of both 句回 constrict. The cons位iction of the pup姐 。fthe non－皿uminated 句哩 is called the consemual light rdla. 咀le affe:r四t limb of 也t light rdla consists of a small ∞础J8mlOf 叩世世act fibtta 也at pass 也配tly from 也e eye to i四 m由al to 郎，uperior co.监culu岛 m血a 也t pttt回al

area.

αk剧时 Optic 阳WI

than to 也e lateral piatlate nudeua of the thalamus,

wMre 也z

majo闹。f由叫他回国min.ate (tee 也o Chap阳 15).

Neurollel of the pre缸纽1 area proj回 bila皿ally 也由E Edinaet-

Watphal nuclei, from which efl"er回t fibres leave 扭曲 饵”lomotorner呢

Accommodation renex Oct』lomot>『阳”W Po『幡

lnte咿eduncular

follll

Fla. 10.4 V.阳t帽”喝啤 of h bniln ahowlng h 阴阳市 of

Pmtion upon a nearby object, by conver伊m of the optic u盹 in喃Ives concomitant 倒回缸岳阳 of the ciliary muscles to 画aeaae 由eco回回ityof 也E len岛也uafoa血11ing 也e image. It is alao aamnpanied by pi早出aJYa>n由iction. ’Ihe phenomenon imol·，自 由£viii.皿 αX筐’马 W恤 COi也X>bulbar fibra 缸岳vatingthe

剑”ch’”鹏 of cninlel ner唰 1,l•nd ”也

paIU)'ID阴thetic neurona of the M皿ga-Watpbal nuclei

但由ri, wi也in 缸 in也rpeduncular fossa （民g. 10均 鹏也o F地． between the 院到国ior cerebral 10.9). The oculom悦。r nerve pa and superior cer由ellar ar四”。ee Fig. 7.2｝，也由 runs an田iorly, 刷鸣 i且也明卫 of 也.e ca.ven回国也UI (lee Pig. 7.11), befo~ gajning aa:四 ω 也E orbit through 也z 111paior orbital fissure. The oatlomotm nave supplies all of the emaorul缸皿.uacl盹 with the a属同on of the superior oblique and h忧国 re由』a and, thus, 也z四om to elev现鸟 d叩睛， and “duct 也t 句由all (Fig. 10.5]. It also inner唱国也翩翩d mwde of the leva1阳阴阳:bme superio.U, serving to devate the up阳 eyelid. 自鸣声nslionic 归ruympa也me neurones from the 剖in伊－Westphal m出u’ terminate i且也e ciliaiy ganglion. located with扭曲e orbit, behind 也t 句哩：ball 耻om hen马 pot咽nglionic n四rones run in the 曲ort ciliary nerves ta innervate the aphi配田（com缸ictor) pupillae m1』acle of 也e iria and the ciliaiy muscle mntained w世曲曲e dliaiy body （胞也0 Fig. 15.2).

The thin 世时II.ear nerve contaim only 10matic motor neurones. 叼\ese arise in the tr副主l四z nud饵，1, which lies in the v回国i part of the midbra画 periaquedu也l grey, at 由t level of the M阳iorco血四lua (Pig. W.7）.岱le elier四t 篮。”严SS donally, around 由E periaquedu血1 grey, and decuuate 扭曲e midlinι 四le trochlear nerve emages from the donal aspect of也E brainatem （也叫7 四nial Il£rft to 由四） just ca啤I to 缸 in缸。r c.ollicul国 仍g. 10.8）. 四e now rouaes round 也 αrebral peduncle to 职in 也e '¥ell田l aspect of the brain (Fig. 10 .9), Sling be阳回E 也e p。“自讪r 但由ra1 and superior 也rebellar u回ies （附 Pig. 7.2), u does 也e oculomotor ner四. It 由皿 rwu anteriorly, M吨扭曲e h阳al wall of the cav四lOUS 归国（see

”“

Pu，ρi/1邸，y light reflex

of li阱ctente血g the eye i，鸣曲M by the me of the pupil. Illumination of the Mina cauaa con’也iction of 也阳pil

回le amount

bila回惠lly.

IV: Trochlear nerve

”

F句~ 7. 11）幽d 四t由也创恤也rough 由em严rior orbital 也剧Z也

It ruppliea just one mlllcl皂白e mpaior oblique. The ac:lion of 由E superior oblique ill compla Depmdi吨回也E 归国吨 院凋ition of the 句eball itαn act to dqm，也 abduct or intort the 句也 lmportan:郎 with the eye ducted, the supe由，r obliQl后 d叩ra1es the 由ual

am.

“

Chapter 10 Cranial nerves and cranial nerve nuclei • 103 ＆』阳'iorn睛，s

l响曲robli明ue

~

La恼耐 racll』S

In伽暗z recllls

’ ”

Inferior刷喃自

Supe而ll' rectus

Medial

La恼ralrectus

『回扣s

Su阴阳oblique

S阴阳oblique

l『白而E nlClus

’”’ught about by 恤··皿m创泪阳 mu8CIH.

Fig. D.I E movement

阳i叩创u由l g『哩，

Ecai阴『斗幅“phal

nucleus

民R树 nucleus

Crus 帽ebri

Oct血:mo曲。rn1，帽 P咽illary ams1ridor

阳帽deofiril

Cilia『Y俱nglion

Shcxtαl町 nerve Fig. 恤， Tran’””’割据lion 笛”啕h笛” most l'Olllral part d恤， midbr菌1. Thed闻ramsho晒 thepalhw町z involved in the direct and consensual 阳pillary l阳ht re阳则8.

l阳rcoll阳l惜一＼．

VI: Abducens nerve

...－－『＼

咀1eabduαm nerve, like 也e trochlea再回1tains

Cerebral equedud

only somatic

mo刨出urones. The all bodies of origin are loca:时 in the

abclucm1 nucleus, w挝也 Ii四 b四倒也由E :Door of 也t fourth 田面de in the ca叫al 萨ms

(Fig. 10.10). Effer四t axons 田田配

丽itrally 也rough 也E po田缸ul emerp: from 也e 四ntral m也m

of and the 胃ramid of them础Ila (Fig. 10.11 ），耻 nerw 曲回归sses anteriorly, 也rough 也eca陀mous siDUS (see Fig. 7.11) and m侃” the orbit 也rough 也t superior orbi钮I fissure. 咀ie abduαns supplL创世le 也E K垣皿阳n at 由ejunc咀m b~ 也E poru

Ia·也ra1 rectuB muacle』 whichabduc凶 the 句尼 supe耐锦得bellar

......._ ＼

I

Crus 帽曹bfi....../

削uncles

""'-

" -Subslantia nigra

mldbniln at the level ot the ·由rtor colllculus. 节18 d问rsmsho明伽e l民划on of the trochlear nucleus and thee剧用自 oftrochl制u nerve fibre唱． F阳.1队，7 Tran刷嘟” section hough the

V: Trlgemlnal nerve 咀le 创胆回国l nerve has bo由 S四”ry 皿d motor compon白银－

It is the main 阳uory nerve 怕也e head 曲也 addi由Dally, it innem.J田 the muacles of mastication. It a幽幽幽 to 也e brains田n 画 two adj缸回t root& (a large &elllO可 and a smaller motor root) on 也E 观~trola阳al aspect of the pons, where tl世s me嘻臼 W挝1 世le middle m由ellar peduncle [Pigs 10.1, 10鸟 10.11). 四le S回sory fibres wi也扭曲t trigeminal ner鸭 are 萨归iary 阳1aory neurones wi也阳圳ieral processes di盹ibu时， via 伽

104

…

NATOMY

I

Superior a>lllculua

;

In制。rcol阳lus

气、 飞｝－一－ Tit刷刷『『回w

Supe阳

ceraballar 阔咀蛐

Middle ceraballar peduncle

Mediallem而ICU8

F幅.10.，。 Tl'IMV81'9…Gtlon thro啕h ’阳’“udal pona. Tha diagram shows the lo臼tlor、 of 廿w abducens nucleus and the course of abducans 「丽附他>ree.

…““ h b,...’”,.n.rem”’II of1” ”…origin ofh cru阳1 ”’回 IV.

F幅1. 10.8 DorHI 。”!Milum, lhow

Ttodll如鹏飞 向ns －.＼ 吨巾I nerve Tit剧协arnerve

M创Lilla

T句emi唰 ne隅

Fig. 10-9 v.ntr.I mtdY.

””ct ofhb • •howlng cnini.i

Glouaphar刑aal

v副bLDxichlaar

『1et'ie

n阳ve

向ns rwr咽”’11,IV

Fig. 恤，， Ye”’..

...嗣t ofthe brain st翩翩啕 th’”lntsof

.nachrr丽而，fen时刨闹仰” YI-民．

、 刷刷d翩翩翩唰盹 W刷明 A创M cran恒l 『W喃 palsy

orbit 阳pe巾rαbltal 他SU陪 synd『ome)

α::ulomotor

arewnar也阳 ωαxnpre臼』m by rumours

(Ag. 10.1到 Is E剧副 by a lesion of the nucleus w恼1in Iha midbrain or by compr四;sion of 甘、自 因『ipheral course al cranial nerve Ill by an an凶”窗n or 11Jmou『. It la回s to drooping of the fJI/刨id (pto副a), dilation of the pupil that is unraspor百阴 阳 l泪ht 副部倒TIIT回alien, and an inability to move the fJI/由副l upwa睛， downwards or 阳自由｛adduction).

A lesion of the trochlaar nerve 阳 man阳t by diplop旧 on lo剧ng n时｜砌则依附翩翩问．附创刷刷ng down幽l陪）． A sixth cranial 帽W palsy 归自. 10.1 苟 恼 caus剧 by a lesion of the abd.后ens m刷刷sin 廿w pons or byα>mp晦skln of the peripheral C剧响。I the ner.咽 by an m创阴m or l\lnour. It 悔创s to an lnabllty to rTIO\得 the fJl/9 outwards t由ductton). Combln回 lnl创er＇创 p由嗣 of cran恒J ner唱IS Ill, IV 町、d VI oc剧『怕m 脑阳市s Blong the~ p创川、er＇副 course where the nerves run ad]ecent to each other, such as w胁In the cavernous sinus，刨出e entrance to the

and within 由E O『bit. There they and an剧时回ns. 节回自慌副s of

such unlate『al lesions are:

• P1o阳． • Dilation of the pupil that is unlllsponsive to lght or accommodation. • p，嗣lys隐时创l eyamovemen恼（oph恤aim。”吨副 causing doub恼

vlslon(dlpl。”’）． Mult~le sciero：曲曲n d阳t 锅内昌 m趴砌ner吭s through

demyelnatlon of the medial lo呗ltudhal fa.so阳us In t栩 brainst阳l，圳、胁 hterfa嗣 with oon]ugate ocular d刷刷刷. Ty回oally, on horizontal gaze, 1网 abductI啕 创18 mα188 nonnally but the edductl啕 W咽刨阳 to folow. Adduction Is W臼erved on conver阳回阳”muclll•r oph阳Imo回•111• ls the 田m 崎国 ω 也哩。rtle th悔 d阳rder (Fig. 10.1 句. See also Ag. 10.27.

Chapter 10 Cranial nerves and cranial nerve nuclei

105

r回 d仕腿”rietal lol提. In d幽ion to 也姐 回曲wayforCONC阳回侃侃reoe鹅 the trigeminal nucleus alto leDdl fibra to the cmbdlu.m and mabl趾ia a number of zdla αmntttiom withαrtaln m悦。r cell groups of 仕.e lnaimtem. Among 6回E ii 由 facial nu幽幽幽rot唱l which att mediated facial grimad鸣 and eye cloautt (corneal n曲z)in~阳回 ω nα皿oua stimulation in the 回首臼rysa硬d by 也etri萨minalnerve 币g. 10.17). The IDUR 皿d cough rdEe& are ini·也:ted by a伽'ell.U running 恒 dth~ the trigeminal nerve (from nasal muco叫 or the vagua R筐’e (from larynx and 田曲“.） and 四必吨 in the 国萨minal m ry nucleus. From her也 indi配toonn仅tions arem e w灿也.phrqmatic. 皿.tercostal and abdominal muscle motor neurones for 也e forceful apullion of air, 缸uiwi曲曲t nuclewi ambi’“恤ne:rva:由lg 阱wyn伊I 皿d lar归伊l muaclea σlg. 10.18). In the jaw Jerk. d跚跚回归田槌ion d也

mUIC抱 时．恤” J•叫，也 Seneoryn刷刷，， blue; motor 阳市盲目，刚．

…

10 Cranial nerv臼…

...…

~· M嗣.， th9 lflaMll

”””画”W In幅ction d 怕’帽胃呵，因Is of the 同emlnalne隅

。•hi唰唰嗣ds

to pail and 阳削p1ion d 唰C悔阳加剧 to 阳

由rma阳、自瓢.->Pl嗣 by one er other of 阳帽hlhalmic, maxi阳ryand mandiblJar b刚刚隅。f 阳啕eminal 闹闹．

In 嘟”o~i..c地附菌i c的他如n of 阳 m础』胁 倒Jdal to 酌， 似』rth vent『捻幅阳dato 阳，他renUalαll11Presslva di部佩剧阳、“

鸣”t:U串串串伽g 啕em nothalamlc ’b睛， ωω同翩翩崎 bssof p由自nd

’”:) In the 阳目．

W叩W由t'9 98nSlbll1y (dlel制”“”””’v t

四iemotor a皿n• of 也t 创胆回归l nerve ar耻 from cells in 由t trlumiinal motor nuclew」 which liea in the pontine tegm四”m medial to the chief 1emmy nu.出田 间. 10.2}. Amns leave the 严ms 扭曲t motor root of也E 回事minal and tb四 join the mandibular division of the ner晚白可 inner咽te varimu mwde也 the most s增ilficant of which are 伽t muscles of mastiαtion (masae阳 and temp。”Ii也 which dose 也e jll'毗姐d the U能回回d medial pterygoida, which op四也t jaw~. Tr帷m且al motor neurones a1ao innmate tensor tym归ni w讪U且也t m凶dle ear, temor wli pala剧， mylohyoid and 也e anttrior belly of dig;utriι

and 阳”la•巳姐d alao 由国1刨出能nsation from part of 也e alttDal ear. 币le 创l k对iea of primuy affu四.t neurones lie in the geuiculate pngllon wi1hin the fad.al cmal of the 严筐OU& tml萨nlbo皿叽1£ cmtral procnaa of talte fibmi tenninat£ in the Z回国l 严n d也~Dud囚111 mlita血，。f the medulla. A缸嚣叫i鸣 6bra 台'OD\ the nucleus aoli田ius pro如ct to the 胃ntta1 阳”阳ior E配leut oftbe 也由mw』回tlch 园”m 段ndsfibra to 也翩翩Y cor恒 of the pari幽I lol比 Afferent 副al naw fibres 也at any aJtane以u aenaatlon t.ermin甜面仕le 刨胆回国l nucleus. Motor fibre& of the fad.al nenoe originate 扭曲e fadal motor nucleuaof 也e ca·叫al pontine t喀皿entum (Fig. 10且｝．四ieaxon1 initially pus dorsomed且l岭， lo咿ngov自由E abducena nuclewi b四eath the floor of the 岛四也回ttricl巳 before leaving 也E

VII: Faclal nerve ’l'he fad.al nerveαmtairu 1e:naory, mo凶’姐d p笛事句mpa血et1c

mmponmtl (Fig. 10.20}. It join& 也 b回皿缸nat 也 ~回I upectof也 cau也1 po111 (Fig. 10.11), near 也

pontomedullary junction，蚀 a r唱阳1 known as 也 但由di。”副m angle. The nerft CODI副 of two roe鼠也e m幌 h忧国（tometime， αlied

tbe J1emJI 缸阳medius) containing 能回ory 皿d parasympathetic fibm, the more medial root bei鸣 composed of motor an皿 四te armory fibm of 由e fad.al Jlerft submw 国tesenaa也应 from the 咀.taior 饥协也inia of 也 tongue. 由e floor of the mouth

M幅副 阳miacus

崎.1D.2t Trm,..,.,..aallan 由rough .＿四”‘ Thad吨ram sh阳E 怕。啕In 11nd coura& of 阳 motor 伽回 of the徊。al n町ve.

Laaim1lg恒M

← 创阳ior saliva\ory nudeus

同BIN句翩阳”叼阳1

)

Fa:涮阳翩『阳却UI

Ger翩翩曲，ganglion

灿a阳路”融曾回

To 归pedila 仙，，阳棚·伽l刷目ftongue

muacle

S切口m嗣刨d 伽胃啊，n Chol由韧npani

To恤恒l muscles

Submandlbul1r Mlivlry gllnd

时．唱队”。酬””•nt flbrea of .＿旬cl•I 闹闹，nd 曲，Ir perlph.,.I dlstrttM刷刷. Blue: 9'1n8ory: or呵，： motor: pur阳： W鸭”nglonlc 阳asympalhetlc;

green: postgangllonlc 田res阴阳阳也．

108 • NEUROANATOMY

“睛”l ham崎hlN

Super阳回响阳帽l gyrua

胁dial g回l阴阳le nucleus

幅ddle ce陪bell笛”也』nde Crusce『鸭”

缸”rtcr ollvary nucleus

幅ddle ce『回到国lar”曲时，e

·Trapezoid body

D回事alcx则由嗣rnuclaus

In自E『ior 阳曹bel脑网LS1cle

Medulla lnfa阳 oll回『yn叫蛐

时ramId

F阳.10.22 阳阳”l 嗣帽，ding comectlons of the aud阳W 阅mponent of the veetlbuloco曲l倒rnerv也

brains惚皿旭也e motor root of 也e facial ntt陀 Motor fibres

are

曲创buted to 也t muscl髓。f facial exp!幽阳， pla.tysma.

stylo峙。id. 由E posterior bdly of the dip血k muscle and 也E stapedi田 muscle of 也E middle 回E

咀ie facial m。”r nu甸回回娼”s affer回b

from oth配 braimt回E of certain reflexes and abo from 也e αrebral corta Reflex connections are establ.Uhed 也at mediate 萨。脏tive 句t closure 旭 E哇’“1se to visual stimuli or tactile stim叫ation of也 cornea （四meal re8tt）也rough fibres from 缸eat for 世1e mediation

也t SU阴阳∞出四lus 血d 也e 回geminal m皿rynud晒

mpectivdy. In 剖.dition, fibres from 由e superior oliv町 nucleus (Fig. 10.22), a part of 由tαnttal auditory pathway, sub阻，e rdl.ex 田n国ctionofthe 皿甲edius m111cle in m归田εto loud noi脆 C.Ortico队tlbar 岳阳回击。m motor cm咀c.al are笛面ner四位也e facial motor nucleus. ’Those that control motor n四rones suppl抽ig the muscle9 of 也.e upper face (fron时is, orbicu1aris oculi) are 曲创buted bilaterally. Those that control 也e motor neurones su酣抖ng 由e muscles of 也t l阴阳 face are en·笛rely ω”ed.U皿la田'al upper motor neurone l回回岛由配由赂 give rise to paralysis of 也E 倒itrala挺ral lower facial muscles.

Chapter 10 Cranial nerves and cranial nerve nuclei

民唱imglionic parasympa也eti.c fibres

of the facial n町ve

创蝠nate in 也E 皿严rlor salivatory nucleus of 也t pons. Fibres I四”也e brainstem in the S四皿ry m帆 of the facial nerve (n由u’ in回medius). From here. they pa腿 to parasympa曲etic ganglia, namely the submandibular and ptery脚ala由e ganglia. where th叮 synapse with pos耶nglionic neuron回．阳，耶nglionic 矗bres 丘。m the submandibular 郭nglion inner咽te the submandi队Jlar and sub！画gualsa且.vary glands. Th创e 仕om the p回ygopal剧m 胆nglion innervate the laa恤al gland and 也e nasal 皿d oral mucous membrane&.

l\\. Bell's 问 ll(;Ute unllater刨 In由amm阳r/ 悔sl阴。f Iha Its cou陪e throogh the skull. Pan Is exi口E『阳宫时 aroo.』nd t闹锦r ar回 th脚 Is PBl'll加Is of the f叫“ m.JS由s unlaterally, with 幅llure to clo锦 tha 酬， m ab阳tt corr回J reflex, hy阳翩翩 on the d阳恒d side end loss d 恒ste s四凶阳、 m the ente『ior two怕1rds of the tongue （：割据 a嗣 同.10.2η.Wh白白E herp臼 zoste『呻us Is the inflammatory agent, a 协白白ular ra由 is ap田r田11 in t阳西到自由naJ 副ditory canal and 甘、自 mucous memb阳市 d theαuptwynx (Ramsay Hid Bell's 阳Jsy repres阳市 m

恒clal r回附 In

”””me).

VIII: Vestibuloc。chlear nerve 咀le 咱tibulocochl回z nerve is a sensmy nerve 阳tcon呢？’ im.pul附齿。也由e 旭ner ear.

It bu two com严ment p缸”：也E

审atibular ner霄， which 也tries information 时ated to the 严汹汹on

and ma呢皿四t of 也t head.

and 也e 四chi田Z DerYE, 咐lich carri臼

auditory in岛miation. Both divi匾。ns oontain 也eaxons of 缸吼叫order 担DSC可 neurone鸟也E den由t国 of which make oontact 明白 hair 创Jsof d也er the vestibul缸 or auditory 叩＇para阳s of 由e inner 回r. Both 世visions pass to尔也n 也rough 由E in也mal auditory mea钮’（which al，。 conta旭s 也e facial nerve）缸ld attach to 也e brains凶n at 也e junction of the medulla and pons (Fig. 10.11), in the z唔m h饵”1 幽也e cerebellopontine angl巳 The vest曲ularnerve 咀咀嚼盟岳阳J.l.ar nerve fibres

make d四.dritiιoontactwi血 hair cdll

d也E咽曲血r portions of 也e membranous h阳inth；也由 cell

bodies are located in the W!Stibular ganglion 明白in the in但mal auditory meatu.s. 咀1e rentral pro四”es ofv四ti1n且E 鱼bres mostly 回d 姐也e 畴，tibular nudei of the rostral medulla. 四m are four 饥础 nuclei {superioi; inferioi; medial 矶dla艇ral~曲叫ar nuclei) located d础 ω萨ther beneath the lateral p笛t of 也e floor of 由efour也 v回国也 Thevestibt血rnuclei es凶.blish contacl w讪 a number of other E唔m for 也e ro血ul of posture, m血田ianreof 呻.rlhD:rium,

coordination af head and 句ema晒nent也皿d themmdoua awar回翩。fft到bular 而mulation. Fi阳回岳m the lateral m伽Jar (Dei阳的 nucleus 幽值ld ipsilaterally in 由ela:回 ves伽阳”nal tJ:皿四eves曲ular nuclci alao con回.bute fibres to the medial lo剧目tudi且al fudculua. 四画也但nds 也roughout the brai皿回1 缸id into 也E spinal. cord; its d幽但ndi咱 compo曲曲t is also lmown aa the med坦I 咽tibul回归al 国.cl. Vestibul田回nal6bmi influmre the 剧唱lity of 1pinal motor neurm田 c:oncDDed 响曲曲E 四ntrol ofbodyp田ture and balance. 咀le asC£I时ingpa且 of 缸

medial lor晤tudinal fa回aJ1us 回旬iblishes connections 回仙也E nudei of曲曲ducens, trocblear 刷刷lomotorner晒缸阳 αxm:lina画onofhead 缸id 句oe lllOY'elJleilts. Some efferent fibr四 from 曲t现stibul缸 nuclei pass 也rough the 旭阳ior caebellar ped回国t to 也t 8oαulonodular lobe of theαrebc业！um, which is cone田led with 也econttol of 同创且M担m. O由er fib瞄豁出td to 也e conttalateral 也alami田〔vmtral. pos回ornucleua〕， which in 缸皿闸由回由E 但由al cm皿 The cortical i:qion responsible 岛·rem回m 却阳回酬。hes曲时.ar sensa:世m is uncatain but is probably adjacent 臼由e 'head’

area of 阳晒回可 oorter: 扭曲归rietal lobe

or a啕缸:ent to the auditory cortex in the 能mpomllobe.

•

109

The cochlear neTVe 咀iecochl但r nerve fibres

make d幽幽itic contact 明白 h甜甜la of the organ of Corti wi也且也e oochlear di.皿 of 也e inner ear. 哑le cell k地iea of these fibres lie wi也m 也e oochl四 and are oollectively called the 叨iral ganglion. 咀ie rochlear nerve joins the brains阳n at the level of the rostral medulla. Its fibres b凶皿ate 阻d end in the dorsal and vmtral cochlear nuclei，咐1ich lie dose ω 也e inferior cerebellar peduncl巳 From here, the 部ce:nding 由ditory pa也way to 也e thalamus 姐d cerebral corte:J: 阴g. 10.22) ii somewhat more com抖icated 阻d 四riable 由皿由at for 也 gEDJ田1 senses. ’There are ~ !orations betw田n the medulla and th且lamu1 where axons may synapse and not all fibres 且也e pathway behavE h 位t 锦me manner. From the oochlear nuclei, second叫order neurones 揭出td into 也epo鹏 some of them crossing to 由E 。也er side of 也e pen由法也gmentum as the tr富.pezoid body. Al 也is level me fibres may 回mi且ate in the superior oli回ry nucleus. 咀山 nucl回』＆ is the site of ori国血。f olivocochlear fibres, whi由 leave 也E brains恒四面也z vestibulocochlear neive and end h 由E mgan of Corti. 咀句 have an inhibitory 缸且dion and 阻四 ” modulate 回rumission of auditory inform回m to the co副ear ner陀 From 也E superior oli:咽ry nuclei，”但nding fibr霄’ comp由e the lai缸”llem跑回，，咐lich runs 也rough tbe pontine t喀mentum to 四d 坦白E 旭ferlor colliculua of也t midbrai且， Some 缸ons wi也阳也.e lateral lemniscus 回minate in a small pon也1e nucleus αlled 也e nucleus of the 1世ral lemnisrus. 哑ie superior olivary nucleus and 也E nucleus d由E K阳allem皿阻JS are thought to establish reflex oonnections with motor E四阳ies of也E 国ganinal and facial motor nucl画， media:由ig c.onttaction of the t田里or tympani and stapedius muscles in response to loud noise.τbe h如ior CD.皿αUUI I四ds axons to 也e medial genlcuhrte nucleus of 也ethalamua. 哑ie final step 迦也e ascending auditory pathway comi.sts of u.ons 由a.t origina恒 in the medial 萨坦坦ililte nucl四S 曲dpaas 也rough 也t internal capsule to 也e prim缸y 甜温饱ry α>Ito: of the temporal lobe.τhia is located predominantly in the 国皿阳回回.poral gyri 但晒l'a gyri or oonvolutions；四 Fig. 13.17), which are situa时 on the upper 皿恤 af the superior temporal gyms and, therefore, are largely hidden 响也in the

,”

la回l 也SUl1巳咀roughout 由e ascendi吨 audito可 projecti盹 there

exists a 卧臼lled 'ton例。1pical’但presentation of 也.e cochlea, which is analogous to 也E ’”＇matotopic' o耶nisa由n of the pa也ways for 萨neral 8四sation. Wi由in 也t brains出m, 曲me 幽幽幽ng:fibres

decussate while O由四 do E吼 τhe represen钮.tion of the 由出lea is, therefore. bila:国al at all lev由 ro由al to 由E 田chlear nuclei. For 也is reason, 四曲缸al

lesions of the ascending audi臼，rypa由way do not cawe monaural deafness but, rathe耳 m manifest as a l侧 。｛ auditory acuity and 扭扭ab副ty to localise 由E directional origin of 跑回ds. The E唔on of the temporal lobe surrounding 由t prim町 auditory cortex is known 笛 the auditory uaociation cor但xor Wemicke’I ar回a It is here that auditory information is in能甲配时 andgi把neon:也血皿I sign温.cmce. Wernicke'a area is important in 也E F民圆白哩。flax唱国萨 by 由E brain （口iapta 13).

~ 翩翩eneurom• 阳 mαJstlc 咽』roma 阳 a 嗣同均n !Umcll.，。f 问啕帕 C『町、leJ

nerve thllt leads to comp明白n of 甘19 『'9l'V9 end 回阳;,ant s刷刷刷 In Iha ”nlbelopon笛”’咱崎 A阳dellum

117 11a 118

Is the 1.aJsest 阴n of the hio.dbrain. It origina刨

食。m 也t donalu严aof 也t brains皿m 四.d a咱也ω 由e four曲 回ttrid巳币te cerebellum 扭曲nnected to 也t brains也m by thrtt stout 归国 of fibre bundl饵，也lied 也e infaior, middle and mpuior mn:bellar 严dunda (Figs 11.1, 11.4; att also Figs 9. 1-9.3）；也m join the ceRhellum b 也 med世k 阳鸡叫 midbrain, reapecli晚ly.1be 旬nction，。ftheαrebellum are en由dy motor and it operatel at an unconscious leYel. It controls the maintenance of 饲凶librium (balance), influences pas阳re and muld.e tonr 组ldα附1rdinatea movem四t

EX幅mal

features d 伽e cerebellum

咀le 田mellum

c:omiltl of”。 la回到lyl。但因 henmpher田， joined in the m划line by 阳市mil (Figs 11.2-11 .4）.四顶，uperior m血ce of 也tαrebellum liel b回ea-也由e dural t回tori山E αrd>elli and the IU归rior v曹mm is raiaed. 岛m且g amidline ridg配 Con帽，el郭世te 恤缸ior Wl11lis lies in a d也p groo呢 betwttn 也e heml1J>hett1. ’Ibe surf.ace of 由tt ce:rebellum ii highly

amwlu时，由e fol也 orfolia （：血备， foliu时， being ori四.ted a回宽回mately U田回帽回y.Betwttll 也e folia

lie fissures of varying Some of the:1e 缸mrea are land皿arks 也at are used to divide the 但由ellum anatomiαUy 恒ω 也ree lobes (Figs 11.211.S). On the superior su血属 the deep primary fui1ure sep缸咀刨 the rel甜my IDlall antttlor lobe from 也t much Jar庐”’阳ior lobe. 阳阳 und四ide, 也eco即阳。ω ”’徊。h也ral fuJ m olifam R回削S

Den值自由 nuc烛』8

G蛐创自 nudel 同.stigial m届创S

Fourth ventrtd自

」一

Midd悔 cerebellar 问cklnc梅

Pons

Fig. 刊」’ H。rtzontal MCtlon hough 伽e cerebelklm and bran帽mattha 崎ival of th，刷刷帽ntrlcle, 8howlng the cerabel阳， nucl创．

116

……

I

MY P耐响 cell layer

(x25)

(x T创｝」－ Gran曲rlayer Fig. ”S 价4习 Tnlnn…”ctlon• of cerHellar tolm ahawhg 由削”.. orttie 四......，阳roo而皿．

协蜘四阳r 阳”r

阳陈lnje 倒l

Grenuler 恒归『

Gtlnulecel

一一一－While malle『

M回事”bres …· · ， ClimbI啕仙幽伽m i响riorol帽rynuc拟捕

•, . ‘…· To cerebellar nuc刷

Fig. ”－，。而·””beli.oort皿.D崎ramshOI崎 afferent and e耐用时 conn翩。明 and 问Irr唰atlonshlps 1o 1he prtndpel 佣Hs of the cerebellar cort鼠

Chap幅r 11 Cer’。bellum

币ie Purkinje 创I layer consists

of a

u皿副Jular l句'tt of the

曲皿阻（cell bodi凶） of Purkinje n四rones. The pro缸ae d幽幽i配

principal d创nations of dfer四t fibres

• 117

are 也e z回αJlarand

” stibular nuclei of 也t medulla 皿d pan鸟也t red nucleus ofthe

atborisations d也甜甜Is (see Fig. 2.lB) exttnd towar也出 S田face of the mrt£X, into the molec叫z 国'tt (Fig. 11.10）.四le atborisa:世ons are flat回ied. and orien也d at right angles to the long axis of the folium. 咀直可 are,. th自由m 恒avened by numerous parallel fiMi饵，岳阳i which they m垣鸭 aritatOiy synaptic input Inhibitory mod由tion of in田.cortical cira曲y is pro世dedby nwnerous o也a neurones kn.awn as Go阔， basket 缸l.d e回M 创Is. 四ie uons of Purkinje cells are 也叫y 缸。D8 to I.eave 也 αr由ellar cort£x. Most of these fibres do not leave 也e cerebellum 团由dybutendin 也E deep 田由ellar nuclei. 咀eo由er type of aft垃mt fibre en缸恒g 也.e r.£rebellar cor但鸟也E climbing fibre. origin.ales 岳阳n the inferior olivmy nucleus of the med创la. 币1倒 伽四 provide relatively discrete emtatOiy input to Purkinje 国ls. At. 也e same time, axon collater曲。f di皿bing fibres acite 也e neuron.es of the dttp cerebellar nuclei. Purkinje 创ls utilise GABA

世leαrebellum

U 也由 neurotrammit回 whi也 m四11 由且也 output of 由t

subdivision也 based upon phylos四etic, 缸tatOl回国缸l.d 缸nctional

whole of the cerebellar oor皿 is media时也rough 也E inhibi由D of cells in theα四bellar nuclei.

considerations (Fig. 11.5).

Cerebellar nuclei Deep within 也e cerebellar white matter. ab~ the roof of 由E 也回由 V回国也 lie four bila缸ally paired nuclei. From medial to h恒时，也ey are known as: • • • •

Fas世gi.al nucl钮’

Globose nucleus Embolifonn nucleus Dentate nucleus σ~ 11.6-11.8)

咀ie d四植.te nucleus is by far 也E K胆t of the cerebellar nuclei and is 由E 创诅yone 由自tcm bediac町ned clear坊 wi由 the naked 句-e (Fig. 11.6). Itαmsists of a thin l甸回 of nerve cells which, in 由-ee dimensioru』 is reminiscent of a c:renated bag; as a :result, 垃 appears somewhat aim丑缸旬 the M如ior oliV31Y nucl四15 of 也e medulla, from which it m四”’ afferent fibres.τheαrebellar nuclei also m咽，eem以:erebellar afferents from 也e vestibul缸 nuclei. retiαliar nuclei，”n也e nuclei and spino臼rebellar tr缸”， predom凶antly by means of co』laterals of mossy fibres des出d 缸也但由ellarco血z From 明白扭曲t 但也ellum, the nuclei receive dense innervation from 也ePurkinje 创ls of 由E 也rebelJar α览馆z it国f. 咀ie rerebellar nuclei constitute the primary saurce of efm四t fibres from 也.e cerebellum to u由E parts of the K血．咀le

midbrain and the v四.tral la田直l nu出us of也e 由alain四． E田temal t嗣n1cture “ the cerebellum •Intern哟， the ce闹剧rum

∞阳l创sofa SI』巾.ca 阳”『 σf

cortex, highly co附eluted to form fol恤， ber回th 附胁阳 圳市胁 matter.

glatJose, embol阳mand dent翻｝．

• The ruclei are 甘冒目 α国in of 囚，回lei恒r elfe雨时自blllS.

matter r画 nuclei 阳地副，

•W协h 酌， white

铺菌国lar

Functional

anat1。my of 由e

cerebellum

is often regarded as cons扭曲tg of three functional

·四teU也icettl:时Jum, or oldest portion in phylo胆teti.Ctfilm』 is 吨uatedwi也 the ftoa:ulonodular loM and the associat£d

faatigial nuclei. ·咀le 阳Jeocu由ellu皿 appr回ma·阳臼由E mid.line回rmisand SUITOUl叫ingpar抑自mis, to醉伽er with the globo1e and 四boll旬rm nuclei. ·四ieneocer曲ellum compri附 the remainder （血d vast majority)

of the cerebellar hemilphere 皿d也e dentate nuclei.

Archicerebellum 咀le 缸由iαrebellum

is primari坊 conαmed wi血也E m血tenance It has ex回回veco皿剧。nswi由也e vestibular 曲d retiatlar nuclei of the brains惚m，也rough 也t inf回or r.£rebellar peduncles (Fig. 11.11). V.副队由z information is carried 岳。m 世ie vestibular nuclei to the mrtex of the ipsila回;tl 组acculonodularlob巳臼rtic.al efferent （阳kinje cell) fibres pr归 to the fastigiaI nucleus w扭曲， in tum, pn:场缸” back to 也e vesti趴血Z nuclei and to 也t m咀cular form础。o.Asi伊监cant proportion of fastigial efferents cross to the contralateral side of 也E brains田n. The influence of the archicaebellum upon 也E lower motor system is, th自clore,. bila但ral and 伊inclpally mediated by m幽幽 of descendi吨础tibulo咿nal 血d ofbal曲α （呵峭.brium).

z四四I皿pinal pn:略目:tio皿

·Purldnje call Vi倒也u阳:ereballar fibres

ReUcu阳plnaland V时bu阳回nal 阳由

Fig.

”

118 •

NEUROANATOMY

v，『l嗣同men刨 d阳”ation

Glo胁，e and embi:量fonn 『1uclei

阳b明pin创阳ct

Fig.

” .12 ConnKllona Dflhe

pa幅画四”b•llum.

D阳泪”“on of pyramids

Fig.

” .13

国恒耐∞『由cospin副阳t

Conned阁”aDftheMO。”’bellum.

Paleocerebellum 咀le 阴leoc自由ellum

d由E rerebral carte:民 involvEd

influences muscle tone and 阴阳re. Afferents

αmsist priI咀归lly of dorsal and 咱也al spinocerebellar 田d n四rones 也at carry informa咀on

from muade. joint and a血neous

recrpton 皿denter 由E 但由ellu皿也rough the inferior and

11.12]. Fibn5 and adjacent pammnis. Caebellar cortic:al efferents from th回t areas 阴晶， ω 也Z globose and emboli币。rm nuclei and also to 阳 也剧gial nucleus. 哑ie globose and emboli伽m nuclei 阴叫田 via the superiorα健bellar peduncle to 也e conttala.teral ml nuclms of 由t midbra跑， w恒a官也eyinflu·团成也t activity of cells giving rise to 也E descending rubr田.pin且l 位act. 皿perior 但ebellar peduncles, res阳由由 陆.

阳mina:也 largely 扭曲E corter. of the ipsila回al VEIIDis

Neocerebellum 四iene“自由ellum

is conαmedwi也 muse叫ar coordin皿础， including the trajectmy, speed 皿dforce of ma田n四ta. The principal affer四t p量也lWllf to 也E neoc:erebellum comim of pon岛。但rebell缸 fibres that originate in the pon由ie nuclei, 1民atemater nerv由

Fig. 愧， V街巾’睛’•pectof~酷 d阳帽阙创on.

Crus 础理tiri 翩翩翩町 body

Cha pt町’ 2 而alamus •

121

Massa In恒rmedla

Fomix Int跚跚刷』lar

foramen Fomlx.

A曲目。F

az:λ飞、二 仨f( ’

咱…·』 也

飞

‘』

..

、

唱

电－－

’

」‘同＂

I

Cere阳l aq即duct

commi民Uni

Optic 由恒m

《~

Optic ne附

’

Fig. 2.2

、、

电…

z

l 节， ！

Hy阿甘刚amicsu以』S

Hypothalamus－」」－ Mammlll目『ybody Medi翩翩啕阳，l ”ctlon af the brain 础，wing 甘冒，刚回lonat巾，时’咽，d阳帽”ha崎n.

in thevm田·lateral part of the subthalamUJ, immediately medial to the in能rnalαpsule （阳 Figs 13.9, 14.8). It has the shape of a biconvex. lens 姐 coronal section. The 皿b由alamic nucleus has 严omin·倒倒mections with 由E ~obuspal且dusand the substanti且皿gra and is impo皿ant m 也E control of movem四.t. It is discu部ed. in more detail in Chapter 14. 咀te zona in岳阳 is a m盹al menaion of 由E brains国n retirular formation. Se晒al impo血nt fibre systeIDll m阳’E the sub也alam田回 route to 也e 由alam皿咀eseind回e ascendi吨’四町 P叫ections (medial !em皿阳岛酬nothalamic tract岛 trigemino由alamic trac时， αrebellothalaJ:旧.c fibres from the dentate nucleus 血d pallido也alamic fibres from 也e inter国I B鸣mentofthe gl.obus pallidus. 咀te latter group of fibres 皿:velop the zona ino四aas 由e l四.ticula:r fa姐.atlus 皿d 由alamic 也cicuJ.us (see Pig. 14.8).

Topographical anatomy d 曲。由alamus External feab.』res 咀re thalaJ:nwi

has been likened in siu and shape to a small b回’s it forms the lateral wall of the third ven刨出也E transition k阳晒1 the 棚。 being marked by a faint groov鸟也.ehypo也alamic sulrus. In most in必吼duals, 他胁。由alami att joined aaoss 曲曲in slit of 由ev四创de by 由ein能地alamic: adh回onormaaaa i且剧media. A fascicle of nerve fibres, the stria medullaris （由alami〕， which has limbic αmn配:lions, courses along the dorsomedial mar回n of the 由d回国 (Fig. 12.2). Along this h已由E 叩钮句mal lining of the 创rdva回desp陋，也e narrowlum四 to 岛m the egg.τb伊也e wi也 the hypothal缸nus,

咽n回cul缸 roof.

far as 也E

the thalamus is l。但也d a 由in l句a- of nerve fibres

comp伺ed of some of the aft坦白.t and efferent co皿ections of 也alamic nuclei.

This is called the internal medullary lamina {Figs 12.3, 12.5, 12.6）.四ielam且a is rougl世y Y-shaped when vi白帽d from above and provides 由E basis for dividing 也E main part of 也e thalamus into three nud回Z IIllllllles: anmior, medial and la能ml. Each of th配 cellular mmplex回归缸ther subdivided into a number of individual>y named nuclei. 咀1£ la:能ral nuclear group, in par世.culaI, has important conn回ions with sensory and motor E唔ons of也e cerebral co民阻 Embeddedwi也扭曲E 旭阳nal medullary lamllt.a are 使咱回1 cell grou阴阳own 叫lectivel.y 曲也恒tralam旭缸 nuclei (Fig. 12.5). Lateral to the main ma”。f也alamic nuclei lies 四.other sh回 of n町E fi.br跑出 lataal medullary lamina 但g. 12.3町，叫咀rh 四nsists of 由alamooortical and oorti田由aJamic fibrea. Be臼陀回 也is and the in田nalαpsule is located a 也in stratum of neurones that constitute the retiad缸 nudeua of the 也alamw F悔 12.38).

Anatomy of th• 笛，alamua •The 廿l&lamUS 恒廿l8 lar职精t

compa咽nt d 廿啕 be阳晒en 甘回 bralnstam

in惚rventricul缸 foramen, 也rough which 由E 也ird 皿d la田al

are in co自由四可. La出al to 由t 由alamus lies 也E

F施国ior limb of 也t in佳mal 臼严ule 血dan恒rola恒rallies 由t h田doftheai:叫血 nucleus

Internal o咆anisation Wi也.in

d陶ncephalon, which 阳 sttua脑d

咀te 姐也riorpole of 也e thalamus ex田1ds as 回ittides

αu也但 (Pip 12 3B, 12.4). Ventral to 曲也血mus lie the subthalamus and hypothal缸nus； αudal to it lies the midbrain.

(Fig.

12.4）.τhe dona! 呻回 of the

thalamus 曲回 forms part of the B.oor of the body of the la键时 回1回d巳 Another fascicle of nerve :fibr理， wi由 limbic conn回ioru1, the 由ia 阳mina且，v marklJ the boun也rybe的愣回也a.lam.us

and

and the

cerebr回 hem即here.

• Almost al thalamlc m』C刷 have rich recp-α划 connections w时1 the ce刚刚 cortex. •The 甘冒恒mus

is divided into

th『回 principal nuc嗣『 m蹦蹦

（创酬。『， m回ial and 剧创'81)

by

由e lnte＂刚『n回ullary lamina. The lat1倒划 nudear IJ'OUP h航向国 conn民tlons w协 sensory and motorcortl。”－ • Embedd回 within the internal m回ul阳『y lamina l阳 lntral田nnar nuclei.

•On the 阳恼百Jasp民t of 甘南 thalamus lies the thin reticular nuc阳山．

122

…

I

NATOMY

A

B

In饲闹闹cular foramen 如llerior nucl回rgn>Up

Ve11白百I anta~or n11e以』’

Third van协le

Globu1 palldue

Fomlx

。”ctract

即阴阳lam1

Cludate nucleus

M创iodorsal nucleus

L.al8r冒d v，晴icl•

U阳副 m创ulla『y 阳nlna

Relic:u阳 nucleus

lnlemal ca阳le V1nn11a•，刚刚嘟u:

Zani 阳湖，．

Subth由mlcnudaue

问.11.3 民B)C。””’l ”otlONI throl』gh1hedlen饵，h•I”. Luxol fest blu，刷刷伽叫刨In.

Pon•

Cha pt町’ 2 而alamus •

123

也alamic nuclei include 也E nuclei of the dorsal tier of the lateral nuclear complex as well as the whole d也t 姐回ior 缸t.d medial comple皿

Lateral nucl倒r group 咀te la健ral nuclear groupαm国ns

all of 由e so-called ’叩国fie'

由alamic nuclei. These 缸E loca能din 也E V四itial part of the

Head of caudate nucleus

mmpler. and include the V自由姐姐徨rior，~臼al K怕乱 ventral m回or, lateral 伊iml也 and medial genkula但 nuclei 但gs 12.5, 12.6). Ventt窗I posterior nucleus 咀ieven田1

posterior {VP) nucleus Ii臼 betw阳E 由E 咽ttrolateral nucleus and 也t pul说nar. Wi由扭曲e venu菌l pos也rior nucl四S 也ere is 田m皿a白，l of all 由t a挺四ding 阴山ways 齿。m 也e spinal 田rd and brainstem 也at cany F田alsensmy 旭岛rmation from 也e contrala恒al half of the body to a con回.OUI level. These pa:也W可冒 include the spino由alarnic 臼acts, m缸lial lemniscus and triger由。由d缸nic 回cts. The 田mination of th回E fibres 扭曲e ven四”’阳ior nucleus is highly o耶副部d somatotopically. An~回isive, lateral portion of the nucleus m刘m 国缸mation from 也.e trunk 皿d limbs 由也E S庐10也alamic tra幽姐d medial lem皿皿lS.τhis is ref由at to 笛也e 鸭nu温l pos恒。ila田al (VPL) di由ion (Fig. 12.6). A smalle也 medi.al portion of the 呢n国l P伺恒ior nucleus E垣~ information from the h四d. 说a the 回gel回no由alarnic 田ct, and is termed 也E 观~tral p俱佳romedial nucleus (VPM). This area also receives wte informa世佣金m 也 nuclem solitarius of 由e medulla and 咽mbular information from the vestibular nuclei. 四ie 观ntral pos阳ior nucleus proj回B to the primary somato阻tsoryαx皿 in the p幅 Primary剖剿，l即回伽晴仔｝

Broca'sar”（81'Ml44A5l一一一

V融踊l u’“祖国on a>曲直 。b刷刷刨

.Weml帽、urea

Lateral 旬，ura

（再）·

P~mary auditory co幽E

Su闵由W饱mporal gyr111

(a恤，利，啕

Pracan恼lgy阳，； primary

Cen苗苗l a』lcua

W脚『∞『阳（缸”4}

阳阳回l 'II『隙， prima叨 叨闹闹ensory cortex 伽『隅’，2,3)

Pnimato『饵”以（81886)

S翩翩yu缸’claUon cor恼X

刻ngu胁 ω阳”

向阳lo-o回pilal I啤刻’

Cingul刷 g庐山 Pra阳晒J COi田

P阳阳y 'Jiaial cortex t’”明 Corputca阳融』m

Vllual um:lallon 回国

Orb阳l 饵”’啤 睛闭I fislu陪

’聋，

Pnhippo帽npal llYNI

UnClll

F幅.13.111 M咖r functional 笛”a of the 饵”bral con肌例 Lateral 笛阳I of left 帽曲创 hemisphere； 回 m回ial aspect of 啕hi 田rebral hemisphere in sagitta陆民lion.

Fionlal pole

。因p刷 pole

l11111la

Temporal 酬’

Fig. 恤’79””roll凰”’“·””“ of ..•left B’ ”brelhem•’”·”. The frontal and partetal ope刷刷刷，国en 『emovad to show向 loc酬。n of the transverse temporal gyrt (H”时，∞『附lutlons) and t陶 lnaua.

..

。”， 1ulol•nd lo”eorth…rebr•lhem幅，... ·币l8 am!b『理I hem阁”回m

•

cons幅幅“

•

&tier而C刷睛，b~创 W酬， ccrwolut创 阳阳n g~and

剖lcl

Underlyir咆 white

matter,

笛’ S郎”.led by 伽，町，a

afferent and 目f阳帽t

lor'G队』dinal Uni and 』olned by the oorpu1 回lk陆um.

lbr回

•

D锦p nucl凶r ma凶串串： the

阳Jamusar回国篇l 惧咱lia

回响pcral

·币田”wi cenibr回 h由1幅ph町回

αinsisting d 由而cal

’”

·币、E hemlsp惰，elsdMd四 hlD

触』『 lobes 价。”al，因而，四”－

and DCC现p闹。由白白

b画jg of 8l』巾CB to阴司~raphy.

•

P~nclpal landmarks 阳t Indicate 廿'Ill dMalons be1w回n

lobes are

甘丽剧，ral ’ssura，“刚刚 sulcus

and parteto-o国pllDI sUCUS.

134 • NEUROANATOMY

叫问

…叫－

Mm

Re由Im蛐

Cα刷刷刷

Sam翩。n

，气

tJ

l 二H 飞 ＋

气

飞

+

·

II s刚刚脚

-

+

运

Abaenla阳lnal nlllme

圄 Lon of阳隅’口n

~ In唰司蛐 movement a』菌匮植

+++ lncre”“饱ndon l'1lflex

t

Exie叫an恼r叩响

F幅．恤，s Unila恼ralcerebr咽•hami”here M品，n.Ref1町创so to Fig. 1.48.

l

~U FoC111ce晴.....”ilon• F时划 αnbral

lesions, e.g. a stro陶 ortumou巳 produce 1hr回 kinds of

neuron臼 in 甘回国阳bral

There田titive dschar，部 of gro1早＞＆ of

cortex p『回uce para:均ISmal ;rtt缸陆

b阳f p回ods and 『回ftecling the 仙nctional prope而西 d

then剧阳晒 con民抑制.

The patient experien民揭 sudden

at恒c陆

d 幽'IOfrTl&I m的剧创恼。r 刷sations 但imp脑协叫“izurea) b阳f alter硝ons in percept阳， mood and M酬。町（四mplex

阳刚画，创四”’~.

or

Focal selZ\」阳 may 111gger g””rallaed

阳nlo-donl创 selzl.』阳．

2. Senaory/motor deftclt8. Th嗣 Is a 阳s of 锦nsa阳l or mO'I朋19时，甸回恒.ble on cHnlcal neurological 曲曲mlnat阳． 3. ...，唱hol。glcal ddclts. Th脚 are br回kdowns In 阴阳市logical pr民洒”es SU仙”阳、guage, peroap11on end memory, d阴阳rab恒。n 因归ho同l圈l evell翩。n.

If the fo田J

S幌di血 anatomist 耻。由nann

produced a numbered, map of也Eαrebral cortex based upon its E咽。nal histological charac回istia. Although la鸣曲剧院~ by the elucidation of function, 旭 some instances，也ere is good corr四pon也la! betw阻iBroduwm’，缸田’由d functionally defined z唱“撼。f山 cor皿 h such casea. Br叫m皿血’s numbers att reta且d in common use 阳 desaiptive P山阴阳． cyto缸由ite由ual

1• Facal 9J!llllPl!c a副副，＿， for

cdl bodi囚，但dritic arbo由atiom and synaptic

in回回nnedio皿 h the ea由归rt d也E 阳回由世l rentu叩，也E

叩nptoms:

恒sti『、g

of~

lesion 面晤缸目。CCU阿i吨，甘咱自町ndroπ丽 of

intnic固自l pre翩翩隅ullB （：酬 Fig.

ralud

5.2}.

A unla:幅ral 。”’bra.I hernia回回帽腼aion cauSE揭 π回内恒l a contra且le刚 E阳tic hemipa睛陋， hype帽自制a and an ei缸阴阳 p阳ntar respcnse (up阳 motor 闹剧ne lesion} and co附刮ateral hem丽ensory loss (Fig. 13.四. A vascu阳 insult to the intern创臼psule, such as an M阳回剧。『 haemoπh.!酬，闹出 to the rapid developm酬。1f this syndrome，，阳。wn as stro阳． The 『啕Ion创以泪l阳atlon of neuropsychologlcel Ill四町、s In the cerebr：创 cortex 恼 summ町协副 In Ag. 1.49. im同m町t (e.g. a国asia),

Long ago in evolution町 his阳ry，也e en由al COI回回国nally

arose in relation to olfactory function. Phyl句庐le面也lly old 归m of the m胆（refi回时 ω 掘脏曲icor皿 and pal回corta.), 1Uch a1 the hippocampus and other parts of the temporal lobe, retain 也rough.out evolution an assod甜on with the olfactory sys能mand have a primiti:鸭曲时甸回ed cytoarcl咀阳ture. These E唔ODii have important 缸且ctions in the emotional aa严曲。f behaviour and in mem町·’I同庐tberwi由。由z parts of 也eoor皿 and certain subcortical nuclei they oo皿岳阳恒缸 limbic sys也m (Chap田 16). How回盹 m皿t of the C£rebral m四E is a more recent a呵皿sition in pbyl句萨netic 阳ma and is re如red to as the neocortez. Al也m耻 its 也回led cytological 翩翩re varies from r晤。nto E咽。比 it is 伊let咀ly E配啕lised as conai.s也igofsiJ:~ 但g.

13.19):

•I匈er I，也t most superficial l勾臼， contains few nmie 叫！ bodies

but many dendritic 皿d a皿nalproce槌剑出 synaptic interact沁n. •I匈喧rII con国ns many small neurm圃， which 笛tabliah

Cerebral cortex Histol。gical

structure

四ie cerebral cortex. forms 也e OU阳则由m d也Eαrebral hem间址阳也 It consists of a 同鸭 several m皿im出~in 刨出四岛

归田cortical connections. • La:阳Ill rontaina medium-&i.zed 田田ones giving ri配” association andαmtmissural 面bres. •L句er IV i，也e site of termination of afferent 矗bres 企om 也e

sp仅Hie thalamic nuclei.

Chap幅r 13

Cerebral hemisphere and cerebr百l c。同ex • 135

II

Ill

IV

v

cf Sarr随他翩翩’Y

VI

问.1S.四 Sci唱，matlccor。”’..翻划” through the cer由ral hemllphere llluslnr世ng the approxlma俑，，matot呻le n111re ntatlon d由econlnll刷ral body heH In ’”’m创町，nd ””四””rtlc恤

”

Whila m回抽r

F幅. 13.19 Hlstol啕l回I structwe of the cere恼，d cortex. 仍m M灿创， GAG and 阳1ttarson, EL 138.s,曲~Anatomy. Lon也:>n: llvfng回'006; 1954. Cour恼:yofChu时暗自lMr嘟嘟时

eL句uVis 由e origin ofprojedion fibres to emacortical targets,

such as the basal 伊nglia, thalamus, brains能m 阻d apinal cord. In the primary motor cortex. of也e 食。ntallobe, 也is I句u αmta皿s thegi皿tB也 cells. which proj四面bres into 也e 阳m皿也l tract. • ［匈er VI also con回maasocia植on 姐d projection n，四roo.es.

Functional 。rganisation 咀le 田由ral corta: is Dent刚liller回到de of the body (simple S饵”’ysel到明｝

•

Sen”’y/motord自由cit － α>ntrala俑，·al hemlsensory loss and an In旬rlor visual fteld loss.

•

Psychologl侧面制t -

an lnablltty to ocpy and oonstruct d回lgns

bey dividing it into 扭扭恒riorlimb，伊nu, pos值iorlimb and retool四ticular part (Figs 13.13, 13.14, 13.25). The 皿.terior limb con回m connections betw回E 也e mediodonal nucleus d也E 也血mus and 仙”rlrontal corta, and.al四齿。，ntopon也ie fibres that proj缸t to 也t pon也ie nuclei in the bual portion of 由E pons. The germ and po1terior Ii皿.bmn钮h mrticobulbar and 口皿α施，pinal motor fibres. Alao wi也面也E pos国iorlimb are 由alamooo顶c.al pmj回iorui p四ing 岳阳缸观ntral p回国or

nucleus to the 严回ary somatolemory con饵缸ui 企om 伽eventral an回iorand ven往al la键时 nuclei tom悦。r z呼ons of the 企'Olltal lobe. The retroler回cul缸 P血。｛ the internal ca伊ule lies p倒回iorto 由E 严施回ior limb and posterior to 也t globus pallidus/p田amen (Fig. 13.14). It conailtl of fibres ari由tg from 也E medial and h恒ral genie血tt nuclei of 由E 由alamus 由at pa11 to 也.e auditory and 由国l ror世阻挡也t auditory and viaual radia咀m也 respecti"V由 Visual thal缸回回副cal fibres (also known as 伊ticulocalca戒配置bres) p甜 laterally round 由e la回革l ven刨出

and, in doing so，岛Uow one o{ two counea to 也e 咧sual corta:

(see Fig. 15.6). Pibru 也at E可X四ent the lower half of the 叫“al field project to 也t UPI四 p皿 of由居世皿al corta (abc阴阳 也lcarine sula皿 of the occipital lobe). They m句 be in四opted 姐 也由四ume by I四on& of the parietal lobe. Fibres 由at E甲回回 the upper half' of the 白ual field lo叩 forw缸由 OV£r the inferior horn of 也t lateralπntricle (M町四’， loop) and th~ p”’ to 也e lower 阴rt of the visual 四”exφdowtheαlcarine sulcus）.四1可 maybe dam德国 along 也.eir course by lesions of the 能mporal lobe. Whl幅 matter or the cerebrel •N目『回他res

he111lephere

within the

d 齿，etwo hem幅ph町es.

sU:Jco而calwh阳 matter

are

classified on the ba幽 d their ortgn and termlna回on. •Assoc幅画m 他res

link cort国l

lhe

princip副 commi随U『'81 system

is

the co刷』s calc陆um. •

Pn:尊自由n 明br田 run betv晒町、

the cereb『al co『tex and 咽『阳JS

regions within a 国『可怕

suboo『曾因l 副rue阳晒s.

h町nispher回. Imper恒nt s归阳ms

pass through 甘回∞阳narad阳恒

a宙： the SI』p町W 阳、gitudinal

甸、d

触sclculus, arcuate 触sclculus, llT他巾r klrGltudlnel 也sclculus

P田由cularνimportant fibres

and ur回nate 阳sclculus. •Oαnm幅剧ral 他『冒8

the in恼π回 capsue.

th曲mocortlcel p叫剧。ns.

pus

R帽阳mofcor阳， callosum

”

An riorlimb ofi『榈mal 饵”响

Genu of internal ca”“le R铺terior lmb of internal 饲psule

R钝'OlentiC1.1lar 闵此，fin悔mal 饵”ule

F幅．惚娼”’rtmntal ”ctlonot 曲”’晴ralhemlsph’”’h阴阳Ing 世圃’阳””’笛” In匍mal 帽”由．

in

this 回：egory are co『甘嘟”n剑， ∞闹。d阳b町 and

be阳睛，、。阳咱sponding 『啕阳、自

Sp幅nium of c:Orpus callosum

Thay

Chap幅r 13 Cerebral hemisphere and cerebr百l c。同ex •

!:_"

141

Pragreulva 曲ronlc an啕h..o叫“a111anl崎

Dement恒町ndromes

ara disthcl 肯tlrTl o「回 anoth町 because d甸回冒冒tiw

bran di蹦掬S have sp四百c toixig呻hie创曲tributions in the brai'I and n融.ropsychological functions ar回 regionally organ四d (Fig. 13.26 创d 凶e Fig. 1.49). Cortlcal 四”phalop冒出阳 币、B most common cortl刷出m阴阳阳刷zh创，睛’， di•帽”’ a ususlly spo『adlc 啕阴阳回ved阳se of t叩刷刷.It d阳ts n回M tern阳回 (hlppocamp呻 structu隅侃us同 amn臼la and t栩阳st自由roe咄咄 口crtex ceus同 aph国且， ap阻四ptlve v恒u副匈阳也 S因t阳l dlso阳咽！Ion

and apraxia. In the 恒te stages of llness, aki111翻也啕idity ar回 my田Ionus 剧院抑自1e. In younger psi阳市， a strongly 但mlllaldl回国g Is 青ontDtemporm 由m..,t恒 (FIDl,a届四Z阳d w时1 atrophy of 廿田面郁而r 背回归国mporal r回民，1ex. The p阳nine『rt clni臼l ch苗苗terislic is bah田iotlal change, whict、阳Ud酷昌阳thy, disinhibition, blunti咱 d 田nations, repel时ve routines and di由ry 由町、ge. 有iis is ace刀mpani回 by B锦州ve＇民聊过阳阳pairmen恼 in at阳t阳， p阳Yl同 and p『曲阳m SOM咱.A町mmetric

involvement of the I创t 阳ntar

langu咱自缸回陪suHsin

t怕自阴阳划w disorder of progre随M nat叫uentaphu恒 (PNFA). Utteranα揭 may be 9ffortful and 阳eking

In grammar. 回国阳刚 of the tempoi创 r回cortex leads to t愉 di阳der al ”m幽幽 demer回国，但D】 In 附胁 patients lose unders恤ding al the d匈制er:创on

Subcartlcal encephalapa剧，． Subcortical enc理阳Jo阳th阳s affect structu『邵阳h as the tha脑网， basal gangia andα抽出lum and the in阳connecting white w脑忱E霄，础』sin自 ”明ical and mental slowi咱 and di低1』lly in motor and 民精闹闹 plan晴咱. Subcortlcal chronic vascular 恒chaem恒（mull耐8rct dementi副 dam啕es the v.t1阳 matter. Hu『曲”脯’， di’””， P•ldn””＇•d幅幅翩 and progreulve 剧pranucle• pal8y lPS同嗣 d饵”neratlve d阳orders of 伽e besal ga咱Ila. PSP Is a rare parklnsonlan syndrome In wt捕、白嗣 Is para加Is of volun回ry 即ema啕ments. Cortica-aubco此i国l encephalopathiea Co巾。副国刃而cal en四川)alo田.！hi民 afll:回国甘、 α则因l and S!Jlco『tical structures. Carllc:oUul d啕·四”'allon damages the 剧目芽ior pa闹剧 ∞『tex and supplem回恼y motorα:inex a!切TIIT回甘icaly, causing cont用阳恒阻l apra泪也啕id邸， akin回a and myod口nus d 骨、earm, which may b刷刷 aulonomol』sly Calen lmb'). Car幅四l U咽阳西F diH圃’ SB阳lively 由Yllages not only 甘'le 副bslant隐时gra but also 甘南阳嗣同or 『回仅刀rtex，嗣.ding to 阴山·nsonism and W明cm后， IOI拥!her wnh cortical 叩nptoms slmlar to those al Alzhelmer's dis凶S自， butw协出ronlc fkJctuat同∞响slon and 叫sual hallucinations.

MuHifoc11I encephalop，由y

”·”

and other 跚跚y stimuli, c蜘plte p『嗣rv回刨阳市阴阳y pe『回事！Ion. FTD, PNFA and SD ere BSSOCl回国时th fronto恒mporal lobar d甸回町剖on palhology，，时帽、画 d回＇net 骨om that of Alzheimer's

A muHlfo瞄刷刷，halopsthy 创部urs In Creut翩翩I-Jakob a (CJ町，且 rare d匈ene圆ve disorder that Is rapidly 倒al wt伽h mo巾． Multiple neuropsychologlcel 由制ts occu『．虱翩笛民刘p恒l 田t国l blindness and ap咽sla. with cerebellar a匈xla, pyram闹剧 limb w回阳1铺s,

d自B画画．

m归口lonus 四d~量zures.

n嗣同1啕 ofwo『ds ~拥mantle apt回l码．饱帽 and ob阳刚剧创st阳 匾，ma)

c。而cobasal degeneration

Pr啕reaaiwl non-fluent－一～，，」

aphasia

F附幅幅mporal d町ner曲

Alzheimer's d国ease 臼巾帽l L酬y 饲dydis阁，e

Creu恒feldt-Jakob d酶，se

Semantic demer曲

1哇！！.•

C阴阳I cortex Multi-in阳刚由imentia

Hunti咱阳旷s dis翩翩 臼r阳阔，副 d喃喃自勘n

C阳启制dt-Jakob a键辅串

向闹n酬’s d脯”

臼rll臼l Lewy body d阳蝠’自 R啕陪蚓ve supranudea『阳抱y

⑨ F地．咽.28 R啕lanal lac:alllllllan Df dlH翩翩回国Ing dementlL 剧 Co刚回Jareas. 陆自由副回 to Fig.

1.49. (B) SL』bcorticel 町回s.

14

Basal ganglia

Ten回lnol叫w and

topographlcal anatomy Functlanal anatomy of 1fle baaal of the baaal ga咽Ila 142 ganglla 144 Sb'恒阳m 1~ Conn田tlons of the strtatum 144 Globus pallldus 144 Conn田tlons of the globus pall ldus 145

With扭曲e cerebral h回啕here lie a number of nuclear m朋es. Apart from the thalamus （由叩值 12), the m倒 prominent of these m 也ecaudate m叫m地 putamen 皿d globu1 pallldu也 which lie 迦 d创eprc国mityto 也e 画出国I caps曲曲d are collee由ely referred to aa 也e basal ganglia』 basal nuclei or 曲咿UI l1riatum （目， 14.1, 14.2; see al皿 Figs 13..3- 1.3.9, 13.14). 四E bual ganglia are primarily conttmed with 血e mn:国l of mav四1ent. Di1ordas of the basal ganglia are man血，t by a阳10rmaU世esofm悦。r mntrol, 院刷re and muscle to阻咀le M踊I 职nglia have i皿归rtant conn回iomwithσ也E E唔oru of the brain. p笛ticularly the 但rebral corte:鸟也t 也且lamus and subthalamic nucleus of the diena;肉alon，皿d the substantia 皿g咀 of the midbrain.

Terminol。gy and top。graphical the basal ganglia

anat。my

of

The t凹n 、创al ganglia’(nuclei) reflects the location of th幌 跑回ctures deep wi也in 也 hemi刷回也咀ie 回m 'ro:早出翩翩m’

Normal functions of the b笛alganglia 147 阳thophysiol啕y of ba抽l ganglia

disore抽阻 148

derives from the radially ori四能ds时ations, com归，，d of 缸scicles ofnerv哩 fibres, which are read丑yseen in s幅画画d sections, ”“四larlywi也M 也E globus pallid皿 币ie globus pa出dul i岛 in pbyl吨~cterm鸟也t oldest 归n of

the coi:pus strian皿幽d is sometimes referred to aa the palec:幅“atum. 白te 曲breriation 'palli由皿’ is matt commonly

med. parti口ilarly in mmpo画.te 阳回E for afl洁白lt 皿d efferent mnnections, such 徊’sub也alam叩alli也1’ or ’pallido由alamic'. 哑le globua pallidus and 耻 putam回旬雷由e are 四metimes collectively called 幽地回町m (orlm笛cular~ compla (or nucleul), because they lie dose U精ether, for回鸣曲 app但由1tly singl.e struαm on gross 皿础。mical eDill姐ation. The name means 1四.til咄aped’， but a closer analogy is a Brazil nut or the S唔nent of an orange. The lentiformα>mplex: is 曲回-sided, h町ing a con回 la恒ral surface and two O也e surfaces th皿 αm哽咽e to a medial apex. whi也 lies against the ~u of 也e internal capsule 但g. 14.1）.四e terms 1entiform’ and q回ticular' are rather archaic and of limited U1龟 although 世iey are still retained 画 cert.a扭扭atomical names [such as 也e retrolenticular

阳阳市rhom d恒tlral v町1刷，

Head of caudale n鹏以捕

E幽mal 臼阳le

自甘冒ne caps1.1le

L.alflral m创ulla『y lamina

：：：~｝~叫ω

同嚣le『ior limb of in恒「nal aapsule

F阳.14.1 Hor恒。”“”Gtlon al the brain sh侧Ing 回tween 唰l

a. reldonehlPI 创the IN刷刷啕Ila. Mulligan's stain has been u酬 tolnσ凶sethecon阳st

…” Bas叫 Co咿us 臼llosum

M田'nll capllJle

Tllll田，...

Cl111钳田’1

Pulamen Globus pal剧U$ C睛”耐d

’

Fig. 4.2 Coranlll •蝇似Hlof伽ebnin lllD'晴啕 h m恒翩翩llllip9 Gfthe ...........灿』旬.，.，，胁 『回国m U8回 toincr回回阳 contr回 between cell而h 翻幽帧刷刷州ta matter.

Anle~orll响b al

悦salg时i1 (co阳制tu!!i•

帽m问吧豆、

广－－－

”

H d d臼ud刷－，

币再副

〔N”翩翩m~蜘叫

nk』E 叫

I

\.

I \ Anllr阳『

〈些些旦~I)

他的

Posllrior

〈些旦些~；＿：.

·Th副am”’ 」－Tall ofcaudata

~

(ienllbrmn唰θ

nucleus

Pullmen Amyg甸11

Fig. 14.3 Non.睛1tlnof 伽·”“－剧，lia. 邸’4.4 La阳划””ct of刷刷 ~ ...鹏阳冉冉阳men.

回rt o{tbe in闹闹笛”也）. On 向l咱自回ic,α>nnectional and func划。nal grow叫a.ho幌呢鸟也E 醉’t且mm

is more dosdy allied

ω 阳回血tenudeua 也an to 也 g灿ω 回国国．

霄ie au.date nuda皿 and 阳”mai amstitute the phylogm.1回国lly molt RCmt parts af the basal ganglia and are best regarded u a 归gle 四tity. Together.，也ey are commonly rd回回 ω ”也e neostriatum, or simply as the stria侃皿. The 切m com~on回.ti an: almost (but not entirely）键阴rated by the anterior limb of 也.e in能rnal capsule but their gross 皿atomical R归ration is not u “伊ificant u their neuronal and functional 剑mil.arities. 咀ae rather con缸a姐g names of, and relational咀.pl betwem, the componentl of 也 basal gang)且 are summarised in Fig. 14.3. Some authorities include the aubstan世a nigra and subthalamic nuclem in the definition of basal ganglia. 咀由 is jus面ed 伽也e pars retiet.血.ta of the .ubrtantia nigra 由“ it shares mu出面 commonw恤也t globus pallidUI and bo也 of也ese have d”。

...洲－－－伽......也有，egl仙』s paid\』S 抱创剧，回 Ill} 阳阳启men. la shown In Theco惕，eou惰阳tern&lca阳，e

r回．币、epWmal'lar市d 阳 闹剧。f阳帽剧.tent则很凰””~tedlll}甘冒’“阳阳帕lb of世l8 hlane.I

俑阴阻”， aiccept at their rr邸，t roatr回＠岱rt where 甘、，制”笛， In con伽llAy.

’

The P阴阳向r mb of the ntemel cap剧le eepara幅画 theglobus p创lldus and PU'恼men 协m th川、alamus.

functionally important in田conn缸咀锢，明也由e sub也lamic nucleus. Strlatum 啦’刨atum (neos创awm)

consi1t1 of 幽幽也挺 nucleus and Their combined three-dimemional shape is reminiacmt af a u句。lewb钮，1凹d h回际 问 14.4). 也E F血皿m.

Caudate nucleus 世ieca叫甜 nudC1.11 ii daaibed u

consisting af a larg障 head, a

body and a taperi鸣，四.Md tail. ηie head of the cau由te is “m例t completely parated from the putamen by the in能mal

”

144 • NEUROANATOMY capltlle 队凡 al 幽幽 roltl'al extremitie鸟也ey are con血.uoua

throu8h and beneath 也ean田ior limb (Fig. 14.4； 配 al90 Pigs 13.4-13.6). At. this an阳ior lad, the molt vm田l and medial part d缸回血皿 COD&ti副恤也e nud四”四皿.bms (1ee Fig. 13.6). 币ie nucleu1 aa:u皿bemhasmnn回iom 1imil缸”也E E回 d the 翩翩m and al崎 lwcon阻挡。ns with the am只到ala. ’Ibe am111由la. which b loα也d w忧副且也t temporal lob«斗 E国r to the m归1ral pole 副 dttp to 伽 lenti阳m complex {att Fig. 13.8) also baa a similar embryological derivation to 也e corpus 由iaunn but is 也nctionally di伽四t. beingp甜。f也e limbic m能m (Cl呻ter 16）.四”叫四’缸mmben1 and an亨国血 provide an important in阳也ce betwei:n 也E bual ganglia and the limbic m恒mand 由可缸随H a role in 也E P峙，iral exp圃，ion of behaviour 伽Mn. by affective and motivational 刷刷． τhe nucleus accumbens is aaaodated with reward and g姐缸:ation and is believed to be a p红t of the mechanism underlying addictive “严础 。fbehav.lou乌 including being an important site of action of addictiv喧 IUbstan也＆ 咀le head of 由e caudate nudeua 伽ma a prominent bulge 扭 曲ela忧国 wall of the an田iorhom of 也E K阳al 础时也（Fig. 14.1; see a1lo Fip 13.3- 13.7），咀le tail of也e a叫ate paueil 阳回iorly, progret9i时yta阳ing as it does so and. foll跚恤gthe cwvature of也e ver回de』 des皿ids into the 田nporal lobe where itliea in 由t roof of the in缸ior hom (Fig. 14.4; 1tt d皿 Figs 13.9- 13.12, 13.14).

Putamen liea lataal to the in阳nalαpsule and glo趴n pallidua （凹， 14.1, 14.2; m 也o Figs 13.7, 13.8, 13.14). It is separated from 也e globua pallidus by a 也in Jam画a of nttve fibtt鸟也t latttal medullary lamina. late组1 to the 萨ltamen liea mor冒E white matter, sandwiched 回创n which E臼 a 由且也tttof g可 ma忧ei; M棚n u 也z da1回国皿咀is separates 也z white m甜g into two lay町，也E atana.I cq11ule and 也E enreme capsule {Fig. 14.1). lateral to 伽 ememe capsule lies 也e cortea: of the ins叫.a.d仅p wi也in the lateral fissure of 也e her皿.sphere.

哑ie putamen

GI。bus

pallldus

The globus pal且dus lies medial to 也t 阴血皿en, separated from it w 也e la也ral medullary Jam皿a. Ita medial apex nestles into 由t

lateral conca世tyofthe i且也mal capltlle (Fig. 14.1）.四ie globua 归lliduaαmaista of 伪VO di咱ions, referred to as 也E E但mal (or lateral] and the intr:mal (or medial) KgllleDtll （由brevi血d al GPe and GPi, res阳tivdy). The 呻nenll m 呻血！能d by a也h sheet of fibm, the medial medull町 lamina {Fig. 14.1｝.τbe smaller ir出mala叩nent 阳m m町，:imilaritie鸟 in 阳ms of cytoJ,叫lfand con幽幽斟响曲伽 pars m白血.ta of the substantia 国grain 注it midbrain {Clia~田 9, p . 96).A抽ough the two att separated anatomically by the 祖temal 笛”wefcraa E由d，也句 areb四 n:gaided aa a single 四tity. in the 缸nctiooal aeme. u described bdow. 四t b刷l part of the rosttal 卸rebra且， deep to the corpus 翩翩m, al.lo includes a E唔onlcn，阴阳”也e substantia innom恒ata (Fig. 14.7 and see Fig. 13.7〕．咀坠 complar唔on contains•阴阳咀1 8以聊。fneurone鸟 one of them being the nud剧’ bualla (of Meyn叫，阳创la ofwhich 伊叫“ widely to 缸 但由ral cortez 姐d u曲，e acrtylcholine 豁出eirneurotr四smit国． 四ne neurones m也:rgo degeneration in Alzl回皿ei1 disea且

τ．”’，.，..比副 ••l:olnv of the b…Ip啕”· ·节咱阳幽l gangla con制 of the

caudate roe以』s, putamen #Id gk>趴』s pa嗣U8.

•n圃， atructu'田” W阳晒曾y α罩在湖响回 with

theα:introl of

阳指b..reand mo明men!.

·节、， caudatll nud融』S l田 in 阳 嗣II d 甘1，阳teral ver甘ride.

•n啕 ha回 σf t闲”u曲曲 1嗣 W削l副 to the Intern创 capsule

and forms a prominent bulge In the 恒恼al w副l of the anterio『

ham of the ventricle.

• The cu附d, tapert啕惚II of the udate folio附仙， cuwtureol t明 la抽烟l ventrtcle Into 晴、e

“

• The putamen ar回 globus 阳llld1局 l悔 late唰 to the Internal C自pllUe,de副p to 甘te oortex of the 同l觑 •Tope羽raphically， 甘1ept血帽、 and 刨出us 倒烛S 阳回tu饱

the lentiform compl&K. the putamen fonn a si「啕le entity, the 闹剧由.tum (striatum), whi灿e globus 阳Jlidus forms the

• Functionally,

ho阐明r,

Cal.』da:幅 nuc阳us 拥d

阳l创施triatum.

•The glob~血 p副lidusαlflS旨Is of ，川剧nal and internal s啕men恒．

tempor创 lobe.

and conn创om (Fig. 14.5）.四ey are often r耶rded a.s the ’input' portions of the bual 院nglia, 血zαthe majority of afferents fr四n other parta of the brain end hett, rather 由血 in 缸脚1bus 归11.idui.

S的飞，但la伯rents

Afferentl to the ltrlatum come 岳阳也ree principal IOllI田：也 α~ebral cor回址，e thalam111 and 由E substan也 n单a. “rtiCXJetria回 fibra OJ幅nate from widespread E唔ons d由E 但由raJ CD~鸟”时ominantly, but not m:lusiv哟， of the ipsilataal s凶怠 Fibres 岳阳也t frontal and 阴rietal lobes pttdominat巳 Motor z咽。ns of 也e frontal lobe project mai由 ω body is 即resented in 血 inver时， 也 putamen, whett apprmima刨y IOmatotopic fa血ion. Mott an国ior E唔on& d也t frontal lobe, and other ullOCiation cortices, project mainly to 也E caudate nucleus. For 也elCI回IODI, the putam四 is considered to be the most ov时.y motor part of也由iatum，也E 倒也.te nuclel.u having more 翩。d四”“nctions. Cor“白白iatal fibres are mi回oryto s创atal neurones and use glutamic 回d as their

w

transmi销也

四le 也由mo1trlatal projedloo comes from 伽 intralamin缸 nuclei {c四tromedian and par也scicular nuclei) of the ipsilateral 血alam111 (Cha阴er 12]. 咀ie nigr回回au1 projection or回回回 from the pan 四mpad:a of the ipsila回-al 1ub11ta皿a 皿graof 也E midbrain 筐gmmtum （也叩恼’， p. 96) . The 回国皿阳 u时 by 也is pathway b the monoamine do阳n油鸟 which lw both ad饵”ry 阻d inhibitory effe由 U归B 削atal neuronn. 哑ie neurones of也E pmα>mpada contain 也t dark pigment neuromelanin (F毡， 14.的， whichia produad u a byproduct of dopamine syn也回＆四t mostrosual and vaitral portion of 也~ Itri.a.tum,，也E nucleua aa:u皿ibem, 阻四~it& d叩aminagic input 岳阳也E 呢E田l 也gmental 缸田，

which lies medial to 也esub&皿也皿gra （阳 Fig. 9.13）.咀由 p叫剧。n is part of the ，。αlled mesolimbic 阳由way which abo p邸，世dead。”minergic inneivation of the a:r町刷刷.Other affemi.ts to 也翩翩m include a projection from neurones of也e braim惚m raph~ nuclei, which utilise seroto皿且 刨出eir 位副wnttter.

Stria姐I e:饰1ren阳

Functional anat。my of the basal ganglia Connecti。ns of the st而atum 四\.e cauda企t nucleua and putamen, to萨由er commonly re缸ttd to 腿也t 由iatum, att best consid缸eduasingle 曲“tysina 也可 由mα>mmon I1£UI0nal o事nisation, neuwtnrumitter sys忧ms

币四”incipal neuronal type 明白且也e 闹剧皿 is knownaa 也t

medium apiny neurone.τhe uom of medium spiny n四rones con回仙也由E effamt F叫配峰。m of the S回a缸m 皿d 由ey 缸E dittc时严incipally to 也etwo 吨皿四”。f the globwi pallidu1 and to 也t pan re.ticul础。f the substantia nigra (strlato阳皿凶al and 由iatonlgral fibres, tt叩创回y). Although 也m is some

Chapter 14 Basal ganglia •

145

Molar co闹X

Caudate nucleus Thalamus Putamen E刷mal aeamant

I

In饱m叫；nant _JG蛐叩Iii邮

＆』刷11阳市 nuc悔us

G伽国响icacid

-

－ 臼mma arnlnobu阶le acid （队BA)

F幅．悦S

Schenmtlc diagram Illus国四”’ the pr1nclpal conn帽tlDnsofthe b画面l gangla and 1'91.md nucl.i. F1口rthe 国陆ofcl笛”，阳 conn副町、s are shewn fer the p川西回n only. The conn民t阳'6 olthecau由幅 nuc阳us are similar. Afferents to the st『恒tum 骨om 甘冒 in甘甜aminar lhalamic nuclei and M司附饱mraph画『lUclei h副， been om时回.All 冒雨睛也 from the basal ga啕lia 町晦m are shewn too啕inalefrom 甘南 internals句men! of the globus pallidus，怕。因怕m the 阳m reticulata of甘回 subslanli国内咽rabeingomitt回. Colours indica恒the neuro甘ansmitlers used. d甘回归到阳南.tun

C臂’阳111 aqueduct

「－ Su阳刚回Ii四lus

」

Connections o，由estriatum •TI啕四川础， m刷刷sand

•They 『留泪阳 a阳田市由m the

cerebral cortex,

h国laminar

tha脑『nlc n1剧创 and t愉阳审 comp臼ta of 廿'18 substa『叫a

nlgra.

\

飞了，.＿ 喝， 、

E何阳回t 向阳咽e arise fro『n

•

putamen are the 'Input’ reglens of 叶iebe捕I ganglia.

『n回lumsplny ne1.』ro晴s.

Sepnte cell groups m阳川 either of the two S到自men恒 d 甘1e globus pallidus (GPe or GPQ or to 曾回回尼用lieu阳恒 d甘冒’ substantia nigra. 有咱自 由俑曾回nts are intibitcry and GABAergic.

c。nnections of the gl。bus

pallidus

咀1etwo s锦m四ts d也脚bus pallidus M”“皿ilar afferent 倒mections to one 曲。也er,

but substantially di岱~tefferent

庐o~. 咀le in阳回i s叩nentof由e globus pallidus is 鸭ry

山脚桐，J 蛐蛐啕阻，」 pars 倒响pada

pars 闸’l:ula恤

Fig. ’也. Tran割帽，，．盹tion 钮，rough 恤e

midbnfn lhDwt啕恤－

subetllntla nlg阻 collatmilisation of axon岛 S叩arate populations of 甜iatal n四rones generally proj四 ω 曲曲。f曲也IttOU飞put ta尊”－ τhese projections are all inhibitory u~on. 归lli也I 姐d nigral n四ron臼 and utilise GABA as 也.eir 伊恤1ary 宫四amitt.er. In addition, a number of neurop叩tidea are ro-loc.alised in 由ale eirerent E四IOne!I. 咀ie cells that project to the in但mal 坦gmentof the globw pallidus (GPi) and 由e substantia nigra con恤 ho由 substance P and 甸回rphin. The 严叫回.on to 也e a田nal 钝gment of 也e globus pallidus (GPe) contains met吃曲叩balin.

d皿且z 扭曲uc:lUre and function to 血E pa15retia血.ta of the s曲血1由 nigra.. from which it is separated by 也ein回回l capsule/ crua CErebri. ~由ei; 也ein恒malpa血dwn and pars reticula:缸。f the sub嗣ntianigr菌 areMg81ded 翻白E ’。u’ut' portion of the basal ganglia. since they are the or幅n of也E majority of basal ganglia efferent fibres 也t p叫回 ω 叫leI le时s of也t neunms.

PallidaJ a'fferen恒 Pallidal aff时四ω

缸ise principally from 也e s创a1Umand 丘。m 也e

sub也alamic nucleus. Striatopalli也l

fibres are of no附 typ凶， as of suiatal mediu皿咂nyne田ones. Bo也 u出院 GABA u 由.eir primary tr.u回ni:包er. In addition, each contains charac田isticp甲tide ∞也ansmittm; fibres projecting to the a田nal 归llidal 挺gment contain enkephalin, while 由。，E proj回ingto 也e in能mal 伊mouslyno时， ori扭曲tg from di缸entp咿.tl皿on&

pal且du皿四nta旭 substance P 缸td 句norphin.

146 • NEUROANATOMY

Internal 侃”. 臼剧也饱 nucl创』，

Exb町nal 饵”ule

Putamen

•L

Globus pallidus

E自由necapsu怡

｜国阳111 啕ment

Clau由um

Internal 啕ment-

Amyg幽恒

Subslan甸 innomin幽

Hippo帽mpus

，阜｝

1

AB

La恼ralm“l』llary lamina

2M创ial n回ull町 lamina

臼剧也le nucleus

v，咱回l 18阳刚刚时，us

。f lh曲mus In悔malcapeule

PUtaman

• IL

Ex能ma崎gment

Globus pallldua

L草·

In怡malaegment

Hippocampus

C『UI 帽，bri

Subthalamlc nucleus Thalamic 饱剧culus

·Subs恒ntia n幅m

Flg.14..7 队，B)Coronal ”ctlons through th，刷刷局”””um and di刷刷，h剧”. L均睡 method for my刨In. (S1时伽nscoUI部syof的e蛐伽ia/Museum of陆坦Ith Bild ＂＇如彼对悟， Armed For四~阳也血 ofPath侃羽y,

WllShington, DC, USA.)

咀t 皿曲曲ala皿呻d且也I projection origina田面由embthalar回E

in恒malcapsule 扭曲esub血ala皿ic fiudculus. This 严oj配岳阳 ia

nudewiof阳αudal dien呻＇halon (Figs 14.7, 14.8 and see

inhibi阳yand 国a GABA 皿 ib tranllmit田．咀le M田nal 吨ment

Figs 12.姐， 13.9）.四tlssmall 白山tureu lo甸回 benea白白t 也alam.us, lying a伊inst 也E medial border of the internal caps\血 In coronal section岛 it has the app臼ranee of a bioon四d四ι SUb由血皿op创且也l fibres pa路 h回:ally 也rough 也E intunalca严ule, contributing to a 鱼breays恒m h脚n as 由esub也alamicfa皿rulua (Fig. 14.町， and 田minate in both I唔nen1JI of the globus pallid盹 d由m晤1田mination is more dense in 也e m但mah嘈nent. 咀ie subthalam叩alli也I pathway is acitatory to 归m也1 neuron白， using glutamic acid as iu transmitt缸 τbe subthalamic nucleus also sends similar fibres to 也e pars retiαJlata d世te

of the globus 归llidus, to醉therwith 由E 归11 reticulata of the substantia 回归， projects 严imarily to the thalamus (ventral lateral, ven田Ian也rior and centro皿ediannucl哟， wi也 a smaller projection to 也 brains回n f(但entum. 币1刷刷职rt neurones att all inhibitory 姐d utilise GABA 幽也.eir ttansmitt也 Pallidotl叫a皿ic6br四 takE one of two routes from 也E GPi to reach 由.eir U耶t 但g. 14.8). Some fibres lo叩 round the an回or m缸gin of the in值nal capsule as the 皿aa lentiatlaria. Others 阴草，也rough the internal capsule as the lmticular fudadus. Medial to the iI晦ma! 饵”ul~ as the latter 矗bres pa”。阳也e subthalamic nucleu鸟也ey are known as Fore!’s field H2. Hav姐S P ed d也a round or 也rough the in恒malca严u1巳 pallido也alaI旧E fibres continue to course medially and 也由 lo叩 dorsally 姐d lateral』y as the 也alamic: fasdatlus (also known 皿 Forel’s 量eld H1）”四ter 也E 由.alamus from its ven往al a吨配t In 岛l』侧ing 也is 田.jec如厅， pallido由alamic fibres ciraunnavigate a e:el1咀缸 E唔on of the sub.thalamus known ”也t mna incerta, which H创 k阳晒1 也E 世talamua and the subthalamic nucleus.

sub刷刷a 皿gra. 也t 创h缸’output' p缸t of 也e basal 但nglia 酬em. 咀teaub也alam叩幽幽I and sub由血nonigral pa也.ways have a pivotal role in the normal function of 也 basal 萨血肉 and in the pa曲。physiology of basal ganglia disord四（see below).

Pallidal efferen幅 咀le 旬帽严m也I 民gments have 阳y 函.fferent d坠rent pre功配tions. 咀ieextemal ，喀回回t pre尊缸” principally to the subthalamic

nuclewi. Such pallidosub由alamic fibres pa囚 medially 由rough the

”’

Chapt町’4

国1世ω恒r fuclculus

Basal ganglia • 147

Zona Inc创a

h饱m创饵psule

Putamen

Exlemal 回gment

of globus pallidus

Fig. 恤， Coron“四面，n 恤rough ’'8CO叩uan阳tum 笛’d dien晤’附alon iluatratina

Pallidothalamic fibres constitute the main outftow from the basal 伊nglia. Their 也ala:r皿E 幅rget nuclei (v回国l 皿也rior and

ventral h阳al nuclei) in tum project excitato叨 glu凶natergic fibres to the motor z唔。”。f the frontal lobE马 principally the 伊imary motor and 皿pplem由国y motor corticeιA smaller contingmt of medial pallidal efferent fibi:四 passes c:au也llyto 缸回扭ate in 也e brainstem t£gmentwn in 也e nucl四皿钮’nm peduncul叩OD由118 (pedunad。”E由E nudeua），抽ich lies at theboun巾rybetw阳i midbrain and pons, near 曲 lateral margin of the superior cerebellar peduncle [ Fig. 14.5; see also Fig. 13.12]. 咀由 region has been 阳med 也e mesencephallc E配，，motor region in lower mammals, since it is involved in 伽 E嗯1lation of

…

Sublha恼micfa鹏阳』lus

In恼mal S匈ment of globus pallid幽

ffenlnt project胁”。fthegl曲回阳llidul.

。。””ec”。”。，由• globus palllclus •TI回 glo~』s pelldus oons际ts of 1wo segments: e:剧目n副 and

interr回． ·国h paJlldel 铺gments re叫随 ~唱le atf9晴t 明bres 骨om

the str恒tum and glut町啊ate咱le Elf阳帽nts 骨。m 甘丽 sub甘回lemlc nucl田』s.

•The 回emal pallldal 啕ment

p叫“ts GABAsrglc 伽res to

the subthalemlc m刷刷s.

•The In匍『nal pell胸l 啕mentls homol吨。us to the par百 回回国t且 d the SU国恒ntia nigra; the two 时ructures are the 'output’『啕阳市E d 伽e

basal

gangla. •The In匍『nal peJ恼l 锐啕W旧时 prq如els GABAe咆ic fibres to 由eth幽mus 阳晴圆 m恒rior. 田市刮阳回刮 and 饲「llrcm国ian

n山时 and

to the b闹闹tern

(peduncu网JOnti『'BnUC隐居｝．

qua由upedalpr1咱.-eaaion.

四tepam E咀四lata of the subs植且也 nigra ia regarded as a homologue of the in回1al s唔n四t of 也E globus pallidus and, 也略 h祖 a similar 血tus as 由E origin of basal ganglia output E田mnes. Like 也e in但mal pallidum，也E P缸冒血tia血tam:重阳回

矗bres from 由e stria阳mend 也e sub也ala:r回E nucleus.τbe pre临出m 伽m the 由iatum

iJl somatotopiαlly O喃划时， both 扭 曲E 庐山dum 四d 皿，毡， such 由at pallidal neurones are associated 严imarily with limb mo陀m四岛 whereas nigral cells control 由t 血al musa血阳岛 including 由.e exttaocular m皿des. As already no恒d, efferent& from 也e in阳nal pallidum proj回 ω 也e 咽ntral an田ior, ventral la!但ral and cmtromedian thalamic nuclei and to the pedunculopontine nuclei皿. Efferents of 由E pars re白血ta of 也E sul>stan由副伊础，。归” to a subr唔on of the ventral lateral 也alamus, 阳 the superior co出口llus and to the brainstem reticular formation (including 也e pedunculopontine nucleus).

pyrami由l

and emapyramidal ’钢忧ms' are 泪.timately related

m怕也皿即arat.e and (2）也at so-called pyrami由l 画伊s are not

all attributable to dy甜mction of 也E pyramidal 田.ct itself (8tt p. 28）.岱le 阳m 'exttapyrami制’ is，也erefore. 阳m回hat 剧时attd but is still in wide甲E四d u且 Current concqrts of 也e role of the basal ganglia ronsider 也at 也eir function iJl to facilitate heh剧。1urand mσ陀皿四.tllthat 缸E Z吨uired and appropriate in 缸1Y particularαm饵” and to inhibit unwanted or inappropriate movemen舰 How 也is might be achieved can be apl血d wi也 refer回ceto 也 internal ω皿创.ODS of the h且l 伊且glia σlg. 14.5). Wb四 a mo略m四t ia initiat.ed from theαrebral mr回 impul幽 幽sdw:萨 nc蝇。inly 也rm晤l cortico币nal and 回国田ibulbar

R血1ways b皿 also 也rough 由eco世m由ia钮lpmj回ion to 由E

Normal functions of the basal ganglia

neOIJ国atu皿. These glutama回回E 盘bm1 c:au旦 excitation d由iatal

四ie ba掘l

medium spiny neurones. 刀ie 由iatumhas 棚。刷刷 by 材世也挝 is able to control the activity of b棚I ganglia output neurones 扭曲 intemal segment of the 脚bus pallidus 咀d 也.e pars reticulata of the substantia nigra. 臼狸。f由四 is the ao-called ’dittct pathway', 倒回皿ngof 础妇”四且也l 四d 础iato皿gral nrurones, which 曲缸tly inhibit 姐回nal 归血血I or pars 理位四lata neurot回也咀始 mechanism baa bem shown to 句>erate in experimental 由虹叩悔，iological studies 画 primate鸟 wh四 ba.w ganglia m职lt neurones a撼。cia回回th a 归rtia.tlar be吻阴皿 or muscle group showapau提 in their action 阴阳也I discharge duri鸣皿阴阳回t

ganglia are sometimes ref回ed to as compon四”。fthe m咀lied 'emapyramidal motor system~ 哑山田m was coined to distin思血h 也e symptoms seen clinically in diseases of the b踊al 但nglia and related 阳uctures, SU也刨出e subswttia nigra and 四b由alamic nucleus, 盘。m the symptoms ob阻四d following stroke in 也e in佳mal capsul巳 Since the latter -were thought to be Clllllled by destruction of 也E pyrami由l tract. 也E 回m ’emapyramidal’挺emed an appropriate d割。”伽缸 diJlordm of the basal ganglia. As understanding of the 旬nctional 缸ia阳叮 of motor control has incre苗时， it has become ap阳mt (1）由at the

148 • NEUROANATOMY

阳rklnson飞s a翩翩’

Chorae

-

Dopamine Glu幅mlcacld

Gamma aminobulyric ac副（GA晌

Fig. 悦’ Schematic di吨ram Ill皿tratlng how actlvt幅幅 lnbullllp咽lla.ndre恒恒d nuclei became dlaor咽，red In Pa血man’adl翩幅幅 and chorea. Overact阳 palhw町saresh阳n by solid lines: un由raciiv田 palhw甸回 are shown by interrup恒d lin盹 Fo『 idenli自由lion d 由uciures, 11回 F国.14.5.

of 也t region. This has k四曲。WDto “四z in 由t in回回I

s创atum.

palllih皿 for limb l'.llmml自由 and h 也z s曲血ntia 皿gra, pars

h出nson’I disease and expel如回国皿皿al studies have

reticulat鸟缸句E mavem四”.

provided insight into the pa也吨向mol唱cal mecha皿皿s 由at

Since intanal 严血也landpam

’”

retia血la output n四IODe11 are 也emse1回 inlubi:旬E势也is lead 曲inhibition

of tar萨t neurones, including those of the mσtor 也由mus. 四emul也ginα圃’E 困山E activity of 幽幽皿icnruron臼 cau棚 m:ita:蚀。n of the 创ls of 也ecaebral co民a. The dkct of 缸由四m of 也t 曲回 pa由W富y is, therefott』 ω 剧目iort or facilitate ongoing movements, 由m咀E 也is po国由E 岛edback to 也e oorta. 耻 。也g route by which striatal n回回回 can influence 也 OU职Jt of the basal ganglia ill the so咀lled 'indir回严由w时，咀 the subthalamic nucleus. A proportion of dkrents from 也e 由ia创m 阳mina也 in the a:temal pallidal s嘈nent and their activation induces inhibi出nofa阳nal pallidal neurones. 四E p血cipal d趾四t proj配tion of 由eex坦malpal且dum is to 由e “bthal皿tic nucleus which, 由erefori己 becomes disinhibited. The resultant 恤αease 扭曲charge of sub曲也mic n四ronea 倒i础 acti四tion of in但口回I pal且也l 四d 皿gra1 E四rones and, in 阳rn, inhibition of thalai:回c: and cortical ceUa. 切由 has the cffea of inhibiting unwanted mOY回1ents.

Studies OD 也t post mortem brains of patients wi也

underlie 由E appearance of parkinsonian symptoms, in par咀cular akinesia (Fig. 14.9}. Normal峙， dopamine appears to ezert an ercita阳ry influ回ce upon striatal neurones of the direct' ”吗配tion to 伽z in回nal pallidal segmen岛四d an inhibitory effect upon neurones of由t 扭曲配r pathway 由at projects to 也E U阳nal pal且dal s唱n四L Lo88 of stria.tal d叩amine, 由自由地 cauaes abnormal wtderactivity of也t dittct pathway, leading to diainhibition of in但rnal pallidal E四ron四. At. 由esametim1巳 le圈 。f atriatal dop扭曲e causes a晒activity of the indirect projection leading to inhibi'由n of a:temal pal且也l neurones，曲inhibition of the sub由alamic nudeua ar叫， thus, ercessive m:ita阳y 巾M of in能mal 阴Jlidal 耐ls. Chan伊 in both the direct and in曲回 ’'

pa也ways, thu岛四mpoundto 田cerl>ate the abnormal 伺erac由ity

of internal pallidal Olli职lt cells, inhibi山18' 也e motor 由也mic nuclei and motor cortiαII area岛 inducing akinesia. 币ie ai:clietypal basal ganglia disea民迦咄ich aa:asiv巳 unwa旦时， abnormal movements （伽.kinesias) occur is Hm世唔阳n’，也1eUe(Hun血gtan’E chorea), which ill an

Pathophysi。logyof ba目l ganglia disorders

inherited，”"Ogr四iwneurod唱团e四~也order. Wi也扭曲t

Basal ganglia 伽function leads to abnormal motor control,

s国atum，也ere is

d能rations in posture and muscular tone and 也t emer伊睛。f

a能rnal s鸣mentof 由t globus pallidus (the 恒direct’ projection),

a阳10nnal, involuntary movements or 伽kines跑回e combination of 句mptomsdep咀dsupon 也e na1ure and si能 of 由elesion. 咀le m曲tαmimon disorder of 也e b幽直I gangl坦 is Parldnao的幽幽匠， which is charac回ised by po回rty and

at least e缸ly on in the 倒tdition.τhis I幽.ds to disinhibition of g阳nal pal且dal neu阻ies and inhibitio也 of也t sub也alar旧ι

slown由 of m1JV四1ent （副nesiafbradykinesia｝，缸'EID.Or 皿d rigi曲.

It i1 raused by d唱团由世.on of 由E d句wrunergicn皿rones

of 也e subst皿由 nigra, p回回mpa血， that project to 也E

particular attrition of the 创ls 由at proj回 to the

nu出国. In回国l pal且也l n四ron筒，也ere阳电 become 由wrmally m也acli.ve. and unwan时， inwlun田y m~ents (chorea) ensue. Sim出r abnormal mamn四”“xm all a complication of the Ion吕－t回田’回恒nent of Par恒nson’， dis咽sewi也 1rDOPA. The underlying B创mll m民baI山m is sim且arbut, 旭 the latter a盹

…” Bas叫 白眼 iabo也 rdative un缸缸tivity of the indittct p础wa歹皿d

le at 由E 叩tic disc and

impo血nt 岛·r vision

叩配 canal.The 制。叩缸 ner咽 converge to fonn 由eoptkdWum on the bale of the brain (Fig. 15.5]. The 恤IDl lies immedia:呻 m四”“e tuber cinemun of the 国阴阳larnwi and k阳'eell the termina问 internal carotid 缸回回（see Figs 7乌 7.3). In the chiasm, amns d四”dfrom 也e nasal hal咽。hl四饵”回也随

in dim ligb画ng conditions. 臼nes are res严maible 缸田ilour 由国l and. beca111e d也eir arnmgimient and neurm回 conn回ion鸟 they con企~high 世sual awity.

Rods and 四E创盹 he阳。geneously d由ibuted aero”也e m世na. 耻地 e四.tly 归回ominate 画 the peripb四l 阴阳 of the

paasinto 缸叩tic ner吨 which 回回事也ea回国I cav均由m咽地t

152 • NEUROANATOMY deru翩艇缸ld 归BS 画ω 由~ contr世.ateml op配 tract, while 也Ole

light refla: ~由ap田 10). From 也 lateral 伊血血trnucleu鸟

叠。m 缸阎明:tal.hm也etinae m回n ipsila回址’lbe 叩缸皿笛

也hd-0rder 也血mα:ortical n皿阳回 p叫出由rough 也

幽回gie lh帽， from the cbiasm 副回归翩翩』nd the 但由'al peduncle

陀trol曲曲血z p础。f the intemal capsule and fonn the 叩tic

ω 回minatem血lyin 缸 la恒al gm阳tla能 nurleus （明白in 由E

E回iation, which 田minatmin 缸 prima哼唱团almr恒 d曲

h回1 geniru1atr body)

ocripital lobe. 哑iepr恤缸7啪”al mrt£1: is loaii田:lprmo皿nantlyon the medial IU由re of the bemisph四 in ther唔on ab慨 and bel阳 也t ca1α血e sulau. Surrounding 也is are鸟也e rest of theαripi回 lobeαms阳回 the 世sual associ副on COl1a. It is concerned w恤

of the thalami皿 Arelati呻 small numberof 剑虹回 leave 也t 叩tic nerve, before read由鸣也e 1.ateml F世四late nude\』鸟 to terI回nate in the 阳能由I araand 也e superior

collirulus. 四册 fibres are involved 旭 medi111也m of the 拟刷Dary

in筐。retation of咀剧al 旭iaga』 mα耶ition, dep也 perc甲tion 皿d colour 喇.on.

There is a

pred腿 point-to-point relationship k臼帽en 世ie retina

and 由E visual CD且E Because of the

importance of也e macu.la in vi1ion. it i，即re11en也d by di!pr叩ortiona呻 h带回.tomes ｛甜甜，e to its me) of the h能ral geniaJ1a能 nucleus and 也t飞r.isual α览馆Z Within the 回皿al cor恒 the mac由 is 田presented m回t 阴阳iorly, in 也E region of the 侃cipital pole. & previ.DU91y no时， objects in ei也缸 half (left or right) of the vist且l field 严。duce images upon 也e nualhemi~由ta of 由E i回la恒:tal. eye 血d 由t 也m萨>ral bemire植naof 由eam国la但ral 句哩（Fig.

15.3).

h出叩世E ner鸭由erefore.

amcani唱 bo也 haha of the visual

field

carries information Because of

（地 15.5).

the deDlent and its readiness for action. (e.g. ser, suckl皿g, dd白白巳 escape. e民.）. Neural s榈als come from a number of 曲urcea. The I.arg臼t input original!臼 from limbic 阳山tures, 也e hlppocampw and 也e amygdala. Fibres of hippocam归I origin mnst:i缸:t£ 也e Com.ix, a large mmponent of which 回min.a:国扭 曲E medial mammilhuy nucleus wi也扭曲e mammillary body (Figs 16.5-16.7). Fibres 岳阳也E 町回ala to the bypothalamwi

run in 世1世，回a 阳minalis (see Fig. 12.3）.吸ienu甸回 solitarius of the m咄h proj础 to the 句”thalamus, corr回归g information coll回国际也E autonomic n町ous system 倒lCellling 也e

Hlppocampus Thalamus

阳”“la 由'CIJlaU咱 b阳d

H~halamus

Bn画nstem

18Ucular fom回.Uan

Flg.11.2 Supraopt峙，nd 阳田”嗣同四lar nuclel proJ属也啕协 the POI翩”” pituitary via the hr阳曲，lam创咽’PhV哩，，l 回ct.

Ph回耐， c:hemi臼l

Nucleus

and hannarllll &ta恒

salillll'ius

Brain•饱m man侃mir明ic

nuck到 灿灿阴阳

___,..

nervouss＇归tam

陶·’M

Newal and non-neural in阳ta of the 崎p创h•阳m皿．

「Crus (p创饱阳

column) offombc

Mamml阳ybody

l『lfundibukJm Plill阳rypor恒川”’自l

网捕lartarplill阳ry

时. 1U

问’. 18.6

，而the

PHultary portal 9Y刷m llnklng anmrtor and po刷arlorp自由 pituitary gland.

Pape哑 clrcu比

The lntercon阳action 例 llmblcstru侃”’thatconst阳曲，阳

……

156

I

MY

Body of伽k α均ω＠阳m

Ant8riorni凰”UI

of Iha阳m..

A阳”。『 hom 一－－

d恼恼，l v，咱icle

Mammilk蜡llllamic Inlet 抽mmil阳yb创y

（舶terio『）

QOlumn of fomix

’

Fig. 1.8 Dlaeatlon of them“阳la鸣”ctafthed阳”鸣曲·阳n ” •haw 伽erelatlan1剧”’fthefaml嚣， mammlllary body and mammllo伽副amlc 齿，ct.

却也俑， nudeu5 oflt回脑mu1

α咱ullllllgyn11

Ci啕ullll'I

Fomlx Mammilloth1l1mic trlci M1mmill1ry 阳刚y

Hlppocampue

F阳.11.7

'Ille Pepe clrcu民 proJected 。”’胁”“lela饵”““th• 髓nibn1l hemllphere.

萨回1Ure within the smo侃b-mUld~ walls

of orga国 N以精US ICalmbens

【barOI配叩ton) and the chemiαI comtituents of曲创d－缸led

cavities (c:bemom鸡拢。”｝． 币le lfll忧。f arousal is communicated by co皿仅筒。”也很。·riginate in the braim饱皿. Mm刷m迦eq国c projections ucen.d in 由e medial 伽ebrain bundle (see Fig. 9.14) 缸ui 也£reticular 伽mation 伊ovidea in严t bo也 directly 四d 阳directly via the 由alamua. 咀E 峙p。也alamusgm回国 responses to these varied 副皿世i by.，咿in. both circulatm:y and n回国 m四皿 但g. 16.8）.旭 扭曲iate relationship wi伯伯t pituitary gland and privileg国 access to its circul副.on (portal m能m) confers the role of ’orchestrator of the endoaine m能m' on the 峙po白血mus，” it dir院ta honnonal syn由ells and Ieleas巳 The neural output of the 峙po由血皿四 U dittc时 to wideapttad E唔Oil& of 山 neur四a. DesαtMling fi.bra 归” ω 也e brain&田nand 阳me reach 也t sp凶al

M曲『 behaviour

PibJi恒ry

阳rmon”

陆阳”’幅幅

αml. In this way.， αmnection

ia made 回也 vari。因 brains恒回 nuclei, including the m阳山rfonruLti。，n, influencing wakefulness and 1le:町，四d control ii a回d 伺er 萨唱imglionic sympathetic and 阴阳sympathetic neurones of也t 剧.ton创nic ner喃us system.

Limbicsy冒tern

”掷地出国恤mus

阳阳iomicNS

阳甸回1剧。咱an con回l

Fig.1U

。翩翩m恒1耐融

Tha阳mus

R剑』cularform自由。n

Wa协伽阳甜，阳”

N刷刷刷刷刷·neun11 output8 “笛” hypo1halamu1.

Cha pt町，e Hypothalamus, limbic system and olfact。ry 町stem • 157

Ascending connec咀.ons p刷 to the limbic sys阳岛 both directly 缸回，由 the 值ialamus, to the oibital frOI血I cerebral cortex. 咀E 峙po也ala皿us can initiate approp血.te motor heh町io山'31 E叩ertoitts of 扭 instinctive kind 也rough its connections wi由也t limbic m回1 and limbic part of 山 mrpus 闹剧皿｛the nucleus acaunbens]. Furthermore, it can influencr, or even 回国d鸟 more compla adaptive behaviour berause of ib close linl.a w世1 也E limbic m也m and 世ie orbital frontal association cortez. Hypothalamic nuclei of many nuclear di白ions, only some of which 回II be described here (Fig. 16.1）.τberegionl~ medial 皿d vat纽'31 to 也e structures of the sub也alam.ua is known aa 也e h也ral hypo也alamua. It is trav四d longiwdinally by ma町 fibr盹 including 也e med且l forebrain b四世le. The K田al 峙pothalamic aI田 is important in the control of food and wa恒 intake and is, in p吼叫回val.ent to the physiologically d曲田 ’feeding 但ntre'. Lateral hypo也抽血id创ions cause aphagia and adipsia. 咀ie medial region of the 均po也alamus corr回ns various nuclei, only some of which have well-d曲ted functions. Anteriorly lie 也t supraopti巳 par由四U阳llar and suprachia&ma咀c nuclei. The supraoptic and para回回cular nuclei bo也 prod皿：e sys也mically k由电 hormor圃，世tlch are released from the pos恒ior pitui田y into 也E E回国I c:irr叫ation. The supm叩tic nuclei.皿 produ由 vasopressin (antidiuretic hormone; ADH).’The supraoptic nucleus contaim osmosensi笛，e neuron倒也at are activa时 bychang四扭 曲E 创molality of circulating blood. An increase in osmolality 但回臼回国se of vasopressin. 'Ibis acts upon the 仙bul臼 of 也e ki也.ey to increase wa胆 reabsorption. 也.US maintaining water homeostasis. The par由四创αliar nucl四a syn由国aftα町tocin. In 由E female, activation of the parav田园cular nucleus.，四d release of hormone, is induced by suckling. 哑由四mula回 milk 咀le 均po由alamus consists

岛出de-stim:回ating hormone （阳句，向roid-stimulating hormone p町， g创世l hormone 缸ld proladin, which are released into 由t general c:irr叫.ation. The factors 也at con·田I 也.em are released from 也e terminals d均po也alamic neurones into 由e capillM>: bed of 也t pituitary por组I m田n 阴g, 16.3）.四回e vessels, which

are in国n画cto 也E W萨布峙百四I stalk,，四nv可由E rel四sed a萨nm

to the ad四olr即ophylis, where 也可 act u归E 也E hormone-a缸eting 创ls. Wi创且也is sys阳n, the neuro位ansmitter d叩amine is synth四”d by 田urones of the 均po世talamic 缸四ate nucleus 四d is rel.eaaed wi也in the neuro峙pop.协is byuons travelling in 也峙po由alam.o栩如opbyseal tract （毗 Fig. 9.14). Dopamine 缸ts to inhib扭曲e release of prolactin W 也e a也nohypophysis. 咀1esyn由国＆ of峙？。由alamic rel曲曲igfactors

isw咀E 位edback 吨曲曲n by hormones produced by 回耶t

organs.

”’pothalamu• •TI回 hypolhalarπUSiB 因此 d t晴 d阳nee回回Ion；目阳 co内nee恼d

to

the pltu陆lly g恼nd v融 the lnf1.』r回lbulum. •TI丽 hypothalarπus

h笛 com脏tionswith 世ie suprachiasm皿cnudeus 姐d 汩汩wived

扭曲tαm田l of circadi扭曲也ms. 咀le 四:ntromedial nud圃，， like 也t lateral~由alamua, is concerned wi由也e c.ontml of food and E凶d intake. 四e ventromedial nucleus ia 呵阻四 with

k四”orted b 廿1e posterio『 回tuitary in the hypotha阳1ohypoph如倒l t阳t.

has

．”1自由te阳r pltu阳ry p『回uces:

hormone,

autα回mic, neurc田回ocrine ar回

adranoo口『唱团同盟E

limbic 仙阳lions and 丽 invclv回

U恒＂nising horm田咽，倒licle­

in the coortlinat阳1 of

的·mulatir可 ho『mone,

ham骸:istalic mechan陆ms. ·嘀嘀 hyp时halamus p『回UC腿

honnones that a阳刚画画回 骨1ll'T1 the 阴嚣恒rior p阳阳『yand

also re国s同旭ctors that control the re抱凶e of hormones tom the anterio『回tu阳ry. and paravenbicular nu曲i of1he

•TI晴剧pra叩tic

hypoth剖面nus w回uce

uterine m田d巳咀1e axons of 创h in the supraoptic and 归mven创αliar nuclei p剧 to the neuro峙popbysis 面也e 峙po也alam.o峙pophyseal 田rt (Fig. 16.2). The neuro姐d民rine produ伽 are transponed 扭曲is tract to 由e neuro均pophysis, where 也句缸eri也a幽d into 也e capillary bed 组吨也U鸟 reach the general ciiculation. 四e supra卤iumatic nuclma is concerned 响曲曲e control of di町nal rhyth皿s and the al~／waking cycl巳 It E配白白 some afferent fibres dir眩，tly 鱼。m the retina. More caudally, dorsomedial and ventromedial nuclei lie deep to 阳 I眠Ial wall of 也e 也ird ventricl巳咀e dorsomedial nucleus

• Vasoprussin a「回。刚回n are

vasop『冒商in

and oxytocin,

resp能回唰y.

T11111ours of the

thyr回d唱linul创咱阳nTione,

growth honnone and prolact的． F部:tors 廿回t control their sec阳tlon 臂’用梅”’d Into 甘l8

’”em of the

pltu阳ry portal s

川tultary st副k g回 c:arrlE拥d to 世19 ante耐，r

plbJ!aly.

•The 阳阳刨 11)1)创唰创nus and the vent阳ned刷 l'VJC峨眉 啕U刷刷同 and

dr1nldng.

•The sup阳时iiasmatic nuc隐居 contro恼臼rcadian rhythms.

”’“halamusand p阳阳市，land

Tumours and at惰『 di民跑揭崎 of the hypothalamus and assocl回回 pit\』ltary gland 阳d to unde『－ or OYet'-pr回四！Ion of ciroulatlng hormones. Th臼e. In tum, produce d始制隅口f grow伽（曲”而，m, ’跑回由m and acrom啕画”，坦xual fun国ion (prmcacl剧， pub•句， hypo圃’回d阳刚， body water co附ol (dlabetm ln&lpl啤•and pathaI啕lcal 嗣nklng），回lir咽（Dbalty and bullmla) ar、d adrenal ∞而回l control (C皿hing’. di回髓， and llllrenllll iNuft'i睛”句~.Since the pltu阳ry g恒nd 面 clo饲W adjacent to 甘ie optic chi陆酬， 1uπioura of the gland 制制阳市邵阳ornaa) may 曲o lead to bitempcral 嘟幽l 制d 阳s

(see Fig. 15.8).

由E P句siologially defined 坦白ty cm:田’ andlmons of 也is E唔on ca田eabnormal』y ir回国lied food

intake. h 也emost rau也I

归rt of 也E E可po也alamus lie 世ie posterior nu1也us and the medial

m皿mlllary nucleus, 也 la饥er being located wi也in 阳 ma皿mi~ body.

Limbic system

The m础n皿血缸ybody is 严rt of the limbic

m但也 remvingafl自由.ts from 也e hippocampus 由也efomix g咀 project凶gto 也t anterior nucleus

of the 也alamw 皿d 由E

braim恒m.

咀1e 峙po也alamus ia the brain αntre for E唔血tion of 也e autonomic nervous sys回1. 臼m曲，缸由四on ofthepos剧。r 句pothalarnic domain is 刷刷刷 wi由 sympathetic m归田es, whereas activation of the an回ior 间，othalamus is associated wi也 parasympathe缸缸tivity.

四le h月均由alamus ala。”白白白扭臼 releasing factol'S and relea悟也hibi由18 fact。”， which conttol 由e r也aae of honnonea by 也e adeno切叩协is. The d囚。峙P叩h~produces adrenoco皿cotmpic hormone {ACI町， lu国ni由ig hormone (UI),

咀ielimbic m田n consi血 of a

number of phyl吨回etically ancient cortical and subcortical struc田res, wi也 complex and widespread co皿ection，也at provide 也E 缸旦出皿回回 neural basis for 姐姐配由冒血d emotional aspects ofbeh剧创ll' and for memory. It has d也 in忧rconn配笛onswi也也e hypo也alamus {F:咿 16.4, 16.8），也rough which emotional 归国 are infl.u四ced 峙，四d media他 changes in physiological 皿d biocb创回.cal conditions. 咀1e limbic m恒m earns its title from 也E IOGI阳1 of 回me of ita major conical componenta on 也E medial rim of the α~bral hemisphere (le grand 胁 I阳陶Me). It consists of a number of structures with complex. h田ronnections and sereral major fibre pathways that project to the hypothalamUB (Fig. 16.9}.

·但他 g 唱喃喃号’幅营ag 喝Eggssg 翼迅雷琶 a 昌也因宫”EEEgEAS 哲明ZaE 邑 aa望自由唱 回苞目 goEZ昌 SS 筝。eg 冒 Ea 局副白”EBB 』g 吾 EAga 百 5 百旨 U寺 asg 贸 ES 唱 aga EEES 目 EaggggaugeH g H a g 古 自 冒 冒 冒 宫 号 A E o d S E E M － E 帽 Z E 咱 自 可 g B 吉日 Mgg 百咽PS奇 BE 帽 〔 2·2·MSE）gs － $3MBg 民且 gaE 占．营目冒冒－自 ggBSh司Ea· zfgEM 吾 gdsga －

gdg

目 gE 丑”看 a誓旦 EB 骨 BEZag 者星电 U且’审理 冒 aE 百；自眉雀眉二百奇百 gaague 币 5 宫号 AZ EBU 窑 Hagg OE昌，宙眉g’ 自民 hoEgsu ｝ 三日宫 £gag 冒 Eag 』 昔日 BUB －a 回aaseEE 唱 AhOHE望 EE a 回回盲目自唱吕 响32E 且geggs 冒 E占旦 gas gg 24 － SSHEEg 冒adE 毒自饵’saSAMHS冒 So S ESSE 冒冒 Eggs 圈’ 目 gggH 理 SE 冒百曹｝ 唱Egg － EE 再 gaga 言。－ 25 吕冒 zsaEggg

军目’在SBEE －gag 军 SS3aaa 嗣昌 ggE850 自昌 g 号ESsegza百 UE咽。冒850E2 官a 昌昌 3 毒。 aess aaF SS 右。§、SS 毒运。 EHES里wagssBDBSgeaaaana SM 帽 g

。9SSa －n 嗣且 响 HSSS百响3 5’ 3SE 写司（ gag

aa 吾召 EBags3 宫＆毡EEgggaEggss9saJE gaggz 喜 AZRSU 组EB 奇古 aHa冒－ gaga 宣宫 dHEgg咽ug 盲目毒害 g 吕 BS85SgZESB － oBS 罢Uhgg 后寥 唱gd 毡基喝 ES 』 毒gSSRE 百 852gsssah益普宫望。 Sza －z ｝画。 － zdH 2 岳阳 3gg 百 ga 』338 gsaESSssassaazas§uzsze O SABS 吕旦 gggE 帽gassas 喝ggaZ 幅 MS官 。“ －a agu－g

营羽 S

石

g

野g 言吕 ES

－

－

hgsg币 u。畏 gaegggS 撞gaizuav 冒＆、旦 agsaaagg理凋SS ·h｛ 冒目。有言32EE s旦宣33 豆昌 苟’ gggaao 冒 zsxgagagssuzsas－

ses育 E 』誓’’ dESEEa－s － g－ass gggga－F 琶 ES·gEBEEze－－ －

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氢罢 ZEggs2

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－－ s －E·g

E －

g 幽 hhMassmEG

响2ξ 哥一幅εLF

SE疆 莹 F 莹

[ 帽喜交差

ε2 也串的

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k 至εgesz 重咂ag但

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M 画艺 83

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Cha pt町，e Hypothalamus, limbic system and olfact。ry 町stem • 159 Howev四 the de叫0严1四t of 也t association areas

严Z地onged afl«tive 血烟， which may 陀fleet approp血忧 responses

2四corta permits

ω 阻四剖ronm四t or be pa由.ological,

of the adapted behaviour to be art 皿d achieved 0阳

proIon京d periodi』 E岳贾缸乱 Motivational sta脑 cm, in man and animala, be ins血由Jal，如 example 鱼缸，由ght. fttdi吨 and 留:ma.I behaviour, and permit self-preserva世on within the environment. Prim缸y emotions occur in humans (and possibly higher apes) in individual respon帽 ω 也t environm四.t and evinced in the same facial expressions of joy and distr盹 swprise 曲d disgus也 fear and an伊由at occur 扭曲

咀le expI四阳n of emotional sta幅画 bothm。”ric and autonomic. The mm四nents of facial apr田，~on. pitch 血d tone of ,.m.饵 and linlb gesture conv町 emotions and 缸E involuntary and under 也e control of the b描画I ganglia (nu由usaccumben’）． 旭.tonomic responses comp血e blushing, hair standing on a圳， goo促 pimpl略的回岱吨， pallor and 回IS. 四1句 d哼咀d on the 也tonomic output of 阳峙pothalam也

humanαtltutts. Inhu皿ans,

'social emotions' are experienad 血d eiqir田d and ha饵 j四lm皿ly 皿d envy. pride and guilt. empatl『r and sympatl可. Moodsrepr回回t

Amygdala

betw田n individu血， for example I~

盘L..._ ....’饱 1

王画 f且 ／

for ewnple depr酬。跑，

ar回ety 副1.d elation.

咀le 缸n丽~a lies near 也e 也mporalpoJ，己 betw也n the inferior

homof 也E K但ral 四ntricle and 也E lentiformα>mplex I (Fig. 16.12; 11tt also Fig. 13.8). It I匹函Yell affer四its 叠。m 由E 巴？呻i1a1 infaior temp叫“sedation cor跑也呻血lUS, I~皿 and 」二二亏一一一一’ 也t olfactory 往配t In a ition, it receives QI忧也olam画e- and ’ 陋就m曲－containing p叫配:tions from the brains能mvia the medial forebraln bundle (see Figs 9.14-9.16）.四le p血cipal d加mtproj创on from the 甜ly回ala is the 削a 阳minalls （脱 自g. 12.3), which IUDB 扭曲ewall of 由t latmtl v回国de. following 由e cunatutt of也e ca.udate nuclei.岛 ω 田millate ul由m国y in

I

“

也z hypo也alam皿币ev四.tral amy回alofl明l pa也W可 also projec:强 ω 也e 峙F也alamus.An d坠rent proj£Ction to 也 nucleus ac.cu皿.berui，也E ’limbic' 严rt of the M皿1 院nglia. permits motor behavioural E回ponaes.

Septum

Flg.18.11 The W.n:onnect阳na beiw-i MIOC恒世帽 iwocarl幅画

”’Ion• and the

campan帽tpa曲时由allmblc•归tem.

The septum. or S叩tal E唔on. lies in the b嗣al p缸tof也e forebrain F也 16.12 咀d see Fig. 13.6). 'Ibe septum is a cellular z唔on, not to be confused wi也 the sep也m pellucidu皿， which is a 也皿， non-n四Il1l. lamina sepa.ra也18 由E an恒rior horns of the lateral 咱也ides (see F也 13.6）.咀le septum intettonnec:t& 回也 k arny回血 andproj缸” ω 由.e hypothalamus 白白emedial

R翩men

Septum - Glo民』E 阳llidus 翩翩。『 comm晦阴阳

时·’也12 Coronal 割副Ion of the brain •h侧lng'lhal翩翩Ion of 曲， amygdala and ar嗣同，， cornml•ure and 曲，lrre缸”。”剧”W蛐 "'8boal ganglla. Mulligan’S S阳Jn~民19 Fig. 1.η．

160 • NEUROANATOMY forebrain bundl巳咀le S叩wm alao influen倒也E monoam凶agic nuclei in 由t M白血m. It do筒，。由 fibres 由at run i且也t a刨a medulla血也ala皿［阳 ~ 12.2, 12.3) to end 扭曲E habenular nuclei of 也E diencephalon (1胆 地. 12.2）.τhe habenular nuclei in tumpmj回．由 the fa皿culus retrofl四11, to the in能甲eduncul缸 nucleus, a small nucl田，面也e ventral mid.brain, which has connections with other E唱om of 也e brains艇mas well as the 峙阳也alamus. In this w町，饵” major pathways Ii出缸 呻饱肌也E hypo也副amus and 也t rnon阳ninergic nuclei of the brains惚m.

hipp“革皿”’ is formed by an infolding of the in缸omedial p皿 of the temporal lobe into 由t la也raJ ve盟国d＇马 along 也I! full! of 也t choroid 也81ltt (F：阜 16.13, 16.14; ltt a1&o Figs 1.3.8-13.12]. 咀lt'! d皿.talE gyms lies b~ 也E parahipp民:arnpal gyrus and the hippoaunpus (Fig. 16.14). 咀le hippocampal 伽mation RCeiv回 affa喧闹 principally from the in如ior temporal cor田由也e ento血M m回归田） of阳 tem.归ra1 lobe F地. 16.14). It also m叫咱 fibres from 他 αm田la阳回I 钮ω血ina1 cortez 四d hippocam~ 由缸阳nix 句富但也皿d hippocampal commissure {commi饵Utt of也t fomix).

Orbltal frontal

四le principal effer四I pathway from

c。rtex

四ie frontal neocor皿 comp血es 由e frontal con·π:Dty 缸l.d 由e

orbital fi回国∞阻（i.ι 也tr唔.OD M吨 above the orbit）.耻 企D皿al CDI回国ty recrivn ’affer四（ info口nation about the world from the posterior 础。由世on cortex.. Pr时配咀om from the 阴阳rior 翩。dation cor回臼由e in如ior temporal n回倒回 also permit 回町 of this in缸mation into the limbic 1)'8tem (amygdala 血d hipp旺皿例如mation). The o曲M frontal cort田 also m回咱 input from 也t frontal con鸭z:i:ty but is more p阴阳缸lly connected to 也e limbic sys能m. Not only are 由ae 严叫创ODS from 创bital frontal to 凶阳ior 国nporal nrocorta: 司且也E undnate f.udculuιbut 也z otbital fun钮I cort£X: pmj国s dir回Jy

。ngulatB llYM

Mammillary

ω 出E 峙po由alamus. Thus，也efmntal com肥lity ii

the hippocampus is 也E fomi:x: [Figs 16.5-16.7; see also Figs 12.2, 13.2, 13.7-13.12）.四E fomix i1 a pron让nent Cshaped fucicle of fibres 也at links the hippocampus wi由 themamm皿ary body of the hypo也alamWI and with the 况ptum. Efferent fibres co~ on the ventricular

阳刘y

related toα事ii世ve executive

岛nctions and 由e planning of behaviour in m句>anseto

回悦ronmen:回旭丑ormation collec时 in the posterior neocor回－ By con国民也。由i旬1 frontal cortex is stron脚 related to 也E structures 由at mediate 也z ins也叫吨 mo笛”:tional and emotional

In the h幽lthy subj缸b the ’C吨;nitive' and ’＇affec:垣隙’ a吨JCCta of behaviour act together in problem-sol世ng in the euvironment. Both mechanisms are su间四”也e results of 严凹im皿 ezperienre. which have en伊nder叫 E回缸也 and 阴皿也ments: that i鸟也句 d叩回d on 由.e memory systems of 阳 limbic m也m.

阳阳iorhomaf~

阳teral 略n甘icle

Hippocampus-

甜咱 infl.u四dngbeh的iour.

”’nalMRlscan

Flg.18.13 C

d由• brain shawl吨由•

hlppac•mpus

a咽。，”w campan•nts al世圃， llmbl四””m.(Cour也syof丹田War

A Jae俗on,

Woll阳？ M时扭曲加四”可Z G回盹 Uni阳'SifyofMan副部缸，

Mar四圃恼， uκJ

阳仰阳

问问叫叫

In fron幅幅mporal dementia (FTD), a n刷刷咿neralive disorder, The pa阳、ts

tt晴『唱插曲回加y of the prefron恼l n民览。rt自E andamyg幽阳. h仰自由:>gnitive

executive dllfic阳 causi咽 poor p肌ning and

and tt田 undergo a 阳现>nallty change with personal, 民忠和atlonal and sc沁脑l br刷刷刷n because of dam筒’自 to 甘冒B pre阳阳J cortex. They 创阅翩pertenoe lo蹈。f prl『nary and 创clal 即回tlons and 甘1ey lose 甘咽k 串ense of d~er dl剧 to 由mega to 甘冒B amygd由. 1he9e patients bE犯。me profol.ndly epat怕回口时1伽伽e 由ease 阳aad9 through t陶 do阴阳.te『a 骨。唰 regions. In some FTD P副自由， th由百恼 sel四tlve lnvo阳ment of 廿币。由Ital frontal nE坦cor惚x. 啕anlsatlon

Wh朋 thisα:x:u丽， α羽nit帽 executive fin:阳、B E回耐a:tiv回y s因『田，

而II ofcaud回－ nuc拖后

but the pa:回回l's behaviour 画 d自inhibi恒d, overact阳 and uncontrolled.

阳陆中。『 horn of

Limbic system: memory

la恼ral van刨de

Memory pro田瞄缸E of three kinds. Episodic memory refers to 由e lear回ngand E回:ollect.ion of autobiographical m自由 in the indi训叫’， life and is d即回d回佣世ie bippocampal formation 皿d its connections. Semantic memory is the acq1回zed knowle甸e of the meaning of verbal 皿d paceptual concep钮， i.巳 knowledge of the world. Semantic memory is dependent on 也e functioning of the middle and 凶缸ior 田nporal gyri of也e neo倒回a Procedural man口可 refer. to 也e learning of sensorimotor skills, for example learn且g to 由iw: a cu: or pl可 a muaical instru皿四t and is d句iendent on cortico-sulx刀币cal motor syst阻， and not on the hippoαmpal formation or the temporal n回回·rtex..

H’pccamp1蹄

Hippocampal formati。n 四iehip萨xampal 如mation consists of 世1e hippocampus

itself, the dentate gyros and parts of the par也ip院xampal gyros. The

EnlDminal cor恤 Fig.US horn d由’’匾u町a幅回町审lcll比

Cha pt町，e Hypothalamus, limbic system and olfact。ry 町stem • 161

叫刷刷刷cleus-,.\,

Anterior horn ar 恼怡ral vantr他la

Crusof fum皿

＿＿＿＿＿＿，.......，飞

飞

Tha阳TIU$

飞

'r

l『帆

’

Choroid plexus

Hip冈campus

Fig. L15 The hippo国mpu.－相mbrt.-fomlx 町，tllm. lhebr百in is vi阴晴dfrcm ab创回. The 幽'llbral cortex and wh阳 matter, indudi咱 the corpus 臼losum, have be回 remo回 to reveal 甘南 lateral ventricle and its co嘟嘟．问 Choroid pl削soflate回venbide intact；回 choroid pl酬sremov回． S山face of 由t hippo臼mp国幽 the fimbria. 四tis p笛sea pos田iorly

and superiorly, to become αm由uouswith 也E crus (posterior 四Ju皿n) of the fomix, w扭曲曲回皿咱也rward benea:也由E splenium of the corpusαH饵U皿〔阳.g. 16.15〕．四etwoαwau皿te in 也E midline. hen甜th the 四rpus calloaum, to form. 世le body of 由E 岛mix (Fig. 16.6). Some fibres er。” to the opposite side rough the small hip萨xampal commissure （＇αmunisrure of 也E fomix). As it passes 阳war也 benea曲曲ecor阴l8 call臼um, 也t b创坊。f也t 阳nix 世rides into two columns. 咀1阻四rve d跚跚anls. forming 由e anterior bonier of the in缸”回回.cular foramen. and en:田 the 峙po也alamus, where 也e majority of 矗bres 恒minate 扭曲E E缸nmill缸ybody. 咀ie mammillary hoe与． in 阳m. projects to 伽e m忧rior nuclear group of 也e 也由mus 材a the m皿m皿othalamic tract (Fig. 16.6）甜d to 伽 bra皿回1 白 白E m皿m血。饨，men创 tract. 哑iean回ior nuclei of the thalamus have major connections wi曲也E cingula.te gyrus. Hip?.ocainpal efferents al阳 p叫缸t to 也e nucleus aαumhens，由且blingmotor respomes.

“

Ii出d by a series of connections, which cons世.tute 由t Papez cin:uit (Fig. 16.η．

ln.Allh耐m臂’. di’””， th阴阳民剧目E E削阶"rl of the hip阴阳mpeJ

(Fig. 16.1 甸 回ding 阳 amr回ia for relatively 『四Jeni 回ients the inablily to 国m new in1ormation of an autob~叩hical kind,

f口『mation

由d

i.e.

lo因 of ep匾。die 『T回m口『y.

ln&emantic 由m田面， a 「丽urod吨，ierat阳 di回国霄，！her冒 is

atrophy of the mi剧le and l『T怕也f t町1po『al n配x:ort回l gyri. ”1日 p副ents P『啕『回国V呻阳泪甘回『n回ning of war由 and pell:epls, i.e. their 阳w1e句， of 阳刚d 阳m创tic memo『y）.民，倒町IP恼， they do

not know the name or m凶ning ot 喇ec恼创d cannot recognise faCE路 (assoc阳御， agnosla). H阴阳ve『，甘冒W have relat惘防'9SC!Mrtlon of memo叩阳 their own 刷刷biographical 锁阴阳ω画， Le. their e回sod怆 memory Is p11186附d，民阳t眉目甘冒B hlppocampal 阳matlon 阳 not prfm创ly affected In t附 d棚掬． ιimbic system: emotion and memory

Cingulate gyn』S

Memory of m四”四d their p笛t mo往回.tional 缸id emotional

咀le cingi血te gyrua and 也E paral啕pocampal gyrwi

曲皿.otations are 也e only 胆de to 缸”recompl凰”cial

由1由1uitywi也 one another around tl哩，plenium

behaviour and are d曲也e essen由I l.inka that 归回erve 也t indi说dual in perrni创ng rapid response to po恒n血lly 由E回ten旭s situations. Input from ho也 functional a吨配ts of the limbic system ii es1mtial in probJem-901ving or eRC1.1世ve functions, 也e

are in of the corpWI αllosum (see Figll 13.2, 13.16). The 由1思由te gyIUll projects to the parahippocampal gyros 悦a 也e fibres of the cin思山m {Figs 13.22, 16.5, 16.6). The 归旭cipal structures of 也t limbicsy就回tare 也.us

162 • NEUROANATOMY

Fig. 侃” Caror111I•田t阳”’rough 世MIC町，bral h11m阳””帽 ofa 阳t阳ltdyngw描I Abi:hllinM"’•di•圃’a. The section shows 剧arged lateral 晴111icles and atrophic ccrtical gyri and hi阴阳ampus. (C汩ntesyofPra脑sorD 抽nn，创忧：aJN阳时制？”惶， Hopef如每剧， U脚宙古歧yof胸脯e暗脂， 胸脯es«缸， uκj

ω阴阳 aspects

of whi血 m d叩endent O且也e functioning of

由E dorsolateral

aspect of 也e frontal association neocor圃， The orbital a早剧。f仙台ontal neocona is intimately linked ω 由e limbic system and 也e processing of motivational 血d

emotional st.a.ti盟． In rapid reaponaes to 田说ronm回国回国1uli, d理 a蝇。ciation areaa of the neo倒回 involved in cognitive functioning can be W归saedand 恒.coming sensory information can en回也e limbic system 由 the 也alamus so 也at relatively automa世c bebaviowal responses such as fight or 缸gbt can be ini出ted via the basal 萨nglia (nucleus accumbens). Theα>peration betw配n 由.e two p缸ts of the limbic sys恒m explains 也E fad. 由at highly emotional 町eriences are readily learned and 由en remembered. It ill important for mrvival of 也E indi世dual to hllVE recollection of precmenu in experienα 也at havep窍，ioualy led to reward or punishm回也已.g. 由e avoL也nαof dangerous animals, plants 姐d 臼ivironments.

r.t t

Limb崎协bedl•o睛”

Alcohol abl』盹 in a 回回ng of di阳ry delici阳明 d th阳mine，国ds to cap副ary h笛”w而甸回s in 甘冒 U同商 bra阳tern and limbic structu『回． 有回国阳『it 倒ls into 回毗』sion and coma (W1田nlcke'a ’R帽，hlll叩d明. Partial 『眼泪V町 may occur, with 幅lure to 阳nember P酬。us 锹阳ience ~耐啕陆deamn瞄a) or to 阳m new 陆加 (anter咱『国eamn能闵．刊iis is 阳own 笛 Korakofl'• psy曲幅画.A

时miler amn倒c syndrome occurs when bllate刷， SU咆阳l tempa刨 lol:l创toπlY In0nlination

Arachnoid mlllBr - Middle of the 由ree meningeal l可as 四时oping the central nemms 巧瞩目1 An州g蝠’－ Lo”。freflees

Arthrllla - Inflammation of one or more joints A latlYe agnosla - In抽出tyto recognise the mea皿ngof

”“

pelα:pts

Astro句t，但stroglial celQ -

A type of neuroglial 叫l (q.v.）也at

may 伽m 也eb协ad-brain bar悦tt

Ataxia - Loss of ability to coordinate voluntazy movements Atrophy - Wu由1gord乓~tion Axon - The nerve fibre ca蚓ng impulses away from 也ecell b饥炒 面roreceptor - Neuronal s四”＇ry ending that 出版ts changes in 缸回ial blood pressure Bio阳Y- Ti”ue 领mple taken from a patient for 也ed泊gnosis of disease Blood-brain barri町－ A selectively permeable barrier b嗣同回 thedrcula由g blood and the brain believed to be formed by as缸。句也S

Bradyklneala - Slowness of m~ment Braln81em - The stalk-like portion of也e brain c.onnecting the cer曲ral hemispheres wi也值ie spinal cord Bulbarpal町－ Weakness of tongue. pharynx and larym resul也18 from disease ofthe lower 饵”al nerves Bulimia- Over但也igdisorder Ca恒racl - Opacity of the lens of the 句'e, leading to de回oration 。fviaion

。“I body -

The part of the neurone that contains the nucleus and possesses dendritic and axonal processes Ce睛，l nerv·例”’归tem - The brain and spinal cord

comprised of饵”四由ral hemispher哩’ Chem。”“ptor- N四ronal 阳ts0ry 四也吨that de田tschan阴

(e.g. 叩ticchiasm) Chor四－ Invohm皿-y, abnormal movem四” of the fa但 and/or

limbs

阳在in

Crani。”my- Neur回回回cal procaiure to 叩entbeaa皿al

cavity 臼JShln，’sdls四”－ 0回grow曲。f也e adrenal glands ca.using at"Usivem钮’eofcortico，回oid hormones D回U8翩翩。”“白ossing 回町of nerve fibres from one side of the

CNS to 值ieother （巳$即rami也I decuaaation) False emotional conviction thatαurent events have

D剑l vu -

“E田red k击。，re Dem甜甜a -

Loss of mental ab出咀es Demyelination - Loss of由emyelin 曲回也皿II0UI1ding n四ronal axons Dendrt恼－ Branching process of a neurone 由at receives U伽mationfrom o也.er neurones and conducts d回rical changes to the cell b~ Dlabe幅s lnslpldus - Failure of the posterior pitui田ygl四d a.using reduced release of antidiUtttic h创mone Diabetes m创lib.ls - A disorder of carbohy由ate metabolism caused by lack of insulin Dorsal root gang Hon - I.oration of cell bodies of严imarya他rent neurones en·能ring the spinal oord 也rough the donal roots of spinal nerves Dura mater- Ou阳m倒t ofthe three meningt盟I layers that 由叫op the 田ttral nervous 阴阳n

”

D arthria - Inability to pronountt D归ph咽ia- Inab也.tyto 阳allow D归phonia -

Inability to produc.e the voic.e

Echo四时iography －咀ieuseoful田sound to display the a皿m

。ftbeheart E”ere耐－臼z归g away from {e.g. striatal d如回t量bres carry

imp叫ses 甜可企omtbestri血im) El嗣troancepl回lography (EEG)- Techn闯出todet倒也E S山face electrical 缸tlvity ofthe brain 四”tromy啕raphy- 'Ii配hniquetode田mine 也.eelectrical acti世.tyofmuscl四

Emetic-

Ca国ingna田ea and vomiting

Encephalopa由y -

Disorder of the brain Entrapment neuropalhy - Nerre injury caused">'.' compression ofanervewi由in a tunnel or at a change 恒 direction

Ependymal cell• (epen句ma) - Epithelial cells lining the 相1创α.tlar system Epllepsy- Par回归mal attack of di础曲ed consciousn倒 and sensorimotor function resulting 丘。m abnormal electrophy冒iological disch缸罄s ofthe brain F幽cicu幅画。”－ Spontan刨出 contraction of d四ervated motor uni毡， visible on inspection Faaclculus - Bundle of nerve 但bres （ιg. medial longitudinal fasciculus) Febrlle - Refers to rai时 body temP.erature （伽a') Flbrtllatlon- Spontan回us contraction of den臼vated muscle fibres, detected on d民tromyography F刷审men- Anop四姐g (e.g. foram四 m咽tum) Ganglion - A coll配lion of nerve cell lx地ies outside the CNS (e.g. donal root ganglion] General paralyais of 世18 inaane (OPI) - Disease of也efrontal lobes caused by late neurosyph监事 Giia- See N回iroglia Glloma －卫llllour derived from glial cells Haematoma - Blood dot Haemont怕自e - Escape of blood from a ru~tured bl“对vessel Hallucina勘n - Abnonnal per四p缸lal experi白白 Hemianopia - Losa of s时lt 必fee由1g one half of也.e visual field (e.g. bi-temporal hemianopia) Hamlpereel• - w回kn饵， of one side ofthe body Hemlplegla - See Hemip缸回is H晤，tole耐cular degener翩。”阳llaon'adl阳”1) - Inherited “侃ase of copper metabolism affecting 也e liver and bra旭 H筒，，s zoster - Virus causing shingles (q思｝ Hunting怕自’s dis髓，e - Inherited d电回回回ve disease of也t brainra田ingchor田（q.v.) and dementia (q.v. ] Hydroce肉，lua - Abnormally la思ea皿ountofcerebros回nal fluid 幅“E由even缸挝es of the brain Hyperacuel• - Increased hea由1g ’钮，itivity Hypemdlexla - Abnormal increase in retla activity Hype阳n幅－ Abnonnal increase 旭 muscle tone H”’r钮’曲，－自由咆ement of tissues Hypo曲”’idiam - Underac由ityof也e thyroid gland cau ng reduced release of thyroid hormone Hypotonia - Abnormal d回国ae in muscle tone Idiopathic - Ofunknown cause l四”n:tlon - Death oftissue r倒时也18 企om impairment of its circulation Inter四川，bral- B剧院回阳。呢rtebrae lpsilateral- Rm.tingto 也t 幽me side lschaemia - R.estri咀on ofblood supply to a 由sue or OiglUl ＠回归g inad呵uate supply of ox亨gen 阳naasthallia - Percep世onofm°＇四1£Dt Lamina- A 也in 同a"(e.g. in恒rnal medull町 lamina) L帽Ion- Siteof仙咽，e or darn鸣e

“

Levodopa －ι－DOPA，且-dlhyd即可phenylalanlne） τk met血olic precursor of dopamine. used in 也e treatment of Par挝D80的 disease

Lobectomy - Surgical res缸山n of lobe of the brai且 Lum•n - A space or 田ity Lym om• - Tumour of the lymphoid system

”’

Magn创icra回nancaim啕ing (I回RI卜 Tt?Chni年皿 for imaging

structure 也at does not employ ionising radiation Mast!饵”。n － τbe act of chewing

MenIr啕es- C。nnective tissue sheaths surrounding 也E CNS, namely dura mater, ara血noidma回血d piamat臼 Meningioma - A tumour arising from the fibrous co四rings (m创n酬。f也.ebrain M四i啕ilia Me幅BIBsis -

Inflammation of them四ingea Spread of tumour to 出血nt 岳阳

Mier唰la -

A type ofneui唰ial cell 归功， M白电a mainly

phage叼tic function 皿 theres归＇nse to brain 也mage or injwy

Migraine - Par阻碍事malhea血che 翩翩is - Pupillary constriction M。”r n创ronedi回＠蛐－ Des阻四.five 幽幽&e ofupper and lowerm悦。rn-四rones, caua画gpara】归is

Multiple sclerosis - Immune dis田se ofthe CNS, r.ausing relapsing disorder of nervous function M刷刷lard归”phy- Inh回.tedd甸回1eration of muscle岛 causing progr魄，ivepai虱l罚U Myasthenla gra咖－ Immune disord缸。f the neuromuscular junction, causing muscular fa部le Myelin - A sheath ofprotein and phospholipid around 也E 缸。即 of但也in neurones M归clonus - Sudden, involun皿ymuscleαmtrac:lions M””由y - Disease of muscle Narco胁’即－ Paroxysmal sleep a阳出 Necrosis - Dea曲。ftissue N嗣plasla- Tumorous~也 ofti”ue Neuro而bromato回事－ Inherited 剑.sease causing wmours of

m四inges, CNS, periph.entl ner咱姐dskin Neuroglia (neurogl幅l cell) - Non-neural supp创ng cells of the CNS comprised of oligod皿曲回歹圃，豁出q圃， mia回国.a.and

申自1句malcells (q黑） Neurolap田c -

Dopamine receptor antagonist 世ugs used to mat

psy由osis

Neuroma - Tumour derived. 齿。m nerv哩 cells Neurone - The ~rincipal 缸nctional cell ofthe nervous 阳能m, sp国alised. to integrate 血d transmit nerve imp曲“ Neurup自由市－因腿植eofn四ecdls Neura町philis - Infi自由E of也E neIVOUS m恒m by a spirochaete Neuratranamit恒r -

Chemical rub!tanc£ stored within vesicles (q.v.) in presynaptic nerve endings and released on depolarisation to act upon 阴阳归apticre四”。” Noel ptlon- S四sitivity to noxious 副mull Nucleus - Structure within a cell 也at contains duomoaomal DNA; d脑 a collection of nerve 创1 bodies with扭曲 CNS(e.g. dentate nuclei叫 N阴阳，mus - To-and-fro movem四1JI of也E 句囚 。edema - Swelling cau回dbyacmm世a饱dfl:回d 。llgodendroc:y旬（ollgodandroglla) - A type of n四roglialα11 ( q.v.} that produces the myelin shea血恒 the CNS Ollgodendrogl阳ma - Tumour derived from olig 阴阳p均掘。1啼， 14a-149 ~ollal

唰且巳 68/ M也i回也ellum,

Agrap比a.. 30

M忧凰踹

M幽~nud础 ，w

14411

Brow岱$伺刷地布盟也咀m也 27

m“胁”8时阳由n. 128{ Can.al of Schlemm, l SO, lSo/ 缸rotid syphon. 61 臼时息吗泊1怠

neural tube-. 7f

epinal cord, 12斗3 spinal llel"f鹤 69, 71'/

Baallar art峙， 61/-62/, 62

组位rior 院由m销量g art创她 63

n剧ral I:\必鸟 7f

Broa向 aft马 136

a昭嗨码皿鸟 63/

CNS~耐。1pm回t. 5

61.f-62{

nuclei,

100

臼l锁店1e sulcus. 1霄，’当f

B制al plate

”倒ior iDCaiorαi:ebellar arlel:y,

CNSd回d。1pment. S

14厅

topograp始“l ana自由时， 142斗44,

117, 117/

amerior ell。·ro说:al g回事 61

29 必M plate

lor:an.ation,

缸hemat!c 必咿拙， 145耳 148/

59f

wr&.a ot 90, '11f

c

nomen嘟”Z毡 ’43/

S9f喝喝r 咽皿础d, 71/

唰M 恼地 7/ Afi'e:rent nude!. ” “100 Aki且咽ia,

咽nttal.

Brmchioru创m 创I column

ndional anatomy. 144翩 149 function鸟 144-149, 14911 mowment disordm, 14911, 149/

必观必noid 说lli.

n'1U111 tube-. 7/

1lar1l\I四础。民 16/

ccnn剧。”。C. 22/

60-61

崎1eoUthumou鸟 ’”

Afferent nei:w 也ding也 peripheral. nervous "9忧也 37-38

，由~ 91-93

Babinski n:8l!思 28

Anterola阳吼叫.a.

25

”waglttal 帽ct!on. 13/

B

d咿M划。比 periphe:r租1

At:ll!均成diolin巳 33-34

Acute 肌.ftammatoxy ne恼。pithy,

放惚nal muctwe of 9711

阳iphe:ral na:w鸟 40/

Alamal. neuroplilthia, 40b

a晤鸣raphy,， “f 汹B也组嚼血’粤、亭， 电也f

臼udalm创凶h， ’1,92/

地S.Mllt.myo回内ic k伽草i sclerolil

anterior ncil础rar闸， 6何 anterior sp注alar馅，， 事。， 61f-62f 阳回ll. 61-63, 61.f, 63耳 6511 gr1咽t rad泊liar 都倒型， 60

Bell'• 阴1”’ 1091i Benign h田01ID总l hyp回ten.ion, 嚣。b

basal 伊且glia, 143翩 144

Alzhtimets di棚’也 24-25 Am时，以 30

h叨叨均阳l arteri毗 创

B硝荡臼盘］$， 82

相尊bl111 h.emi呐四~ 17：乒 18{

Alesi.a, 30 Al抖ia motor neuIO且峪 muscl也 36

B制U peduD.culi,

spin阳鬼也e1lar ttaCI鸟 81/ 也叫踹削deus, 57/, 65/

90

CODllec:tiOll也 22/

lntemal v四ebral 削erie岛 12 62-63

Blp。Jar 阻eurone也 32

ooronalM则， 132/

coronal 舶ctlon, 130其 M颂”’f

l彷归讪伽1ne artl!l'Y,

Blind a叭’也 151

coronal 阳筒。lll, 129/-13以 143/,

lateral 啕阳也 143/

mi创le menin伊alar馆，， 12

Bio叫－bWD

pontine ar阳陆 62/

Brachia! pla:驰 3, 41{

Am刚al怠， 划，叫， 159

Am·”’op泌ιJamal sdaotil (ALS),

”’创iorcom皿mica也igar棚’

7411 An翩，th回i息， epidur乱 72'h

Anen1呻hafy， ’告

Aneur”

肘，terior per击On:蚀ngartm.~ 63

M垣n arterial supp.哥y, 63/

”’阳ior i:adiClllar art町， 60/

neuromUKU!ar di阳鹤 ”， 31/

阴阳iors冽naJ. ai:阳ies. 60.

6of

Annulo.p胁l nel"f弯曲dlnp,38，章建f

Arterl帽moue

也romb帽i也 67b ~幢幢回匾。也 67/ 汇兑lit,

Ip协且I co:础， 68

60 malformation.

咄咄i 精E匾。也 1'1/

sp恼且l cord,. 7耳 12-13, 14/

Brachium of in伽i。r colliculua. b'llDf，四e 帽dion,

64告

32-35

Cen.1能在l canal

1l:amV'1'院附tion. 94/ 臼DIIal. 锣叨， CnlD8咄咄 S剧。也 92/,

'JSf

Bra必Jumpon1哟 ’丸’3/-94/

radicular 割伽ie也 12,

Angioma, “如

avulaion 。C. 411>

Brachium con如ncO:叽血， 96

61/-62/

旭g国曙aphy

146f, lS

A:rtay o( Ad.amid阳le鸟 币。

都惚ial II真pp}如 61-63, 6lf”63耳 65告

An踹 lentlcul.aii鸟 coronal 掘~on.

A副到1岱且，g tt罩eta

咄咄i 帽dio也 Sf

blood 钝pp耐p; 8-12, 12"

do ml 捕归钱， lo/

创帽iDg也 如 12, 12b., ’2/, 50-54

147/ Anterior. ddini曲也 1/ Anteriorαi:ebral ill阳型， 61”62,

coronal section, Sf m皿 ccrd, 13, 77{ w也ite matter. 71 ~lion fib~

61.f-62{

138-139

品－23

devdopm但也 4-8.5队得好

咄'ly dewlopmen·飞 8f emb粤咽nlc development ot

8t

affmnt 锐11 sroup讪’也 7f

latl!l'al 呻盹 町

alar plate, 5 b幽al plat鸟 5

却也m叫pi.OSI岛 7811

main f曲也!It鸟 ”翩 14

dlstrlbutio魅 In bra烛， 63/

制叨地 34,

median 相gittal. 辅dion, 10/-ll/

brainrtem, 7-8, 9/

MIUangi咿llp~ 64/

M岱OC)'tom鹉 3Sll

”Z嗣gittal 幌d:io也 13{

αi:ebcllum.. 7-8，理f

At:.皿all

四JCUla阳岛 61-67

αi:ebral aqueduct. 9/

angl。1gnnu.

63/

Anterior choroidal u闸， 61 Anterior dinoid proce幌 51/ An忧rior cammi.Nur吃 154f-155f

o>ronal •制。II,

13够

median 呻ttal a础。比 121/

Anterior commur也aring ar饱，， 61-62, 61/ 翩翩。zαl1lliaJ. 如刷， 50, 51/ Anterior (?11盟国I) honu. 刷刷E 咽地 7f. 13, 14/ Anterior lnfl!rior 出n!bellar ar也厅， 61f” 62/

34f

明军畸刚i他 24翩25 响E阻碍 主8-29, 78i』

Auditory o>rt饵，

19

Autooomk 伊峭ion, autooo副c

ne:IYOUI m忧也 46 必.It.Ono：国ιDem>\11 syltem，，”也

46” 46 d四川量b-. 46 d四盟~t n创m岱＠岛 46

α~bril hemi.spher略 7-8,

必幽rdmot “b vmouadra讪略 65-67, 66/-67：耳

α:rebrum.

∞币。ra qua.drlgem烛怠， 8

6711 咽tral. up盹 10/-U/

∞叩\II 锅ria:tum,

晒t而cular "'1帽， 14-15. 15/

dim吨池alon. 7

Brain grey a刷a; ccronal 蝇ct!on. Bra始就f!lll,

,,

7-8 7-8

effer剧创i groupinp. 7/

4

Sf

fourth 四a创d也 'Jf

14, 89－费7

globu’ ”llidull, , ,

aaa!lldin&trac跳 89

CNSd刷呻ment. 7-8,

翩翩。rl必也 superior sur命战 113/

functioru ot 46t 创ganl幽tion, 46, 46f” 47/ A响.dsion of the brachial. plmu, 4111

Anterior pmor袖血事创t踊a. 63

Aml!iJ睛， 40”41

AD伽iorpitui饵”’ 154/-155/

Axouonal 勿在句JR. 33

inf创or Q)llh:ul\1$, 8，要f

9f

inttawn创α也rforam也1,

咄咄i 帽dio也 Sf

later划，也回d鸟 到f

d咽αndiugtrac旬， 事，

g略战。1bloqaQ..

dorql 阳山n. 份， 8'Jf

g帽aioephalon. 7

e血nW featuttJ也 89唰90, 90岳

me田c:ephalon,

7

7-8

9f

Cen1位“ ner回ω 刷忧m 〔CNS〕 (Con伽剧｝

lat回国P团在 19f

。因血皿 llltcri回国（cirde ofWtl!Q1),

medial 8lpl'Ct. 19/

皿dbraln, 要f

pres:en缸咀l 8)'IU岛 19f

myel皿呻，haJon, 7 neural tube devel叩ment. 5, 6/ E四mtlation, S

p由1啕咽I

pom, 7 3, ’f prlmaiy brain 'ff到de鸟 7, 8t pn:圃盟aphal国tlot1， 且 prc蛐enaphalon,

7

碍。因’“必剧盹 7f. 8, ’ f-JIJ/ 血omhf盟田，~halon,

7

扭曲E也iybra扭回由icle鸟 7

gyri, 19{

刚nal

Cerebral haemorrhas鸟 ~ Cel世＞ral h田园，phn骂 13 14, 16 19, 127-140 。mtral sul四.I, 127 白erebral an:瞌盟L 16 CNS elev由pment. 7-8, '9f

coronal eec.1ion, 130/, 143{. 146/ h回国血I 脏曲。n, 132.f. 14布 αM且岛 50,

st/

effer回tt nudel, 100-1日E 创brU町m 尚属 Slf

1Ulf

血陋。r cranl.al foua,

臼tnmlllural

fibrei, 138耳 139 Common peroneal Deift compn回lon, 45& C.Ompressive E国mp唱血ie也 45& 臼mp回£11 tomography （町，

horizontal 田由.on,

Con山 m“凶Jar饵，迦.alco地 68,

l回国鸟 134/ lob盹 127-128,

13311

median 植gjttal 阳:ti.on,

10/, 128/

ata画剧， 24-25

dor叫“pttt. ID/ 回缸na1 fatura,

113,

113乒114[.

胃’国I 町eel, 102耳 120/

臼meal reda,

Sl申目。b：阳al .up剧在 133/

Coronal, definition, 2 Corpora qua出igemina. 8

DecuRa即111of也z pyra皿de. E碍。g

Co，因 calloswn. 13-14, 1S耳

D睛’但rtbnll Wm. 6S

horizo血l 脏咀on.

matter. 137-140, 140b

倒回回1 ，制。鸟 1吁， 122/. 128/-129耳 143[.

dorsal tedlon. 123/

D回dr＜》dendritlc ll)'D甸回e, 33

Cerrica』 α，rd

P翩翩鸣声阳1 ”aion. 13/

cortico币na1 国血， 82[

c.oφω 附尬凶血＇ 19

dOI9lli colu皿a. 78/ rulm呻inal tract. 83/

c.o剧创l v回回岛 MIUaq闯~·峙，

“

17/

缸缸咀.onal IU1钮’“ 133f

cord, 68

°'

7'9f, 82/ 140/

臼皿coapinal tractι 82-83，但耳” transftISe 脏咀on. 94/

Cortkoatrlatal fib圃，

国皿回回阳:Ii盹 93/

65 lSo/ Ci!Wyga晤。n, 103/ Cilia哼皿lldt』 150, 150/ Ciliaiybc啡， 150,

Cingul眼睛饵 ’万 162/

medianaar)也l lledi。n. 128/

19/ median~臼l lledion. 128/ Cin醉lum, 156f Ciide of＼＼而llil, 12. 63

93/

apinal men旭棉 布， 7o/ tractll, 96

D回成ndlng 回到cul”p旭al brain皿盒m,

89

国mnal 植划an,

5/

144

splnoc:a:喧:bellar tracll,

82-84, 85& 16-19, 120, 12of CNS development. 7 国rly dt:9elopm四L 8/ Direct llgb.t reik鸟 1倪， 103/ Dien呻1halon,

臼ugh red鸥 1侃f

回国odated 翩旦回oiylo饵 ”b

αanial m四”.nges,

D呵国mine, 33-34 Donal a时uearnud凰凰 Om富al columns brainstem, 89

52-54, 5411 αanial ner叫’）， 3, 16, 19-2口， ” -ll2, lOOt cranial ner四 I, IOOt cr:anial ner四 n.-0p咀E ner鸭 aania1 ne!鸭皿皿 Oculomotm nerve Cllllllial ner四 IV. sa Trochlear llelft

α且醉l血 gyru鸟 19.f. 96/-97耳 156.f.

trans回rae tedion,

Den:世ul础 H伊血回L 伺f， πf

spinal 倒也 ”， 77/

hori2.o血I 阳也n.

由.oroidal 回n.

Cin醉l配皿』咽， 17-1.9,

93/

臼rtlro叩Ina! film国

旬，ddea

57-58

161-162, 1611'-16.劫，

回国－脏曲。n.

115[

D国cen曲tgtr.at:置，

C.Onk:opo111由tt fibn坞 ，。

14-15, 56乒57耳 65/

arebl'Ollpinal 姐回cl,

66/ rtloobulbar Ii.bra, major motor p姐回咽， 22f

回回再皿国ct. 84/

αm叫帽aion,

hori刷ttal 盹ctlon,， 且Sf

CNS development. 7-8

币且“四：bellar 田血 81/

Choroid pl回蝠，

咀!ral sula鸟 1雪f

multiple sci.er田峪 3Sb neum归thiu. 40b Demlrit盹 2-3, 3f Deftd丘tk arborita植on. 32, 32/ Dentate nucku.

阳嗣.gittal ，剧。也 13/

11吁， 127-140, 135耳 138b

!)ftp peron四I ~ 43/

m创恤’唰削阳lion, 1呼吁

曲。回d, IS日， 1坷

14-15, 15耳 SS, 5孚56/, 58/ 59.f. 89 细 CNS ck时句回缸”， 9/ coronal KCl匾。n. 131/ median B唔出l 旺tion. 11/. 121/ 1IllnsvaK ledion. 95/, 145/ 臼由ml cortex. 町’7.f. 115-117.

22f

paramedial ealP阳I Rdion, 53f

”ramedlal 蛐glttal 帽..:tion, 53/

C自由国叫U础c:t.

四阳 pathwaya,

啊泪缸ida, 8

n.euromusrular dis幽幽鸟 28-29, 28'1

四tral a，白马 1旷

D

M阻， 58/

8/ Charco(s joi且他 79b 由ief llelllOif nucleu鸟 1口6/ Cholecystokinin, 34 Oiorda tym归坷， lCYlf Chorea, 2’, 149b

阳”－·剧灿 ’矿

15'/

4翩且峭如 1391t

char回d piaus. 57-58

Qmeate 1ubm:I鸟 89

D咽町elina:tion

coronal MRI, 132/

Cer由rospinal 坦国d(C町， 57-58,

~dezur飞回rlyd凹dopment.

碍。四 localbati盹 14可

140/

56/-57耳 139耳 154[. 156/

Cerebral peduncle, 61/ Cerebral white E且t1£I; rqion.al loca且a咀on. 141/

11911 ln\emal strudUre of. 114-117,

m副翩 tagittal 阳U刷'I, 1（）.严llf

CSF.seeCer吐>rospinal 坦国4

an:咀U呻iDal tract鸟 ”，“f

Cer币cal enla电Dner吨咂na1

lateral a，配t, 10f I剧。”。t; 11911

回国1 sedio饵 ’l/

1IJ6/

cmonal s础。鸟 13o/

furu:tiona1 an血ω皿'f ~ 117-118,

回回国l lledion.

Come也 150, 15口f

cermaI hemiapher鸭 127

回现ib咀皿抖Dal tiadl也 85/

11号 117b

84/ 145/

127-128 币2目也ala皿k 国di, 7'J/ sulci, 127-128, 13311

咂血。也血皿k 国剧， 79/

11411

阳芷圄E血al traa,

国皿町alle sedion,

580

CNS de叫。pment. 7斗， 9{ 回nnections of 23/

spino也alamic traci:鸟 79/

prea盟缸:al Z归UI,

叫咀.te

113-118, 113/

rubrospinal 国坞 的f

归血皿edial z晤时脏lion, 53/

horizon·刨阳垣阻， 115/

c.erebellu皿， 7-3, 15耳 16,97且

140/

Corda臼my, 79b

Corona radi础， ”， 20/

。pera血， 127

回回Il1l asp盹 1叮－11/

缸咀盹 llS/

light ~ 102

70/

~缸sure, 口， 1呀， 127

coronal lledi·。n. 115/

Ca'd>dl叩ontiJK a昭ι 107

dorsal 配咀on. ’口f

midbrain, 20/

臼naensua1

115/

dorsal colWDI现 78/

Jo/

~aap叫 1吁， 127/

Ce:rel对Jar 叫:tltc matter.α)l'()nal

131/. 143/

∞皿ω咂皿al 田吗 82, 82/, 86/

扭.temal c:ap田ili』 127

WI思吨e a圃， 137

h饵ral upect. 113/ c.erebellar nuclQ， 且7 c.erebellar polll＇也e a唱也 56/ Ce:rel对Jar 回DDil. comnal lledi·。·n.

coron.al 幽:lion,

nn』mmuaa.tlar dhea跑 到，

major 配nsmypathw句’』 19-21,

SO

cru. cer由Ii, 90, 103/. 1σ厅， 163/

扭剧.tlaψ 127

major motor 归吐twayS, 21-23, 22f

Ce:rel对Jar hemitph~

89, 99-112 99 100

臼chlear nenoe. 10有f

h而.zon刨属缸岳阳， 18/

回ebral he:t血phere邑 127, 12万

af£er回t nuclei,

臼也lea,

F也 127-128

Jamal a哩回ct. 127/ median.唔出1 sectioJJ. 128/ Cephalic 坦aure. 8/

α也咀.al !lei四 nudd,

romn.al 拙函。n. 琐叼 127,

由国四ntticle,.

21/ neurological diseas鸟 23/ 四JO.tlamr‘~ 61-67 c:er血ahulClll鸟 17-19, 19/ 回ebral~ 19/

nerve entrapment, 24

面rona. radlat鸟 127

白血皿m 7-8, ’f

啊E血icle鸟 8

’阳帽咖liar 田啪 ”，侃f α佩蹄忧um

cranl.al M胃 XII. #II 可poglos副

Cranlal roots of aa:esaory neno也 叫

dor国I aa庐~ lo/

1/

E钮’也

cord dorsal horn. 74

CNS.-o曲时 n町’四”现em

曲时COip凶.al trac:I鸟 82/

9/

cranial !lei胃 X 且.. va,胆s nerve cranial !lei回 XI.JM/ta,国IOI)'

。“悔’•column

咽。叫 1。calisatlon, 14矿

t.e1白白，halon,

回回回lie 阻non,

54, 54f. 56f. 58/ 阴阳med!翩翩gittal.配tlon, S3f

p由1d阴l 由lei. 19/

叫剧。rcolliaJ.lu鸟 ’f

7

Clo蝇。＇Ph阳yn.萨al nerv琶

CQ民;emam唱:na.

128f二13项 138/

attlaJ11 limiwu马 5

。四且l ner回民刷

12, 63

国皿al llleI四 v. 翩，币1萨mina1

Abdw::ma

ne!\le

国Dial 11erTe VD.

lesioru』 78!1

major sensory pathw霄’』 20-21 111uclei, 20-21, 21/ spinal ami. 12-13, 14/. 77-78, 78/ Dmsalfi.皿kulu鸟，pinal rolumn, 72/ Donal(p回国ior) hoIJ坞，pinal OOI址，

l1eIVe

国Dial ner四 VI. -

107/

sa Fad.al ner回

国Dial llleI四 vm.M现ibulol:刀ch』田z na:四

7耳 12-13, 14耳 72f-73f.

73-74 D四ul mroian sula皿 'Pinalαml. 72 tnuJI\'四 lllped.

72f

Donal motor nudeul, of咽gu鸟 93 Donal ramua. apl.nal ner吼 叫

”ruaglual 眠tlon, 13/ 毡12/

Dor咀l rapht!nudew』 tr.um哩l1e

阳咀on, 叼

臼mmam创l)l n创m脯， 3呼吁，

Pasdcl髓。f倒回刷抖nal fibm, 79/, Pasdml田 ClUI国tu’

D回国I root 萨峭岛 68/ 酬.na.l am!, 7耳 12 13, 14/

doraal colum且.. 77 doraal 阻tlon, 89/ 叫or 9el1'0if pathway9.

酬nal nerv跑 回，可

国阳四 aealon， ’布

major 幽amy 归曲ways.

21.f

Donal1p凶al B四e roots, 68耳 6'J Dor咀I 馆gmen凶 decu且咀on,

84/

臼nlculate 伊lgllon. 20－组

Pasdml皿 gradlia doraal 幽.pert.

Duchenne m1』scular 句回盟”” 37b Dura mam, 8-口， 12/. 52, 53耳

sp旭al

r:onl. 13

transvene 阳重on,

92/

llasciallus propriu岛 77

spinal cord, t'lf,πf spine. 68／，可 国皿回'le lledion, 6可

l'laltlglal nuda鸟 horizontal 姐姐。盟，

65

o,skin国且， 29

pathways, 却， 21/

目。woe!"~ D~ ending鸟 ”， 38/,

74

E

民回1 田ebral

国ingu-Walphlli nuckua.

100-101,

lesion, 134b, 134/

Foram四 laamm,

Slf

Foia1Dm magnu:m』 50, 51/

101/-103/ 国m酣睡，a:)险。ri. 95f

l!ffectoro再plilll』 2

民IIlllII皿 magnu皿’咀mm岛 52b

autonomic navoua 句’但m. 46 nami1 tubι 万

FoialDm of Lu皿曲， 89-90 four也咽坦创de, SS FoialDm ofM笔~ 55 FoialDm of Monro, 55 FoialDm ova1e 50, 51/

眼nal 田地 7/

民IIlllilm rotun也皿， so

l!ffamt Daft mdi且， 38 回国四t neum画略 4.4/

咂皿l na:咽..

69

E:mboliform 皿deUI..

民m皿m spin幅um,

horizontlli

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