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FIFTH Neuroanatomy

EDITION

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Fifth edition

Copyright © 2016 Wolters Kluwer.

Copyright © 2009 Wolters Kluwer Health / Lippincott Williams & Wilkins. Copyright © 2005 Lippincott Williams & Wilkins, a Wolters Kluwer business. Copyright © 2000 by Lippincott Williams & Wilkins. Copyright © 1995 by Lippincott-Raven Publishers. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via our website at lww.com (products and services).

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I dedicate this work to my beloved wife, Marie. Your strength, courage, and love are the engine that moves our family forward and provides the foundation for our girls to grow into proud, strong women. I love you. Thank you.

Douglas J. Gould

I dedicate my contributions to this book to my son, Lincoln. You are the light of my life and you make each and every day meaningful and fun! You have already taught me a lifetime of lessons about love, life, and the importance of play in the short 9 1/2 months that we have had together and I am eternally grateful to you for that. I hope that we will have the blessed opportunity to share many more years learning from and loving each other. I love you to the moon and back, my sweet bunny.

Jennifer K. Brueckner-Collins

Contents ix

5MENINGES, VENTRICLES, AND

CEREBROSPINAL FLUID 36

Contents xi

16 BASAL NUCLEI AND EXTRAPYRAMIDAL MOTOR SYSTEM 120

17 CEREBELLUM 126

19 CROSS-SECTIONAL ANATOMY OF THE BRAIN 142

I Introduction 142

20 NEUROTRANSMITTERS 161

Appendix I: Table of Cranial Nerves 167

Appendix II: Table of Common Neurological Disease States 170

Glossary 173

Index 183

Anterior commissure

Septal

area

Medial hypothalamus

Amygdala

Stria Hippocampal

Mammillary terminalis formation body

Figure 1-4 Midsagittal section of the brain showing the components of the limbic lobe.

f.Limbic lobe (Figure 1-4)—a C-shaped collection of structures found on the medial hemispheric surface that encircles the corpus callosum and the lateral aspect of the midbrain. It includes:

●Paraterminal gyrus and subcallosal area—located anterior to the lamina terminalis and inferior to the rostrum of the corpus callosum.

●Cingulate gyrus lies parallel and superior to the corpus callosum and merges with the parahippocampal gyrus.

●Parahippocampal gyrus lies between the hippocampal and collateral sulci and terminates in the uncus.

●Hippocampal formation (Figure 1-5)—connected to the hypothalamus and septal area via the fornix.

g.Olfactory structures—found on the orbital (inferior) surface of the brain and include the following:

●Olfactory bulb and tract represent an outpouching of the telencephalon. The olfactory bulb receives the olfactory nerve (CN I).

●Olfactory trigone and striae

●Anterior perforated substance created by penetrating striate arteries.

●Diagonal band of Broca interconnects the amygdaloid nucleus and the septal area.

2.Basal nuclei (ganglia) (Figure 1-6) constitute the subcortical nuclei of the telencephalon and include:

a.Caudate nucleus—part of the striatum, together with the putamen.

b.Putamen—part of the striatum, together with the caudate nucleus and part of the lentiform nucleus along with the globus pallidus.

c.Globus pallidus—part of the lentiform nucleus, together with the putamen.

d.Subthalamic nucleus—part of the diencephalon that functions with the basal nuclei.

Figure 1-5 Horizontal section of the brain showing the components of the internal capsule.

Body of caudate nucleus

Stria terminalis

Thalamus

Head of caudate nucleus

Putamen

Globus pallidus

Amygdala

Tail of caudate nucleus

Figure 1-6 Schematic diagram of basal nuclei.

6Chapter 1

3.Lateral ventricles (see Figure 1-5)—ependyma-lined cavities of the cerebral hemispheres that contain CSF and choroid plexus. They communicate with the third ventricle via two interventricular foramina (of Monro) and are separated from each other by the septum pellucidum.

4.Cerebral cortex consists of a thin layer or mantle of gray matter that covers the surface of each cerebral hemisphere and is folded into gyri that are separated by sulci.

5.White matter includes the cerebral commissures and the internal capsule.

a.Cerebral commissures (see Figure 1-2) interconnect the cerebral hemispheres and include the following structures:

●Corpus callosum—the largest commissure of the brain and it interconnects the two hemispheres. It has four parts, including the rostrum, genu, body, and splenium.

●Anterior commissure—interconnects the olfactory bulbs with the middle and inferior temporal lobes.

●Hippocampal commissure (commissure of the fornix)—located between the fornices and inferior to the splenium of the corpus callosum.

b.Internal capsule (see Figure 1-5) consists of the white matter located between the basal nuclei and the thalamus. It has five parts:

●Anterior limb—located between the caudate nucleus and putamen and contains a mixture of ascending and descending fibers.

●Genu—located between the anterior and posterior limbs and contains primarily the corticonuclear (corticobulbar) fibers.

●Posterior limb—located between the thalamus and lentiform nucleus (comprising the putamen and the globus pallidus) and is primarily made up of corticospinal fibers.

●Retrolenticular portion—located posterior to the lentiform nucleus and contains the optic radiations.

●Sublenticular portion—located inferior to the lentiform nucleus and contains auditory radiations.

B.Diencephalon (see Figures 1-2 and 1-7) receives the optic nerve (CN II) and consists of the following structures:

1.Epithalamus

2.(Dorsal) Thalamus—separated from the hypothalamus by the hypothalamic sulcus.

3.Hypothalamus (Figure 1-8)

4.Subthalamus (ventral thalamus)—inferior to the thalamus and lateral to the hypothalamus.

5.Third ventricle and associated structures.

C.Mesencephalon (Midbrain) (see Figures 1-7 and 1-8)—located between the diencephalon and the pons and contains the cerebral aqueduct interconnecting the third and fourth ventricles.

1.Anterior surface

a.Cerebral peduncle

b.Interpeduncular fossa

i.Oculomotor nerve (CN III)

ii.Posterior perforated substance—created by the penetrating branches of the posterior cerebral and posterior communicating arteries.

2.Posterior surface

a.Superior colliculus (visual system)

b.Brachium of the superior colliculus

Figure 1-8 Anterior surface anatomy of the brainstem.

c.Cranial nerves, including glossopharyngeal nerve (CN IX), vagus nerve (CN X), (spinal) accessory nerve (CN XI), and hypoglossal nerve (CN XII)

2.Posterior surface

a.Gracile tubercle

b.Cuneate tubercle

c.Rhomboid fossa

i.Striae medullares of the rhomboid fossa

ii.Vagal trigone

iii. Hypoglossal trigone

iv.Sulcus limitans

v.Area postrema (vomiting center)

F.Cerebellum (Figures 1-7 and 1-9)—located in the posterior cranial fossa, attached to the brain-

stem by three cerebellar peduncles. It forms the roof of the fourth ventricle. It is separated from the occipital and temporal lobes by the tentorium cerebelli and contains the following surface structures/ parts:

1.Hemispheres consist of two lateral lobes.

2.Vermis

3.Flocculus and vermal nodulus form the flocculonodular lobule.

4.Tonsil is a rounded lobule on the inferior surface of each cerebellar hemisphere. With increased intracranial pressure, it may herniate through the foramen magnum.

5.Superior cerebellar peduncle connects the cerebellum to the pons and midbrain.

6.Middle cerebellar peduncle connects the cerebellum to the pons.

7.Inferior cerebellar peduncle connects the cerebellum to the pons and medulla.

8.Anterior lobe lies anterior to the primary fissure.

9.Posterior lobe is located between the primary and posterolateral fissures.

10.Flocculonodular lobe lies posterior to the posterolateral fissure.