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NeuroanatomyNeuroanatomyXiangya
2nd
HospitalZhang
HeRunner
up
in
Anatomical
Society
Best
Image
Award2013.
Axial
diffusion-weighted
MRI
tractographyimage
of
living
human
brain.Afferent
nucleiGeneral
sensory
information
(touch,
pressure,pain,
temperature)
from
head
to
pons
andterminate
in
trigeminal
sensory
nucleus
(largenucleus
run
whole
brainstem
and
cervical
cord).Special
sense
of
motion/position
andhearingterminate
in
vestibular
and
cochlear
nuclei
inmedulla.Visceral
afferent,
including
taste,
terminate
innucleus
solitarius
of
medulla.Efferent
nucleiOn
basis
of
embryological
derivation,
efferentcranial
nerve
nuclei
divided
into
three
groups
indiscontinuous
longitudinal
column.Nuclei
of
the
somatic
efferent
cellcolumnOculomotor
nucleus
to
IIITrochlear
nucleus
to
IVAbducens
nucleus
to
VIHypoglossal
nucleus
to
XIINuclei
of
the
branchiomotor
cell
columnInnervate
striated
muscle
derived
frompharyngeal
arch(咽弓)in
human
and
branchialarch(鳃弓)infish.(also
special
visceral
efferent)Trigeminal
motor
nucleus
to
VFacial
motor
nucleus
to
VIINucleus
ambiguus
to
IX,
Xcranial
part
of
XINuclei
of
parasympathetic
cell
columnEdinger–Westphalnucleus
to
IIISuperior
salivatory
nuclei
to
VIIInferior
salivatorynuclei
to
IXDorsal
motor
nucleus
of
vagus
to
X(in
vagus
distributed
to
thoracic
and
abdominal
viscera)III:
Oculomotor
nerveInclude:General
somatic
efferentGeneral
visceral
efferentOcularmotor
nucleus
supply
levator
palpebrae
superioris
andsuperior
rectus
(Superior
branch),
medial
rectus,
inferior
rectus,and
inferior
oblique
muscles
(Inferior
branch).EW
nucleus
supply
parasympathetic
fiber
to
eye
via
ciliaryganglion
to
control
sphincter
pupillae
muscle
(affecting
pupilconstriction)
and
ciliary
muscle
(affecting
accommodation).Pupillary
light
reflex
Pretectal
nucleus
project
crossed
and
uncrossed
fibers
toipsilateral
and
contralateral
EW
nuclei.Accommodation
reflex
Nearby
object,
visual
cortex,
corticobulbar,
optic
axis
convergent,EW
nuclei,
iris
constriction.Short
ciliary
nerveDirect
light
reflexConsensual
light
reflexPretectalnucleusPathways
in
Ciliary
ganglionParasympathetic,
Sympathetic,
Sensory
nervesClinical
significanceParalysis
of
oculomotor
nerve
due
to:Direct
traumaDemyelinating
disease
(e.g.,
multiple
sclerosis)Increased
intracranial
pressure
(leading
to
uncal
herniation)due
to
a
space-occupying
lesion
(brain
cancer)
or
SAH
(aneurysm)Microvascular
disease
(diabetes)In
diabetes
or
older,
oculomotor
palsy
with
sparing
ofpupillary
reflex
due
to
fiber
controlling
pupilsuperficial
and
spared
from
ischemia
of
diabetes.Conversely,
aneurysm
compress
oculomotor
nerveaffect
superficial
fiber
manifest
as
III
nerve
palsy
withloss
of
pupillary
reflex.IV:
Trochlear
nerveUnique
among:Smallest
nerve
containing
axon.Greatest
intracranial
length.Only
cranial
nerve
exit
from
dorsal.Lesion
of
nucleusaffect
contralateral
eye
while
allothernuclei
ipsilateral.Innervating
muscle
on
opposite
side.Clinical
significanceExamination:Look
'down
and
in'
for
exam
superior
oblique,
Alsoask
reading
newspaper
or
walking
down
stairs.(Vertical
diplopia
and
Torsional
diplopia)Causes:Peripheral
lesion:
acute
palsy
is
head
trauma
stretchor
compress.
Chronic
palsy
is
congenital
IV
nerve
palsywhen
compensation
fail.Central
lesion:
is
to
nucleus.
Cortical
control
of
eye movement
(saccades,
smooth
pursuit)
is
conjugate gaze,
not
unilateral
eye
movement.VI:
Abducens
nerveCauses:Peripheral
lesion:
compress
or
damage;
most
common
isdiabetic
neuropathy;
Rare
cause
are
Wernicke
and
Tolosa
Hunt.“False
localizing
sign”:
right-sided
nerve
palsy
does
notnecessarily
imply
a
right-sided
cause.Nuclear
lesion:Dorsal
pons:
VI+VII;Ventral
pons:
VI+corticospinal;Nucleus
has
two
cells:motor
neuron
to
lateral
rectus
muscle,Interneuron
by
medial
longitudinal
fasciculusSupranuclear
lesion:
bilateralClinical
significanceLesion
of
cranial
nerve
III,
IV,VIV:
Trigeminal
nerve
(Largest
cranial
nerve)Sensory
nerve
for
head,
Motor
for
mastication.Trigeminal
nucleus
receive
differenttype
of
sensory
information:Spinal
trigeminal
nucleus
receivepain-temperature
fibers;Principal
sensory
nucleus
receivetouch-position
fiber;Mesencephalic
nucleus
receiveproprioceptor
andmechanoreceptor
fiber
from
jawand
teeth.Spinal
trigeminal
nucleusRepresent
pain-temperature
sensation
from
face.
Pain-temperature
fiber
from
peripheral
nociceptor
carriedin
V,VII,
IX,
X.Somatotopic
representationWithin
spinal
trigeminal
nucleus,
information
isrepresented
in
an
onion-skin
fashion.Spinal
trigeminal
nucleus
send
pain-temperature
tothalamus,
mesencephalon,
reticular
formation.The
latter
pathway
is
analogous
to
spinomesencephalicand
spinoreticular
tract.
Mesencephalon
modulate
painfulinput
before
reach
level
of
conscious.
Reticular
formationresponsible
automatic
(unconscious)
orientation
of
body
topainful
stimuli.Principal
nucleusRepresent
touch-position
from
face
and
mouthvia
V,
VII,
IX,
X.Analogous
to
dorsal
column
nuclei(gracile
and
cuneate
nuclei)
of
spinal
cord.Touch-position
from
teeth
and
jaws
of
onesiderepresent
bilaterally
to
thalamus
and
cortex.Position,
refer
to
conscious
proprioception.Proprioceptor
(muscle
spindle
and
Golgi
tendon
organ)for
joint
position
and
muscle
movement.Unconscious
level
(by
cerebellum
and
vestibular
nuclei)Mesencephalic
nucleusNot
a
true
nucleus
but
sensory
ganglion
(liketrigeminal
ganglion)
embed
in
brainstem.
This"internal
ganglion"
cells
discovered
by
medicalstudent
Sigmund
Freud.Two
type
of
sensory
cells:Proprioceptor
from
jaw;
Mechanoreceptor
from
teeth.Automatic
biting,
chewing,
swallowing
requirelittle
conscious
and
involve
sensory
component(touch-position
feedback)
process
at
unconscious
levelin
mesencephalic
nucleus.Touch-position
from
body
sent
to
ventralposterolateral
nucleus
(VPL)
of
thalamus
andface
to
ventral
posteromedial
nucleus
(VPM).Then
project
to
parietal
lobe
somatotopically
as"little
man".Pain-temperature
sent
to
VPL
(body)
and
VPM(face).
Also
to
other
thalamic
nuclei
and
projectto
insular
and
cingulate
for
simultaneousperception
(sight,
smell,
taste,
hearing
andbalance)
in
memory
and
emotional
state.From
Muscle
of
masticationTemporomandibular
jointRelayedfrom
face,
scalp,cornea,nasal
oralcavity,
teeth,
paranasalsinus,
intracranial
dura
and
arteryTo
substantia
gelatinosain
cord,
considered
to
bebrainstem
homologueTrigeminal
lemniscusTrigeminalmotor
nucleusTo
masticate
(masseter
andtemporalis
to
close
jaw,lateralandmedialpterygoid翼to
open
jaw)Also
innervate
tensortympani(鼓膜张肌)within
middle
earAnalogous
to
spinaldorsalroot
gangliaSubstantia
gelatinosa(脊髓胶状质)in
lamina
I–III,receive
smallest
myelinated
(A
delta)andunmyelinated
(C)nociception
afferent
withglutamic
acid
and
substance
P
as
transmitter
toascending
spinothalamic,
spinoreticular
tract.眼轮匝肌V
from
nasal
mucosaX
from
larynx
and
tracheaVII:
Facial
nerveFacial
nerve
contain
motor(medial
root)
,sensory
and
parasympathetic
(lateral
root).Sensory:
geniculate
ganglionfor
taste
to
nucleussolitarius
of
medulla
project
to
thalamus
and
parietallobe.Motor:
facial
motor
nucleus
of
pons
looping
overabducens
nucleus
to
muscle
of
facial
expression.Parasympathetic:
superior
salivatory
nucleus
of
ponssubmandibular
and
pterygopalatine
ganglia.Facial
motor
nucleus
receive
afferentsfrom:Cerebral
cortex:
to
upper
face
musclebilateral
and
lower
face
unilateral.Reflex
connection:to
protective
eye
closurein
response
to
visual
stimuli(superiorcolliculus),
tactile
corneal
reflex
(trigeminalsensory
nucleus), stapedius
muscle镫骨肌
contact
to
loud
noise
(superior
olivarynucleus).翼腭神经节镫骨肌鼓索茎乳孔VIII:VestibulocochlearnerveSensorynerveconveyimpulse
from
inner
earVestibular
nerve
forposition
and
movementofhead;Cochlear
nerve
forauditory
information.Vestibular
nerveVestibular
nerve
make
dendritic
contact
withhair
cell
of
vestibular
portion
of
membranouslabyrinth;Vestibular
ganglion
in
internal
auditory
meatus;Vestibular
system
locate
in
inner
ear
withbipolar
ganglion
extend
to
five
sensory
organs.End
in
four
vestibular
nuclei
(superior,
inferior,medial
and
lateral
vestibular
nuclei)
in
medulla.Vestibular
nerve
transmit
sensory
information
byhair
cell
locate
in
two
otolith
organ耳石(utricle椭圆囊
and
saccule球囊)and
three
semicircular
canal
viavestibular
ganglion.Otolith
organ
reflect
gravity
and
linearacceleration
of
head.Semicircular
canal
reflect
rotational
movementofhead.Both
necessary
for
sensation
of
bodypositionand
gaze
stability
to
moving
environment.Vestibular
nuclei
to
other
regions:To
vestibulospinal
tract
for
body
posture.To
vestibulocerebellum
(flocculonodular
lobe)for
equilibrium.To
abducens,
trochlear
and
oculomotor
forcoordination
of
head
and
eye
movement
viamedial
longitudinal
fasciculus.To
thalamus
and
cortex
for
consciousawareness
of
vestibular
sensation.Vestibulo-ocular
reflexRotation
of
head
triggerinhibitory
signal
toextraocular
muscle
onone
side
and
excitatorysignal
to
the
other.Result
is
compensatorymovement
of
eye.CochlearnerveHair
cell
of
organ
of
Corti
activate
receptor
inresponse
to
pressure
wave
via
transduction
ofsound
to
spiral
ganglia
of
innerear.Nerve
bifurcate
and
end
in
dorsal
and
ventralcochlear
nuclei,thenascending
auditorypathway
to
thalamus
and
Wernicke
area.Unilateral
lesion
of
auditory
pathway
do
notcause
monaural
deafness,
but
manifest
as
lossofauditoryacuityand
inability
tolocalizedirectional
origin
of
sound.Descending
auditory
pathway:Olivocochlear
fibre
(橄榄耳蜗系统)leave
from
superiorolivary
nucleus
in
vestibulocochlear
nerve
and
end
inorgan
of
Corti.Medial
olivocochlear
system
(MOCS)
is
prior
tolateral
olivocochlear
system
(LOCS)
for
itsmyelinatedfibre
easier
to
electrically
stimulate
and
record.Hypothesis
of
MOCS
in
three
category:Protect
cochlear
against
loud
sound;Development
of
cochlea
function;Detection
and
discrimination
of
sound
in
noise.Organ
of
Cortior
spiral
organHigh-frequencyIntermediate
frequencyLow-frequencyHidden
withinlateral
fissureWernicke
areaAuditory
information
contextualinterpretIX:
GlossopharyngealnervePrincipally
sensory;Also
parasympathetic;A
few
motor.Sensory:Sensation
in
pharynx,
posterior
third
oftongue, Eustachian
tube
and
middle
earTaste
of
pharynx,
posterior
third
of
tongueChemoreceptor
in
carotid
body
andbaroreceptor
in
carotid
sinus.motor
:nucleus
ambiguus
tostylopharyngeusfor
swallowing
(茎突咽肌辅助喉头上升).Parasympathetic:inferior
salivatory
nucleusto
otic
ganglion耳then
parotid
salivary
gland唾液腺.呕吐X:
Vagus
nerveAfferent,
Motor:Parasympathetic:From
dorsal
motor
nucleus
ofvagus,
To
cardiovascular,respiratory,
gastrointestinal.Also
sympathetic
role
byactivation
of
chemoreceptordue
to
hypoxemia
enablevasoconstriction
and
increaseblood
pressure.Afferent
fibre
of
vagus:General
sensation
from
pharynx,
larynx,oesophagus,
tympanic
membrane,
external
auditorymeatus
to
trigeminal
sensory
nucleus;Chemoreceptor
in
aortic
body,
baroreceptor
inaortic
arch,
receptor
throughout
thoracic
abdominalviscera
end
in
nucleus
solitarius.Motor
fibre
of
vagus:From
nucleus
ambiguus
to
softpalate,
pharynx,larynx,
upper
oesophagus
to
control
of
speech
andswallowing.XI:
Accessory
nervePurely
motor,
innervated
by
bilateral
cortex.Cranial
root
of
accessory
nerve
origin
fromnucleus
ambiguus.
At
jugular
foramen
joinvagus
nerve
to
soft
palate,
pharynx,
larynx.Spinal
root
arise
from
C1-C5
spinal
greymatter.
Not
via
ventral
root
but
enter
cranialcavity
through
foramen
magnum.
Then
joinwith
cranial
root
leave
cranial
cavity
throughjugular
foramen.Moveheadand
shoulderXII:
Hypoglossal
nervePure
motor
in
function.Hypoglossal
nucleus
to
extrinsic
andintrinsicmuscle
of
tongue
to
move
and
change
shape.From
reticular
formation,
involuntary
andunconscious
movement
of
speech,
articulation,swallowing
to
clear
mouth
of
saliva.Innervation
of
hypoglossal
nucleus
from
motorcortex
is
bilateral,但主管伸舌作用的颏舌肌由对侧大脑皮质支配.From
nucleus
solitarius
and
trigeminalsensory
nucleus
for
reflex
of
chewing,sucking
and
swallowing.Also
from
corticobulbar
fibre
to
voluntarymovement
of
tongue
in
speech.Signal
from
muscle
spindleon
the
tonguetravel
through
hypoglossal
nerve,
movingonto
lingual
nerve
which
synapse
ontrigeminal
mesencephalic
nucleus.Control
equilibrium,
posture,
muscle
tone,coordination
at
an
unconscious
level.Connect
medulla,
ponsandmidbrainbyinferior,middle
and
superior
peduncle.Consist
medial
vermis
and
lateral
hemisphere.Divided
anterior,
posterior,
flocculonodularlobes.Primary
fissure
divide
small
anterior
lobe
and
larger
posterior
lobe.Posterolateral
fissure
demarcate
flocculus
(hemisphere)
and
nodule(vermis),
together
form
flocculonodular
lobe.Cerebellar
cortexAfferent
to
cerebellum
from
(extracerebellar):Spinal
cord
(spinocerebellar
fibre),Inferior
olivary
nucleus
(olivocerebellar
fibre),Vestibular
nuclei
(vestibulocerebellar
fibre)
,Pons(pontocerebellarfibre)Also
afferent
from
(intracerebellar):Purkinjecell
(of
cerebellar
cortex)Efferent
from
cerebellum
to:Reticular,
vestibularnuclei
(of
medulla,
pons),Red
nucleus
(ofmidbrain),Thalamus
ventral
lateral
nucleus.Origin
of
cerebellarefferent
fibre顶核Based
upon
phylogenetic,
anatomical
and
functional:Archicerebellum
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