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Anatomy

6.1

January 24, 2012


Dra. Sta. Ana

Development of CNS and Meninges


OUTLINE
I. Development of the CNS

a. Spinal Cord

b. Medulla Oblongata

c. Pons

d. Cerebellum

e. Midbrain

f. Forebrain

g. Cerebral Hemisphere

h. Clinical Correlation
II. Meninges

a. Types/Layers

b. Septa

c. Dural Venous Sinus

d. Arachnoid

e. Pia Mater

f. Meninges of the Spinal Cord

g. Clinical Considerations
III. Ventricular System
IV. Cerebrospinal Fluid
V. Spinal Cord Barrier (BBB)

Primary
Vesicle

Forebrain
Vesicle

Midbrain
Vesicle

Hindbrain
Vesicle

*In ITALICS are notes mentioned by the lecturer.

ENDODERM
MESODERM
ECTODERM

GERM CELL LAYER


GIT, Lungs, Liver
Muscle, CT, Vascular System
Nervous System

Development
Beginning of the third week as a slipper-shaped plate of thickened
ectoderm, the neural plate, in the middorsal region in front of the
primitive node
Elevation of lateral edges forming neural groove and neural folds
Fusion of Neural folds forming the Neural tube
o Neural tube closes around 4 weeks
o Sinks beneath surface of ectoderm (neural crest is now b/n
surface ectoderm and neural tube)
o Fusion begins in the cervical region to the caudal positions
o Cranial Neuropore(temporary anterior opening formed by neural
tube closes at 25th day)
o Caudal Neuropores (temporary posterior opening formed by
neural tube closes at 27th day)

Prosencephalon
(FOREBRAIN)
(5 Week OLD
embryo)

Mesencephalon
(MIDBRAIN)

Rhombencephalon
(HINDBRAIN)

2 Division

Adult Structures

telencephalon

Cerebral
hemisphere,
basal ganglia,
hippocampus
Thela -/
hypothalamus,
pineal body,
infundibulum
Tectum
Tegmentum
Crus Cerebri
Pons
Cerebelum
Medulla
oblongata

diencephalon

Metencephalon
Myelencephalon

Rhombencephalic isthmus deep furrow that seperates the


mesencephalon from the rhombencephalon
Pontine Flexure boundary b/n metencephalon and
myelencephalon
Central Canal lumen of the spinal cord
o Cont. w/ the brain vesicle
th
Cavity of Rhombenceph = 4 ventricle
rd
Diencephalon = 3 ventricle,
rd
th
** Lumen of mesencephalon connects 3 and 4 ventricle (this lumen
becomes very narrow and is then known as the aqueduct of Sylvius)
Cerebral hemisphere = lateral ventricles

Figure 1. Development of the CNS

1 Division

Figure 2. Formation of vesicles

Group 22 | Hidalgo, E., Hidalgo, J., Homol, H. Hugo, P.,Inandan, D., Inciong, M., Jeanjaquet, K., Jimenez, J.


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Simultaneous to the formation of the primary division, it also forms 2


flexures
Cervical flexure at the junction of the hindbrain and the spinal cord
Cephalic flexure in the midbrain region

Anterior median Fissure deep longitudinal groove formed from


the continued growth of the basal plates
Posterior Median Septum walls of the posterior portion of tubes
that fused
Central Canal - lumen of the neural tube

SPINAL CORD
Neuroepithelial cells wall of the closed neural tube
o Extends over entire thickness which forms a thick
psuedostratified epithelium
o During closure of tube, cells divide rapidly.
o Collectively known as the neuroepithelium
o Referred to as the ventricular zone
o Nuclei move in toward the cavity of the tube to divide and out
toward the periphery
Neuroblast
o Large round nucleus, pale nuceloplasm and dark staining nucleus
o Primitive nerve cell
o Repeated division of the matrix cell
o Migrates peripherally to form the mantle layer which later forms
the gray mater of the spinal cord (intermediate zone)
o As the neuroblast grows peripherally and gives rise to nerve
fibers, it forms the marginal zone, which becomes the white
mater
Matrix cells also forms astrocytes and oligodendrocytes
Microglia cells migrate into the developing spinal cord from the
mesenchyme along with the blood vessels
Ependymal cells formed from the matrix cells that line the neural
tube

Figure 3. Neuroblast migration and proliferation


**Continuous proliferation of the neuroblast narrows the neural tube
forms a dorsiventral cleft with thick lateral walls and thin floors and
roof plates.

Basal Plate large anterior thickening formed in the intermediate
zone of the lateral wall of tubes
o Neuroblast becomes Motor cells of the anterior horn
Alar Plate small posterior thickening
o Neuroblast becomes sensory cells of the posterior horn
** Sulcus limitans separates basal plate and alar plates

Figure 4. Formation of the spinal cord


st
Neural Crest Cells 1 afferent sensory neurons
o Migrate into a posterolateral postitionn and becomes cell clusters
Cell clusters will become neuroblast
Neuroblast develops
o Peripheral Process - Joins the anterior root to form the spinal
nerve. Grow out laterally and becoming typical axons of sensory
nerve fibers
o Central Process - Posterior root of spinal n.
Axons that grow into the posterior part of the developing
spinal cord
Either ends in posterior gray column or ascends through the
marginal zone to one of the higher brain centers
Capsular or Satellite cells
Surrounds the unipolar nerve cell bodies in a ganglion
Formed by some of the neural crest cells
**Posterior root of ganglion = unipolar neurons + capsular cells

Development of Meninges
o 3 layers of meninges = formed from the mesenchyme (sclerotome)
that surrounds the neural tube
o First two months of intra uterine life = spinal cord has the same
length with vertebral column

**the vertebral column grows faster**
@ birth = coccygeal end of cord @ L3
Adult = lower border of of L1

Filum Terminale pia mater that extends downward as a slender
fibrous strand from the lower end of the cord to the coccyx
Cauda Equina anterior and posterior spinal nerves + filum terminale
that occupies the lower end of vertebral canal (L3-L4, L4-L5)

In this region, below the level of the lower end of the spinal cord
that a spinal tap can be performed

Group 22 | Hidalgo, E., Hidalgo, J., Homol, H. Hugo, P.,Inandan, D., Inciong, M., Jeanjaquet, K., Jimenez, J.

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Subarrachnoid space cavity in the messenchyme, which becomes


filled with CSF
Ligamentum denticulatum formed from areas of condensation of the
mesenchyme
Cervical and Lumbar Enlargements swollen spinal cords in the area
th
due to development of limb buds during the 4 month

MEDULLA OBLONGATA

Figure 6. Formation of pons

Pontline nuclei
CN of Alar + CN of Basal
Axons grow transversely to enter the developing cerebellum of the
opposite side
Forms transverse pontline fibers & middle cerebellar peduncle

Figure 5. Development of the Medulla Oblongata


As development proceeds, alar plates becomes lateral to the basal
th
plates due to increasing size of 4 ventricle

Basal plate motor nuclei (CN IX to XII) become situated in the floor
th
of the 4 ventricle medial to the sulcus limitans
Alar plate sensory nuclei (CN V, VIII, IX and X) + gracile and
cuneate nuclei; olivary plate other cell that migrate ventrolaterally

Roof plate becomes stretched into thin layer of ependymal tissue-
*formed by choroid plexus

Pia Mater = vascular mesenchyme lying in contact with the outer
surface of the roof plate
Tela choroidea = roof plate + pia mater
Choroid plexus formed by vascular tufts of tela choroidea that
th
projects into the cavity of the 4 ventricle
th th
At 4 -5 month:
-produces CSF
-foramen of luschcka
-foramen of magendi
-CSF passes into subarachnoid space

Floor remains narrow and forms the region of the median sulcus

Pyramids prominent swelling of descending axons of the precentral
gyrus of in the marginal layer on the anterior portion of the anterior
aspect of the medulla

PONS

Arises from the anterior part of metencephalon


But also receives some cells from the alar part of
myelencephalon
Basal plates- CN V, VI and VII
Alar plates- CN V, VII and VIII; pontine nuclei

CEREBELLUM

Figure 7. Devt of the Cerebellum


Formed from the posterior part of the alar plates of
metencephalon
Bends medially forming Rhombic lips
th
As it enlarges, it moves caudally over the roof plate of 4 ventricle
and unites at the midline
Vermis small middle portion @ 12 week
o Fissures also arise
Cerebellar hemisphere formed lateral to vermis. Initially appeared
as lateral swellings
th
4 month of development- Fissures appear that gives rise to folia
appearance. .




Group 22 | Hidalgo, E., Hidalgo, J., Homol, H. Hugo, P.,Inandan, D., Inciong, M., Jeanjaquet, K., Jimenez, J.

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Cerebellar cortex neuroblast derived from matrix cells of ventricular


zone that migrate toward the cerebellum
Dentate other neuroblast that remain close to the ventricular
surface

From the midbrain vesicle


Neural cavity decrease in size because of thin size of marginal zone
Cavity becomes cerebral aqueduct / aqueduct of sylvius
rd
th
Neuroblast of basal plates = nuclei of 3 and 4 cranial nerves, red
nuclei, substantia nigra and reticular formation
Alar plates + roof plate = tectum
Anterior portion of midbrain (Basal) is swollen- part of marginal
zone /white matter which contains traversing axonal fibers than
contain the corticobulbar, corticospinal, corticopontine tracts.
Alar superior colliculus visual; Inferior colliculus auditory

Superior and inferior colliculi
Alar neuroblast
Four swellings on the posterior surface of midbrain
Superior visual reflex
Inferior Auditory reflex

th
4 cranial nerve fibers emerge on the posterior surface of the
midbrain and decussate completely in the superior medullary velum
rd
3 cranial fibers emerge anterior surface b/n cerebral peduncles

FOREBRAIN

Figure 8. Cerebellar peduncles. Three cerebella peduncles connecting


the cerebellum to the rest of the central nervous system.
Superior Cerebellar Peduncle axon/nerve fibers that run grow out
into the mesencephalon into the forebrain. Connect the cerebelleum
to the midbrain.
Middle cerebellar peduncle connection of the axons of
pontocerebellar fibers + corticopontine fibers (connects cerebral
cortex to cerebellum)
o Superior & middle Cerebellar peduncles connect the cerebellar
cortex to the midbrain and forebrain .
Inferior cerebellar Peduncle from sensory axons of spinal cord,
vestibular nuclei and olivary nuclei. Connect cerebellar cortex to the
spinal cord

MIDBRAIN

Figure 9. formation of the midbrain

Figure 10. formation of the forebrain


From the forebrain vesicles
Formation of lateral diverticulum optic vesicle
Optic vesicle + stalk = retina & optic nerve

Telencephalon
Lies rostral to the optic vesicles
Develops a lateral diverticulum on each side of cerebral hemisphere
(cavity will become lateral ventricle)

rd
**anterior part of 3 ventricle = medial part of telencephalon and
ends at the lamina terminalis (rostral end of neural tube)

Interventricular foramen (of Monro) opening into each lateral
ventricle. Connect lateral ventricles to the third ventricle.

Diencephalon
rd
Cavity forms the greater part of 3 ventricle
Pineal body small diverticulum immediately anterior to the
midbrains at the roof
rd
Choroid plexus of 3 ventricle remainder of the roof
Thalamus thickening of the alar plates on each side

Group 22 | Hidalgo, E., Hidalgo, J., Homol, H. Hugo, P.,Inandan, D., Inciong, M., Jeanjaquet, K., Jimenez, J.

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Medial and lateral geniculate bodies solid buds posterior to the


thalamus
Interthalamic conncetions of grey mater fusion of two thalami in
some individuals.
Hypothalamic nuclei lower part of the alar plate
Mammillary body rounded swelling on the side of the midline of
the inferior surface of hypothalamus
Infundibulim develops from the floor of diencephalon
rd
Continues rest of 3 ventricle

CEREBRAL HEMISPHERE
External capsule cortical projection fibers that pass lateral to the
lentiform nuclei

Figure 12. lateral view of the brain


Insula fixed area of the cortex covering the lentiform nucleus
o Becomes curved under lateral sulcus

Figure 11. Devt of the cerebral hemisphere


th
Arises from the 5 week of dev
As expands superiorly, walls will thicken and interventricular
foramen becomes reduced
I condensation of the mesenchyme b/n each cerebral hemisphere
Formation of lobes: (in order)
1. Frontal
2. Parietal
3. Occipital
4. Temporal
Choroid plexus of lateral ventricle ependymal cells + vascular
mesoderm
Tentorium cerebella condensation of the mesenchyme that
separates occipital lobe from cerebellum
Corpus striatum projection of neuroblast that encroaches on the
cavity of the lateral ventricle
Differentiates into:
o Caudate nucleus dorsomedial portion
o Lentiform nucleus ventrolateral potion; divides into
Putamen lateral part
Globus pallidus medial part
**caudate nucleus + lentiform nucleus= corpus striatum
**caudate nucleus and thalamus in close contact
Hippocampus longitudinal thickening in the wall of the forebrain
vesicles that protrudes into the lateral ventricle
Internal capsule - compact bundle of ascending and descending
tracts; neuronal fibers that pass (medially) between the caudate
nucleus and thalamus; and laterally the lentiform nucleus.

Figure 13. Insula

CEREBRAL CORTEX
COMMISSURES
Lamina terminalis bridge b/n two cerebral hemisphere; enables
nerve fibers to pass from one cerebral hemisphere to the other
ANENCEPLAHLY
o w/o cranial vault
o large and ant. Of brain is absent
st
Anterior commissure 1 commissure to develop
o runs in the lamina terminalis
o Connects the olfactory bulb and the temporal lobe of the cortex
Fornix
nd
o 2 to develop
o Connects the cortex of the hippocampus in each hemisphere
Corpus callosum
rd
o Largest and most important commissure, 3
o Connects the frontal lobes and later the parietal lobes
rd
o Arches back over the 3 ventricle
Septum pellucidum
o remains of lamina teminalis
o lie b/n corpus callosum and fornix
o thin septum
Optic chiasma
o Formed in the inferior part of the lamina terminalis
o Contains fibers from the medial halves of the retinae
o Passes to lateral geniculate body and superior colliculus


Group 22 | Hidalgo, E., Hidalgo, J., Homol, H. Hugo, P.,Inandan, D., Inciong, M., Jeanjaquet, K., Jimenez, J.

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CLINICAL CORRELATION
Spinal Bifida
Failure of mesenchyme (located bet. surface of ectoderm and
neural tube) to form vertebral arches and spine.
Opening/Defect in the Post. Vertebral canal .
Meninges ,CSF & spinal cord herniates
Usually found in lower thoracic, lumbar & sacral regions
1. Occulta



Figure 14. Occulta
ventral canal open posteriorly (arches and spine)
covered by posterior vertebral ms.
Manifestations: usually tuft of hair in lower lumbar region or fatty
tumor
Usually symptomless b/c spinal cord & cauda equina is within its
normal location.
No treatment needed: incidental finding on xray
2. Meningocele


Figure 15. Meningocoele
cystic swelling containing meninges
o herniates through defect
o CSF abundant
Spinal cord, nerves usually normal
Surgery for treatment
3. Myelomeningocele

meninges + neural tissue (spinal cord and . or nerve roots affected)


o adherent to the sac
surgery for treatment

Anencephaly
W/o cranial vault
Large part of brain absent
Abundant or high fluid volume in skull
Brain and cranial vault
Failure of Rostral end of neural tube to close (cause)
Optic nerve absent
Neural tube opens at cervical end
Diagnose: womb ultrasound/xray
Still born babies or baby dies shortly after birth

Figure 17. Anencephaly

Hydrocephalus
Noncommunicating Hydrocephalus
th
Blockage between choroid plexuses and the apertures of the 4
ventricle.
aqueduct stenosis
masses
haematoma, intraventricular
tumors
abscesses
atresia of apertures
Communicating Hydrocephalus
No obstruction
CSF reaches the subarachnoid space
Irritation of meninges; inc. CSF viscosity

Figure 18. Hydrocephalus

Figure 16. Myelomingocele

Group 22 | Hidalgo, E., Hidalgo, J., Homol, H. Hugo, P.,Inandan, D., Inciong, M., Jeanjaquet, K., Jimenez, J.

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Encloses the SUPERIOR SAGITTAL SINUS ( on its fixed


margin) on its superior convex border and the INFERIOR
SAGITTAL SINUS ( on its lower concave free margin)
Straight Sinus: connection b/n Superior sagittal and Inferior
Sagittal sinuses

MENINGES
TYPES OR LAYERS OF MENINGES

Figure 19. Meningeal Layers


DURA MATER (Pachymeninx)
Most external layer; nearest to the cranium
Made of dense connective tissue
Venous Sinuses: large space b/n endostium and meningeal layer
Cranial portion has 2 layers that are closely applied to each
other except in areas where venous sinuses are located:
1. Endosteal layer
o Lines the cranium
o Doesnt become continuous with the dura mater of the
spinal cord
o When it reaches the foramen magnum becomes
continuous with the periosteum on the outside of the
skull bones.
o At sutures continuous with the sutural ligament
2. Meningeal layer
o dense strong fibrous membrane covering the brain
o dura mater proper
o when it reaches the foramen magnum it becomes
continuous with dura mater of the spinal cord
o provide tubular sheaths for the cranial nerves
o when cranial nerves exit the foramina, they bring with
them for a short distance part of the meningeal layer
of the dura mater after w/c it becomes continuous
with the epinurium.
o has 4 major processes/ folds w/c divide the cranial
cavity into compartments
o Function: restrict the displacement of the brain
associated with acceleration and deceleration when
the body moves

SEPTA

Restricts the displacement of the brain associated with acceleration
and deceleration when the head is moved
1. Falx cerebri
Sickle-shaped fold of dura mater; extends into the
longitudinal fissure which divides the cerebral hemispheres
Attaches to crista galli of the ethmoid bone to the internal
occipital protuberance where it becomes continuous with
the tentorium cerebella to enclose the straight sinus

2. Tentorium cerebelli
Separates the occipital lobes from the cerebellum
Crescent shape fold of dura mater that roofs over the
posterior cranial fossa
Transverse membrane that attaches
o Posteriorly and Laterally to the skull at the transverse
sinuses
o Anteriorly to the petrous portion of the temporal bone;
clinoid process of the sphenoid bone
Slopes up and fuses with falx cerebri at midline
Has a curved free anterior border w/c leaves a large
opening, incisura tentorii (tentorial notch), which allows the
passage of the upper brainstem, aqueduct and vessels
Encloses 3 sinuses: The STRAIGHT SINUS; the (L&R)
TRANSVERSE SINUSES and (L&R)SUPERIOR PETROSAL
SINUSES
FXN: Support the occipital lobe of the cerebral hemisphere
& forms a roof over the upper surface of cerebellum.

3. Falx cerebelli
Located in between the cerebellar hemispheres attached to
the internal occipital crest
Smaller version of Falx cerebri ; sickle shaped
From internal occipital protuberance to foramen magnum
Projects from the inner surface of the occipital bone and is
attached below the tentorium cerebella
Encloses the OCCIPITAL SINUS (posterior)

4. Diaphragma sellae
Connects the clinoid attachments of the tentorium cerebella
Roofs over the sella turcica;
Perforated by the stalk of the hypophysis cerebri

DURAL NERVE SUPPLY
st
CN 5,10 and 1 3 cervical spinal nerves

Group 22 | Hidalgo, E., Hidalgo, J., Homol, H. Hugo, P.,Inandan, D., Inciong, M., Jeanjaquet, K., Jimenez, J.

Figure 20. Falx and Tentorium cerebelli

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DURAL ARTERIAL SUPPLY


Arteries:

Internal carotid

Maxillary Middle meningeal a.

Ascending pharyngeal

Occipital

Vertebral A
Middle meningeal artery
o Most important ( particularly the Anterior division)
o Arises from the maxillary (Branch of External Carotid a.) in
the infratemporal fossa
o Enters the cranial cavity through the foramen spinosum
o Lies b/n meningeal and endosteal layers of dura mater
o Ascends from the inner surface of temporal bone to the
anteroinferior angle of the parietal bone
o It will continue upward to follow the line whereinin the pre-
central gyrus can be found

Venous Drainage:
the middle meningeal veins that accompany the middle
meningeal artery will drain into the pterygoid venous
plexus and the sphenoparietal sinus.

DURAL VENOUS SINUS

Figure 21. Sinuses


Lined with endothelium
No valves and have thick walls but no muscular tissue
Lies b/n meningeal and endosteal layers of dura
Receive blood through the brain from cerebral veins and csf from
the subarachnoid space through the arachnoid villi
Drain into Internal Jugular Vein
Emissary veins valveless
o Connect the dural sinuses with the diploic v. of the skull and
veins of the scalp
Superior Sagittal sinus
o Occupies the upper fixed border of the falx cerebri
o Confluence of the sinuses
Become cont. with the right traverse sinus and receives the
occipital sinus
o Drains the superior cerebral veins
o From foramen cecum to internal occipital protuberance

Inf. Sagittal Sinus


o Occupies the free lower margin of falx cerebri
o Runs backwards and joins the great cerebral v. (of Galen) at the
free margin of the tentorium cerebella forming the straight sinus
Straight Sinus
o Occupies the line of junction of the falx cerebri and tentorium
cerebella
o Inf sagittal sinus + great cerebral vein
o Forms the Left Transverse sinus
Transverse Sinus
o Paired structures begins at internal occipital protuberance
o Right sinus cont with sup. Sagittal sinus
o Left sinus cont with straight sinus
o Occupies the fixed margin of the tentorium cerebella
o Receives the superior petrosal sinus
Superior cerebral And Cerebellar veins
Diploic veins
End downward at sigmoid sinus
Sigmoid Sinus
o Direct cont of transverse sinus
o Lies posterior of mastoid antrum
o Cont w/ the superior bulb of the internal jugular v
o Sigmoid sinus Jugular foramen Internal jugular v.
Occipital Sinus
o Occupying the attached margin of the falx cerebella
o Commences near the foramen magnum
o Communicates with the vertebral veins
o Drains into the confluence of sinuses
Cavernous Sinus
o Situated in the middle cranial fossa and lies lateral to each side of
the body of the sphenoid bone
o Spongy appearance from numerous trabeculae
o Internal carotid a and sympathetic nerve plexus run through it ;
abducent nerve
o CN 3, 4, 5, 6
o Tributaries
Sup/inf ophthalmic v.
Sphenoparietal s
Inf. Cerebral v.
Central vein of retina (within optic n.)
o Drains to posterior:
Superior petrosal sinus Transverse sinus
Inferior petrosal sinuses Internal Jugular v.
o Inferior:
pterygoid venous plexus (Communicates through the anterior
and posterior intercavernous sinus)
o The most common route of infection via superior ophthalmic v ( it
connects the facial vein to the cavernous sinus)

ARACHNOID
From Greek word arachnes meaning spider
Web - like membrane made up of reticular fibers; delicate and
impermeable
Fuses with the epineurium
Avascular; gets nutrition from the CSF
Together with the pia mater forms the leptomeninges
The outer and inner surfaces are covered with flattened mesothelial
cells
Subarachnoid cisternae formed in situations where the arachnoid
and pia are widely separated.
o Cisterna cerebellomedullaris - lies b/n inferior surface of the
cerebellum and the roof of fourth ventricle

Group 22 | Hidalgo, E., Hidalgo, J., Homol, H. Hugo, P.,Inandan, D., Inciong, M., Jeanjaquet, K., Jimenez, J.

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o Cisterna interpeduncularis lies b/n cerebral peduncles


Arachnoid granulation pacchionian granulation/ groups of
arachnoid villi
o Projections of the arachnoid into the venus sinus
o most numerous along the superior sagittal sinus
o acts as a major site where CSF diffuses into the bloodstream;
Absorbs CSF
o connected to the pia mater by fibrous tissue
Subarachnoid space - Structures passing to and from the brain to
the skull or its foramina must pass through here. All the cerebral
arteries and veins lie in the space , as do cranial nerves. ( Snell & lec)

PIA MATER

Vascular membrane covered with mesothelial cells


Invest the brain covering the gyri and sulci
Extends out over the cranial nerves and fuses with epineureum
Cerebral arteries entering the brain carry a sheath of pia mater
Forms the Tele choroidea of the roof of the 3rd and 4th ventricle
rd
CHOROID PLEXUS tela choroidea + ependyma (In the lateral, 3
th
and 4 ventricle)
o Produce CSF
Escapes from the ventricular system of the brain through the
th
three foramina in the roof of the 4 ventricle and enters the
subarachnoid space

Epidural Hematoma

Subdural hematoma

VENTRICULAR SYSTEM
2 Lateral Ventricles
rd
3 Ventricle
th
4 Ventricle

Lined by ependyma

Filled with CSF

MENINGES OF SPINAL CORD


DURA MATER
Dense strong fibrous membrane that closes the spinal cord and
cauda equina
Cont. above the through the foramen magnum going to the filum
terminale at the lower border of S2
Dural sheath lies loosely in vertebral canal and separated from the
wall by Extradural space
Space contains loose areolar tissue and internal venous plexus
Inner surface of dura mater is in contact with the arachnoid mater

ARACHNOID MATER
Delicate impermeable membrane that covers the spinal cord
Lies between the pia matter internally and dura mater externally
Seperated from the pia matter by the Subarachnoid space
Contains CSF in the subarachnoid space
Foramen magnum S2 Lower border
Spinal n. root SA space

PIA MATER
Vascular membrane that closely covers spinal cord
Forms ligamentum denticulatum
o Suspends spinal cord in the middle of the dural sheath
Extends along each nerve root and becomes cont. w/ the
connective tissue surrounding each spinal nerve

CLINICAL CONSIDERATIONS
Epidural Hematoma
Meningeal artery and vein; most
common in ant div of middle
meningeal artery
Blow to the side of the head
Spread is limited
Lens shaped between dural
layers

Subdural Hematoma
Tearing of the superior cerebral
veins from its attachment to the
venous sinuses.
Blow on the front or back of
head
Acute and chronic forms occur
Crescent shape between dura
and arachnoid mater

Figure 22. Ventricles


Lateral Ventricles:
2 Cavities:

Cerebral hemispheres

C-shaped

4 parts

Body, Anterior, Posterior and Inferior horn

Choroid plexus present



rd
3 ventricle bet 2 thalami
Choroid plexus formed from tela choroidea

Group 22 | Hidalgo, E., Hidalgo, J., Homol, H. Hugo, P.,Inandan, D., Inciong, M., Jeanjaquet, K., Jimenez, J.

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Provides mechanical buoyancy & support for the brain Cushions


& protects the CNS from trauma
Serves as a reservoir and assists in the regulation of the contents of
the skull.
Nourishes the CNS.
Removes metabolites from the CNS.
Serves as a pathway for pineal secretions to reach the pituitary
gland.

Formation:
choroid plexuses- lateral, 3rd and 4th ventricles
ependymal cells of ventricles
brain substance

Figure 23. 3rd ventricle

* The roof of the lateral ventricle is formed by the undersurface of the


corpus callosum. The floor is formed by the body of the caudate
nucleus, and its medial wall is formed by the septum pellucidum.
Choroid plexus projects into the lateral ventricle on its medial aspect.
*The third ventricle is a slit-like cleft between the two thalami so it
communicates anteriorly with the lateral ventricles through the
interventricular foramen or the so-called foramina of Monroe, and
th
posteriorly with the 4 ventricle through the aqueduct of Sylvius. The
aqueduct of Sylvius which is a very narrow canal in the interventricular
foramen.

th
Cerebral aqueduct of Sylvius & 4 ventricle:
Cerebral aqueduct inch long
th
4 ventricle
o Pons & upper medulla
o Cerebellum
o Apertures (foramen)
Foramen of Luschka
Foramina of Magendie

*The aqueduct of Sylvius is a narrow channel usually inch long that
connects the third ventricle to the fourth ventricle.
*The fourth ventricle is a tent-shaped cavity filled with CSF. The roof of
the fourth ventricle is pierced in the midline by a large aperture called
the foramen of Magendi, while the lateral openings of the fourth
ventricle is the foramina of Luschka. In the fourth ventricle, there are 3
openings. In the midline, foramina of Magendi. Laterally, the two
lateral openings of the fourth ventricle, foramina of Luschka. These
openings permit the CSF to flow from the ventricular system to the
subarachnoid space.

CEREBROSPINAL FLUID
Physical Characteristics:
Appearance

clear, colorless
Vol.


130 ml
Rate of production
0.5ml/min.
Pressure (lateral recumbent) 60-150 mmH20 - MAY INCREASE

Composition:
Protein
15-45 mg/100ml
Glucose
50-85 mg/100ml
Chloride
720-750 mg/100ml
No. of cells
0-3 lymphocytes/cu. mm.
Functions:

Figure 24. Choroid plexus

Circulation of the CSF:


rd
Choroid plexus (CSF) lateral vent. (intervent. for) 3 ventricle
th
(cerebral aqueduct) 4 ventricle central canal of sc apertures
subarachnoid space subarachnoid cisterns spinal

*How does the CSF circulate?
First, CSF is produced mainly from the choroid plexus found in the
lateral ventricles, and also some from the third and the fourth
ventricles. From the lateral ventricles, which are the main source of the
CSF, the CSF will enter the third ventricle through the interventricular
foramina. And from the third ventricle, it passes through the cerebral
aqueduct to enter the fourth ventricle. From thereon, it passes through
the central canal of the spinal cord which is closed at its lower end. The
central canal of the spinal cord is actually sort of like a blind pocket.
From there at the lower end, this is the so-called terminal ventricle.
The three openings or apertures from the fourth ventricle would allow
also the CSF to pass from the ventricles to the subarachnoid space. The
CSF fills the tubular extension of the subarachnoid space that forms a
sleeve around the spinal cord. The spinal subarachnoid space ends at
the level of S2 forming a blind pocket. Movement of the CSF occurs
through change in posture, so any movement will render the CSF to go
up and forward until it reaches the cerebral hemispheres where
reabsorption occurs in the arachnoid villi into the venous bloodstream
in the sinus.


Subarachnoid Cisterns:
Cisterna magna

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Pontine
Chiasmatic
Interpenduncular

Virchow-Robin Space
Perivascular spaces within the brain substance

*There is a space known as the perivascular space or Virchow-Robin
space which is a space within the brain substance. The subarachnoid
space extends into the substance of the nervous system through
extensions around the blood vessel, and these extensions are known as
the perivascular spaces. In this area, small solutes or metabolites from
the brain tissue reaches the subarachnoid space through diffusion in
these spaces

CSF Absorption:
Main site for absorption: arachnoid villi/granulations
Absorption of CSF into the venous sinuses occur when the CSF
pressure > venous pressure in the sinuses

*The main site of the CSF absorption is in the arachnoid villi that
project into the venous sinuses especially the walls of the superior
sagittal sinuses. The arachnoid villi would act as a one-way valve that
allows the flow of CSF from the subarachnoid spaces into the venous
blood. The arachnoid villi in effect act as a diverticulum of the
subarachnoid spaces that pierces the dura where the sinuses are
located.

transport of glucose and some amino acids into the blood-brain


barrier.

Functional Significance of the BBB:
- semipermeable barrier PROTECT the brain & spinal cord from
harmful substances
- permits entry of gases & nutrients

*In effect, the blood barrier allows preservation of the homeostasis of
the nervous system by promoting entry of needed substances such as
gases and nutrients, and excluding unwanted substances

Breakdown of the BBB results from:

Infections

Stroke

Brain tumors

Seizures

Trauma

BB (-SPINAL CORD) BARRIER (BBB)


Characteristics:
Tight junction between endothelial cells
Few pinocytic vesicles
Foot processes of astrocytes

Figure 25. Blood brain barrier

*The blood-brain barrier is described as a physical barrier resulting


from the combination of membrane properties and cellular transport
system. The solutes that can penetrate the blood-brain barrier are
characterized by small molecules, so only small molecules can enter
the blood-brain barrier readily. Large proteins do not enter the blood-
brain barrier. Substances that are bound to serum proteins also
cannot penetrate the blood-brain barrier. Substances that are lipid-
soluble can readily penetrate the blood-brain barrier, and also there
are carrier mechanisms within the blood-brain barrier that allow the
Group 22 | Hidalgo, E., Hidalgo, J., Homol, H. Hugo, P.,Inandan, D., Inciong, M., Jeanjaquet, K., Jimenez, J.

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