Nervous system 1: Sensory Pathways Dorsal surface of the brainstem 1.

Identify the following structures on the dorsal surface of the brainstem Medulla oblongata (most inferior part) Gracile and cuneate tubercles Locaton of 4th ventricle (creates a diamond shaped indent) Superior and inferior colliculi (tectum) 4 round lumps at the top of the brainstem

Medulla oblongata Structure and organisation similar to spinal cord Gracile and cuneate tubercles Round swellings on either side of the midline (marked by posterior median sulcus) Contain dorsal column nuclei receive fibres of dorsal white column of cord; gracile and cuneate fasiculi respectively (ascending sensory tract pathways) 2. Label the diagram of the sensory tract (ascending) pathways in the spinal cord

IVth Ventricle Rhomboid fossa (diamond shaped) forms floor of IVth ventricle; comprises anterior half of dorsal surface of medulla and dorsal surface of pons; limited by: Laterally middle cerebellar peduncle Anterior superior cerebellar peduncle Posteriorly gracile and cuneate tubercles Superiorly narrows and is roofed over where the central canal forms aqueduct of midbrain Inferiorly - obex (inferior apex)

There are several raised areas on the floor of the ventricle reflecting underlying cranial nerve nuclei Tectum Superior part of the midbrain, above the aqueduct

Comprises of four small swellings of grey matter known as colliculi Superior colliculi (x2) visual function Inferior colliculi (x2) auditory function

3. Label the diagram of the dorsal surface of the brainstem

Medial surface of cerebrum 4. Identify and describe the medial surface of the cerebrum: Thalamus and hypothalamus Pineal and mammillary bodies Lateral ventricle, interventricular foramen and 3rd ventricle Cerebral aqueduct and 4th ventricle Corpus callosum

Diencephalon The diencephalon contains the third ventricle; walls comprise of: Two major regions: Thalamus and hypothalamus Two smaller regions: Subthalamus and epithalamus Thalamus Large structure (approx. 4cm), oval in cross section, situated either side of the third ventricle Forms third ventricle wall superiorly (hypothalamus forms rest of wall) Interthalamic adhesion flattened disc on medial surface; joining thalami of each side Each side thalamus divided by sheets of white matter into 3 parts: anterior, medial and lateral Contains important group of nuclei, for transmitting information to and from the cerebral cortex: Specific thalamic nuclei project to and receive fibres from restricted cortical areas Non-specific thalamic nuclei project diffusely to large areas of cortex Nuclei Anterior nuclear group Receives fibres from: Mammillary bodies (limbic) Medial nuclear group Hypothalamus, amygdala (limbic) Ventral anterior nucleus Basal ganglia Ventral lateral nucleus Globus pallidus, substantia nigra, cerebellum Ventral posterior nucleus Lateral: somatic afferent fibres from body Projects fibres to: Cingulate cortex Prefrontal cortex Premotor cortex Primary motor cortex (frontal) Somatosensory cortex (parietal)

Medial geniculate nucleus Lateral geniculate nucleus Pulvinar

Medial: somatic afferent fibres from head Inferior colliculus

Optic tract and superior colliculus Extensive connections with association cortices of parietal, temporal and occipital lobes

Auditory cortex (temporal) Visual cortex (occipital)

5. Label the diagram of the thalamic nuclei and which parts of the cortex these communicate with:

Epithalamus Small region above thalamus containing habenula (cranially) and pineal body (caudally) Pineal body Endocrine gland (not composed of nervous elements) synthesising hormones including melatonin May have an effect on the circadian (24h) rhythm of bodily functions Inhibitory effect on gonads, therefore lesions may result in abnormal sexual development Commonly calcifies with age (becoming visible on radiographs) 6. Complete the diagram of sagittal section of the brain to show structures related to the third ventricle

7.

Identify and describe sensory structures and pathways to the sensory cortex: Thalamus Internal capsule and corona radiate Sensory and associated cortex Sensory homunculus

Internal capsule Contains virtually all cerebral cortical projection fibres including those to and from thalamus, corpus striatum, pontine nuclei, tectum of the midbrain, reticular formation, cranial nerve nuclei and spinal cord Gross arrangement of fibres: Frontal projection fibres placed most anteriorly Temporal and occipital fibres placed most superiorly Parietal fibres in between

Thalamic radiations: anterior and medial thalamic connections pass through anterior limb; lateral nuclei pass successively more posteriorly through posterior limb Optic radiation fibres from lateral geniculate to occipital cortex (retrolenticlar part of internal capsule) Auditory radiation fibres from medial geniculate body to temporal lobe (retro/sublenticular) Fans out to each cortex via corona radiate

8. Label the following diagram of the white matter of the internal capsule Look at book Somatosensory cortex Primary somatosensory cortex (Sm 1; Brodmanns areas 1,2,3): postcentral gyrus (parietal lobe) The parts of the body are represented along somatosensory cortex in a similar manner to adjacent motor cortex, e.g. probably area of cortex specialised for taste near to area for tongue Note sensory and motor cortex strongly interconnected by cortico-cortical association fibres Secondary somatosensory cortex (Sm II): Adjacent to head region of primary somatosensory cortex, extending posteriorly along parietal cortex buried in lateral fissure As for the primary area, there is somatotopic representation of body Somatosensory association cortex (Brodmanns area 5): located posterior to primary somatosensory cortex in superior part of parietal lobe Look at Clinical radiology of the nervous system Section C: Clinical Cases Scenario: Mr. Phillips is 70 y/o has been suffering with gradually worsening headaches, which he is now unable to control with pain relief. He has also noticed that his vision seems blurred despite recently getting new glasses from the optician. 1. Describe the appearance of the specimen Two nectrotic black lesions supratentorial <- 2/3 are supratentorial (above tentorium cerebelli) 2. What is the most likely diagnosis in this case? Malignant astrocytoma (type of glioma) primary tumour of glial cells 3. How common is this condition in the UK? 7 in 100,00 more common in males 4. In which age group in this condition most common? Elderly

5. Secondary brain tumour or metastases are x10 more common than primary brain tumours. Give examples of common malignancies, which spread, to the brain. Breast, lung, renal, colon, skin 6. What general symptoms might the patient present with? Uncoordinated 7. Look at pox X. What symptoms might the patient present with specific to the lesion in this location? Cerebellum so loss of coordinated movement 8. What is the most likely course of treatment? Surgery, chemotherapy, radiotherapy 9. What is the prognosis for this condition? Survival rate of 30% (after 50 years) The 4th ventricle is in the cerebellum The cerebellum is intratentorial Section D- Applied Anatomy of the Nervous System 1. 2. 3. 4. Sensory pathways (tract anatomy) Sensory Homunculus Surface anatomy of sensation (dermatomes) area of the skin innervated by a spinal nerve Conditions presenting with impaired/abnormal sensation Diabetes Parathesia Brain injury Phantom limb pain Modality Pain, temperature, coarse touch Fine touch, Vibration, Proprioception Proprioception

Sensory Pathways Anterolateral spinothalamic tract Dorsal column Spinocerebellar Sensory Homunculus Pre central gyrus motor Post-central gyrus sensory

Diabetes Poorly controlled leads to peripheral neuropathy Can affect all peripheral nerve: Sensory, motor and autonomic Glove and stocking distribution Parathesia Abnormal sensations in the absence of specific stimuli i.e. burning, tingling Brain injury Trauma Major head injury Can have a variety of sensation disturbances Contre comp injuries rapid deceleration front and occipital lesions Stroke

Lack of blood supply to the brain Haemorrhagic or ischaemic Haemorrhagic = trauma (burst of vessel) Ischaemic = elderly

Phantom limb pain Sensation that a missing limb is still attached to the body Carpal tunnel syndrome Compression of median nerve Muscle wasting of thenar eminence Loss of sensation over part of palm High incidence in diabetics, pregnancy, hypothyroidism Tested for by tinels sign + phalens test Drugs Phenytoin + Carbamazepine causes peripheral neuropathy Medulla -> Thalamus -> internal capsule -> somatosensory cortex