Neuroanatomy

Scarlett Hinson 542 Principles

Nervous System divided into:

1. CENTRAL:
Brain & Spinal Cord = responsible for integration

2. PERIPHERAL:
transmits sensory input & executes central commands Development of nervous system occurs following Gastrulation w formation of Neural Tube, a derivative of

ECTODERM

Zygote cell that results from fertilizaiton

3 germ layers form following gastrulation

1. Endoderm 2. Mesoderm 3. Ectoderm 1. The neural plate forms from ectoderm & becomes Neural Tube
a. Nervous system contains a fluid filled opening (to become ventricles)

2.Early brain: Forebrain, midbrain, hindbrain

a. Further differentiation occurs into Telencephalon

Neural Tube forms

th 15-28

day

Anterior portion of Neural tube differentiates into:

Forebrain, Midbrain, Hindbrain.

Founder cells around the ventricle divide and eventually produce neurons, which migrate outward to cortex, & differentiate into Neuroblasts. They send out axons & then dendrites. Eventually they form numerous synapses Neural tube is embryonic structure that develops into the brain and Cord. Very early ibaby s development, a layer of cells folds over and Zips Up to form the neural tube. If the neural tube fails to zip up completely at some point, the spine or brain s development will be impacted: Spina bifida, Anencephaly

Neural tube fails to ZipUp

Most common forms of neural tube defects affecting about 1 in q 500 preg. 1 in q 600 births the difference due to loss of pregnancies affected w neural tube defects

Spina bifida occurs within first 28 days of pregnancy

Hindbrain
Cerebellum appears as separate structure cauliflowerlike appearance behind brain controls fine motor movement, timing; motor memory, planning of movement, also practice related memory and detection of errors in non motor tasks Reticular formation consists of densely packed, reticulated (netlike) cells located in central core of hindbrain thought to activate thalamus & cortex, so often called "reticular activating system RAS Pons connects cerebrum with cerebellum contains centers regulating sleep, feeding &facial expression Medulla 1st part of brain above Cord, essentially a continuation of Cord controls HR, RR, BP, digestive functions

Midbrain
Tectum 4 bumps: colliculi superior (higher up) colliculi r/t eye movement & localization of objects inferior (lower down) colliculi r/t sense of hearing Tegmentum -includes red nucleus & substantia nigra, involved in control of movement contains part of reticular formation

Forebrain: (below Cerebrum)

Basal ganglia: involved in motor control Limbic system: not 1 structure but several: hippocampus, amygdala, septum, cingulate gyrus middle of septum:"pleasure centers amygdala:emotions, fear, defensive, aggres behaviors hippocampus interacts w temporal lobe to help establish event memory Thalamus: participate in control of sleep & attention - Relay station; receives input from eyes, ear, Cord, relays info to Cortex Hypothalamus involved basic functions eating, sex, temp control, sleep, aggression

 HYPOTHALAMUS: produces sex, growth & stress related hormones carried down axons to pituitary gland, released from there into bloodstream to activate and organize distant

Brain: Midsagittal View

Cerebrum Forebrain Diencephalon Thalamus Hypothalamus Pituitary gland Cerebellum Midbrain Brainstem (c) Midsagittal section
Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings.

Corpus callosum

Pons Medulla oblongata Spinal cord

Figure 9.11c

LIMBIC SYSTEM

 Cerebral surface is divided into number of groves (a Sulcus) and elevations (a Gyrus). Central Sulcus: Prominent medial lateral grove Anterior to this grove on Precentral gyrus resides Motor cortex. Posterior to this grove, on Postcentral gyrus, resides somatosensory cortex

Cerebral Cortex (Cerebrum) is divided into 4 lobes

1. 2. 3. 4. Frontal Parietal Temporal Occipital (rear)

Like motor functions, sensory functions are also projected on Cortex. The area for many Sensory functions is located just behind central fissure at front of parietal lobe

Central Fissure: separates Somatosensory strip & Motor strip

Central Fissure
Just in front of central fissure, at back of frontal lobe, lies MOTOR area of Cortex Impulses that control the skeletal muscles originate in MOTOR area. If an experimenter were to stimulate this area electrically, it would cause movements of parts of body. Each specific part of the motor area sends impulses to specific muscles.

grid lies over left primary Motor and Sensory cortex, near vertex of the skull. primary motor cortex is located with the use of extraoperative somatosensory evoked potentials and intraoperative cortical stimulation, as well as the grid described in the previous image Instrument in the field is positioned over primary motor cortex.

CNS: BRAIN & SPINAL CORD

Contains 1011 neurons Contains 1014 synapses CNS comprises 2% of body weight (3 4 pounds)
Receives 15% of blood supply

High metabolic rate

Brain uses 20% of oxygen consumed by body at rest Brain uses 50% of glucose consumed by body at rest

Depends on blood flow for energy Depends on aerobic glycolysis Requires glucose and oxygen No glycogen stores Fatty acids not used for energy Ketones used during extreme conditions

CNS: Glial Cells

90% of CNS composed of glia ( glue- in LATIN) function primarily as physical support for neurons 5 types of glial cells
Astrocyte numerous functions Ependymal cells line cavities Microglia phagocytes Oligodendrocytes form myelin Schwann cells (located in PNS) form myelin

Glial Cells

CNS: Gray & White Matter

CNS: Gray & White Matter

CNS well-protected from internal/external change

1. Blood Brain Barrierprotection from toxins, etc 2. Skull and vertebrae protects from physical insults 3. Meninges--nourishment from blood and protection 4. CSF: brain floats in it : 4 primary fx:
Cushions, Immunologic protection for brain/Cord, protects from acute BP changes, intracerebral transport medium

Capillaries - Sites of exchange between blood and interstitial fluid Blood-brain barrier - Special anatomy of CNS capillaries which limit exchange

BBB
Composed of 2 membranes in series:
1. Lumenal 2. Ablumenal membranes of the brain capillary endothelial cell which are separated by approximately 300 nm of endothelial cytoplasm. Transport systems must exist on both lumenal and ablumenal membranes of the endothelial cell if solute transcytosis from blood to brain is to occur. There are a number of specialized carrier transport systems within the BBB that mediate brain uptake of circulating nutrients, such as glucose, amino acids, choline, purine bases, or nucleosides

Cerebral Cortex a.k.a Cerebrum

Most of man's awareness and conscious behavior involves the Cerebral Cortex: Man has a proportionately larger Cortex than any other animal's. Cortex function is broken down into:
SENSORY functions (Afferent) MOTOR functions (Efferent) associative functions *SensoriMotor system denotes combined afferent & efferent processes required to produce coordinated movement *SomatoSensory Soma means Body Sensory sensation *Tracts = bundle of nerve fibers (axons) that connects different regions of CNS *Proprioceptive proprio ones own ceptive to receive

Spinal Cord
Cord consists of specific Ascending and Descending nerve pathways: communicate info between body & brain. Nerve fibers that descend from motor Cortex form CoticoSpinal tract a.k.a Pyramidal Tract bc many cell bodies in Motor Cortex are triangular shaped & look like small pyramids. Most corticospinal axons decussate cross to opposite side in brainstem & descend in lateral corticospinal tract in CORD. At spinal segment level, CSTract axons terminate on interneurons, which terminate on Alpha motor neurons Motor control refers to control of Posture & Mvment Cord involved in reflexes which are simple behaviors (i.e. withdrawal reflex)

CNS: Descending Tracts

Spinal Cord: Ascending Tracts

Spinal Cord & Spinal Nerves

Gray matter: functional halves
Dorsal: sensory functions Ventral: motor functions

Spinal nerves are mixed White matter forms Tracts

Ascending (i.e. SpinoThalamic Spino indicating origin in Spinal Cord & end of word where tract leads Thalamus Descending (i.e. CorticoSpinal) originates in Cortex & travels down toward Motor neurons in SpinalCord

Spinal Cord Tracts

Spinal Cord: White Matter

White matter can be considered to lie either dorsally (above dorsal horn of gray matter), laterally (between butterfly wings), or ventrally (below ventral horn of gray matter). Each of these 3 regions is called a Funiculus. 1. Lateral tracts run within lateral funiculus 2. Ventral tracts run within ventral (or anterior) funiculus 3. Dorsal column pathways run within dorsal (or posterior) funiculus.

4 diff terms are often used to describe bundles of axons such as those found in White matter: Funiculus, Fasciculus, Tract, Pathway
Funiculus is a morphological term to describe a large group of nerve fibers which are located in a given area (e.g., posterior funiculus). Within a funiculus, groups of fibers from diverse origins, which share common features, are sometimes arranged in smaller bundles of axons called fasciculus Fasciculus is primarily a morphological term whereas tracts and pathways are also terms applied to nerve fiber bundles which have a functional connotation. A TRACT is a group of nerve fibers which usually has same origin, destination,course & similar functions. Tract name is derived from their origin and their termination i.e., corticospinal tract -tract that originates in Cortex and terminates in cord; lateral spinothalamic tract - a tract originated in lateral cord and ends in thalamus).

Ascending Pathways Sensory tracts:

Dorsal Columns: carry Touch & Proprioceptive info to brain. Light touch, deep pressure, &
proprioceptive senses (carried out by muscle spindles & other sensory receptors) are carried through these pathway

SpinoThalamic tracts: carry Pain & temp (free nerve endings in skin) carried by these tracts to brain

Transmission of Sensory Info within CNS

Sensory impulses are transmitted via specialized pathways to CNS: Dorsal column Medial Lemniscal system (DCML) Anterolateral Spinothalamic Tract (AST) 1st stage of sensory integration & perceptual awareness occurs at level of

THALAMUS

FUNCTIONAL ANATOMY of the SOMATIC SENSORY PATHWAYS

The dorsal column-medial lemniscal system & anterolateral spinothalamic system mediate different somatic sensations DCML system: touch and limb position sense AL system: pain & temp, less touch Both project to opposite cerebral hemisphere DCML first relay = dorsal column nuclei in Medulla, first order neurons synapse on second order neurons AL first relay = dorsal horn of Cord DCML & AL have diff relay nuclei in Cord & brainstem The 2 somatic sensory pathways decussate at different levels of neuraxis DCML decussates in MEDULLA AL decussates in CORD

Dorsal root axons w diff diameters terminate in diff CNS locations

Large diameter axons (touch and position) enter more medial (at large diameter fiber entry zone) than small diameter axons (pain &temp via Lissauer s tract)

3 classes of termination in Cord: 1. Segmental branches:

- enter gray matter &synapse on interneurons, motor neurons,&neurons that project 2 brain

2. Ascending branches: carry sensory info rostrally to upper Cord & to brain 3. Descending branches: synapse on interneurons located caudal to level of entry

A Delta: Fast Pain, C: Slow Pain via Lissauer s tract

Somatic Sensory Pathway 2 Basic Pathways

A. 2 Basic Pathways 1. Dorsal Column-Medial Lemniscal Pathway
a. Touch and proprioception

2. Spinothalamic Pathway a. Pain & Temp

2 main systems which transmit Sensory signals within CNS:

Dorsal Lemniscal System (fine precise sensations)decussate (cross) at Medulla (brainstem) Anterolateral Spinothalamic System (crude type sensations)
Decussate at level of Cord

Dorsal Column-Medial Lemniscal Pathway

C. DCML Pathway 1. In the DCML pathway information ascends through the dorsal column on ipsilateral side of Cord 2. Synapses in Medulla 3. Decussates & ascends via Medial lemniscus to thalamus (VP) 4. Synapses in VP thalamus 5. Projects to Cortex

DCML pathway: light touch (fine), vibration, pressure, proprioception

1) First-order neurons located in DRG at all levels 2) Second-order neurons located in Medulla (3) Third-order neurons located in Thalamus

Spinothalamic Tract
1. Info crosses to contralateral side in Cord 2. Ascends via Spinothalamic tract 3. Synapses in the Thalamus (VP) 4. Projects to Cortex.

E. Information carried in each pathway remains separate

1. Segregated all the way to Cortex 2. Thalamus a. Ventral posterior (VP) nucleus receives info and projects to Somatosensory cortex

Thalamas capable of gating out irrelevant sensory info while directing relevant info to cortex: cental yellow structure is thalamus thalamus is central yellow structure

Transmission of Sensory Information within the CNS

Sensory pathways carrying general sensory info (touch, temp, proprioception) terminate in different sensory regions of Cortex Once info reaches primary sensory region in Cortex we are able to recognize both the source and intensity of sensations Final perception of whats occurring in environment or within our bodies is achieved once sensory info has been integrated & interpreted by the associated areas of Cortex, limbic system.

 The somesthetic, or bodily, senses on the cortex receive impulses generated at receptors in the peripheral nervous system. The impulses ascend the Cord, enter the brain, & are relayed through thalamus to Sensory area of cortex. If an experimenter were to stimulate point A, a sensation in the hand would be reported. These areas are terminal points for impulses arising in the sense organs When stimulated by light rays, neurons of eye send impulses to visual cortex on Occipital lobe. Sound vibrations in ear propagate auditory impulses that terminate in auditory cortex on temporal lobe. An area on the parietal lobe receives taste sensations. In addition to receiving and sending sensory and motor impulses, the brain integrates, interprets, and stores information. Of the 12 billion neurons in the human brain, the majority are involved in these associative functions.

Somatosensory Cortex
Parietal lobe a. Post-central gyrus i. Most complex processing occurs in Cortex

Somatotopy

Somatotopy
Mapping of body's surface sensations onto a brain structure 2. Features of the map: a. Not continuous b. Not scaled to human body c. Relative size of Cortex devoted to each body part is correlated w the density of Sensory input (i.e., lips versus the skin on your calf). d. Size is related to the importance of the sensory input (i.e., finger tip versus elbow)

Topographical Organization:

Sensory

Posterior Parietal Lobe

1. Primary Somatosensory Cortex receives simple segregated streams of sensory info 2. Integration takes place in post parietal cortex

Dorsal Lemniscal System

Touch sensations: High degree of localization of stimulus. Fine graduations in intensity of stimulus. Phasic sensations (vibrations). Sensations of movement against skin. Fine positional & pressure sensations
.

Dorsal Lemniscal system begins w somatosensory axons entering Cord via dorsal root and ascending in dorsal columns ipsilaterally. 1st synapse point for this pathway is in Dorsal column nuclei located in MEDULLA The axons of neurons originating in the dorsal column nuclei decussate (cross over), ascending via the Medial Lemniscus to the contralateral Ventral Posterior Thalamic Nucleus (VPN). Somatosensory fibers of trigeminal nerve (CN V), carrying info from contralateral side of face & head, also synapse in VPN. The majority of VPN neurons project to primary somatosensory cortex (SI), the remaining project to the secondary somatosensory cortex (SII) of the posterior parietal lobe.

Anterolateral Spinothalamic System

Thermal sensations:
Cold Warm

Pain sensations Crude pressure and touch sensations Tickle and itch sensations Sexual sensations

 Anterolateral system begins w Somatosensory axons entering Cord via dorsal root and synapsing upon entry. Majority of these 2nd-order axons decussate, and ascend to brain via the anterolateral portion of the cord WHITE matter.
This Ascending system is composed of 3 separate tracts: 1. Spinothalamic tract: projects to thalamus. Touch, temp,

sharp pain 2. Spinoreticular tract: projects to brainstem reticular formation on its way to thalamus. Perception of deep, chronic pain 3. Spinotectal tract: projects to Tectum of midbrain. Likely involved in some aspect of pain perception. The tracts of AL system project to both primary &secondary somatosensory cortex, & to more posterior locations within parietal lobe

Pain and Its Control Nociception 1. Sensory process that provides signals that trigger pain B. Characteristics 1. Pain is influenced cognitively 2. Hyperalgesia a. Tissue already damaged is much more sensitive to pain i. Nociceptors are sensitized by various substances released by damaged tissue (prostaglandins, histamines, etc.)
A.

Regulation of Pain

1. Pain can be modified by non-painful sensory input (i.e., rub skin around bruise) a. Gate Theory of Pain-circuit in cord of dorsal root 2. Several brain regions can act to Suppress Pain a. PAG (Periacqueductal Gray Matter) project to the raphe (serotonin) that sends axons to Cord (5-HT is inhibitory synaptic activity) 3. Brain chemicals a. Endorphins i. Share many opioid properties & bind to opioid receptors in brain ii. Opioid receptors are throughout body, but esp in the brain&particularly in brain areas that process & modulate nociceptive info (PA, raphe, Ccord)

Rexed Lamina II
some sources say (II,III) SUBSTANTIA GELATINOSA
10 layers of Gray Matter identified By Bror REXED. *Zone where 2 horns meet called: Intermediate GRAY: most of the interneurons that are part of reflex pathways are located here *Central Canal: remnant of lumen of Embryonic Neural Tube

Whats Raphe Nuclei? Main Fx: RELEASE SERoTONIN (SSRIs believed to act here) Brainstem: Moderate nuclei cluster in middle of RETICULAR FORMATION Projections from the raphe nuclei also terminate in dorsal horn of Spinal Cord Gray matter where they regulate release of: ENKAPHALINS: (inhibits pain sensation by inhibiting Substance P release)

RAPHE NUCLEI
Raphe nuclei make connections all up and down brain and cord, releasing 5-HT pretty much everywhere, though in very low amounts. 5-HT doesn't really have direct control over something critical (like, say, acetylcholine or glutamate), but it wields some massive influence on things like: mood,nausea, migraines, anxiety, pain, premature ejaculation

What is Substance P? discovered 1931 NEUROTRANSMITTER in Brain & Cord

Fx: to CAUSE PAIN, PAIN TRANSMITTER associated w INFLAMMATORY PROCESS in joints Potentiates Excitatory Inputs to Nociceptive neurons Extensively studied: specific substance P pathways exist in CNS & is a neuroactive peptide that regulates the excitability of dorsal horn nociceptive neurons & present in the limbic system of the CNS, including the Hypothalamus & Amygdala -areas assoc w emotional behavior Substance P also is involved in several physiologic activities, including the vomiting reflex, defensive behavior, change in cardio-vascular tone, stimulation of salivary secretion, smooth muscle contraction, and vasodilation

Comparison of thalamus & RAS responses to pain stimulus

Reticular Activating System

In core of Brainstem between: Medulla Oblongata &
Continuous with spinal cord Lowest portion of brainstem Controls autonomic fx, breathing, HR, digestion

Mesencephalon
midbrain connects pons & cerebellum

Reticular Activating System (RAS)

Network of neural fibers in brain stem. Like the thalamus the RAS is a relay station for incoming sensory impulses. While the thalamus relays to specific cortical areas, the RAS relays to nonspecific areas A loud noise would send an impulse through thalamus to be relayed to an auditory area of the cortex. Impulses resulting from the same stimulus also reach the RAS which, in turn, sends impulses to diffuse areas throughout the brain.

Reticular activating system (RAS)

The RAS functions to alert or "wake up" the cortex and prepare it for more specific stimuli. While the thalamus "tells" an isolated area about a specific stimulus, the RAS tells the entire cortex to "pay attention -- something is happening out there." Damage to a person's reticular activating system results in a deep coma. The organism is still capable of receiving stimuli, but if the RAS is not functioning, the person does not come out of his coma

Corpus Callosum Tough Body in latin a.k.a Collosal Commissure

Connects L & R cerebral hemispheres Facilitates interhemispheric communication Largest White Matter structure in Brain 250 million contralateral axonal projections

Motor Cortex
Motor cortex is located in rear portion of frontal lobe, just before the central sulcus (furrow) that separates the frontal lobe from the parietal lobe. The motor cortex is divided into 2 main areas, Area 4 and Area 6. Area 4, a.k.a primary motor cortex, forms a thin band along the central sulcus. Area 6 lies immediately forward of Area 4 Area 6 is wider and is further subdivided into 2 distinct sub-areas.

Motor Cortex
To carry out goal-directed movements, your motor cortex must first receive various kinds of info from various lobes of brain: info abt body's position in space, from parietal lobe abt goal to be attained & approp strategy for attaining it, from anterior portion FRONTAL lobe abt Memories of past strategies, from Temporal lobe

Production of movement is organized into various levels of control

At the highest level, the Cortex controls voluntary movements which all require coordination & precision to adapt to particular situations on basis of info provided by senses. At most basic level, movement is controlled by spinal cord alone, with NO help from Brain. Cord neurons take charge of Reflex movements , as well as rhythmic movement involved in walking

SPEECH
BROCA: contains motor neurons involved in control of speech Wernicke: involved in the understanding of written and spoken language

Structural Overview of Brainstem

Midbrain, Pons, Medulla 4th ventricle Foramen magnum

Brainstem Sections
Caudal medulla Rostral medulla Caudal pons Rostral pons Caudal midbrain Rostral midbrain

Skipping most CN

Brainstem Structural Components

1. Tracts
Ascending
ALS, DCML

Descending
Corticospinal, corticopontine, corticobulbar

Relay
Cerebellar peduncles

2. Internal structures: reticular formation, relay nuclei

 In 1870, Hitzig and Fritsch electrically stimulated various parts of a dog's motor cortex. They observed that depending on what part of the cortex they stimulated, a different part of the body contracted. Then they found that if they destroyed this same small area of the cortex, the corresponding part of the body became paralyzed. This is how it was discovered that every part of the body has a particular region of the primary motor cortex that controls its movement. But what is remarkable about this "motor map" is that certain parts of the body those that can make the finest movements take up much more space than others.

Topographical Organization

: Motor

Primary sensory projection of cortex

MOTOR Tracts: Lateral Corticospinal Tract

LCT carries info abt movement from brain to cord; brain decides that it wants your legs to move, it has to send this voluntary movement command down to region of Cord thats responsible for leg movements. ACT Anterior Corticospinal tract is much more minor, but it crosses at spinal level of the motor neuron it synapses on... so it runs contralaterally.

Reflex Arc

Stretch Reflex

Withdrawal &Crossed-Extensor Reflexes

CN IX: Sensory: posterior 1/3 of tongue, carotid sinus (blood pressure and chemistry) Somatic motor: a muscle of the pharynx Parasympathetic motor: parotid gland NOTE CAROTID BODY

Olfactory Bulb

Olfactory Epithelium

Olfactory Epithelium
Thin sheet of cells high up in our nasal cavity b. Size of the olfactory epithelium is proportionate to olfactory acuity
i. Man has 10 cm2 ii. Dog has 170 cm2

iii. Dogs also have 100x a many receptors per cm2

IV. Taste Neural Pathway

A. Circuit 1. NT release from taste cells causes an AP in the gustatory afferent axon 2. 3 different CN (VII, IX and X) innervate taste buds and carry taste information from tongue, palate, epiglottis and esophagus

Cord Blood Supply consists of:

Anterior spinal artery
primary blood supply of anterior 2/3 of spinal cord, including both the lateral coricospinal tract and ventral corticospinal tract

Posterior spinal artery (right and left) primary bld supply to dorsal sensory columns

Spinal Cord Blood Supply

(a) The thoracolumbar segment of cord is vascularized by branches of thoracoabdominal aorta via the intercostal and lumbar arteries. (b) Intercostal or lumbar artery arises from aorta and divides into anterior and posterior branches. Posterior branch subdivides into:
-Radiculomedullary artery, Muscular branch, and dorsal somatic branch. - Radiculomedullary artery further subdivides into anterior and posterior radiculomedullary arteries

Blood Supply of Cord

Blood is supplied to vertebral column by way of segmental arteries that arise near it from Aorta, or from adjacent arteries in areas beyond extent of Aorta; dependence on 3 vessels: ANTERIOR median logitudinal arterial trunk & PAIR of POSTERIORolateral trunks near the posterior nerve rootlets; *Metabolic demands of Gray matter are > those of white matter, which contains fewer capillary networks

Anterior Spinal Artery:

- single artery runs in ventral midline from foramen magnum to filum terminale; - artery is supplied by series of 5-10 unpaired radicular arteries that originate from vertebral arteries & aorta and its branches;

- blood supply of anterior portion of cord is much more vulnerable than posterior portion
and can be decompensated by occlusion of large radicular branch or lesions of the aorta; - 2 longitudinal pathways include the anterior spinal artery (ASA) & posterolateral arteries; 75% of the blood supply to spinal cord is derived from ASA; - ASA arises from the vertebral artery caudal to the basilar artery; - 2 arteries from either side, one from each vertebral artery, join each other between C1 & C6 & form single arterial channel;

Posterior Spinal Arteries:

- Paired Posterior spinal arteries: are fed by smaller radicular arteries at nearly every spinal level

Segmental Arteries
of the vertebral column supply radicular arteries; - in thoracic and lumbar regions segmental arteries are known as intercostal & lumbar arteries which arise from posterior aspect of aorta; - these segmental arteries proceed to intervertebral foramina appropriate to their level, where they divide into terminal branches; - 1 of the largest radicular arteries is the ARM (or Artery of Adamkiewicz)

Artery of Adamkiewicz;
*largest of the segmental arteries w/ a characteristic hairpin bend is referred to as the arteria radicularis magna (ARM): a.k.a Artery of Adamkiewicz (comes off LEFT SIDE) *although in early embryonic development every segment of Cord receives paired radicular arteries, these disappear, leaving 1 or 2 Cervical,2 or 3 thoracic, and 1 or 2 Lumbar arteries; *most commonly arises at T10 on LEFT side, however, position may vary from T7 to L4, with it being on R side in 17% of pts;usually artery enters a single intervetebral foramen between levels of T9T11

 Thoracic and thoracoabdominal Aortic Repair are still complicated by Cord ischemia & paraplegia Controversies still concern anatomical arrangement of the anterior spinal artery (ASA) & arteria radicularis magna (ARM) a.k.a Adamkiewicz artery

SSEP:monitor integrity of Dorsal column Sensory pathways of Cord

Sensory Evoked Potentials

Technique signal initiation
lower extremity usually involves stimulation of posterior tibial nerve behind ankle upper extremity usually involve stimulation of Ulnar nerve

signal recording
transcranial recording of somatosensory cortex

Disadv: not reliable with respect to monitoring the integrity of the anterior spinal cord pathways reports exist in literature of an ischemic injury leading to paralysis despite normal SEP monitoring during surgery

MEP:monitor integrity of lat & ventral corticospinal tract of Cord

MEP Monitored Evoked Potentials

Technique signal initiation
transcranial stimulation of motor cortex

signal recording
muscle contraction in extremity (gastroc, soleus, EHL of lower extremity)

Adv: effective at detecting a ischemic injury (loss of anterior spinal artery) in anterior 2/3 of Cord Disadv: often unreliable due to effects of anesthesia