This: (1) makes it very easy to identify any and all clinical comments or examples on each page; (2) does not reduce clinical concepts by trying to compress them into small summary boxes; (3) keeps all clinical correlations and information in their proper neuroanatomical context; and (4) emphasizes the overall amount—and relevance—of the clinical information presented in this Atlas. This: (1) makes it very easy to identify any and all clinical comments or examples; (2) does not reduce clinical concepts to small summary boxes; (3) keeps all clinical contexts and information in their proper context; and (4) emphasizes the overall amount—and relevance—of the clinical information presented.
Imaging the Brain (CT and MRI)
The use of these images in a contemporary educational setting is absolutely essential to preparing the student for the realities of the clinical experience. The goal is to provide students with the knowledge base and skills necessary to excel in the clinical setting.
Computed Tomography (CT)
These include: (1) consistently correlating the anatomy of the central nervous system (CNS) with magnetic resonance images (MRIs) and computed tomography (CT), and making these latter images available to teach basic neurobiology; (2) the introduction of numerous clinical terms, phrases and examples in their proper context; (3) emphasis on cerebrovascular anatomy and selected variations, all with clinical examples; (4) the emphasis on regional brain anatomy, internal vascular territories throughout the CNS, and the myriad deficits resulting from vascular lesions as broadly defined; and (5) presenting a comprehensive treatment of systems neurobiology that integrates pathways, connections, blood supply, and deficits at all levels of the neural axis. A thorough knowledge and understanding of systems, reflexes, pathways, their blood supply, and the results of lesions thereof, is essential to the diagnosis of the neurologically compromised patient.
Magnetic Resonance Imaging (MRI)
Fourth, the revised color palate was also used in spinal cord and brainstem line drawings for all sensory and motor nuclei. Consequently, the color of the sensory and motor nuclei of the spinal cord and trunk on all left sides is consistent.
Rostral (A, superior surface), caudal (B, inferior surface) and an inferior view (C, inferior aspect) of the cerebellum. The first segment of the MCA (M1) courses laterally and diverges into superior and inferior trunks at the level of the limen insulae (entrance to the insular cortex).
Cranial Nerves in Their Larger Functional/Clinical Context (Figures 3-9 to 3-15)
This part of the neurological examination tests the integrity of the afferent and efferent arms of the reflex. In addition, deficits may be seen that reflect damage affecting the functioning of the cranial nerves, but this damage is not in the afferent or efferent limbs of the reflex; this indicates a wider problem in the central nervous system. Lesions to any of these structures result in visual disturbances such as hemianopia or quadrantanopia, which reflect the specific part of the visual system that is damaged.
The auditory part of the eighth cranial nerve is concerned with the perception of sound. The vestibular portion of the eighth cranial nerve functions in the arena of balance, equilibrium, and maintaining posture.
Meningitis, Meningeal Hemorrhages, and Meningiomas
In the living situation, the arachnoid is attached to the inner surface of the dura. Axial views of the midbrain (B, T1-weighted), pons (C, T2-weighted), and medulla (D, T2-weighted) represent the corresponding planes marked in the sagittal view (A). Patient C has blood in the third ventricle and in the atrium of the right lateral ventricle.
Images E and F are from patients with tumors in the glomus choroideum of the choroid plexus of the lateral ventricle. Thus, when looking at the slice, the observer's right side is the left side of the brain disc.
Brain Slices in the Coronal Plane Correlated with MRI 77
Rostral surface of the coronary section of the brain through the level of the anterior tubercle of the thalamus and the column of the fornix just caudal to the anterior commissure. This section also includes two parts of the globus pallidus: the medial or inner segment and the lateral or outer segment. The two MRIs (both are inversion recovery) are in the same plane and show many of the structures identified in the brain slice.
On the other hand, the amygdaloid nucleus is located in the rostral tip of the temporal horn and appears very homogeneous in MRI (see above). Based on the coronal plane, the transition from one to the other can happen quickly.
Brain Slices in the Coronal Plane Correlated with MRI 79
Posterior limb of internal capsule (PLIntCap) Dorsomedial nucleus of thalamus (DMNu) Lateral dorsal nucleus of thalamus. The rostral surface of a coronal section of the brain through caudal parts of the ventral lateral nucleus, massa intermedia, ventral posterolateral nucleus, red nucleus, substantia nigra, and basilar pons. This slice beautifully illustrates that fibers within the internal capsule (posterior limb in this slice) traverse and enter the crus cerebri.
The two MRIs (both are inversion recovery) are in the same plane and show many of the structures identified in the brain slice.
Brain Slices in the Coronal Plane Correlated with MRI 81
Rostral surface of a coronal section of the brain through the pineal, caudal aspects of the pulvinar, superior colliculus, brainstem tegmentum, and middle cerebellar peduncle.
Brain Slices in the Coronal Plane Correlated with MRI 83
Rostral surface of the coronary section of the brain through the splenium of the corpus callosum, the posterior horn of the lateral ventricle, and the cerebellum, including part of the dentate nucleus. So when looking at the slice, the observer's right is the left side of the brain slice, and the observer's left is the right side of the brain slice. This view of the slice correlates precisely with the orientation of the brain as seen in the accompanying axial MRIs.
86 5: Internal brain morphology in unstained slices and MRI—Part II: Brain slices in the axial plane correlated with MRI. Ventral surface of an axial section of the brain through parts of the corpus callosum, the rostrocaudal extent of the superior parts of the lateral ventricle, and the head and body of the ventricle.
Brain Slices in the Axial Plane Correlated with MRI 87
The ventral surface of an axial section of the brain through the lenticular nucleus, four limbs of the internal capsule, the main thalamic nuclei, the third ventricle, and the pineal gland. The medial and lateral segments of the globus pallidus are clearly visible on the left side. The two MRIs (T1, left; T2, right) are in the same plane and show many of the structures identified in the brain slice.
Brain Slices in the Axial Plane Correlated with MRI 89
The ventral surface of an axial section of the brain through the optic tract, hypothalamus, mammillary body, red nucleus, superior colliculi, and the medial and lateral geniculate nuclei. The two MRIs (T1, left; T2, right) are in similar planes and show many of the structures identified in the brain disc.
Brain Slices in the Axial Plane Correlated with MRI 91
The ventral surface of an axial section of the brain through the rostral parts of the basilar pons, rostral parts of the fourth ventricle and the adjacent superior cerebellar peduncle and dentate nucleus in the white matter nucleus of the cerebellar hemisphere. MRIs (both T1-weighted) are in the same plane and show many of the structures identified in the brain disc.
Brain Slices in the Axial Plane Correlated with MRI 93
Ventral surface of an axial section of the brain through the medullary surface at the general level of the pons-medulla junction. This level is characterized by the restiform body, the pyramid, the olivary eminence and associated sulci, as well as the fourth ventricle and the lateral incision of the fourth ventricle. Note the blood in the fourth ventricle and extending into the lateral incision of the fourth ventricle (compare brain slice with CT).
The importance of these relationships is clearly seen in the combinations of deficits that generally characterize lesions at different levels of the neuraxis. Third, motor and sensory deficits on the same side of the head and body are usually indicative of a lesion in the forebrain.
Color-Coded Spinal and Cranial Nerve Nuclei and Long Tracts
First, only abnormalities of the body, excluding the head, which may appear as motor or sensory losses (long paths) on the same side, or opposite sides, indicate spinal cord lesions (eg Brown-Séquard syndrome). Spinal cord injuries typically have motor and sensory levels; these are the lowest functional levels remaining in the compromised patient. Second, cranial nerve deficits (on one side of the head) in combination with long tract signs (on the opposite side of the body) characterize lesions in the brainstem (eg lateral medullary and Weber syndrome).
In these cases, cranial nerve signs are better localization signs than long tract signs.
Correlation of MRI and CT with Internal Spinal Cord and Brainstem Anatomy
In the adult spinal cord, this general posterior/anterior relationship is maintained (Figure 6-1, lower middle). The SL is present in the adult brainstem and separates the medially located basal plate derivatives (motor nuclei) from the laterally located alar plate derivatives (sensory nuclei). Second, in the brainstem special functional components, as traditionally identified (SVE to muscles of the pharyngeal arches; SVA to taste; SSA to vestibular and auditory), form cell columns that are restricted to the brainstem and are not represented in the spine. cord.
Similarly, cells with the GSA (spinal trigeminal, main sensory) component that appear in the ventricular floor in the alar region also migrate ventrolaterally to their mature locations. The relative positions and color coding of the various components shown in the image above (right) translate directly to Figure 6-2 on the facing page.
Function Components in the Neural Tube, Spinal Cord, and Brainstem (Figures 6-1 and 6-2)
The lower portions of the cervical spinal cord (starting at about C4 and extending through C8) appear oval on MRI (left) and CT myelogram (center and right). 110 6: Internal morphology of spinal cord and brain in stained sections - degenerated corticospinal tract. 112 6: Internal morphology of the spinal cord and brain in stained sections - Medulla oblongata with MRI and CT.
Transverse section of the medulla through motor decussation (decussation of the pyramids [pyramidal decussation], crossing of corticospinal fibers). 130 6: Internal morphology of the spinal cord and brain in Pons-stained sections with MRI and CT. 140 6: Internal morphology of the spinal cord and brain in stained sections—MRI and CT midbrain.
154 6: Internal morphology of the spinal cord and brain in colored sections - The diencephalon and basal nuclei with MRI.
