Menu Expand
Clinical Neuroanatomy and Neuroscience

Clinical Neuroanatomy and Neuroscience

Estomih Mtui | Gregory Gruener | M. J. T. FitzGerald

(2011)

Additional Information

Book Details

Abstract

Clinical Neuroanatomy and Neuroscience by Drs. M. J. T. FitzGerald, Gregory Gruener, and Estomih Mtui, already known as the most richly illustrated book available to help you through the complexity of neuroscience, brings you improved online resources with this updated edition. You’ll find the additional content on Student Consult includes one detailed tutorial for each chapter, 200 USMLE Step I questions, and MRI 3-plane sequences. With clear visual images and concise discussions accompanying the text’s 30 case studies, this reference does an impressive job of integrating clinical neuroanatomy with the clinical application of neuroscience.

  • Aid your comprehension of this challenging subject by viewing more than 400 explanatory illustrations drawn by the same meticulous artists who illustrated Gray’s Anatomy for Students.
  • Get a complete picture of different disorders such as Alzheimer’s disease and brain tumors by reading about the structure, function, and malfunction of each component of the nervous system.
  • Grasp new concepts effortlessly with this book’s superb organization that arranges chapters by anatomical area and uses Opening Summaries, Study Guidelines, Core Information Boxes, Clinical Panels, and 23 "flow diagrams," to simplify the integration of information.
  • Use this unique learning tool to help you through your classes and prep for your exams, and know that these kind of encompassing tutorials are not usually available for self-study.
  • Access outstanding online tutorials on Student Consult that deliver a slide show on relevant topics such as Nuclear Magnetic Resonance and Arterial Supply of the Forebrain.
  • Confidently absorb all the material you need to know as, for the first time ever, this edition was reviewed by a panel of international Student Advisors whose comments were added where relevant.

Understand the clinical consequences of physical or inflammatory damage to nervous tissues by reviewing 30 case studies.


Table of Contents

Section Title Page Action Price
Front cover cover
Clinical Neuroanatomy and Neuroscience i
Copyright page iv
Table of Contents v
Preface vii
Chapters and Pages vii
Chapter title pages feature: vii
Website features vii
Faculty resources vii
The table below lists the main clinical perspectives covered in the book viii
Clinical Perspectives viii
Panel of Consultants ix
Student Consultants ix
Acknowledgements xi
1 Embryology 1
Chapter Summary 1
Study Guidelines 1
Spinal Cord 1
Neurulation 1
Spinal nerves 1
Brain 1
Brain parts 1
Ventricular system and choroid plexuses 2
Cranial nerves 2
Cerebral hemispheres 4
References 6
2 Cerebral topography 7
Chapter Summary 7
Study Guidelines 7
Surface Features 7
Lobes 7
Frontal lobe 8
Parietal lobe 8
Occipital lobe 8
Temporal lobe 8
Limbic lobe 8
Diencephalon 8
Midline sagittal view of the brain 8
Internal Anatomy of the Cerebrum 8
Thalamus, caudate and lentiform nuclei, internal capsule 8
Hippocampus and fornix 16
Association and commissural fibers 18
Association fibers (Figure 2.20) 18
Cerebral commissures 18
Corpus callosum 18
Minor commissures 18
Lateral and third ventricles 18
References 29
3 Midbrain, hindbrain, spinal cord 30
Chapter Summary 30
Study Guidelines 30
Brainstem 30
Ventral view (Figures 3.1 and 3.2A) 30
Midbrain 30
Pons 30
Medulla oblongata 30
Dorsal view (Figure 3.2B) 31
Sectional views 32
Midbrain (Figure 3.4) 32
Pons (Figure 3.5) 37
Medulla oblongata (Figure 3.6) 37
Spinal Cord 38
General features 38
Internal anatomy 38
Cerebellum 40
References 44
4 Meninges 45
Chapter Summary 45
Study Guidelines 45
Cranial Meninges 45
Dura mater 45
Innervation of the cranial dura mater 45
Meningeal arteries 46
Arachnoid mater 46
Pia mater 46
Subarachnoid cisterns 46
Sheath of the optic nerve 48
Spinal Meninges (Figure 4.9) 51
Circulation of Cerebrospinal Fluid (Figure 4.10) 52
References 54
5 Blood supply of the brain 55
Chapter Summary 55
Study Guidelines 55
Introduction 55
Arterial Supply of the Forebrain 55
Anterior cerebral artery (Figure 5.2) 55
Middle cerebral artery (Figure 5.3) 56
Posterior cerebral artery (Figures 5.2 and 5.5) 57
Neuroangiography 59
Arterial Supply to Hindbrain 59
Vertebral branches 60
Basilar branches 60
Venous Drainage of the Brain 60
Superficial veins 60
Deep veins (Figure 5.13B) 60
Regulation of Blood Flow 61
The Blood–Brain Barrier 62
Blood–CSF barrier (Figure 5.17) 65
Blood–ECF barrier (Figure 5.18) 66
Roles of microvascular pericytes 66
Functions of the blood–brain barrier 67
References 69
6 Neurons and neuroglia: overview 70
Chapter Summary 70
Study Guidelines 70
Neurons 70
Internal structure of neurons 70
Intracellular transport 71
Transport mechanisms 72
Synapses 73
Electrical synapses 73
Chemical synapses 73
Receptor activation 75
Lock and key analogy for drug therapy 76
Inhibition versus disinhibition 77
Less common chemical synapses 77
Neuroglial Cells of the Central Nervous System 78
Astrocytes 78
Oligodendrocytes 78
Myelination 78
Microglia (Figure 6.14) 78
Ependyma 78
References 82
7 Electrical events 83
Chapter Summary 83
Study Guidelines 83
Structure of the Plasma Membrane 83
Ion channels 83
The resting membrane potential 84
Resting membrane permeability 84
Potassium ions 84
Sodium pump 86
Response to Stimulation: Action Potentials 86
Electrotonic potentials 86
The shape of action potentials 86
Propagation 87
Conduction velocities 88
Reference 92
8 Transmitters and receptors 93
Chapter Summary 93
Study Guidelines 93
Electrical Synapses 93
Chemical Synapses 93
Transmitter liberation (Table 8.1 and Figure 8.2) 93
Target cell receptor binding 94
Ionotropic receptors 94
Metabotropic receptors 94
Cyclic AMP system 96
Phosphoinositol system 96
Arachidonic acid system 97
Gene transcription effects 97
Transmitters and Modulators 97
Fate of neurotransmitters 98
Amino acid transmitters 99
Glutamate 99
Ionotropic glutamate receptors 99
Metabotropic glutamate receptors 99
GABA 99
Ionotropic GABA receptors 99
Metabotropic GABA receptors 100
Recycling of glutamate and GABA 102
Glycine 102
Recycling 102
Biogenic amine transmitters 103
Acetylcholine 103
Nicotinic receptors 105
Muscarinic receptors 105
Recycling of acetylcholine 105
Monoamines 105
Catecholamines 105
Dopamine 106
9 Peripheral nerves 112
Chapter Summary 112
Study Guidelines 112
General Features 112
Microscopic Structure of Peripheral Nerves 112
Myelin formation 113
Myelin expedites conduction 114
Central nervous system–peripheral nervous system transitional region 115
Degeneration and Regeneration 115
Wallerian degeneration of peripheral nerves 116
Regeneration of peripheral nerves 116
Degeneration in the central nervous system 119
Transneuronal atrophy 119
End result of central nervous injury 119
Regeneration in the central nervous system 119
References 119
10 Innervation of muscles and joints 120
Chapter Summary 120
Study Guidelines 120
Motor Innervation of Skeletal Muscle 120
Motor end plates 122
Motor units in the elderly 122
Sensory Innervation of Skeletal Muscle 122
Neuromuscular spindles 122
Innervation 122
Activation 125
Passive stretch 125
Information coding 125
Active stretch 125
Tendon endings 125
Free nerve endings 126
Innervation of Joints 126
References 128
11 Innervation of skin 129
Chapter Summary 129
Study Guidelines 129
Sensory Units 129
Nerve Endings 129
Free nerve endings (Figure 11.1A, B) 129
Functions 129
Follicular nerve endings (Figure 11.1A, D) 129
Merkel cell–neurite complexes (Figure 11.1A, C) 129
Encapsulated nerve endings 129
References 133
12 Electrodiagnostic examination 134
Chapter Summary 134
Study Guidelines 134
Introduction 134
Nerve Conduction Studies 134
Nerve conduction in the upper limb 134
Motor nerve conduction 134
Stimulation 134
Recording 134
Motor nerve conduction velocity (MNCV) 135
Second choice 135
Sensory nerve conduction 136
Sensory nerve conduction velocity (SNCV) 137
Second choice 137
Nerve conduction in the lower limb 137
Nerve root pathology 138
The H response (see Ch. 12 tutorial onsite) 138
Electromyography 141
Needle electrode 141
The normal electromyogram 141
Some clinical applications 142
Denervation of muscle 142
Reinnervation of muscle 143
References 147
13 Autonomic nervous system and visceral afferents 148
Chapter Summary 148
Study Guidelines 148
Components of the Autonomic Nervous System 148
Sympathetic Nervous System 148
Parasympathetic Nervous System 149
Cranial parasympathetic system 150
Sacral parasympathetic system 150
Neurotransmission in the Autonomic System 151
Ganglionic transmission 151
Junctional transmission 151
Junctional receptors 152
Sympathetic junctional receptors (adrenoceptors) (Figure 13.5) 152
Parasympathetic junctional receptors 152
Other types of neurons 157
Regional Autonomic Innervation 157
Innervation of the genital tract 157
Interaction of the Autonomic and Immune Systems 160
Visceral Afferents 160
Visceral pain 160
Pure visceral pain 160
Visceral referred pain 160
Viscerosomatic pain 162
Tenderness 162
Pain and the mind 162
Note on vascular afferents 162
References 164
14 Nerve roots 165
Chapter Summary 165
Study Guidelines 165
Development of the Spinal Cord 165
Cellular differentiation 165
Neural cord 165
Ascent of the spinal cord (Figure 14.2) 165
Neural arches 166
Adult Anatomy 166
Distribution of Spinal Nerves 168
Segmental sensory distribution: the dermatomes 168
Segmental motor distribution 169
Nerve root compression syndromes 169
Lumbar puncture (spinal tap) 171
Anesthetic procedures 171
Anesthesia and childbirth 171
References 175
15 Spinal cord: ascending pathways 176
Chapter Summary 176
Study Guidelines 176
General Features 176
Types of spinal neurons 176
Spinal ganglia 177
Central terminations of posterior root afferents (Figure 15.5) 177
Ascending Sensory Pathways 178
Categories of sensation 178
Conscious sensations 178
Nonconscious sensations 178
Sensory testing 178
Somatic Sensory Pathways 179
Posterior (dorsal) column–medial lemniscal pathway 179
Functions 180
Spinothalamic pathway 181
Functions 181
Spinoreticular tracts 182
Spinocerebellar pathways 182
Nonconscious proprioception 183
Information from reflex arcs 183
Other Ascending Pathways 183
References 185
16 Spinal cord: descending pathways 186
Chapter Summary 186
Study Guidelines 186
Anatomy of the Anterior Gray Horn 186
Cell columns 186
Cell types 186
Tonic and phasic motor neurons 186
Renshaw cells 186
Segmental-level inputs to α motor neurons 187
Descending Motor Pathways 187
Corticospinal tract 187
Targets of the lateral corticospinal tract 188
Distal limb motor neurons 188
Renshaw cells 189
Excitatory internuncials 189
Ia inhibitory internuncials 190
Presynaptic inhibitory neurons serving the stretch reflex 190
Presynaptic inhibition of first-order afferents 190
Upper and lower motor neurons 191
Reticulospinal tracts 192
Locomotion 193
Posture 193
Tectospinal tract 194
Vestibulospinal tract 194
Raphespinal tract 194
Aminergic pathways 194
Central autonomic pathways 194
Note on the rubrospinal tract 194
Blood Supply of the Spinal Cord 194
Arteries 194
Veins 196
References 197
17 Brainstem 198
Chapter Summary 198
Study Guidelines 198
General Arrangement of Cranial Nerve Nuclei 198
Background Information 198
Study guide 200
Overview of three pathways in the brainstem 201
C1 Segment of Spinal Cord (Figure 17.10) 204
18 The lowest four cranial nerves 216
Chapter Summary 216
Study Guidelines 216
Hypoglossal Nerve 216
Phylogenetic note 216
Supranuclear supply to the hypoglossal nucleus 216
Spinal Accessory Nerve 216
Glossopharyngeal, Vagus, and Cranial Accessory Nerves 220
Glossopharyngeal nerve 220
19 Vestibular nerve 223
Chapter Summary 223
Study Guidelines 223
Introduction 223
Vestibular System 223
Static labyrinth: anatomy and actions 224
Kinetic labyrinth: anatomy and action 225
Nystagmus 226
Vestibulocortical connections 227
References 228
20 Cochlear nerve 229
Chapter Summary 229
Study Guidelines 229
Auditory System 229
The cochlea 229
Sound transduction 230
Cochlear nerve 230
Central auditory pathways 230
Functional anatomy (Figure 20.4) 230
Cochlear nuclei 230
Superior olivary nucleus 231
Lateral lemniscus 231
Inferior colliculus 231
Medial geniculate body 232
Primary auditory cortex 232
Brainstem acoustic reflexes 232
Descending auditory pathways 233
Deafness 233
References 233
21 Trigeminal nerve 234
Chapter Summary 234
Study Guidelines 234
Trigeminal Nerve 234
Motor nucleus (Figures 17.16 and 21.1) 234
Sensory nuclei 235
Mesencephalic nucleus 235
Pontine nucleus 235
Spinal nucleus 236
Innervation of the teeth 236
Innervation of cerebral arteries 236
Trigeminothalamic tract and trigeminal lemniscus (Figure 21.6) 238
Mastication 239
The jaw jerk 239
References 239
22 Facial nerve 240
Chapter Summary 240
Study Guidelines 240
Facial Nerve 240
Supranuclear connections 241
Nuclear connections 242
Corneal reflex 242
Nervus Intermedius 242
References 244
23 Ocular motor nerves 245
Chapter Summary 245
Study Guidelines 245
General Because of the immense diagnostic and therapeutic importance of ocular innervation, and because of its inherent complexity, neuro-ophthalmology has become a branch of medicine in its own right. It is especially important to appreciate the way in which premotor centers are able to operate bilaterally in order to keep the gaze on target, even when the head is moving. 245
Particular 245
The Nerves 245
Oculomotor nerve 245
Trochlear nerve 246
Abducens nerve 246
Nerve Endings 246
Motor endings 246
Sensory endings 247
Pupillary Light Reflex (Figure 23.4) 247
Accommodation 248
The near response 248
Pathway for the accommodation reflex 248
The far response 248
Notes on the Sympathetic Pathway to the Eye 248
Ocular Palsies 249
Control of Eye Movements 250
Scanning 251
Tracking 251
References 252
24 Reticular formation 253
Chapter Summary 253
Study Guidelines 253
Introduction 253
Organization 253
Aminergic neurons of the brainstem 254
Functional Anatomy 255
Pattern generators 255
Respiratory control 256
Medullary chemosensitive area 260
Carotid chemoreceptors 260
Cardiovascular control 260
Sleeping and wakefulness 260
Ascending reticular activating system 263
Sensory modulation: gate control 263
Segmental antinociception 263
Supraspinal antinociception 263
Magnus raphe nucleus (Figure 24.8) 263
References 266
25 Cerebellum 267
Chapter Summary 267
Study Guidelines 267
Introduction 267
Functional Anatomy 267
Microscopic Anatomy 268
Spatial effects of mossy fiber activity (Figure 25.6) 269
Representation of Body Parts 269
Afferent Pathways 269
Olivocerebellar tract 270
Efferent Pathways (Figure 25.10) 272
Anticipatory Function of the Cerebellum 273
Postural stabilization 273
Postural fixation 273
Clinical Disorders of the Cerebellum 273
The Cerebellum and Higher Brain Functions 273
Posturography 275
References 276
26 Hypothalamus 277
Chapter Summary 277
Study Guidelines 277
Introduction 277
Gross Anatomy 277
Boundaries 277
Subdivisions and nuclei 278
Functions 278
Hypothalamic control of the pituitary gland 278
The parvocellular neuroendocrine system 278
The magnocellular neuroendocrine system 279
Antidiuretic hormone 280
Oxytocin 280
Other hypothalamic connections and functions 280
Autonomic centers 280
Temperature regulation 282
Drinking 282
Eating 282
Hypothalamic response to psychological stress: gender matters 282
Rage and fear 282
Sleeping and waking 282
Sexual arousal 282
Memory 283
References 283
27 Thalamus, epithalamus 284
Chapter Summary 284
Study Guidelines 284
Thalamus 284
Thalamic nuclei 284
Specific nuclei 284
Association nuclei 286
Non-specific nuclei 286
Oscillation 287
Thalamic peduncles 287
Epithalamus 287
References 288
28 Visual pathways 289
Chapter Summary 289
Study Guidelines 289
Introduction 289
Retina 289
Structure of the retina 290
Photoreceptors 291
Cone and rod bipolar neurons 291
Cone bipolar neurons 291
Rod bipolar neurons 291
Horizontal cells 291
Amacrine cells 291
Ganglion cells 291
Coding for color 292
Coding for black and white 292
Foveal specialization 292
Central Visual Pathways 292
Optic nerve, optic tract 292
Medial root of optic tract 292
Lateral root of the optic tract and lateral geniculate body 292
Geniculocalcarine tract and primary visual cortex 294
Retinotopic map 295
References 298
29 Cerebral cortex 299
Chapter Summary 299
Study Guidelines 299
Structure 299
Laminar organization 299
Cellular laminae of the neocortex (Figure 29.1) 299
Columnar organization (Figure 29.1) 299
Cell types 300
Afferents 301
Efferents 302
Cortical Areas 302
Investigating functional anatomy 302
Positron emission tomography 302
Functional magnetic resonance imaging 303
Sensory Areas 304
Somatic sensory cortex (areas 3, 1, 2) 304
Components 304
Afferents 304
Efferents 305
Somatic sensory association area 305
Superior parietal lobule 305
Inferior parietal lobule 306
Intraparietal cortex 306
Secondary somatic sensory area 306
Plasticity of the somatic sensory cortex 306
Sensory competition 306
Visual cortex (areas 17, 18, 19) 306
Primary visual cortex (Figure 29.4) 306
Plasticity of the primary visual cortex 307
Visual association cortex (Figure 29.4) 307
The ‘Where?’ visual pathway (Figure 29.9) 307
The ‘What?’ visual pathway (Figure 29.10) 307
The V1–V5 nomenclature 308
Auditory cortex (areas 41, 42, 22) 308
Motor Areas 308
Primary motor cortex 308
Plasticity in the motor cortex 309
Sources of afferents to the primary motor cortex 310
Premotor cortex 310
Supplementary motor area 310
Cortical eye fields 310
Dorsolateral prefrontal cortex 311
Cingulate cortex 311
Supplementary eye field 311
Frontal eye field (FEF) 311
Parietal eye field (PEF) 311
References 312
30 Electroencephalography 313
Chapter Summary 313
Study Guidelines 313
Neurophysiological Basis of the EEG 313
Technique 313
Types of Pattern 313
Normal EEG rhythms 313
Awake state EEG 313
Normal sleep EEG 315
Glossary 315
EEG activation procedures 316
Maturation of wave format 316
Abnormal EEG rhythms 316
Focal abnormalities without seizures 316
Focal slowing 316
Phase reversal 318
Generalized abnormalities without seizures 318
Seizures 318
References 322
31 Evoked potentials 323
Chapter Summary 323
Study Guidelines 323
Sensory Evoked Potentials 323
Visual evoked potentials 323
Brainstem auditory evoked potentials 323
Evidence for a ‘Where’ auditory pathway 324
Somatosensory evoked potentials 325
Motor Evoked Potentials 325
Motor training 325
References 330
32 Hemispheric asymmetries 331
Chapter Summary 331
Study Guidelines 331
Handedness and Language 331
Language areas 331
Broca’s area (Figure 32.1) 331
Wernicke’s area (Figure 32.1) 332
Right hemisphere contribution 333
Angular gyrus 333
Listening to spoken words 333
Modular organization of language 333
Cognitive Style 334
Neuroanatomy of reading (Figure 32.4) 334
Glossary 334
Reading sequence 334
Parietal Lobe (Figure 32.5) 335
Superior parietal lobule and the body schema 335
Handedness and balance 337
Parietal lobe and movement initiation 337
Prefrontal Cortex 338
References 341
33 Basal ganglia 342
Chapter Summary 342
Study Guidelines 342
Introduction 342
Basic Circuits 342
Motor loop 342
What are the normal functions of the motor loop? 343
Cognitive loop 343
Limbic loop 344
Oculomotor loop 344
References 351
34 Olfactory and limbic systems 352
Chapter Summary 352
Study Guidelines 352
Olfactory System 352
Olfactory epithelium 352
Olfactory bulb (Figure 34.1) 353
Central connections 353
Limbic System 353
Parahippocampal gyrus 354
Hippocampal complex 354
Connections 356
Afferents 356
Efferents 356
Memory function of the hippocampal complex 358
Glossary 358
Clinical and experimental observations 358
Left vs right hippocampal functions 360
Anterior vs posterior hippocampal functions 361
Long-term medial temporal lobe dependency 361
Prefrontal cortex and working memory 361
Insula 361
Cingulate cortex and posterior parahippocampal gyrus 361
Amygdala 361
Afferent pathways 366
Efferent pathways (Table 34.2) 367
Notes on the efferent target connections 368
Nucleus accumbens 370
Septal area 370
Basal forebrain 371
Neurogenesis in the adult brain 373
References 376
35 Cerebrovascular disease 377
Chapter Summary 377
Study Guidelines 377
Introduction 377
Anterior Circulation of the Brain 378
Internal capsule 378
Posterior Circulation of the Brain 378
Transient Ischemic Attacks 378
Clinical Anatomy of Vascular Occlusions 379
References 391
Glossary 392
Index 406
A 406
B 407
C 407
D 408
E 409
F 409
G 410
H 410
I 410
J 411
K 411
L 411
M 411
N 412
O 413
P 413
Q 414
R 414
S 415
T 416
U 416
V 417
W 417
Y 417
Z 417