ANATOMY, PHYSIOLOGY & PATHOLOGY

NOTES OF THE

NERVOUS SYSTEMAND SPECIAL SENSES

FOURTH EDITION
PRE-SUMMARIZED FOR THE TIME-POOR
READY-TO-STUDY MEDICAL, PRE-MED,
HIGH-YIELD NOTES USMLE OR PA STUDENT

297 PAGES
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Table Of Contents:

What’s included: Ready-to-study anatomy, physiology and pathology notes of the nervous system presented in
succinct, intuitive and richly illustrated downloadable PDF documents. Once downloaded, you may choose to either
print and bind them, or make annotations digitally on your iPad or tablet PC.

Anatomy & Physiology Notes:

- EMBRYONIC DEVELOPMENT OF THE NERVOUS SYSTEM
- OVERVIEW & ORGANISATION OF THE NERVOUS SYSTEM
- SURFACE ANATOMY OF THE BRAIN
- BLOOD SUPPLY OF THE BRAIN
- CRANIAL NERVES
- THE SPINAL CORD
- NEURONAL PHYSIOLOGY
- NEUROTRANSMITTERS
- NEUROBIOLOGY OF MEMORIES
- NEUROBIOLOGY OF EMOTIONS
- SOMATOSENSORY PROCESSING
- MOTOR PROCESSING
- THE AUTONOMIC NERVOUS SYSTEM
- PAIN & NOCICEPTION
- SPECIAL SENSES - VISION
- THE TONGUE & GUSTATION (TASTE)
- OLFACTION (SMELL)
- HEARING AND EQUILIBRIUM
- REGIONAL ANATOMY OF THE NERVOUS SYSTEM
- IMPORTANT CLINICAL NEUROLOGICAL THINGS

Pathology Notes:
- STROKES
- INTRACRANIAL HAEMORRHAGES
- ISCHAEMIC ENCEPHALOPATHY
- RAISED INTRACRANIAL PRESSURE
- SPINAL CORD SYNDROMES
- TRAUMATIC BRAIN INJURIES
- EPILEPSY
- GUILLIAN-BARRE SYNDROME
- HUNTINGTONS DISEASE
- MOTOR NEURONE DISEASE (MND)/AMYELOTROPHIC LATERAL SCLEROSIS (ALS)
- POLIOMYELITIS
- MULTIPLE SCLEROSIS
- LEUKODYSTROPHIES
- MYASTHENIA GRAVIS
- PARKINSON’S DISEASE (“Shaking Palsy”)
- BRAIN TUMOURS
- DEMENTIAS
- PERIPHERAL NEUROPATHIES
- INFECTIONS OF THE NERVOUS SYSTEM
- EAR PATHOLOGIES
- VISION DISORDERS
EMBRYONIC DEVELOPMENT OF THE NERVOUS SYSTEM
 EMBRYONIC DEVELOPMENT OF THE NERVOUS SYSTEM

General Embryonic Development is Described as Either:

• Trimesters (3x 3-Month Periods):
o First: - Foundations of Major Organs
o Second: - Development of Organs
o Third: - Rapid Growth & Fully Functional Organs.
• OR... Anatomical Stages: **(These are more relevant)
o Pre-Embryonic Period: 0-2 Weeks
§ Fertilisation
§ Blastocyst Formation & Implantation
§ Gastrulation
o Embryonic Period: 3-8 Weeks
§ Development & Differentiation of 3 Germ Layers into foundations of Organs.
o Foetal Period: 9 Weeks → Birth.
§ Period of Growth, NOT Differentiation.

Source: Unattributable

Some Useful Terminology:

- “Rostral” = Head
- “Caudal” = Tail
- “Dorsal” = Back
- “Ventral” = Front
- “Ganglia” = Groups of Nerve-Cell Bodies
- “Gyrus” = Elevations (Crests) of the folds on the Cerebral Cortex.
- “Sulcus” = Grooves / Furrows between the Gyri on the Cerebral Cortex.
Embryonic Development of the Nervous System:
1. Blastocyst: (Pre-Embryonic Period)
a. A fertilised egg reaches the Morula stage (Day 3), differentiates into a Blastocyst (Day 7) and then
implants in the endometrium.
b. The implanted Blastocyst consists of an ‘Inner-Cell Mass’ surrounded by Trophoblasts.
c. This ‘Inner-Cell Mass’ differentiates to form the ‘Bilaminar Disc’ (2 layers of cells)
i. Epiblast Layer: The top layer of Columnar Cells.
ii. Hypoblast Layer: The bottom layer of Cuboidal Cells.

Ttrue12, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

2. Gastrulation: (Embryonic Period [wk 3+])
a. Gastrulation = the process that establishes the 3 Primary Germ Layers in the Embryo.
b. Begins with formation of the Primitive Streak (a shallow midline groove) along the caudal/tail half of
bilaminar disc.
c. At the cephalic/head end of the Primitive Streak is the Primitive Node which surrounds the small
Primitive Pit. Cells of the Epiblast proliferate & migrate through the Primitive pit into the gap
between the Epiblast & the Hypoblast. This is known as Invagination
d. The Epiblast then becomes the Ectoderm, the invaginated cells become the Mesoderm and the
Hypoblast becomes the Endoderm.

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

3. Neurulation:
a. Neurulation = Where the ectoderm around the midline thickens to form an elevated Neural Plate.
b. This Neural Plate invaginates to form a Neural Groove down the midline, flanked by 2 Neural Folds.
The Notochord, a flexible rod of mesoderm-derived cells, defines the primitive axis of the embryo.
c. The outer edges of the 2 Neural Folds continue folding towards the midline where they fuse
together to form the Neural Tube. (Note: Initially this happens around the centre of the embryo,
leaving open Neural Grooves at both the Cephalic & Caudal ends. However, these Neural Grooves,
aka Neuropores, close off by around wk 6 of development. Failure of a Neuropore to close can result
in Neural Tube Defects such as Spina-Bifida )
d. The hollow part inside the Neural Tube is called the Neurocoele
e. The Neural Tube then separates from the Ectoderm and sinks down to the level of the Mesoderm.
i. The Mesoderm that flanks the sunken Neural Tube develops into The Somites, which
eventually become the Skin, Skeletal Muscle & Vertebrae+Skull.
f. Next, some cells on the top of the Neural Tube differentiate and separate to form the Neural Crest.
Cells of the Neural Crest eventually migrate & give rise to Peripheral Sensory Neurons, Autonomic
Neurons & Sensory Ganglia of the spinal nerves.
OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons
The Somites:
• Somites = The Mesoderm Tissue directly adjacent to Neural Tube.
o The Mesoderm that flanks the sunken Neural Tube develops into The Somites, which eventually
become the Skin, Skeletal Muscle & Vertebrae+Skull.
• Somites grow in association with the developing nervous system → establish early connections.
• Somites differentiate into 3 regions:
o Sclerotome: Becomes the Vertebral Column & Skull
o Myotome: Becomes Skeletal Muscle
o Dermatome: Becomes Skin
• Hence, the Somites determine the distribution of Nervous Supply to all Mesoderm-Derived Tissue.

Homme en Noir, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

Development of the Neural Tube Into the Spinal Cord:

1. Once the Neural Tube closes, the cells differentiate into Neuroblasts
2. These Neuroblasts give rise to 2 concentric layers, The Mantle Layer (Inner) and The Marginal Layer (Outer).
a. Mantle Layer: Later forms the Grey-Matter of the Spinal Cord. (Ventral & Dorsal ‘Horns’)
b. Marginal Layer: Later forms the White-Matter of the Spinal Cord.
3. The Dorsal & Ventral regions of the Mantle Layer thicken forming 2xBasal Plates, and 2xAlar Plates.
a. Basal Plates: (Motor Plates) Develop into Motor Neurons innervating skeletal muscles.
i. Become the Ventral Horns
b. Alar Plates: (Sensory Plates) Develop into Sensory Neurons.
i. Become the Dorsal Horns
- Note: The Lateral Horns in the Thoracic & Lumbar Regions of the Spinal Cord are Autonomic Motor Neurons
and their Axons exit via the Ventral Roots.

Developing Spinal Cord vs Adult Spinal Cord

Source: Unattributable
Development of the Neural Crest cells Into the Sensory (‘Dorsal-Root’) Ganglia of PNS:
1. Neural Crest Cells also differentiate into Neuroblasts which become the Sensory (‘Dorsal-Root’) Ganglia.
2. The Neuroblasts of the Dorsal-Root Ganglia develop 2 processes:
a. Penetrates into the Alar Plate of the Neural Tube AND/OR into the Marginal Layer & up to brain.
b. Grows distally (outwards) and integrates with the Ventral Motor Root, forming the Trunk of the
Spinal Nerve. These neurons eventually terminate in the sensory receptors in skin/muscle/tendons.
Note: These Dorsal-Root Ganglia Processes form the ‘Sensory PseudoUnipolar’ Nerve-Type.

Source: Unattributable

Note: By Wk 7 we have a Nearly-Functional Nervous System very similar in Organisation to Adult Anatomy.

Source: Unattributable
Development of the Head & Brain:
1. Neural-Tube Enlargement (Cephalic End):
a. At around 3-4wks, the Cephalic portion of the Neural Tube enlarges to form 3 regions; the Primary
Brain Vesicles:
i. Prosencephalon (Fore Brain)
ii. Mesencephalon (Mid Brain)
iii. Rhombencephalon (Hind Brain)
Note: The Cephalic Flexure between the Prosencephalon & Mesencephalon – important in humans
for Bipedalism (Brain @ 900 to Spinal Cord).
b. By around 4-5wks, the Primary Brain Vesicles develop further:
i. Prosencephalon (Fore Brain) develops into:
1. Telencephalon (Future Cerebral Hemispheres)
2. Diencephalon (Future Thalamus & Hypothalamus)
ii. Mesencephalon (Mid Brain)
iii. Rhombencephalon (Hind Brain) develops into:
1. Metencephalon (Future Pons & Cerebellum)
2. Myelencephalon (Future Medulla)

https://open.oregonstate.education/aandp/chapter/14-1-embryonic-development/

2. Brain Formation:
a. At around 11-13wks, there is massive Proliferation of Neuroblasts in Cephalic Neural Tube, causing
folding due to lack of space within the cranium.

Source: Jonathan Dimes for BabyCenter; https://www.babycenter.com/pregnancy/your-baby/fetal-development-

your-babys-brain_20004924
3. Pharyngeal Arches & Cranial Nerves:
a. Pharyngeal Arches = Similar to the Somites in lower parts of embryo. Each Pharyngeal Arch consists
of:
i. Ectoderm Tissue → Cranial Nerves & Skin of Face.
ii. Mesenchyme (Mesoderm) Tissue → Musculature of Face & Neck
iii. Endoderm Tissue → Pharyngeal Epithelium.
b. Note: Essentially, this results in Segmental Development of the Head & Neck, similar to Somites.

Loki austanfell, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

 4. Formation of Ventricles:
a. The Neurocoele of the Neural Tube becomes the Ventricles of the Adult Brain.
i. Lateral Ventricles (Vent. 1 & 2):
1. Sits in the Cerebral Hemispheres (Telencephalon)
2. Are shaped due to folding of brain during development.
3. Each Consists of:
a. An Frontal (Anterior) Horn
b. A ‘Body’
c. An Occipital (Posterior) Horn
d. A Temporal (Inferior) Horn
ii. Third Ventricle:
1. Sits in the Diencephalon
2. Lateral Walls formed by Thalamus & Hypothalamus
3. Connects with the 4th Ventricle via the Cerebral Aqueduct.
iii. Fourth Ventricle:
1. Sits in the Brainstem
2. Is Continuous with the Spinal Canal (Central Canal).

Creative Commons: https://www.researchgate.net/figure/Neurulation-and-formation-of-the-cerebral-vesicles-a-

neural-tube-at-the-end-of-the-3_fig2_335125768

BruceBlaus, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

OVERVIEW & ORGANISATION OF THE NERVOUS SYSTEM
 OVERVIEW & ORGANISATION OF THE NERVOUS SYSTEM

The Nervous System - Overview:

• Macro Structures:
o Brain
o Spinal Chord
o Peripheral Nerves
o Sense Organs
§ Eyes
§ Ears
§ Tongue
§ Olfactory bulbs
§ Skin
• Functions:
o Detection of stimuli (external/internal)
o Response to stimuli
o Coordinates activity of other organs & systems

Organisation of the Nervous System:

• Central Nervous System (the “CPU” & “Motherboard”)
o Brain
o Spinal Cord
• Peripheral Nervous System (the “Cables”)
o Cranial Nerves & Spinal Nerves
o Communication between CNS & rest of body

Nervous
System

Central Nervous Peripheral

System Nervous System
(Brain & Spinal (Cranial Nerves
Cord) & Spinal Nerves)

Afferent
Efferent
(Incoming)
(Out-going)
- Sensory

Somatic
(Voluntary) Autonomic
(Involuntary)
- Motor Function

Sympathetic NS Parasympathetic NS
(Fight/Flight) (Rest & Digest)
The Neuron - Structural Features:
a) Receptive Field: Dendrites
o Stimulated by inputs
b) Cell Body: Soma
o Responds to graded inputs
c) Efferent Projection: Axon (and Axon Hillock)
o Conducts nerve impulses to target
o Myelinated and unmyelinated
d) Efferent Projection: Myelin Sheath
e) Efferent Projection: “Nodes of Ranvier”
f) Output: Synaptic Terminals (Axon Terminals)

BrunelloN, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

Supporting Cells: “Neuroglia” (Glia)

o Smaller support cells of NS
o Outnumber neurons 10:1
o Structural & mechanical support
o Roles in maintaining homeostasis & Myelination
o Immune responses via phagocytosis.
• Neuroglia of the Central Nervous System (CNS):
o Astrocytes
§ Nutrient bridge between neuron & capillaries
§ Guide migrating young neurons
§ Synapse formation
§ Mop up excess K+ ions + neurotransmitters
o Microglia
§ Long thorny processes
§ Monitors neuron health
§ Senses damaged neurons
§ Migrates to damaged neuron
§ Phagocytoses microbes & debris (immune cells are denied access to CNS)
o Oligodendrocytes
§ Myelin formation in CNS
o Ependymal Cells
§ Lines central cavities of brain + spinal chord
§ Blood-brain barrier
§ Beating cilia circulates cerebrospinal fluid
• Neuroglia of the Peripheral Nervous System (PNS):
o Schwann Cells
§ Myelin Formation – wrap around axon
§ Regeneration of damaged neurons
o Satellite cells
§ Surround neuron bodies
§ Structure, nutritional support & protection.
 Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). CC BY 3.0
<https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Connective Tissue Sheaths on Peripheral Nerves:

• Endoneurium
o Delicate connective tissue layer
o Surrounds each axon
• Perineurium
o Coarser connective tissue layer
o Bundles groups of fibers into fascicles
• Epineurium
o Tight, fibrous sheath
o Bundles fascicles into a single nerve.
o Houses blood vessels

https://www.tamiapland.com/blog/2018/8/7/fascial-layers-part-2-anatomy-of-a-nerve
Gray Matter & White Matter:
• Gray Matter
o Made up of Neuron bodies (Soma)
o Imbedded in Neuroglial cells
o Eg:
§ Cortex of Brain
§ Centre of Spinal Chord
§ Ganglia/nuclei

• White Matter
o Neuron fibers (axons & dendrites
o White due to myelin
o Eg:
§ Peripheral Nerves & Plexuses
§ Central fiber tracts

Ms. Emma Vought, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons

OpenStax, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons

Ganglia
• = Collections of neuron cell bodies in PNS
o Afferent Spinal Nerves:
§ Cell bodies of sensory neurons
§ ‘Dorsal root ganglion’
o Efferent Spinal Nerves:
§ Cell bodies of autonomic nerve fibers
§ ‘Sympathetic trunk ganglion’
o In Central Nervous System:
§ Called: Basal Nuclei / Nuclei
o Important for BOTH Motor & Autonomic Nervous Systems

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Spinal Nerves:
• Dermatomes - Innervation of the Skin:
o A portion of the mesoderm (skin, sensory receptors, sebaceous glands, blood vessels) innervated by
the cutaneous branches of a single spinal nerve.

https://commons.wikimedia.org/wiki/File:Dermatomes_and_cutaneous_nerves_-_posterior.png
OpenStax, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons
SURFACE ANATOMY OF THE BRAIN
Surface Anatomy of the Brain:
- Dorsal Landmarks:
o Fissures:
§ Longitudinal Fissure: Separates Left & Right Hemispheres
§ Transverse Cerebral Fissure: Separates Occipital Lobe from Cerebellum
o Sulci:
§ Central Sulcus: Separates the Frontal & Parietal Lobes.
§ Lateral Sulcus: Separates the Temporal Lobe from the Other Lobes.
§ Parieto-Occipital Sulcus: Separates Parietal Lobe & Occipital Lobe
o Lobes:
§ Occipital Lobe: Most Caudal Lobe (Visual Cortex)
§ Temporal Lobe: Most Lateral Lobe
§ Frontal Lobe: Most Anterior Lobe

OpenStax, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons

- Ventral Landmarks:
o Olfactory Bulbs: Responsible for sense of smell
o Optic Chiasm (“Optic Crossing”): ‘X’-shaped crossing-over of Optic Nerves.
o Infundibulum: Connection between Pituitary & Hypothalamus.
o Hypothalamus: Responsible for many autonomic homeostatic functions
o Pituitary: Important neuroendocrine organ.
o Mammillary Bodies: Form part of the Limbic System & are important for recollective memory.
o Pyramids (Pyramidal Tracts): Carry motor fibres from the cerebral cortex to the spinal cord.

https://etc.usf.edu/clipart/53100/53182/53182_brain.htm
 - Medial Landmarks (Ie: On Sagittal Section):
o Cingulate Gyrus: Part of the Limbic System. Involved in emotion and behaviour regulation.
o Corpus Callosum: Thick bundle of connecting nerve fibres connecting left and right hemispheres.
o Lateral Ventricle: Holds Cerebrospinal Fluid
o Pineal Body: Involved in Circadian Rhythm (night/day body clock)
o Thalamus: Multiple physiological roles including sensory, motor, & consciousness regulation.
o Hypothalamus: Regulates hunger, thirst, temperature control, memory & stress responses.
o Pituitary Gland: Controls metabolism, growth, sexual function, blood pressure & others.
o Colliculi: Nestled in between the Cerebrum & Cerebellum.
§ 2x Superior: Controls eye movements
§ 2x Inferior: Part of Auditory Pathway
o Cerebellum: Important for coordination, precision & timing of movements.
o Pon: Critical for respiratory rhythm & breathing.
o Medulla Oblongata: Relays messages between the brain and spinal cord. Also regulates
cardiorespiratory functions.
o Fourth Ventricle: contains CSF.

Source: Encyclopaedia Britannica; https://www.britannica.com/science/superior-colliculus#/media/1/574381/93859

- Coronal Section Landmarks:
o Cortex (Grey Matter): Key roles in attention, perception, awareness, thought, memory, language,
sensation, and motor functions.
o White Matter: Mostly axons & myelin – Relays action potentials to their destinations.
o Lateral Ventricle: Contains CSF
o Caudate Nucleus: Important in planning & executing movement. Also has learning, memory, reward,
motivation & emotional functions.
o Corpus Striatum: Reinforcement circuit of the brain.
o Thalamus: Multiple physiological roles including sensory, motor, & consciousness regulation.
o Massa Intermedia: The Bridge between the Left & Right Thalamus.
o Hippocampus: Major role in learning and memory.

https://anatomyinfo.com/corpus-callosum/
BLOOD SUPPLY OF THE BRAIN
 BLOOD SUPPLY OF THE BRAIN

Why Does the Brain Need Blood?

- Consumes 15-20% of the body’s total energy needs, (and receives 15% of Cardiac Output), despite being
only 2% of total body mass.
- Neurons require high ATP to:
o Maintain Ion Gradients across Plasma Membrane
o Regulate Neurotransmitter synthesis/re-uptake.
- Neurons have NO ANAEROBIC CAPACITY → Therefore the brain absolutely depends on Oxygenated Blood.
o Hence, any deficit in blood supply is detrimental (≈30+sec lack of blood/O2 to brain → unconscious)

Blood Supply to the Brain is an ANASTOMOSIS:

- Anastomosis: Where Multiple Arteries Supply the Same Region of Tissue. Ie: A Dual Blood-Supply.
- The Advantage: If one of the arteries becomes blocked/damaged, the other artery will compensate for it.

Arterial Supply of the Brain:

- Brain is Supplied by 2 Arterial Systems:
o 2x Vertebral Arteries → 1x Basilar Artery → Circle of Willis
o 2x Internal Carotid Arteries → Circle of Willis
- ‘Circle of Willis’, The Anastomosis of the Brain:
o (The ‘Roundabout’ of Arteries on the underside of the Brain with multiple ‘Roads’ coming off it)
o (Encircles the Optic Chiasma, The Pituitary Gland & the Mammillary Bodies.)
o The ‘Roads’: (Anterior → Posterior)
§ 2x Anterior Cerebral Arteries
§ 1x Anterior Communicating Artery
§ 2x Internal Carotid Arteries
§ 2x Middle Cerebral Arteries
§ 2x Posterior Communicating Arteries
§ 2x Posterior Cerebral Arteries
§ 1x Basilar Artery
o Note: Communicating Arteries are always patent, but generally not functional (no blood flow) when
blood flow from both Carotids & Basilar Arteries is normal. However, if blood flow from one of the
major arteries is impeded, blood is shunted through the Communicating Arteries to compensate.

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

 OpenStax, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons

Distribution of Cerebral Arteries:

- Anterior Cerebral Arteries:
o (Travels up and over the Corpus Callosum, sprouting branches outwards towards the cortex)
o Medial Portion of Frontal Lobe (Incl. Cortex)
o Medial Portion of Parietal Lobe (Incl. Cortex)
o Corpus Callosum
- Middle Cerebral Arteries:
o (Travels through the Lateral Fissure/Sulcus and emerges onto the Lateral Surface of the Brain)
o Lateral Portion of the Frontal Lobe (Incl. Cortex)
o Lateral Portion of the Parietal Lobe (Incl. Cortex)
o Entire Temporal Lobe (Incl. Cortex)
- Posterior Cerebral Arteries:
o (Travels along the Inferior brain surface between the Cortex and the Cerebellum)
o Inferior Portion of Temporal Lobe (Incl. Cortex)
o Posterio-Medial Portion of Parietal Lobe (Incl. Cortex)
o Entire Occipital Lobe (Incl. Cortex)
derivative work: Frank Gaillard (talk)Brain_stem_normal_human.svg: Patrick J. Lynch, medical illustrator, CC BY-SA
3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons
The Blood-Brain Barrier:
- Isolates Brain from Blood to provide a Stable Environment, necessary for control & function of CNS Neurons.
- How?:
o 1. The Endothelial Cells of the CNS Capillaries are seamlessly joined by Tight Junctions.
§ This prevents diffusion of most materials except dissolved gasses & lipid-soluble compounds.
§ Therefore, any required water-soluble compound must be transported across the BBB.
o 2. Thick Basement Membrane of Capillary

- Note: In the 2 Choroid Plexuses, the BBB is formed by Tight Junctions between Glial (Ependymal) Cells as
the capillaries in this region are Fenestrated & highly leaky.
- The BBB exists everywhere except:
o Hypothalamus – (Monitors chemical composition of blood. Ie: Hormone levels, water balance, etc)
o Vomiting Centre - (Monitors poisonous substances in blood)

(Diagram over page)

Credit: NIH Medical Arts; https://www.ncbi.nlm.nih.gov/
Venous Drainage of the Brain – Via “Dural Sinuses”:
- Venous Drainage begins with venous blood collecting in small venous channels known as “Dural Sinuses”.
- Sinuses Sit Within The Dura-Mater:
o The Dura-Mater is the thickest & outermost of the 3 Meninges of the brain. It extends deep into the
brain in 2 locations, the Falx Cerebri & the Tentorium Cerebelli:
§ 1. Falx Cerebri:
• The Dura Mater folds deep into the Longitudinal Fissure (Falx Cerebri) of the brain,
where it forms 2 Sinuses:
o 1. A Triangular ‘Superior Sagittal Sinus’ at the top of the dural fold.
o 2. A lower ‘Inferior Sagittal Sinus’ at the bottom of the dural fold.

OpenStax, CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons

§ 2. Tentorium Cerebelli:
• The Dura Mater folds deep into the Transverse Cerebral Fissure (Tentorium
Cerebelli) of the brain, where it forms a pair of sinuses:
o The R.&L. “Transverse Sinuses”.
o Note: All blood from Sup. & Inf. Sagittal Sinuses and the Straight Sinus
empties into these Transverse Sinuses.

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 o The L.&R. Transverse Sinuses then become the L.&R. Sigmoid Sinuses (Respectively).
o These Sigmoid Sinuses turn Inferiorly and become the Internal Jugular Veins.

OpenStax College, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Regulation of Blood Flow to the Brain:

- Blood Flow to the Brain is AUTOREGULATED:
o Ie: BP in the Brain is kept constant, despite systemic BP fluctuations.
o It also means different areas of the brain control their blood flow depending on metabolic activity.
- The Myogenic Autoregulation of Blood Flow to the Brain:
o When Mean Arterial Pressure rises, the SNS constricts the larger arteries of the brain to prevent
damaging high pressures in the smaller, more delicate vessels. (Important for preventing Stroke)
- The 3 Metabolic Autoregulatory Factors Affect Blood Flow to the Brain:
o **1. Blood [CO2]:
§ ↑[CO2] → Vasodilation (to ↑ Blood Flow)
§ ↓[CO2] → Vasoconstriction (to ↓ Blood Flow)
o 2. Blood/CSF pH:
§ ↑[CO2] → ↑[H+] via carbonic anhydrase → ↓pH → Vasodilation (to ↑ Blood Flow)
§ ↓[CO2] → ↓[H+] via carbonic anhydrase → ↑pH → Vasoconstriction (to ↓ Blood Flow)
o 3. Blood/CSF [O2]:
§ ↓[O2] → Vasodilation (to ↑ Blood Flow)
§ ↑[O2] → Vasoconstriction (to ↓ Blood Flow)
Intracranial Pressure:
- What is it?
o The pressure within the cranium created by the cerebrospinal fluid (CSF), and exerted on the brain
tissue & the brain's blood circulation vessels.
- Determinants:
o CSF Production/Resorption (Eg: ↑Production + ↓Resorption)
o Brain Tissue (Eg: Tumour / Inflammation)
o Blood (Eg: Haemorrhage)
- High Intracranial Pressure:
o Compresses the Cerebral Arteries → Decreased Blood Supply → Brain Damage
o Can also displace the brain.
- Symptoms of High ICP:
o Altered Consciousness
o Changes in BP & HR
o Changes in Eye Responses
o Changes in Motor Function

Cerebral Blood Flow And Intracranial Pressure:

• Cerebral blood flow is carefully regulated under normal conditions.
• Cerebral Blood Flow:
• What percentage of cardiac output goes to the cerebral circulation at rest?
• 750ml/min (15% of cardiac output)
• Relationship Between Cerebral Blood Flow & Arterial Pressure:

https://derangedphysiology.com/cicm-primary-exam/required-reading/cardiovascular-
system/Chapter%20474/cerebral-blood-flow-autoregulation

• Kelly-Monroe Doctrine:
• States that the Cranial Compartment is Incompressible, and the Volume is Fixed.
• The Cranial Constituents (Blood, CSF, and Brain Matter) create a state of Volume Equilibrium:
• Any increase in Volume of one of the constituents must be compensated by a decrease in
volume of another.
• Volume Buffers:
• Both CSF and, to a lesser extent, Blood Volume
• (Eg: In Extradural Haematoma → CSF & Venous Blood Volumes are Decreased)
• → Maintain normal ICP
• Buffer Capacity ≈ 100-120mL
Flow & Production of CSF

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Reabsorption of CSF into the Dural Sinuses:

- Note: CSF is constantly being produced, and therefore must also be constantly drained to prevent a rise in
intracranial pressure. Therefore:
- CSF is Reabsorbed into the Venous System via diffusion through Arachnoid Villi (Arachnoid Granulation).
o Arachnoid Villi are invaginations of Arachnoid Mater through the Dura Mater and into the Superior
Sagittal Sinus.

Mysid, Public domain, via Wikimedia Commons

Cerebral Oedema:
- What is it?
o An excess accumulation of water in the intracellular and/or extracellular spaces of the brain.
- Types of Cerebral Oedema:
o Vasogenic:
§ (Extracellular Oedema)
§ Due to a breakdown of tight endothelial junctions which form the BBB.
§ Eg: Hydrostatic Cerebral Oedema – where acutely high cerebral capillary pressure results in
fluid moving from Capillary to ECF.
o Cytotoxic:
§ (Intracellular Oedema)
§ Due to a defect in cellular metabolise → inadequate functioning of the Na/K-ATPase in the
cell membrane → cellular retention of H2O
o Osmotic:
§ (Extracellular Oedema)
§ Where a drop in Plasma Osmolality (compared to CSF Osmolality) causes water to flow from
the Venous Sinuses back into the Sub-Arachnoid Space.

Migraines:
- What are They?
o Incapacitating Neurovascular disorder characterized by unilateral, throbbing headaches,
photophobia, phonophobia, nausea & vomiting.
- What Causes Them?
o Decrease in Serotonin Levels → ↑Sensitivity to Migraine Triggers + Cerebral Vasoconstriction →
↓cerebral blood flow → Raphe Nuclei in Brain-Stem release Serotonin → Cerebral Vasodilation +
Release of Proinflammatory Mediators from Trigeminal Nerve & Spinal Nerves → Perivascular
Cerebral Inflammation → Pain.
- Classic Vs. Common:
o Classic:
§ Associated with ‘Aura’. (A visual symptom, such as an arc of sparkling (scintillating) zig-zag
lines or a blotting out of vision or both)
o Common:
§ Migraine without ‘Aura’ (Only 20% of sufferers experience aura. Most bypass the aura
phase)
- Migraines as a Risk Factor:
o ↑ Risk of Silent Post. Cerebral Infarcts.
o ↑ Risk of Stroke & CVD (Women)
o ↑ Risk of MI (Men)
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