Head Neck

&
Neuroanatomy
Dr. Md. Abdullah Al-Amin Shohan
MBBS, BCS (Health)
FCPS Part-1, Surgery
MS Phase-B (Urology), DMCH
Important Topic
1. Thyroid gland ∞*
2. Pharyngeal derivatives ∞*
3. Foramen of skull ∞*
4. Triangle of neck** & Carotid Sheath*** & Deep Cervical Fascia ***
5. Vessels of the neck**
6. Facial Nerve***
7. Parasympathetic Ganglions***
8. Glands: Salivary glands***, Pituitary glands**, Parathyroid gland***,
Thymus**
Important Topic
9. Scalp**
10. Face**
11. Tongue***
12. Larynx***
13. Nose***
14. Ear***
15. T-M Joint***
 87

Pharyngeal Derivatives
Pharyngeal cleft
Ectoderm-lined indentation between pharyngeal arches on their
external surfaces.

Pharyngeal pouch
Endoderm-lined indentation between pharyngeal arches on their
internal surfaces.
 Arch Nerve Muscle Skeleton Artery
1st Maxillary&mandibular divison of Muscle of Maxillary process: 1st
aortic arch-Persist as a
(Mandibular- Trigeminal nerve(Cr.N-V) mastication(Temporal,messeter,medial&later Premaxilla, maxilla, zygomatic, part of temporal bone maxillary artery
maxillary& al pterigoid) Mandibular process:
mandibular Myelohyoid sphenomandibular ligament,Lingula of mandible
process) Ant.belly of digastric Meckels’cartilage:
Tensor palatine malleus,incus,ant.ligament of malleus
Tensor tympani Quadrate cartilage

2nd arch Cr.N-VII(Facial nerve) Muscle of facial Stapes,Styloid process, 2nd aortic arch-Stapedial
(Hyoid arch) expression(buccinator,auricularis,frontalis,pla Styloid ligament, artery(from dorsal part)
tysma,orbicularis oris,orbicularis occuli) Lesser horn&upper portion of body of hyoid bone
Post.belly of digastric,
Stylohyoid
Stapedius

3rd arch Cr.N-IX(Glossopharyngeal nerve) Greater horn&lower portion of the hyoid bone 3rd aortic arch(Ventral part-
Stylopharyngeus CCA,Dorsal part-stem of ICA)

4th arch Superior laryngeal branch of vagus Cricothyroid 4th aortic arch(Rt-proximal part
N. Levator palatine Laryngeal cartilage:(both 4th &6th arch) of rt.subclavian artery,Lt-part
(External Laryngeal nerve ) Constrictors of Pharynx Thyroid cartilage(4th arch mainly) of arch of aorta)
Cricoid cartilage
Arytenoid cartilage
6th arch Recurrent laryngeal branch of vagus Intrinsic muscle of larynx except cricothyroid Corniculate cartilage 6th aortic arch(Rt. ventral-rt.
N. Cuneiform cartilage pulmonary artery,Rt. dorsal-
Disappears;Lt.ventral-lt
pulmonary artery,Lt.dorsal-
Ductus arteriosus
 Pouches Derivatives
1st pouch Middle ear cavity
Auditory tube
Endodermal lining of tympanic membrane
2nd pouch Palatine tonsils
3rd pouch Inferior parathyroid gland(Parathyroid III)
Thymus
4th pouch Superior parathyroid gland(Parathyroid IV)
Lateral thyroid element
5th pouch Ultimobronchial body which later form the parafollicular cell or
‘C’ cell/Clear cell of thyroid gland
 217

SCALP
 218

Cranial fossa & Foramen of the skull

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Pterion
➢Junction of frontal, parietal, sphenoid, and temporal bones.
➢The bone in this area is particularly thin and overlies the anterior
division of the middle meningeal artery, which can be torn by a skull
fracture in this area, resulting in an extradural hematoma.
 219

Pituitary Gland
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DURAL VENOUS SINUSES
These are venous spaces the walls of which are formed by the dura
mater.
 220
Cavernous Sinus
• Situated in the middle cranial fossa, on either side of the body of the
sphenoid bone.
• Floor formed by: Endosteal layer of dura mater
• Lateral wall, roof & meal wall formed by: Meningeal layer of dura
mater
Structures in the lateral wall of the sinus:
• Maxillary division of V nerve.
• Oculomotor nerve.
• Trochlear nerve.
• Trigeminal ganglion.
• Ophthalmic division of V nerve.

Structures passing through the centre of the sinus:

• Internal carotid artery with the venous and symphathetic plexuses
around it.
• Abducent nerve- inferolateral to ICA.
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Facial Nerve
229
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Branches & Distribution
A. Within the facial canal:
(1) Greater petrosal nerve; (2) the nerve to the stapedius; and (3 )the chorda
tympani.

B. At its exit from the stylomastoid foramen:

(1) Posterior auricular (2) Digastric; and (3) Stylohyoid.

C. Terminal branches within the parotid gland:

(1) Temporal (2) Zygomatic (3) Buccal (4) Marginal mandibular and (5) Cervical
D. Communicating branches with adjacent cranial and spinal nerves.
 230

Parasympathetic Ganglions
 230
Parasympathetic Ganglions 4 in numbers

1. Ciliary Ganglion
2. Otic Ganglion
3. Pterygopalatine
4. Submandibular Ganglion
 230
Area supplied by Parasympathetic Ganglions

1. Ciliary Ganglion- Ciliary muscle, Sphincter pupillae

2. Otic Ganglion- Parotid Gland
3. Pterygopalatine Ganglion-Lacrimal gland, nasal stuff, paranasal sinus
palate & pharynx
4. Submandibular Ganglion- Submandibular and Sublingual salivary
gland
[COPS]
• Cranial nerves having parasympathetic nucleus- 3, 7, 9, 10
• Parasympathetic nucleus-
 234

Salivary Gland
234
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Parotid Gland
 234
Structures within the Parotid Gland:
Arteries:
External Carotid Artery
Maxillary Artery
Superficial Temporal Artery
Posterior Auricular artery (may be)
Veins:
Retromandibular vein (Sup Temporal+Maxillary)
Nerves:
Facial (enters through PM surface & terminal branches emerge through
AM surface)
Parotid Lymph nodes
 234

Structures within the Parotid Gland

234
Anatomical relations to the submandibular
gland***
• Lingual nerve
• Hypoglossal nerve
• Marginal mandibular branch of the facial nerve
• Anterior facial vein
• Facial artery
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NECK
NECK 222
222
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CAROTID SHEATH

Contents:
• CCA, ICA—Medially
• IJV—Laterally
• Vagus Nerve—Between
and behind the CCA &
IJV
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Deep Structures of the neck

223
Q. Deep cervical fascia encloses-[42nd Special BCS]
(a) Larynx
(b) Thyroid gland
(c) Pineal gland
(d) Submandibular gland
Ans: D
S. During surgery in posterior triangle of neck which structure more
susceptible for injury?
a) Accessory spinal nerve
b) Transverse cervical nerve
c) CCA
d) Great auricular nerve
e) Dorsal scapular Nerve

A
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Vessels of The Neck

224
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Branches of Internal Carotid Artery
[mnemonic-CHOAMPA]
C- Cavernous branches to the trigeminal ganglion
H- Hypophyseal (superior&inferior) branches to the Hypophysiscerebri
O- Opthalmic artery
A- Anterior cerebral artery
M- Middle cerebral artery
P- Posterior communicating artery
A- Anterior chorroidal artery
Internal Carotid ARTERY
Internal 225
Jugular
Vein
 229

Face
58-59 Page
229
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 225

Thyroid Gland
225
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Situation and extent:

(a)Each lobe extends from the middle of thyroid cartilage to the fourth
or fifth tracheal ring.
(b)The isthmus extends from the 2nd to the 4th tracheal ring
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Blood supply of thyroid gland:
Arterial supply:
•Upper 1/3rd of lobe & upper ½ of isthmus – superior thyroid artery,
branch of external carotid artery.
•Lower 2/3rd of lobe & lower ½ of isthmus- inferior thyroid artery,
branch of thyrocevical trunk.
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Venous drainage:
•Superior thyroid vein, drains into internal jugular or common facial
vein.
•Middle thyroid vein, drains into internal jugular vein.
•Inferior thyroid vein, drains into left brachiocephalic vein
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During thyroidectomy, superior thyroid artery should be ligated as close

to the apex of thyroid lobe as possible to avoid injury to the external
laryngeal nerve.

during thyroidectomy, the inferior thyroid artery should be ligated as

away from the base of the thyroid lobe as possible to avoid injury to
the recurrent laryngeal nerve.
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Parathyroid Gland
 226
• Two Paris (Superior and inferior) of small endocrine glands
• Usually lie on the posterior border of the thyroid gland
• The superior parathyroid is more constant in position
• The inferior parathyroid is more variavle in position
• Rich blood supply from the inferior thyroid artery and from the
anastomosis between the superior and inferior thyroid arteries.
• Cells
1. Chief cells
2. Oxyphilic cells
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Nose & PNS

 228
Little’s area

PNS
 228
NASAL CONCHAE & MEATUS

Meatus Drainage

Inferior (largest) Naso-lacrimal duct

Middle Ethmoidal Bulla Middle Ethmoidal sinus

Hiatus Semilunaris Anterior Ethmoidal sinus
Maxillary sinus

Infundibulum Frontal sinus

Superior Posterior Ethmoidal sinus

Spheno-ethmoidal recess Sphenoidal sinus

 231

Oral Cavity
Palatine
Tonsil
Palatine
Tonsil
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Tongue
231
 TASTE BUDS 231

➢ Neuroepithelial Receptor
➢ Carries Taste sensation

Location Taste Buds

Vallate Papillae Most numerous
Foliate Papillae Numerous
Post 1/3rd of tongue Numerous
Fungiform Papillae Sparsely distributed
Filiform Papillae Absent
Soft palate, epiglottis, pharynx Present
TONGUE (MUSCLES) 231

[Ref: BD Chaurasia’s Human Anatomy, vol 3]

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Parts of the tongue

Nerve supply Ant.2/3rd Post.1/3rd Post.most part of vallecula
Sensory Lingual N Glossopharyngeal N Internal laryngeal branch of Vagus

Taste Chorda tympani Glossopharyngeal N Internal laryngeal branch of Vagus

except vallate papillae including the vallate
papillae
Development of Two Lingual swellings 3rd arch which forms 4th arch which forms small dorsal part
epithelium from & One large ventral part of of hypobranchial eminence
endoderm Tuberculumimpar of hypobranchial
1st arch. eminence
Tuberculumimpar
which soon
disappears
Nerve Supply 232

Of Tongue
Lymphatic
232
Drainage Of
Tongue
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Larynx
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Pharynx
233
Piriform Fossa:
Lateral wall of the Laryngopharynx shows an
anterior extension which forms a depression
on each side of the inlet of the larynx, called
Piriform fossa.
Beneath the mucosa- Internal laryngeal
nerve
FB impaction
Removal of FB from the fossa may damage
the nerve causing anaesthesia in the
supraglottic part.
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Ear
235
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EXTERNAL AUDITORY CANAL
Length : 24 mm
2 parts :
Bony- 16 mm, Medial two-thirds; formed by tympanic plate of temporal bone
Cartilaginous- 8 mm, Lateral one-third; contains hair, sebaceous glands and ceruminous
glands
Nerve Supply : Anterior half- by Auriculotemporal nerve
Posterior half- by Auricular branch of X
Middle Ear 236
Cavity
 236
MIDDLE EAR : CONTENTS

3 ossicles- Malleus, Incus, Stapes

Ligaments
2 muscles- Tensor tympani(Mandibular), Stapedius (Facial)
Vessels & Lymphatics
Nerves- Chorda Tympani, Tympanic plexus
Air
 INNER EAR/ LABYRINTH
Lies in the petrous part of Temporal bone
Consists of –
Bony Labyrinth (filled with Perilymph, contains Membranous labyrinth)
Membranous Labyrinth (filled with Endolymph)
Bony Labyrinth : 3 parts- Cochlea
Vestibule
Semicircular canals
Membranous Labyrinth : Spiral duct of Cochlea
Utricle & Saccule
Semicircular ducts
Inner Ear
Inner Ear
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Apparatus for Hearing &
Equilibrium

Hearing apparatus Apparatus for

equilibrium
The external ear The semicircular canals
The middle ear The utricle
The cochlea of the inner The saccule
ear
 EUSTACHIAN TUBE
Also known as Auditory tube or Pharyngotympanic tube
Length : 4 cm
Direction : Downwards, Forwards and Medially; more wider and straight in children
Connects Middle ear cavity with Nasopharynx
2 parts:
Bony part- 12 mm, Posterior and Lateral one-third
Lies in the Petrous temporal bone
Cartilaginous part- 25mm, Anterior and Medial two third
Lies in the sulcus tubae
Attached muscles- Tensor veli palatini, Levator veli palatini, salpingopharyngeus
EUSTACHIAN TUBE
Lining Epith- Ciliated columnar with mucous glands
Nerve Supply : Bony part- Tympanic plexus
Cartilaginous part- Mandibular nerve
Functions : Ventilates middle ear cavity
The tube is usually closed; opens during swallowing, yawning and
sneezing
Eyelid & Orbit
 CONTENTS OF THE ORBIT
Eyeball
Fascia- Orbital & Bulbar
Muscles- Extraocular
Vessels- Ophthalmic artery
Superior, Inferior ophthalmic veins
Lymphatics
Nerves- II, III, IV,
Branches of Ophthalmic & Maxillary nerves
Sympathetic nerves
Lacrimal gland
Orbital fat
Temporomandibular Joint
 114 Page
Important Topic
• Type: Condyloid/Hinge
• Which muscle elevate TM JOINT? MTM
114 Page
Neuroanatomy
 249
Parts of NERVOUS SYSTEM
• Central nervous system (CNS): responsible for integrating,
coordinating the sensory information and ordering
appropriate motor actions.
• Peripheral nervous system (PNS): provide afferent impulses
to CNS and carries efferent impulses to muscles, glands,
blood vessels and heart
Brain divided in 3 parts 249
Parts Subdivision Cavity
1. Forebrain A. Telencephalon (cerebrum), made up of two cerebral hemispheres and Lateral
(Prosencephalon) the median part in front of the interventricular foramen, Basal ganglia, ventricle
Hippocampus
B. Diencephalon (thalamencephalon), hidden by the cerebrum, consists Third ventricle
of:
a. Thalamus
b. Hypothalamus
c. Metathalamus, including the medial and lateral geniculate bodies, and
d. Epithalamus, including the pineal body, habenular trigone and posterior
commissure
e. Subthalamus

2. Midbrain Crus cerebri, substantia nigra, tegmentum, and tectum, from before
(mesencephalon) cerebral aqueduct backwards
3. Hindbrain A. Metencephalon, for made up of two pons and two cerebellum Fourth
(rhombencephalon) B. Myelencephalon or medulla oblongata ventricle
 249
WHITE MATTER OF THE CEREBRAL HEMISPHERES
(1) Commissural fibers,
• corpus callosum,
• the anterior commissure
• the posterior commissure
• the fornix
• habenular commissure
(2) Association fibers
(3) Projection fibers.
 249
WHITE MATTER OF THE CEREBRAL HEMISPHERES
(3) Projection fibers
• Internal capsule
• Corona radiate
• Optic radiation
CELLULAR ARCHITECTURE
The nervous tissue is made up of:
1. Nerve cells or neurons
2. Neuroglial cells (neuroglia): In peripheral nervous system,
these are replaced by Schwann’s cells.
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NEURON
Structural & functional unit of nervous system.
1 A cell body:
• forms grey matter
• Nuclei in the CNS
• Ganglia in the peripheral nervous system.

2 Cell processes
a. Dendrites
b. The axon: Collectively the axons form tracts (white matter) in the
CNS, and nerves in the peripheral nervous system.
 251
Differences between Axon and Dendrites
Traits Axon Dendrites

Number Always single in a neuron May be single or multiple

Site of origin Arises from the nerve at axon hillock Arises from any part

Size Longer Short

Branching Usually unbranched, if branched, branches are Usually branched

few
Functional nature Motor Sensory

Nissl granules absent present

 251
Classification of Neuron
I. Functional classifications of neuron
a. Sensory neuron:
•First order neuron: carry sensation from periphery to spinal cord.
Presents in dorsal root ganglion of spinal nerves
•Second order neuron: carry sensation from the spinal cord to the
thalamus. Present in the grey matter of spinal cord and in brainstem.
•Third order neuron: carry sensation from the thalamus to ' the
sensory cortex of the brain. Seen in thalamus
 251

b. Motor neuron
•Upper motor neuron- arise in CNS (cerebral cortex) and ends in CNS
(anterior horn of spinal cord)
•Lower motor neuron- arise from the CNS (anteric horn of the spinal
cord, motor cells of the cranial nerve nucleus) and ends in the
peripheral organs.
 251
2. Morphologic Classification
Morphologic Arrangement of Neurites Location
Classification
Unipolar Single neurite divides a short Posterior root Mesencephalic nucleus of the 5th cranial nerve
ganglion
distance from cell body
Bipolar Single neurite emerges from either end of cell Retina (Bipolar cells of the retina),
body Sensory cochlea (Hair cells of cochlea)
&Vestibular ganglia,
Olfactory cells.
Multipolar Many dendrites and one long axon all motor and internuncial neurons

Pseudounipolar T shaped process Dorsal root ganglia

Cranial nerve ganglia except VIII CN
 252

According to length of axon

Golgi type-I Single long axon • Pyramidal cells ( cerebral cortex)

• Purkinjee cells ( cerebellar cortex)
• Anterior horn cells of the spinal cord]

Golgi type –II Short axon • Cerebral & cerebellar cortex

 253
NEUROGLIAL CELLS
Neuroglia Function
1. Astrocytes:*** 1. Provide supporting framework
a.protoplasmic 2. form blood–brain barrier.
b. fibrous

2. Oligodendrocytes 1. Formation of myelin sheath of the nerve fibers in the CNS

3. Microglia 1. Proliferate in diseases and phagocytosis.

2. Are formed by blood monocytes

4. Ependyma 1. Ependymocytes assist in the circulation & absorption of CSF

[Lining the cavities 2. Tanycytes transport substances from CSF to hypophyseal-portal system
of the CNS] 3. Choroidal epithelial cells produce & secrete CSF
• Brain tumours arise chiefly from the neuroglial cells
Q. The supporting cells of nervous system is called-[39th Special BCS]
(a) Neuron
(b) Neuroglia
(c) Ganglia
(d) Purkinjec cell
Ans: C
COMPOSITION of GREY MATTER
• Cell body (soma)
• Neuroglial cells
• Blood vessels
COMPOSITION of WHITE MATTER
• Nerve fibres- Axons
• Neuroglial cells
• Blood vessels
 253
Cerebrum
Structure of the Cerebral Cortex
The nerve cells present in the cerebral cortex are:
1. Pyramidal Cells,
2. Stellate Cells,
3. Fusiform Cells,
4. Horizontal Cells Of Cajal
5. Cells of Martinotti
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Some of the main anatomical connections of the Cerebral cortex (sensory)

Functions Origin Cortical area Destination

Somatosensory (most to Ventral posterior lateral and Primary somesthetic area (B3, 1, Secondary somesthetic
Contralateral side of ventral posterior medial nuclei and 2) posterior centalgyrus area, primary motor area
body, oral to same side, of thalamus
pharynx, larybnx, and
perineum bilateral)
Vision Lateral geniculate body Primary visual area (B17) Secondary visual area (B18
and 19)
Auditory Medial geniculate body Primary auditory area (B41 and 42) Secondary auditory area
(B22)
Taste Nucleus solitaries Posterior centrealgyrus (B43_)
Smell Olfactory bulb Primary olfactory area, Secondary olfactory area
periamygdaloid and prepiriform (B 28)
areas
 255
Thalamus
• Two thalami
• situated on each side of the third ventricle.
Function of the Thalamus
1. Sensory information converges
2. Interpretation of sensations.
3. Voluntary movements.
4. Subjective feeling states and the personality.
5. Reticular formation
 255
Hypothalamus
Biological clock of body
Function:***
1. Autonomic: Anterior portion – Parasympathetic
Posterior – Sympathetic
2. Endocrine control
3. Neurosecretion
4. Temperature control
5. Regulation of food and water intake
 255
Hypothalamus
6. Emotion and behavior
7. Control of circadian rhythm
8. Sexual behavior and reproduction:
Control gametogenesis, reproductive cycle, maintenance of secondary
sexual characteristic by controlling anterior pituitary
 255
Cerebellum
• Functional lobe:
• Paleocerebellum:(Spinal Cerebellum): Facilitate muscle tone and
posture of the limb.
• Neocerebellum: (Cerebro-ponto-cerebellum): Concerning with
smooth performance of skilled acts by co-ordinations of movements.
• 3. Archicerebellum:(Vestibular cerebellum): Maintaining equilibrium,
tone and posture of trunk muscle.
 255

Cells of Cerebellar cortex

1. Outer molecular layer: Stellate & Busket cells
2. Purkinjee cell layer: Purkinjee & Golgi cells
3. Granular layer: Numerous small, rounded ground cells with nuclei
 255

Nuclei of Cerebellar cortex

• Dentate
• Emboliform
• Globose
• Fastigeal
 256
Internal Capsule
• projection fibres
• Lies mainly between the head of the caudate neucleus & thalamus
medially and lentiform neucleus laterally.
Constituent fibres of the internal capsule:
a. Anterior limb
b. Posterior limb
c. Genu
d. Retrolenticular part
e. Sublentiform part
 256

Clinical anatomy: Rupture of lenticulostriate branch of middle cerebral artery(Charcoat artery) is

common resulting stroke, hemiplegia of opposite side.
256
 256
BASAL NUCLEI
The basal nuclei are subcortical and, intracerebral masses of grey matter
forming important parts of the extrapyramidal system.
Parts:
1. Corpus striatum
- Caudate nucleus
- Lentiform nucleus
a) Globus pallidus (Medially)
b) Putamen (Laterally)
2. Amygdaloid nucleus
3. Claustrum
256
 256

Functions of the Basal Nuclei

1. Control gross muscular movements by influencing the cerebral
cortex
2. Influence the skilled cortical motor activities.
3. Influence the execution of a particular movement
4. Help prepare for the movements.
5. Have no direct control through descending pathways to brainstem
and spinal cord.
 257
Limbic System
Components of the limbic system include
• Olfactory nerves, bulb, tract, striae and trigone
• Anterior perforated substance, thalamic nuclei
• Pyriform lobe consisting of the uncus, Parahippocampal gyrus
• Posterior part of Parahippocampal and cingulate gyrus
• Hippocampal formation including hippocampus, dentate gyrus,
indusiumgriseum and longituidinalstriae,entorhinal cortex
• Amygdaloid Nucleus, Septal region
• Fornix, Striaterminalis, habenularis, anterior commissure
 257
Limbic System
MNEMONIC: Limbic system function:
F- Fear, Food habit
E- Endocrine and emotion
A- Anger
R- Recent memory
S- Sexual behavior, smell
Meninges of the Brain
Three membranous coverings (meninges):
a. The outer dura mater (pachymeninx)
b. The middle arachnoid mater
c. The inner pia mater.
The arachnoid and pia are together known as the leptomeninges.
The spaces in relation to meninges are
a. Extradural/epidural
b. Subdural
c. Subarachnoid
Lumbar puncture:
Done by passing a needle in the interspace between the third and
fourth lumbar spines
 257
CEREBROSPINAL FLUID (CSF)
• Contained in the ventricular system of the brain and in the
subarachnoid space around the brain and spinal cord.
• Volume: 150 ml.
• Normal pressure of CSF is 60 to 100 mm H2O.
Formation
1. The bulk of the CSF is formed by the choroid plexuses of the lateral
ventricles and lesser amounts by the choroid plexuses of the third and
fourth ventricles.
2. Also formed by the capillaries on the surface of the brain and spinal
cord.
 257

CSF absorption
The main sites for the absorption of the cerebrospinal fluid are the arachnoid villi
257
 258
Blood Supply of Brain
ARTERIES OF BRAIN
• By two vertebral and two internal carotid arteries

CIRCLE OF WILLIS
• It is a hexagonal arterial circle, situated at the base of brain in the
interpeduncular fossa.
 258
Formation
Anteriorly: Anterior communicating artery joining the two anterior
cerebral arteries.
Anterolaterally: Anterior cerebral arteries
Laterally: Internal carotid arteries
Posterolaterally: Posterior communicating arteries
Posteriorly: Posterior cerebral arteries

• Provides a collateral circulation in the event of obstruction to one of

its components.
258
258
ARTERIAL SUPPLY OF CEREBRAL CORTEX
• Middle cerebral is main artery on superolateral surface
• Anterior cerebral artery is chief artery on medial surface
• Posterior cerebral is principal artery on inferior surface
Q. Medial surface of brain is supplied by: [39th Special BCS]
(a) Middle cerebral artery
(b) Anterior cerebral artery
(c) Verlebral artery
(d) Porterior inferior cerebellar artery
Ans: B
Artery Supply of Cerebellum
The little brain is supplied by following arteries
1 Superior cerebellar
2 Anterior inferior cerebellar
3 Posterior inferior cerebellar
BLOOD–BRAIN BARRIER
The BBB is formed by structures between the blood and nerve cells of
brain.
a. Capillary endothelium
b. Basement membrane of endothelium
c. The foot processes of astrocytes
 261
Spinal Cord
• 18 inches or 45 cm in an adult male and 42 cm in female
• Extends from upper border of atlas vertebra to the lower border of
first lumbar vertebra in an adult.
• In children it extends up to L3 vertebra.
• Extends in the lower part of 1st lumbar vertebra as conus medullaris.
• Below the level of conus medullaris only pia mater is continued as a
thin fibrous cord, the filum terminale.
261
 261
Cauda Equina
Dorsal and ventral nerve roots of right and left sides of L2 to L5, S1 To
S5 and Co1 nerves lie almost vertically around filumterminale. These
are called cauda equina as these resemble a horse’s tail.

Cauda Equina Syndrome: Damage to Cauda Equina results

a. LMN type of paralysis in the lower limbs due to compression of
ventral nerve roots.
b. Root pains is an important symptom due to involvement of dorsal
nerve roots.
c. Bladder and bowel involvement is late.
262
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Brown- sequard syndrome: (In case of tranverse hemisection of spinal cord/spinal cord injury)

Same side Opposite side

Sensory change Loss of fine touch, tactile localization, tactile discrimination These sensations remain
& kinesthetic sensation due to the damage of tracts of Gall unchanged
and Burdach.
Crude touch, pain & thermal sensation remain unchanged Loss of crude touch, pain
& thermal sensation due
to the damage of the
spinothalamic tract.
Motor change Extensive paralysis of UMN type due to damage of lateral Either no paralysis or little
corticospinal tract. Temporary loss of vasomotor tone paralysis occurs
Difference between pyramidal & extrapyramidal lesions
Traits Pyramidal tract lesion Extrapyramidal tract lesion
1. Paralysis • Flaccid paralysis • Spastic paralysis (release
• Loss of performance of phenomenon)
fine skilled voluntary • Severe paralysis with little or no
movements especially muscle atrophy
at the distal ends of • Incapacity & disability are less
the limbs
• Incapacity & disability
are more
2. Reflexes • Superficial reflexes are • Deep reflexes are exaggerated
absent • Clonus may be present
• The Babinski sign is
present
3. Clasp-knife • Absent • Present
reaction
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Differences between UMN & LMN lesions

UMN lesion LMN lesion
Inspection Usually normal (wasting in Wasting, fasciculation
longstanding lesions)

Tone Increased with clonus Normal or decreased, no clonus

Type of paralysis Spastic Flaccid
Weakness Preferentially affects Usually more focal, in
extensors in arms, flexors in distribution of nerve root or
leg peripheral nerve
Superficial reglexes Absent Absent
Deep tendon Increased Decreased/ absent
reflexes
Planter response Extensor (Babinski sign Flexor
positive)
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Cranial Nerves
Attachment of the nerves to brain:
I, II to the forebrain
III, IV to midbrain
V, VI, VII, VIII to the pons
IX, X, XI, XII to the medulla oblongata
Functional Component
Autonomic Nervous System 264
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Thank You