INTERNAL STRUCTURES

BY RONO.W
Brain SBRAIN STEMTEM
• Located btwn the cerebrum and the SC
• Provides a pathway for tracts running btwn higher and lower neural centers.

• Consists of the midbrain, pons, and.

• Each region is about an inch in length. medulla oblongata

• Microscopically, it consists of deep gray matter surrounded by white matter fiber

tracts.

• Contains vital centres that Produce automatic behaviors necessary for survival.
Midbrain
• Located btwn the diencephalon and the pons.
• 2 bulging cerebral peduncles on the ventral side. These contain:
• Descending fibers that go to the cerebellum via the pons
• Descending pyramidal tracts
• Running thru the midbrain is the hollow cerebral aqueduct which connects the
3rd and 4th ventricles of the brain.
• The roof of the aqueduct ( the tectum) contains the corpora quadrigemina
• 2 superior colliculi that control reflex movements of the eyes, head and
neck in response to visual stimuli
• 2 inferior colliculi that control reflex movements of the head, neck, and
trunk in response to auditory stimuli
CONT..
• On each side, the midbrain contains a red nucleus and a substantia
nigra
• Red nucleus contains numerous blood vessels and receives info
from the cerebrum and cerebellum and issues subconscious motor
commands concerned w/ muscle tone & posture
• Lateral to the red nucleus is the melanin-containing substantia nigra
which secretes dopamine to inhibit the excitatory neurons of the
basal nuclei.
• Damage to the substantia nigra would cause what?
PONS
• Literally means “bridge”
• Wedged btwn the midbrain & medulla.
• Contains:
• Sensory and motor nuclei for 4 cranial nerves
• Trigeminal (5), Abducens (6), Facial (7),
and Auditory/Vestibular (8)
• Respiratory nuclei:
• Apneustic & pneumotaxic centers work w/ the medulla to maintain respiratory rhythm
• Nuclei & tracts that process and relay info to/from the cerebellum
• Ascending, descending, and transverse tracts that interconnect other portions of the CNS
• Bulge in the brainstem, rostral to
the medulla
Ascending sensory tracts
Descending motor tracts
Pathways in & out of cerebellum
Nuclei concerned with sleep, hearing, balance, taste, eye
movements, facial expression, facial sensation, respiration,
swallowing, bladder control & posture
cranial nerves V, VI, VII, and VIII
MEDULLA OBLANGATA
• 3 cm extension of spinal cord
• Ascending & descending nerve tracts
• Nuclei of sensory & motor cranial
nerves (IX, X, XI, and XII)
• Cardiac center adjusts rate & force of heart beat
• Vasomotor center adjusts blood vessel diameter
• Respiratory centers control rate & depth of breathing
• Reflex centers for coughing, sneezing, gagging, swallowing, vomiting,
salivation, sweating, movements of tongue & head
• Pyramids and olive visible on surface
• Most inferior region of the brain stem.
• Becomes the spinal cord at the level of the foramen magnum.
• Ventrally, 2 ridges (the medullary pyramids) are visible.
• These are formed by the large motor corticospinal tracts.
• Right above the medulla-SC junction, most of these fibers cross-
over (decussate).
• Nuclei in the medulla are associated w/ autonomic control, cranial nerves, and
motor/sensory relay.
• Autonomic nuclei:
• Cardiovascular centers
• Cardioinhibitory/cardioacceleratory centers alter the rate and force of
cardiac contractions
• Vasomotor center alters the tone of vascular smooth muscle
• Respiratory rhythmicity centers
• Receive input from the pons
• Additional Centers
• Emesis, deglutition, coughing, hiccupping, and sneezing
• Sensory & motor nuclei of 5 cranial nerves:
• Auditory/Vestibular (8), Glossopharyngeal (9), Vagus (10),
Accessory (11), and Hypoglossal (12)
• Relay nuclei
• Nucleus gracilis and nucleus cuneatus pass somatic sensory
information to the thalamus
• Olivary nuclei relay info from the spinal cord, cerebral cortex,
and the brainstem to the cerebellar cortex.
LIMBIC SYSTEM
• Includes nuclei and tracts along the border btwn the cerebrum and the
diencephalon.
• Functional grouping rather than anatomical
• Functions includes:
1. Establishing emotional states
2. Linking conscious cerebral cortical functions w/ unconscious functions of the
brainstem
3. Facilitating memory storage and retrieval
4. Limbic system  the center of emotion – anger, fear, sexual arousal, pleasure,
and sadness.

• Limbic lobe of the cerebrum consists of 3 gyri that curve along the
corpus callosum and medial surface of the temporal lobe.
Reticular Formation
• Extensive network of neurons that runs thru the medulla and projects
to thalamic nuclei that influence large areas of the cerebral cortex.
• Midbrain portion of RAS most likely is its center
• Functions as a net or filter for sensory input.
• Filter out repetitive stimuli. Such as?
• Allows passage of infrequent or important stimuli to reach the
cerebral cortex.
• Unless inhibited by other brain regions, it activates the cerebral
cortex – keeping it alert and awake.
FUNCTION
1. Regulate balance & posture
 relaying information from
eyes & ears to cerebellum
 gaze centers allow you to track moving object
2. Includes cardiac & vasomotor centers
3. Origin of descending analgesic pathways
4. Reticular activating system:- Regulates sleep & conscious attention
• injury leads to irreversible coma
Cerebral cortex histology
the Cell are arranged in five layers as follows :-
1.Plexiform (molecular) layer.:- it is the most superficial layer mainly contains
dendrites and axons of cortical neurones making synapses with one another;
the sparse nuclei are those of neuroglia and occasional horizontal cells of Cajal.

2.Outer granular layer. A dense population of small pyramidal cells and stellate
cells make up this thin layer which also contains various axons and dendritic
connections from deeper layers.
3.Pyramidal cell layer. Pyramidal cells of moderate size predominate in this
broad layer, the cells increasing in size deeper in the layer. Martinotti cells are
also present.
Cont..
4.Inner granular layer:- This layer consists mainly of densely packed
stellate cells.

5.Ganglionic layer. Large pyramidal cells and smaller numbers of stellate

cells and cells of Martinotti make up this layer, the name of the layer
originating from the huge pyramidal (ganglion) Betz cells of the motor
cortex.

6.Multiform cell layer.. It contains numerous small pyramidal cells and cells
of Martinotti, as well as stellate cells, and fusiform cells in the deeper part.
THALAMUS
Oval mass of gray matter protruding into lateral ventricle (part of
diencephalon)
Receives nearly all sensory information on its way to cerebral cortex
• integrate & directs information to appropriate area
Interconnected to limbic system so involved in emotional & memory
functions
• Epithalamus (Pineal Gland)
CEREBELLUM
Cont…
• Right & left hemispheres connected by vermis
• Parallel surface folds called folia are gray matter
• all of output comes from deep gray nuclei
• large cells in single layer in cortex are purkinje cells synapse on deep nuclei
• Connected to brainstem by cerebellar peduncles
• White matter (arbor vitae) visible in sagittal section
• Sits atop the 4th ventricle
LOBES
• Anterior lobe: Is seen on the superior surface.

• Middle or posterior lobe is the largest part of the cerebellum.

• It is separated from the anterior lobe by the primary fissure.

• Flocculonodular lobe is separated from the middle lobe by

uvulonodular fissure.
Cont…
There are three prominent fissures as follows:
• A deep horizontal fissure separates the superior and inferior surfaces
of cerebellum; has no morphological or functional significance.

• The primary fissure (Fissure prima): This V-shaped fissure separates

the anterior lobe from the middle lobe

• The posterolateral/ uvulonodular fissure: Separates flocculonodular

lobe from the middle lobe.
PARTS OF VERMIS
The vermis has the following parts:
• Lingula
• Central lobule
• Culmen
• Folium
• Declive
• Tuber
• Pyramid
• Uvula
• Nodule
FUNCTION OF VERMIS
• Coordinate the movements of the central body trunk,head,proximal
limbs
Histological features
A parasagittal section through the cortex reveals three
layers:
• The external, molecular layer: Contains outer stellate cells and inner basket
cells
• The middle, Purkinje cell layer: Has Purkinje cells. These are flask shaped and
have short, thick dendritic spines that form synaptic contacts with the parallel
fibres from granule cell axons. These cells also have connections with basket
cells and intracerebellar nuclei and vestibular nuclei in the brain stem.
• The internal, granular layer: Contains Golgi and granular cells. Granular cells
send axons to that form T-junctions in the molecular layer which synapse with
Purkinje cells. Also they synapse with mossy and climbing fibres.
Cont…
There are four masses of gray matter embedded in the gray matter.
The intracerebellar nuclei are composed of large,multipolar neurons whose
axons form the cerebellar outflow in the superior and inferior cerebellar
peduncles.
These are named as follows, from lateral to medial:
• Dentate: It is the largest of the four. Has a shape of crumpled bag with the
opening facing laterally. Grasping and fine motor (tremors)
• Emboliform: Is oval
• Globose
• Fastigial: Lies near midline in the vermis and close to the roof of the fourth
ventricle mainly control posture and locomotion
FIBERS
They are grouped into:
1. Intrinsic
2. Afferent
3. Efferent
Cerebellar functions
1.It controls motor-related functions, such as maintaining balance and
posture, and motor learning including coordination of movements
through complex regulatory and feedback mechanisms.

2.Control of cognition and emotion, and patients with cerebellar

dysfunction experience cognitive and affective symptoms
CEREBELLAR LESION
• Cerebellar lesions cause
1. Dysmetria,
2. Ataxia, and
3. Intention tremors
BASAL GANGLIA
The term is used to apply to a collection of masses of gray mater
situated within each cerebral hemisphere. They are:
• Corpus straitum
• Amygdaloid nucleus
• Claustrum

General function – play an important role in control of

posture and voluntary movement
Corpus striatum
• Located lateral to the thalamus

• It is completely divided by a band of nerve fibres,

the internal capsule into the caudate nucleus and
lentiform nucleus
CAUDATE NUCLEI
• Is a large C-shaped mass of gray matter that is closely related to the
lateral ventricle and lies lateral to the thalamus.

• Laterally it is related to the internal capsule.

• It is divided into head, body and tail (for descriptive purposes).

• The head forms the lateral wall of the anterior horn of the lateral
ventricle.
Cont…
• Fibers of gray matter pass between the head of caudate nucleus and
lentiform nucleus through the internal capsule, giving the region a
striated appearance, hence the term corpus striatum.

• The body forms part of the floor of the body of the lateral ventricle.

• The tail runs in the roof of the inferior horn of the lateral ventricle
terminating in the amygdaloid nucleus.
LENTIFORM
• It is lateral to the caudate nucleus and the thalamus, separated by the
internal capsule.
• Lateral to it are external capsule, claustrum, extreme capsule and
insula in that order.
• It is divided into putamen laterally (outer) and globus pallidus
medially (inner).
• The putamen is continuous with the head of the caudate nucleus.
Descending (Motor) Pathways
• Descending tracts: they relay motor instructions from the brain to the
spinal cord
• They are divided into two groups
1. Pyramidal, or corticospinal, tracts
2. Indirect or extrapyramidal pathways, essentially all others
• The Motor pathways involve two neurons
1. Upper motor neuron (UMN)
2. Lower motor neuron (LMN)
• aka ‘anterior horn motor neuron” (also, final common pathway)
1. They Includes all the other motor pathways that are not part of the
pyramidal system
2. Upper motor neuron (UMN) originates in nuclei deep in cerebrum
(not in cerebral cortex)
3. Upper Motor Neurones does not pass through the pyramids!
4. Lower Motor Neurones exit through the anterior horn motor neuron
1. This system includes
1. Rubrospinal tract - facilitate flexor muscles and inhibit extensors
2. Vestibulospinal tract- facilitate extensors muscles and inhibit flexors
3. Reticulospinal tract - fibers from reticular activating system
4. Tectospinal tracts- audio-visual reflex activities in tilting the head
2. They Regulate:
1. Axial muscles that maintain balance and posture
2. Muscles controlling coarse movements of the proximal portions of limbs
3. Head, neck, and eye movement
Cortical spinal tracts
General features of the Pyramidal or the
(Corticospinal) Tracts
1. They Originate in the precentral gyrus of brain (aka, primary motor area)
• I.e., cell body of the UMN located in precentral gyrus

2. Pyramidal neuron is the upper motor neuron(UMN)

• Its axon forms the corticospinal tract

3. UMN synapses in the anterior horn with LMN

• Some UMN decussate in pyramids = Lateral corticospinal tracts
• Others decussate at other levels of s.c. = Anterior corticospinal tracts
1. LMN (anterior horn motor neurons)
• Exits spinal cord via anterior root
• Activates skeletal muscles
2. Regulates fast and fine (skilled) movements

3. They are in two tracts (anterior and lateral cortiospinal tracts)

•ASCENDING TRACTS
•SENSORY PATH WAYS
General features of the Sensory Pathways
1. Monitor conditions both inside the body and in the external
environment
2. Sensation-stimulated receptor passes information to the CNS via
afferent (sensory) fibers
3. Most sensory information is processed in the spinal cord ,
thalamus, or brain stem. Only 1% reaches the cerebral cortex and
our conscious awareness
4. Processing in the spinal cord can produce a rapid motor response
(stretch reflex)
5. Processing within the brain stem may result in complex motor
activities (positional changes in the eye, head, trunk)
Transmit impulses to two destinations:-
a) To the cerebral cortex:- Concerned with specific sensory modalities: pain,
temperature, touch, proprioception, that reach a conscious level
I. Fasciculus gracile
II. Fasciculus cuneatus
III. Lateral spinothalmic tracts
IV. Anterior spinal thalamic tracts
(b) To the cerebelum:- concerned with tactile and stretch receptors to subconscious
centers located in the cerebelum
V. Anterior Spinocerebellar tracts.
VI. posterior spinal cerebellar tracts.
VII. cuniocerebellar tracts
1. Anterior spinothalamic-transmits pressure and non discriminative touch
information
2. Lateral spinothalamic-transmits pain and temperature impulse
3. Anterior spinocerebellar- transmits information on muscle joint sense
4. Posterior spinocerebellar- transmits information from muscle spindles and tendon
spindles
5. Cuneocerebellar-direct root on muscle joint sense from upper trunk
6. Spinotectal– information on the head position following visual tagets
7. Spinoreticul- reticular activating pathway for emergency and alertness
8. Spino-olivary- information on the head position following audio targets
9. Visceral sensory tracts- information from the organs and glands
PERIPHERAL NERVES
• Cervical plexus
• Branchial plexus
• Intercostal nerves
• Lumbar plexus
• Sacral plexus
Cervical plexus
• 1. Cutaneous Branches
• a. Lesser Occipital Nerve (C2)
• ■ Ascends along the posterior border of the sternocleidomastoid to
the scalp behind the auricle.
• b. Great Auricular Nerve (C2–C3)
• ■ Ascends on the sternocleidomastoid to innervate the skin behind
the auricle and on the parotid gland.
• c. Transverse Cervical Nerve (C2–C3)
• ■ Turns around the posterior border of the sternocleidomastoid and
innervates the skin of the anterior cervical triangle.
• d. Supraclavicular Nerve (C3–C4)
• ■ Emerges as a common trunk from under the sternocleidomastoid
and then divides into anterior, middle, and lateral branches to the skin
over the clavicle and the shoulder.
Motor part
• a. Ansa Cervicalis
• ■ Is a nerve loop formed by the union of the superior root (C1 or C1
and C2; descendens Hypoglossi) and the inferior root (C2 and C3;
descendens cervicalis).
• B.Phrenic Nerve (C3–C5)
• ■ Arises from the third, fourth, and fi fth cervical nerves but chiefl y
from the fourth cervical nerve; contains motor, sensory, and
sympathetic nerve fibers; and provides the motor supply to the
diaphragm and sensation to its central part.
• Twigs From the Plexus
• ■ Supply the longus capitis and cervicis or colli, sternocleidomastoid,
trapezius,levator scapulae, and scalene muscles.
• d. Accessory Phrenic Nerve (C5)
• ■ Occasionally arises as a contribution of C5 to the phrenic nerve or a
branch of the nerve to the subclavius (C5), descends lateral to the
phrenic nerve, enters the thorax by passing posterior to the
subclavian vein, and joins the phrenic nerve below the first rib to
supply the diaphragm
• ■ Is formed by the union of the ventral rami of the first three lumbar
nerves and a part of the fourth lumbar nerve.
• ■ Lies anterior to the transverse processes of the lumbar vertebrae
within the substance of the psoas muscle.
• Subcostal Nerve (T12)
• ■ Runs behind the lateral lumbocostal arch and in front of the
quadratus lumborum.
• ■ Penetrates the transverse abdominal muscle to run between it and
the internal oblique muscle.
• Innervates the external oblique, internal oblique, transverse, rectus
abdominis, and pyramidalis muscles
• Iliohypogastric Nerve (L1)
• ■ Emerges from the lateral border of the psoas muscle and runs in
front of the quadratus lumborum.
• ■ Pierces the transverse abdominal muscle near the iliac crest to run
between this muscle and the internal oblique muscle
• Ilioinguinal Nerve (L1)
• ■ Runs in front of the quadratus lumborum, piercing the transverse
and then the internal oblique muscle to run between the internal and
external oblique aponeuroses.
• ■ Accompanies the spermatic cord (or the round ligament of the
uterus), continues through the inguinal canal, and emerges through
the superficial inguinal ring
• Genitofemoral Nerve (L1–L2)
• ■ Emerges on the front of the psoas muscle and descends on its
anterior surface.
• ■ Divides into a genital branch, which enters the inguinal canal
through the deep inguinal ring to reach the spermatic cord and supply
the cremaster muscle and the scrotum (or labium majus), and a
femoral branch, which supplies the skin of the femoral triangle.
• Lateral Femoral Cutaneous Nerve (L2–L3)
• ■ Emerges from the lateral side of the psoas muscle and runs in front
of the iliacus and behind the inguinal ligament.
• ■ Innervates the skin of the anterior and lateral thigh.
• Femoral Nerve (L2–L4)
• ■ Emerges from the lateral border of the psoas major and descends in
the groove between the psoas and iliacus.
• ■ Enters the femoral triangle deep to the inguinal ligament and lateral
to the femoral vessels, outside the femoral sheath, and divides into
numerous branches.
• ■ Innervates the skin of the thigh and leg, the muscles of the front of
the thigh,
• Obturator Nerve (L2–L4)
• ■ Arises from the second, third, and fourth lumbar nerves and
descends along the medial border of the psoas muscle. It runs
forward on the lateral wall of the pelvis and enters the thigh through
the obturator foramen.
• Divides into anterior and posterior branches and innervates the
adductor group of muscles,the pectineus, the hip and knee joints, and
the skin of the medial side of the thigh.
• Accessory Obturator Nerve (L3–L4)
• ■ Is present in approximately 9% of the population.
• ■ Descends medial to the psoas muscle, passes over the superior
pubic ramus, and supplies the hip joint and the pectineus muscle.
• 9. Lumbosacral Trunk (L4–L5)
• ■ Is formed by the lower part of the fourth lumbar nerve and all of
the fifth lumbar nerve, which enters into the formation of the sacral
plexus.
SACRAL PLEXUS
• Sacral Plexus
• ■ Is formed by the fourth and fi fth lumbar ventral rami (the
lumbosacral trunk) and the first four sacral ventral rami.
• ■ Lies largely on the internal surface of the piriformis muscle in the
pelvis.
• 1.Superior Gluteal Nerve (L4–S1)
• ■ Leaves the pelvis through the greater sciatic foramen above the
piriformis.
• ■ Innervates the gluteus medius, gluteus minimus, and tensor fascia
lata muscles.
• 2. Inferior Gluteal Nerve (L5–S2)
• ■ Leaves the pelvis through the greater sciatic foramen below the
piriformis.
• ■ Innervates the gluteus maximus muscle.
• 3. Sciatic Nerve (L4–S3)
• ■ Is the largest nerve in the body and is composed of peroneal and tibial
parts.
• ■ Leaves the pelvis through the greater sciatic foramen below the piriformis.
• ■ Enters the thigh in the hollow between the ischial tuberosity and the
greater trochanter of the femur.
• 4. Nerve to the Obturator Internus Muscle (L5–S2)
• ■ Leaves the pelvis through the greater sciatic foramen below the piriformis.
• ■ Enters the perineum through the lesser sciatic foramen.
• ■ Innervates the obturator internus and superior gemellus muscles.
• 5. Nerve to the Quadratus Femoris Muscle (L5–S1)
• ■ Leaves the pelvis through the greater sciatic foramen below the piriformis.
• ■ Descends deep to the gemelli and obturator internus muscles and ends in
the deep surface of the quadratus femoris, supplying the quadratus femoris
and the inferior gemellus muscles.
• 6. Posterior Femoral Cutaneous Nerve (S1–S3)
• ■ Leaves the pelvis through the greater sciatic foramen below the piriformis.
• ■ Lies alongside the sciatic nerve and descends on the back of the knee.
• ■ Gives rise to several inferior cluneal nerves and perineal branches.
•THANK YOU