ANATOMY COPUTER

VERSION

GROSS MORPHOLOGY & TRCTOLOGY

NEUROANATOMY

BY
DR. SAMEH DOSS (PH.D)
PROFESSOR OF ANATOMY
FACULTY OF MEDICINE, CAIRO UNIVERSITY
 Anatomy Computer Version

BY
DR. SAMEH DOSS ( Ph.D )
PROFESSOR of ANATOMY
FACULTY of MEDICINE , CAIRO UNIVERSTIY
CONVERTED BY
The SCIENTIFIC COMMITTEE of the 5TH BATCH-
MEDICAL SCHOOL
at
21ST SEPTEMBER UNIVERSITY for MEDICAL and
APPLIED SCIENCE
CONTACT WITH the COMMITTEE
t.me/samehdossbot
[email protected]
 INDEX OF CONTENTS
* MORPHOLOGY OF CNS
Spinal cord 1-5
Morphology subdivision of the brain 6
Medulla oblongata 7-8
Pons 8-9
Midbrain 9-11
Interpeduncular fossa 11-12
Ant.& post. Perforated substances 12
Fourth ventricle 13-14
Cerebellum 15-17
Cerebrum 18-31

Basal ganglia 32-33

Lateral ventricle 34-36

Diencephalon 37-40

Third ventricle 41-42

Superficial attachment of the cranial nerves 43-44

Arterial supply of the brain 45-52

Venous drainage of the brain 53-54

Meninges of the brain 55-56

Cerebrospinal fluid 57

* INTERNAL STRUCTURE & TRACEOLOGY

internal structure of spinal cord, afferent & efferent pathways 58-71
internal structure of The medulla 72-73
internal structure of The Pons & the lemniscus 74-76
internal structure of The Midbrain & the med. Longitudinal bundle 77-82
Reticular formation of the brain stem 82
internal structure of The Cerebellum &cerebellar peduncles 83-85
internal structure of The Cerebral hemisphere& types of its fibers 86-93
Internal capsule 94-95
internal structure of The Basal ganglia & limbic system 96-97
internal structure of The Diencephalon 98-102
Deep origin ()nuclei) of the cranial nerves 103-106
 21UMAS SAMEH DOSS

CERTAIN DEFINONS
1) Tract:
is a group of nerve fibres inside the C.N.S having the same origin ,the same course , the same
termination and the same function.
2) Bundle or fasciculus:
a group of nerve fibres inside the GNS having the different origins, terminations & functions.
3) Peduncle:
a thick bundle Supporting part of the brain (e.g cerebral peduncles & cerebellar peduncles).
4) Nucleus:
a group of nerve cells inside the C.N.S lying very close to each other and having the same function
(e.g nuclei of cranial nerves).
5) Ganglion:
a group of nerve cells outside the C.N.S in relation to sensory or autonomic nerves, (e.g sensory
ganglia of the cranial nerves, dorsal root gariglia of the spinal nerves , sympathetic & parasymp.
gattg).
6) Synapse or relay:
is the region of contact of the axon of one neurone & the dendrites or the cell body of another
neurone

7) Pathway:
a Series of neurones transmitting impulses inside or outside the C.N.S.

8) Commissure:
a band of grey matter or white matter connecting a part of the C.N.S on one side with the same
part on the opposite side.

9) Decussation:
the criss-crossing of 2 fellow tracts in the middle line.

10) Lemniscus;
a bond of ascending sensory fibres in the brain stem. It begins from a decussation below & ascends
to end in the thalamus above.

11) Exteroceptive sensation:

sensations from the skin (pain, touch & temperature).

12) Proprioceptive sensation:

sensations from muscles, ligaments, joints & fascia (sense of position, passive movements &
vibrations).

13) Ipsilateral:
of the same side of the body.

14) Contra-lateral:
of the opposite side of the body.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 0

 21UMAS SAMEH DOSS

THE SPINAL CORD

It is the part of the C.N.S enclosed inside the vertebral Column. C

 Shape:
Compressed cylindrical column.
 Site & extent:
it oceupies the upper part of the vertebral canal being 25 cm- shorter than the
length of the V. column in the adult. T

 Length:
about 45 cm in the adult.
 Beginning:
at the F. magnum as a downward
continuation of the medulla oblongata
 Termination: L
1) at the 3rd month of intrauterine life:
the spinal cord fills the whole vertebral
canal.
2) at birth: 3 moths At birth
It ends at the level of lower L3.
3) in the adult:
It ends at the level of lower border of L1 below this level the vertebral canal
adult
contains the lumber, sacral, coccygeal nerves which form a bundle called cauda equina.
 N.B:
the lower end of the spinal cord shows a tapering conical extrimity called Conus Medullaris.
 Enlargement:
the spinal cord presents 2 enlargements>>
1) Cervical enlargement: opposite the lower
cervical vertebrae (Corresponding to the region from
which the brachial plexus arises).
2) Lumbar enlargement:
opposite the lower thoracic vertebrae
(Corresponding to the region from which the lumbar
& sacral plexuses arise).
 Coverings of the spinal cord:
the spinal cord is covered by 3 membranes (meninges),
from inside outwards they are:
- Pia mater
- Arachnoid mater
- Dura mater

1) Pia mater:
It is closely adherent to the spinal cord.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 1

 21UMAS SAMEH DOSS

- The pia mater ends below at the apex of the Conus Medullaris by forming a glistening thread
Called the Filum Terminal which descends
among the nerves of the Cauda equina,
pierces the arachnoid & dura at the level
of S2 vertebra then emerges from the
sacral hiatus to be attached to the back of
the Coccyx.

~The pia mater is thickend on either side

to farm serrated lat- extensions Called the
denticulate ligaments which pass laterally
ti attach the spinal cord to the dura
mater:

2) The Arachnoid mater:

- Continuous above with the arachnoid
mater of the brain.
- ends below at the level of S2 Vertebra.
- it lines the inner surface of the dura
mater & is separated from the pia mater
by the Suborachoid Space containing CSF.

3) The Dura mater:

- Continuous above with the dura of the
Cranial cavity & is attach to the margins of
the foramen magnum.
- it ends below at the level of S2 Vertebra
like the arachnoid mater.
- it lines the vertebral canal & is attached
on either side to the margins of the intervertebral foramina.

 Fixation of the Spinal cord: the spinal cord is fixed inside the
vertebral canal by the following:
a) the filum terminal which is attached to the back of coccyx.
b) the denticulate ligaments of the pia mater which are
Termination
attached to the dura mater, they lie between the ventral
of pia mater
& dorsal roots of spiral nerves.
c) The Dura mater which is attach above to the margins
of the foramen magnum & on either side is attached to
the inter-vertebral foramina & posteriorly it is attached Termination of
to the post. longitudinal lig. dura & arachnoid
mater
Filum
L
terminal

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 2

 21UMAS SAMEH DOSS

Anterior
 External Features of the
gray column Posterior
Spinal Cord: gray column
the outer surface of the S.cord
shows the following:
1) an anterior median fissure
or sulcus:
a deep groove

2) posterior median septum:

A thin neurological septum
extending forwards from the Ant. Nerve Post. Nerve
root root
pia mater covering the post-
aspect of the spinal coral.

3) 2 Posterolateral sulci ( one

on each side):
at the line of attachment
(enterance) of the post. sensory
roots of the spinal nerves to the spinal cord.

4) 2 Anterolateral sulci ( one on each side):

along the line of emergence of the ant motor roots of the spinal nerve from spinal cord.

 The Spinal nerves:

- 31 pairs of spinal nerves are attached to the spinal cord:
8 cervical, 12 thoracic, 5 lumbar, 5 sacral, one coccygeal nerve.
- each spinal nerve is attached to the spinal cord by 2 roots:
1) a dorsal root containing sensory fibres & carrying a spinal
(sensory) ganglion.
2) a ventral root contain a motor fibers.

- The 2 roots unite at the intervertebral foramen to form the

spinal nerve ( mixed sensory motor)

- Each spinal nerve emerges from the intervertebral foramen.

- Immediately after leaving the inter vertebral foramen, each
spinal nerve divided into anterior & posterior 1ry rami, each of
them is mixed (contains motor & sensory fibres).
The ant. & post. 1ry rami supply the ant. & post. aspects of the
body respectively.

 The internal Structure of the Spinal Cord: See page

58.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 3

 21UMAS SAMEH DOSS

Blood Supply of Spinal cord Basilar a.

(A) Arterial Supply:
1) ant-spinal artery: Rt. Lt.
- formed inside the cranial cavity by the union of Rt, Lt- vertebral a. vertebral a.
ant. spinal arteries arising from the Rt, Lt vertebral aa.
Ant.
- It descends infront of the ant. median fissure of the spinal cord
spinal a.
extending fom the medulla above to the filum terminal below. Post.
Post.
spinal a. spinal a.
N.B:
the ant. spinal a. is the longest artery in the body.
Ascending
cervical a.
2) post. spinal arteries (Rt, Lt):
- each artery arises inside the cranial cavity from one vertebral
artery.
- each artery divides into 2 banches which descend infront &
behind the dorsal roots of the spinal nerves.

3) Radicular arteries:
- they enter the vertebral canal through the
intervertebral Post.
foramina to supply the spinal cord segmentally. spinal a.
- their origin differs according to the region as follows:
(a) in the cervical region:
they arise from vertebral arteries, ascending cervical a.
(b) in the thoracic region:
they arise from the post intercostal arteries and
subcostal artery.
(c) in the lumbar region:
they arise from the lumbar arteries.
(d) in the Sacral region:
they arise from lat-sacral arteries, and supply the Cauda
equina.
- each radicular a divides into ant & post branches that
accompany the ant & post-roots of the spinal n. to Ant.
reach the spinal cord. spinal a.

N.B:
Arteria Radicularis Magna:
- it arises from the 2nd lumbar artery Post.
- it is the largest radicular artery (as it supplies the radicular
lumbar enlargement of S. cord). a.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 4

 21UMAS SAMEH DOSS
Ant.
(B) Verrous drainage of the spinal cord:
- the spinal cord is supplied by 6 longitudinal veins:
- one vein in the median plane anteriorly.
- one vein in the median plane posteriorly.
- 2 veins, one behind each ventral root of spinal n.
- 2 veins, one behind each dorsal root of spinal n.
● These 6 longitudinal veins are drained as
follows:
1) above:
they are continuous with the veins of the medulla
oblongata & communicate wilh the dural venous sinuses.
2) laterally:
they open inte the internal vertebral venous plexus which is drained by interverbral veins that
emerge from the intervertebral foramina to end in:
○ vertebral veins in the neck.
○ the intercostal veins in the thoracic.
○ the lumbar veins in the abdomen.
○ the lat. sacral veins in the pelvis.

Meningeal Spaces of the Spinal cord:

1) Extradural (Epidural) space:
- it lies between the dura & the
vertebral periosteum.
- it contains loose areolar tissue & the internal
vertebral venous plexus.
2) Subdural Space:
- it lies between the dura mater &
the arachnoid mater.
- it contains thin film of fluid.
3) Subarachnoid Space:
- it lies between the arachnoid Dura
mater & pia mater. It contains:
○ cerebrospinal Fluid (CSF) Arachnoid
○ the vessels of the spinal cord.
○ roots of spinal nerves. Pia
○ fibrous tissue trabeculae.

Lumbar puncture:
- it is the process of introduction of a special needle into the
subarachnoid space to get sample of CSF or for make spinal anesthesia.

- Site:
between L3 & L4 to avoid ingury of the spinal cord.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 5

 21UMAS SAMEH DOSS

THE BRAIN
It is the part of the CNS enclosed inside the skull.

Cerebral hemisphere

Diencephalon

M. B.
Cerebellum
Pons

Morphological Subdivisions:
a) The cerebrum:
the Rt & Lt Cerebral hemispheres.

(2) The Cerebellum:

below the post. part of the cerebrum.

(3) The brain stem:

formed of the following parts ( from below upwards):
1) medulla oblongata.
2) pons lying infront of the cerebellum.
3) Midbrain
4) Diencephalon (thalamus related structures):
lying in between the 2 Cerebral hemispheres

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 6

 21UMAS SAMEH DOSS

I) Medulla Oblongata:
- it is the lowest park of the brainstem (3 cm)
 Extent: Midbrain
- above:
it is continuous with the pons
- below:
it is continuous with the spinal cord at the foramen magnum.
Pons

 Parts:
a) its lower 1/2 is called Closed Medulla as it encloses a central olive
canal continuous with that of the spinal cord.
b) its upper 1/2 is called the Open Medulla as it opens into the pyramid
4th ventricle ( forming the lower part of its floor).
Anterolateral
sulcus
 External features:
Ant. Med. posterolateral
A) Anterolateral Surface: fissure sulcus
Presents the following features from medial to lateral:
1) Anterior median fissure:
in the middle line, Its lower part is obliterated by the pyramidal (moter) decussation.
2) The pyramid:
an elongated elevation formed by the pyramidal (Corticospinal) tract.
3) The olive:
an oval elevation formed by inferior olivary nucleus
4) The antero-lateral sulcus:
a groove between the pyramid & olive giving exit to the rootlets of hypoglossal n.
5) Posterolateral sulcus:
a groove between the olive & the inf-Cerebellor peduncle giving exit to the glossopharyngeal,
vagus & cranial accessory n. from above downward.
6) the inferior cerebellar peduncle ( I.C.P):
a rope-like bundle connecting the medulla with the cerebellum
passing upwards & laterally.
Vestibular
trigone Medullary
B) The posterior surface: stria

1) the post. surface of the lower 1/2 (Closed medulla):

is continuous with the post. surface of the spinal cord & presents
the following features from medial to lateral:
- Posterior median fissure.
- Gracile tract. forming a longitudinal elevation ending above by
an oval swelling called gracil tubercle (overlies gracil nucleus).
- Cuneate tract: a longitudinal elevation (lat. to the gracit tact)
ending above by oval swelling called cuneate tubercle which
overlies the cuneate nucleus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 7

 21UMAS SAMEH DOSS

b) the post-surface of the upper 1/2 (open medulla):

- forms the lower part of the floor of the 4th ventricle & separated from the post. surface of the
pons by transverse fibres Called Medullary Stria.
- it presents the following features from medial to lateral:
1) a median longituolinal fissure
2) an inverted V- Shaped depression called (the inferior fovea)- the area between
the 2 limbs of the V is called vagal trigone (overlies the dorsal nucleus ef vagus).
3) hypoglessal trigone: a medial to the inf. fovea (overlies the hypoglossad nucleus).
4) vestibular trigone: lateral to the inf. fovea ( overlies the inf. vestibular nucleus).

 Blood supply of medulla: branches from the vertebra a. directly & from its post. inf. cerebellar
branch.
 Internal structure: see page 72

II) Pons
Optic
 Extent: chiasma Optic tract
It extends from the medulla oblongata below to the
midbrain above & lies infront of the cerebellum.

 External Features: Motor root Mid brain

(A) Anterior surface: presents: Sensory root
1) Basilar groove:
longitudinal groove in the middle line for basilar a.
Pons
2) Transverse streaks:
on each side of the basilar groove the & produced by 6 7 8
the transverse ponte Cerebellar fibres that collect on
either side to form the middle cerebellar peduncle.
3) Trigeminal N: 9
12
arise by large sensory root & small motor root 10
from the Lat. part of the ant surface of the MCP
11
pons (at its junction with the a middle cerebellar
peduncle). ICP
4) Middle cerebellar peduncle (M.C.P):
a thick bundle formed of ponto cerebellar fibres which
collect at the fat. part of the pons.
It turns backwards to sink into the corresponding cerebellar hemisphere.
5) the Abducent nerve:
emerges from the lower border of the porns near the middle line (between the pons & the
pyramial of the medulla ).

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 8

 21UMAS SAMEH DOSS

6) The facial (7) & Vestibulo-cochlear (8) nerves: emerge from the pontocerebellar angle which is a
triangular space between:
(a) the lower border of the M.C.P ----------(above)
(b) the upper border of medulla ----------(below)
(c) the cerebellum--------------(behind).

(B) Posterior Surface of the Pons:

forms the upper part of the floor of 4th ventricle & presents the following features:
1) Median longitudinal sulcus:
in the middle line.
2) Medial eminence:
a longitudinal elevation on either side of the median sulcus,
produced by the abducent n. nucleus.
3) facial Colliculus:
a rounded swelling on the fewer part of the medial eminence, It is
produced
by the facial m. which encircles the abducent nucleus.
4) Medullary Stria:
transverse nerve fibers which separate the post. surface of pons
from that of medulla

* Blood Supply of Pones: pontine branches of basilar

artery.
* Internal Structure: see page 74

III – Midbrain
* Extent:
it extends between the pons (below) and the diencephalon (above), It is the shortest
part of the brain stem.

* Site:
it occupies the tentorial notch & is largely hidden by the lower
parts of the cerebral hemispheres

* connections:
It connects the pons & cerebellum to the subthalamic region of the
diencephalon.

* Parts:
in transverse section, the midbrain is formed of:
(1) tectum: posteriorly, behind the aquiduct of Sylvius.
(2) tegmentum: in the middle infront of the aquiduct of Sylvius.
(3) basis pedunculi: most anteriorly infront of the tegmentum.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 9

 21UMAS SAMEH DOSS

External features of the midbrain:

The midbrain has 4 surfaces: an anterior, a posterior, & 2 lateral surfaces:

(A) The anterior surface:

1) 2 Cerebral peduncles: 2 large rope-like bundles that emerge directly from the upper surface of the
pons (below), ascend upwards diverging from each other (separated by the inter peduncular fossa) to
disappear in the substance of the cerebral hemisphere (above).
Each cerebral peduncle Consists of 3 parts:
(a) basis pedunculi anteriorly (formed by the fibers of the pyramidal tract).
(b) Substantia nigra in the middle (one of the extra-pyramidal nuclei).
(c) tegmentum posteriorly (contains nuclei & tracts of the midbrain).

2) Oculomotor n :emerging from the groove on the medial side of the Cerebral peduncles.

(B) The Posterior Surface: presents:

(1) 4 rounded elevations or Colliculi (Corpora quadrigemina) which include:
(a) 2 Superior Colliculi (above):
which are centers of visual reflexes,
each is connected to the lat. geniculate body
( L.G.B) of thalamus by sup. brachium.

(b) 2 inferior colliculi (below):

which are centers of auditory reflexes,
each of them is connected to the med.
geniculate body ( M.G.B) of thalamus by
means of inferior brachium.

(2) the 4 Colliculi are separated from each

other by a cruciform sulcus.

(3) 2 sup. cerebellar peduncles (S.C.P):

emerge from the post. surface of midbrain &
run downwards, backwards & laterally along
the sides of the upper part of the 4th ventricle
to enter the cerebellar hemispheres

(4) a membrane called sup. medullary velum stretches between the 2 sup. cerebellar peduncles.

(5) the trochlear n :

emerges from the post surface of the midbrain immediately below the inf colliculus piercing the sup.
medullary velum to curve forwards around the lat. side of midbrain.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 10

 21UMAS SAMEH DOSS

(C) The lateral surface of the midbrain: presents:

(1) brachium of sup. colliculus:
Passing upwards & forwards to end in the lat.
geniculate body (L.G.B).

(2) brachium of inf. colliculus:

passing upwards & forwards to end in the med.
geniculate body (M.G.B).

(3) In addition, the lat-surface of the midbrain is

crossed by the following structures which wind
around the cerebral peduncle:
(a) the optic track.
(b) the basal vein.
(c) the trochlear n.
(d) the post. cerebral artery.

* Blood Supply of the midbrain:

the midbrain is supplied by branches from the arteries
forming the circle of Willis.

* Internal Structure of the midbrain:

see page 77.

Interpeduncular fossa
* Shapes & site:
It is a rhomboidal-shaped space
lying at the central region of the base of the brain.

* Boundaries:
a- Optic chiasma ---- anteriorly.
b- Optic tracts ---antero-laterally.
c- Cerebral -peduncles ----postero-laterally.
d- upper border of pons ----- posteriorly.

* Contents:
(1) The tuber cinereum:
an elevated area in the ant. part of the fossa just behind
the optic chiasma.

(2) The Infundibulum:

a stalk connecting the tuber cinereum with the pituitary gland (below).

(3) 2 mamillary bodies (2 small rounded elevations):

- they lie one on each side of the middle line in the post. part of the fossa.
- they receive afferent fibres via the columns of the fornix.
- they send efferent fibers to the thalamus ( mammillo- thalamic tract).

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 11

 21UMAS SAMEH DOSS

and to the tegmentum of the midbrain (mamillo-tegmental tract).

* they form part of the hypothalamus & are probably concerned with the visceral sensations.

(4) The posterior perforated substance:

- It lies in the post-part of the inter-peduncular fossa behind the 2 mamillary bodies in the angle between
the 2 cerebral peduncles.
- it is perforated by the central branches of the post. cerebral artery which supply the thalamus.
- the post. perforated substance constitute apart of the hypothalamus.

5) The oculomotor nerves:

emerge from the post. part of the interpeduncular fossa, each nerve is attached to the groove just medial
to the cerebral peduncle.
N.B: the tuber cinereum, infundibulum, mamillary bodies & post. perforated substance. are parts of the
hypothalamus.

* Relations of the inter-peduncular fossa:

(1) The circle of Willis overlies the fossa.
(2) The 3rd ventricle lies above it.
(3) The pituitary gland lies below it.
(4) The anterior perforated substance lies anterolateral to it.

Anterior perforated substance

* Definition:
it is an area in the base of each cerebral
hemisphere which is perforated by the central
branches of the anterior & middle cerebral
arteries.

* Site:
it lies behind the olfactory trigone & the diverging
med. & lat. olfactory stria.

* Relations:
- anteriorly: olfactory trigone & the 2 olfactory
stria.
- Posteriorly: uncus of the temporal lobe.
- medially: optic tract & optic chiasma.
- laterally: stem of the lat. sulcus.
- above: it is continuous with the grey matter of the corpus striatum (head of caudate nucleus).
- below: it is related to the termination of the internal carotid artery & the beginning of the ant. & middle
cerebral arteries.

* Function:
it constitutes a part of the limbic system (see tractology).

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 12

 21UMAS SAMEH DOSS

The Fourth Ventricle

It is the cavity of the hind brain.

* Position : It lies between:

a) The pons & the upper part of
medulla anteriorly.
& (b) the cerebellum posteriorly.

* Shape:
It is tent- shaped when seen from
the side & diamond shaped when
seen from behind

* It has:
- A Floor (anteriorly).
- A Roof (posteriorly).
- 4 lateral boundaries (where the roof at he Floor meet).
- 4 angles ( sup. , inf. & 2 lat. angles).

I) Boundaries of the 4th Ventricle:

(1) the sup. cerebellar peduncle on each side forms the upper lat.
boundary.
(2) the inf. cerebellar peduncle, cuneate gracil tubercles (on each vein Artery
side) form the lower lateral boundary.

II) Angles of the Ventricle:

superior angle:
where the 4th ventricle is continuous
with the aqueduct of the midbrain.
inferior angle:
where the 4th ventricle is continues
with the central canal of the Closed
medulla.
Two Lateral angles:
where the Cavity of the ventricle is
pulled laterally to form 2 lat. recesses,
each lat. recess opens into the sub-
arachnoid space.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 13

 21UMAS SAMEH DOSS

III) The Floor of the 4th Ventricle:

- it is diamond shaped in outline.
- it is formed above by the post surface of the pons & below by the post. surface of the upper part of
medulla (open medulla).
- the floor is subdivided into Rt. & Lt. identical halves by the median sulcus.
- it is crossed in the middle by transverse fibres Called medullary stria which divide the floor of the
ventricle into:
(a) an upper (pontine) part. (b) a Lower (medullary) part.

(a) the upper pontine part presents:

(1) median sulcus}
(2) medial eminence}
(3) Facial Colliculus} describe in distal as in page .......9
(4) Superior fovea}

b) the lower medullary part presents:

1) median sulcus.}
2) the inferior fovea (vagal trigone).}
3) Vestibular trigone.} describe in details as in page 7
4) hypoglossal trigone.}

IV) The Roof of the 4th Ventricle:

(1) its upper part is formed by the medial borders of the 2 superior cerebellar peduncles & the sup.
medullary velum (a Sheet of white matter stretching between the 2 sup. cerebellar peduncles).

(2) its middle part is formed by the inf. vermis of the cerebellum.

(3) its lower part us formed by the inf. medullary velum connecting the 2 inf. cerebellar peduncles & is
invaginated by choroid plexus ( secreting C.S.F).

* Openings of the 4th Ventrile:

(1) Median aperture ( foramen of magendi ):
in the Lower part of the inferior medullary velum.

(2) 2 Lateral apertures (foramina of Luschka):

one in each lat. recess.

N.B:
through these 3 apertures, the CSF leaves the 4th ventricle to the subarachnoid space.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 14

 21UMAS SAMEH DOSS

The Cerebellum

* Embryological origin:
it's the largest part of the hindbrain.

* Site:
2 occupies most of the post. cranial fossa.

* Relations:
(1) Superiorly:
the tentorium cerebelli, separating it from
the Cerebral hemispheres.

(2) Anteriorly:
The cavity of the 4th ventricle separate it
from pons & medulla.

(3) On each side:

It is related to the sigmoid venues sinus, mastoid antrum & mastoid air cells .

* Shape, Surfaces, Parts:

○ upper surface Ant. Notch occupied ○ lower surface flocculus
by the midbrain

Horizontal fissure
Sup. vermis

Inf. vermis

post. Notch Vallecula

tonsil
2 cerebellar hemispheres
- the Cerebellum is globular in shape & formed of 2 cerebellar hemispheres connected by a median vermis.
The Cerebellum has :
(1) post. notch: occupied by the falx cerebelli.

(2) ant. notch: wider & lodging the midbrain, pons & medulla.

(3) upper surface: Flattened, lies under the tentorium cerebelli & presents:
(a) sup. vermis: indistinct & sloping in the hemisphere.
(b) lingula: prolonged from the sup. vermis on sup. medullary velum.
(c) Fissure prima: the main fissure between the ant. & middle Lobes

(4) lower Surface: rounded on each side & presents:

(a) vallecula: a deep groove between the 2 hemispheres occupies by the inf. vermis.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 15

 21UMAS SAMEH DOSS

(b) inf. vermis: well distinct worm-like structure between the 2 cerebellar hemispheres in the bottom of
the vallecula.
(c) tonsil: one on either side of the inf. vermis
(d) floccules & pana Floccules : behind the middle cerebellar peduncle.
(e) horizontal fissure: separate the inf. & post. surfaces & extending from the ant. to the past notch.

* Subdivisions of the Cerebellum:

I) Morphological subdivision: 2 cerebellar hemispheres connected by median vermis

II) True anatomical subdivision:

(1) ant. lobe: infront of the fissure prima.

(2) middle (or posterior) lobe: the major part of the cerebellum, from the fissure prima to the postero-lat.
sulcus.

(3) posterior (or flocculonodular) lobe: formed of 2 flocculi ( one on each side) & nodule in the middle.

III) Functional Subdivision:

(a) Vestibular part or archi-cerebellum:
- it is formed of the flocculonodular lobe.
- developmentally, it is the oldest part of the cerebellum.
- it receives afferent impulses from the vestibular apparatus of the internal ear ( utricle, saccule, &
semicircular canals) via the direct & indirect vestibulo- cerebellar tracts.
- it is Concerned with equilibrium.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 16

 21UMAS SAMEH DOSS

(b) Spinal Part or paleocerebellum (cerebellum of proprioception):

- It is formed of: the vermis of the ant. lobe + the uvula & pyramid which are the ant. parts of the inf.
vermis.
- It receives afferent proprioceptive impulses from muscles & tendons via the spino-cerebellar tracts
(dorsal & ventral) mainly & also by dorsal & ventral external arcuate fibres.
- it is concerned with muscle tone.

(c) Cerebral part or neo-cerebellum (cerebellum of cerebral Cortex):

- it is the remaining largest part of the cerebellum.
- it includes the 2 cerebellar hemispheres + the middle part of the vermis.
- it receives afferent impulses from the cerebral cortex via ponto cerebellar tracts (Cerebro- ponto-
Cerebellar pathway).

* Internal structure of cerebellum: see page 83.

* Cerebellar connections (Peduncles): see page 83.

* Blood supply of the cerebellum:

the cerebellum is supplied by 3 arteries on each
side:
(1) superior cerebellar a:
arise from the basilar artery & supplies the sup.
surface of the cerebellum.

(2) post. inf. cerebellar a. :

arises from the vertebral a. &
supplies the post. part of the inf. surface of the
cerebellum.

(3) ant. inf. cerebellar a. :

arises from the basilar a. & supplies the ant. part
of the inf. surface of the cerebellum

* Functions of the Cerebellum:

each cerebellar hemisphere influences the muscular activity of the Ipsilateral 1/2 of the body:

(1) it coordinates the action of the different groups of muscles, so that the movements are done smoothly
& accurately, this is chiefly done by the neo-cerebellum.
(2) it controls the muscle tone, posture & equilibrium of the body, this is chiefly done by the
archicerebellum & paleocerebellum.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 17

 21UMAS SAMEH DOSS

The Cerebrum
- It is the upper & largest part of the brain.
- It is divided incompletely into Rt. & Lt. cerebral hemispheres by the median longitutdinal cerebral fissure.
- at the floor of this fissure, a mass of white matter called the corpus collosum unites the 2 cerebral
hemispheres together.

The Cerebral hemispheres

* Site:
thay occupy the ant. , the middle & the upper part of the post. cranial fossae.

* Relations:
1) the 2 cerebral hemispheres are sepatated from each
other by a sickle shaped fold of dura called the falx cerebelli which occupies the median longitutdinal
cerebral fissure.
2) the 2 cerebral hemispheres are separated from the cerebellum by a horizontal fold of dara called the
tentorium cerebelli.

* Surfaces:
each cerebral hemisphere has 3 surfaces:
1) Lateral (supero-lateral) Surface :
is convex, directed upwards & laterally and applied to the inner aspect of the vault of skull.
2) Medial Surface:
is flattened & separated from the medial surface of the
other cerebral hemisphere by the median longitudinal
fissure containing the falx cerebri.
3) Inferior Surface:
irregular & is divided by the
stem of the lateral sulcus into 2 parts:
a)) ant. part called orbital surface lying on the roof of orbit.
b)) post. part called tentorial surface lying on the tentorium cerebelli.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 18

 21UMAS SAMEH DOSS

• Borders : Each hemisphere has 3 borders:

1) Supero-med (superior) border:An arched border extending from the frontal pole to the occipital
pole, it separates the lat. Surface from the med. Surface & is related to the sup. Sagittal sinus .
2) Infero-lateral (inferior) border:Extends from the temporal pole to the occipital pole, it separates
the lat-surface from the inf. Surface.
3) Super-ciliary border:A curved border separating the lat-surface from the orbital Part of the inf.
Surface.

• Poles:
Each hemisphere has 3 poles:
1) Frontal pole: At the ant. End of frontal lobe.
2) Temporal pole: At the ant. End of temporal lobe.
3) Occipital pole :At the post. End of occipital lobe
.

Lobes of each hemisphere:

• Each cerebral hemisphere is divided by

3 main sulci or fissures into 4 lobes
(which have been given the names of
the skull bones under which they lie),

• These 4 lobes are:

1) the Frontal lobe.
2) the parietal lobe.
3) the temporal lobe.
4) the occipital lobe.

• The 3 major sulci (fissures) which divide the hemisphere into lobes are:
1) The central sulcus (fissure of Rolando:(
− starts at a point a little behind the middle of the superior border.
− runs obliquely downwards & forwards (without interruption), a cross the lat. Surface.
− ends below at a point just above the middle of the post. Ramus of the lat. Fissure.
− its upper end usually extends a Iittle on the medial surface of the cerebral hemisphere
− it separates the frontal lobe (infront of it) from the parietal lobe (behind it(

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 19

 21UMAS SAMEH DOSS

2) The Lateral Fissure (Fissure of Sylvius(

− Starts on the inf. Surface of the hemisphere lat
. To the ant. Perforated substance.
− Its Stem extends laterally between the
temporal & frontal lobes to reach the lat.
Surface
where it divides into 3 rami :
a) post. Ramus: the longest; runs backwards
between the frontal & parietal lobes (above) &
the temporal lobe (below.(
b) ant. Horizontal ramus: runs forwards into the
frontal lobe .
c) ant. Ascending ramus: runs upwards into the frontal lobe.
- the lat. Sulcus lodges :
(1) the middle cerebral a. & its branches.
(2) the deep middle cerebral vein.

3) The Parieto-occipital Sulcus:

- it is found mainly on the med. Surface of the hemisphere infront of the occipital pole.
- extends for a short distance on the lat. Surface 2" infront of the occipital pole.

Boundaries of the lobes of the hemisphere

1- the Frontal lobe : lies

- infront of the central sulcus&
- above the post. Ramus of the lat. Sulcus.

2- the Parietal lobe : bounded:

- anteriorly: by the central sulcus.
- posteriorly: by the upper 1⁄2 of a line connecting the parieto-occipital sulcus & the pre-occipital
notch which lies on the inf. Border 3-4cm infront of the occipital pole .
- inferiorly by the post. Ramus of the lat. Sulcus & an imaginary line joining the post. Ramus with the
centre of the line between the parieto-occipital sulcus & pre-occipital notch.

3- the temporal lobe: bounded:

- superiorly: by the post. Ramus of the lateral sulcus.
- posteriorly: by the lower 1⁄2 of the line joining the parieto-
occipital sulcus & the preoccipital notch.

4- the Occipital lobe: lies behind the imaginary line connecting the
parieto-occipital sulcus & the pre-occipital notch.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 20

 21UMAS SAMEH DOSS

Sulci & Gyri of the Cerebral hemisphere:

• The surfaces of the hemisphere is formed of grey matter & called Cerebral cortex.
• Each surface is divided by Sulci (grooves) into gyri (Convolutions.)
• These infoldings result in marked increase in the surface area of the cerebral cortex without
increasing the size of the cerebral hemisphere.

1. The Sulci & Gyri of the lateral Surface

A- Frontal lobe
• Important sulci :
1) Precentral sulcus:
- lies nearly parallel to the central sulcus & about one finger's breadth infront of it.
- it is usually divided into 2 parts : upper & lower.

2) Sup. Frontal sulcus:

- begins at the upper part of the precentral sulcus.
- runs forwards nearly parallel to the sup. Border of the hemisphere.

3) Inf. Frontal Sulcus:

- begins at the lower part of the precentral sulcus.
- runs forwards & downwards below the sup. Frontal sulcus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 21

 21UMAS SAMEH DOSS

• Important Gyri:

1. The Precentral gyrus : lies between central sulcus & the precentral sulcus.

2. The Superior frontal gyrus : lies above the superior frontal sulcus.

3. The Middle frontal gyrus : lies between the sup. Frontal sulcus & the inferior frontal sulcus.

4. The Inferior frontal gyrus : lies below the inferior frontal sulcus.

B- Parietal lobe
• Important Sulci:

1. the Postcentral Sulcus: runs nearly parallel to the central sulcus & about one finger breadth behind

it . It may Be formed of 2 parts: upper & lower.

2. the intra-parietal sulcus : runs backwards like an arch beginning at the postcentral sulcus and

passes parallel to the sup. Border towards the occipital lobe.

• Important Gyri : the parietal lobe is divided into:

- one main gyrus

- 2 lobules

- 2 Small gyri

1. the postcentral Gyrus: is the main gyrus & lies between the central sulcus & the post central sulcus.

2. the Superior parietal lobule : a small part lying above the intraparietal sulcus.

3. the Inferior parietal lobule : a larger part lying below the intra parietal sulcus.

4. the Supramarginal gyrus: a small arched gyrus surrounding the upper end of the post. Ramus of the

lat. Sulcus. It is the most convex part of the lat. Surface .

5. the angular gyrus: small arched gyrus surrounding the upper end of the sup. Temporal sulcus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 22

 21UMAS SAMEH DOSS

C- Temporal lobe
• Sulci:
1) The Superior temporal sulcus :
− begins near the temporal pole.
− runs backwards perallel to the post. Ramus of the lat. Sulcus & about 1 finger breadth below it .
− it ends by turning upwards in the parietal lobe where it is surrounded by the angular gyrus.
2) The middle temporal sulcus : it is an interrupted sulcus. It runs parallel to the sup. Temporal
sulcus & about one finger breadth below it.

• Gyri :
1. The sup. Temporal gyrus :Lies between the post. Ramus of the lat. Sulcus(above) & the sup.
Temporal sulcus(below. (
2. The middle temporal gyrus : lies between the sup. Temporal sulcus(above)And the middle
temporal sulcus (below.(
3. The inferior temporal gyrus: lies below the middle temporal sulcus.

D- Occipital lobe
• The main part of the occiprtal lobe lies on the medial surface.
• only a small part appears on the lat. Surface and presents one sulcus called the transverse occipital
sulcus.

The Insula

Frontoparietal
operculum

Orbital
operculum
Temporal
operculum insula Apex of insula

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 23

 21UMAS SAMEH DOSS

• Definition: the insula is the part of the cerebral cortex which is hidden in the bottom of the lateral
sulcus & appears when the lips of that sulcus are separated.

• Shape: it is a conical mass having a base & an apex .

• the base: is surrounded by the circular sulcus of the insula.
• the Apex: is called limen insulae & is directed downwards .
• its surface: is marked by a number of gyri radiating superiorly from the stem of the lat. Sulcus &
crossed by the middle cerebral artery.

• the opercula of the insula: are the parts of the cerebral hemisphere which cover the insula (
fronto-parietal opeculum, temporal operculum & orbital operculum(

Sulci & Gyri of the inf. Surface

• The ant. ⅓ of the inferior surface is called the orbital surface.

It represents the inferior surface of the frontal lobe & rests on the orbital plate of frontal bone .

• The post. ⅔ of the inferior surface is called the tentorial surface . it represents the inferior surface
of the temporal & occipital lobes.

The tentorial surface partly rests on the upper surface of the tentorium cerebelli.

Sulci & Gyri of the Orbital surface

1) olfactory sulcus: a straight

deep sulcus which
lies near the medial border &
nearly parallel to it
. It lodges the olfactory bulb &
tract.

2) Gyrus rectus (straight gyrus):

lies medial to
the olfactory sulcus.
3) the remaining part of the

orbital surface: is divided

into:Ant. , post. , med. & lateral
gyri by H-shaped orbital sulci.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 24

 21UMAS SAMEH DOSS

The Sulci & Gyri of the Medial & Tentorial Surfaces

• The important Sulci:

1) the Callosal & hippocampal sulci:
a. Callosal Sulcus: is an arched sulcus which lies just above the corpus callosum. It begins
below the rostrum of the corpus callosum ,forms an arch over its genu & body then bends
around its splenium to become continuous with the hippocampal sulcus .
b. Hippocampal sulcus: seems to be the continuation of the callosal sulcus.

It passes forwards from the splenium of corpus callosum to end in the bend between the uncus & the
hippocampal gyrus (See the figure.)

2) Cingulate Sulcus: an arched sulcus lying about one finger's breadth above the callosal sulcus &
parallel to it. It ends a little behind the upper end of the central sulcus by dividing into 2 branches :
a. the marginal sulcus: which turns upwards to cut the sup. Border.
b. the subparietal sulcus: which continues backwards in the main direction of the cingulate
sulcus.
3) Calcarine Sulcus: it is a deep arching sulcus having 2 parts:
Ant. & post. Which meet each other almost at right angle:

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 25

 21UMAS SAMEH DOSS

a. An anterior part called precalcarine: begins below the splenium of corpus callosum & runs upwards
& backwards to meet the lower end of the parieto-occipital sulcus.
b. A posterior part called postcalcarine: extends downwards & backwards from the lower end of the
parieto-occipital sulcus to reach the occipital pole.

4) Parieto-occipital Sulcus:
- begins at the junction of the precalcarine & postcalcarine sulci.
- runs upwards to cut the upper border of the C. hemisphere about 2” infront of the occipital
pole .

5) Collateral Sulcus:
- It is the best marked sulcus on the tentorial surface.
- It begins at the temporal pole & extends backwards & parallel to the calcarine sulcus and lat. To it
till it reaches the med. Surface of the occipital lobe.

6) Inferior temporal (occipito-temporal) sulcus:

- It is an irregular interrupted sulcus lying on the tentorial surface lat. To & parallel with the collateral
sulcus.

• The important Gyri:

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 26

 21UMAS SAMEH DOSS

1. Cingulate gyrus:
- lies on the medial surface between the cingulate sulcus & the callosal sulcus.
- its posterior end turns downwards around the splenium of the corpus callosum to form the isthmus
which joins the hippocampal gyrus anteriorly.

2. Hippocampal gyrus & uncus:

- lies on the tentorial surface between the hippocampal sulcus and the ant. Part of the collateral
sulcus.

- its ant. End bends to form the uncus.

3. Medial Frontal gyrus:

- lies on the medial surface above the cingulate gyrus & infront of the paracentral lobule .
- It forms the medial surface of the sup. Frontal gyrus .

4. The Cuneus:
- it is a triangular gyrus lying between the parieto-occipital sulcus and the post calcarine sulcus.

5. The Pre-Cuneus: it is a quadrilateral gyrus lying between:

a. the marginal sulcus(infront.(
b. the parieto-occipital sulcus(behind.(
c. the subparietal sulcus(below.(
d. The sup. Border of the hemisphere (above.(

6. The paracentral lobule:

- it is a quadrilateral gyrus surrounding the upper end of the central sulcus.
- it contains the motor & sensory areas of the lower part of the lower limb.

7. Lingual gyrus:
- Lies between the calcarine sulcus (above) & the post. Part of the collateral sulcus (below.)

8. Fusiform gyrus (med. Occipito-temporal gyrus:(Lies between the collateral sulcus & the inferior
temporal sulcus.
9. Inferior temporal gyrus: lies lateral to the inf. Temporal sulcus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 27

 21UMAS SAMEH DOSS

Important functional areas of the different lobes of the cerebral hemispheres

Primary motor cortex

Somatosensory association cortex
Premotor cortex
Frontal eye field

Visual association cortex

Prefrontal cortex

Primary visual cortex

Broca's speech area of l. hemisphere Primary auditory cortex

Auditory association cortex

(Wernicke's speech area)
I – Frontal lobe
1) The Motor area (area 4(
• Site : occupies the precentral gyrus & extends to occupy the ant. Part of the paracentral lobule on
the medial surface of the cerebral hemisphere .
• Function: it contains the giant pyramidal cells of
Betz which give origin to 80% of the pyramidal tract
which controls the motor activity of the skeletal
muscles of the opposite 1⁄2 of the body (except
the eye .(
• Body representation: the body is represented
upside down in this gyrus I – e the area of the lower
limb occupies the uppermost part followed by the
trunk , the upper limb, the neck & the head
(arranged from above downwards.(
N.B: the movements and not the muscles are
represented in the area4
• Lesion of the area 4: results in contralateral
hemiplegia (of upper motor neuron lesion(

2) Premotor area (area 6:(

• Site: infront & parallel to the motor area. It is wide above (5cm) & narrow below (1cm.(
• function: it is the main extrapyramidal area for the body except the eye (which is found in the
occipital lobe(
3) Frontal eye Field (area 8(
• Site : infront of the premotor area, in the post. Part of the middle frontal gyrus

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 28

 21UMAS SAMEH DOSS

(4) Broca’s Speach area (area 44 , 45):

 Site : in the post. part of inf. frontal gyrus in the dominant hemisphere.
(left hemisphere in the right-handed persons).
 function : it lies near to the motor area of the larynx, tongue & lips (all together
are necessary for speech.
 Injury to this are causes patients to speak slowly & with effort (nonfluent speech).
(5) Prefrontal cortex (areas 9, 10, 11 & 12):
 Site : in the remaining part of lat. surface of the frontal lobe as far as the frontal pole.
& also extends to the med. surface.

 function : it is concerned with the control of conduct, behavior, thinking & emotions.
 Injury to this area leads to frontal lobe syndrome which comprises :
(a) abnormal social behavior. (b) emotional disturbances. (c) educational regression .

(6) Orbital Surface of frontal lobe : is related to the control of autonomic activity .

II- Parietal Lobe

(1) 1ry Somatosensory cortex (Main sensory area) : areas 3,1,2
 Site : it occupies the postcentral gyrus on the lat. surface of the cerebral
hemisphere & extends to the post. part of the paracentral lobule on the med. surface.
 function :
(1) it receives pain, touch, proprioception, temperature & taste sensations from the
opposite 1⁄2 of the body (The body is represente upside down).
(2) it contributes to the pyramidal tract (giving 10% of its fibres).

 lesion to this area results in loss of tactile discrimination from the opposite 1⁄2 of the body .
(2) Somatosensory association Cortex (areas 5 & 7) :
 Site : in the sup. parietal lobule.
 function : knowing the meaning of the sensations felt (by associating the visual,
auditory & tactile sensations).
 lesion to this area results in:
(a) inability to recognize the felt objects (asteriognosis) .
(b) disturbed body image (astatognosis) : in ability to recognize the position of body
parts in space (the patient may feel that the Rt. 1⁄2 of his body is the Lt. 1⁄2 ).
(3) Supramarginal gyrus (area 40) :
 site : it surrounds the upper end of the post. ramus of lateral sulcus.
 function : it interrelates sensory, auditory & visual stimuli .

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 29

 21UMAS SAMEH DOSS

 Injury of this area leads to apraxia (inability to perform purposefll movements):

(a) Ideomotor apraxia : inability to perform complicated motor tasks e.g. Saluting.
(b) Ideational apraxia : inability to use objects (e.g when tools are placed in a patient hands).
(c) facial apraxia : inability to perform facial-oral movements e.g licking the lips.

(4) Angular gyrus (area 39) : (visual auditory conversion area) :

 Site : it surrounds the upper end of superior temporal sulcus .
 function : it receives input visual impulses from areas 18, 19 & projects them
to the Wernicke’s area) .
 Injury to this area leads to :
(a)agraphia : inability to express thoughts in writing .
(b) dyscalculia : difficulty with arithmetics ( inability to do simple sums).

III- Temporal lobe

(1) Auditory Sensory area (area 41,42):
 Site : in the middle part of the sup. temporal gyrus (Heschl's gyrus):
 Function : it receives the auditory radiation from the medial geniculate body .
 Injury : unilateral destruction results in only partial deafness (due to bilateral
cochear representation).
(2) Auditory association area (area 22) :
 Site : in the post. part of Sup. temporal gyrus . It includes Werniche's speech area
which is connected to Broca’s area by the arcuate fasciculus.
 Function : it is responsible for Knowing the meaning of sounds.
 Injury of this area in the dominant hemisphere leads to Wernicke’s aphasia:
the patient finds difficulty in understanding spoken language , speaks
faster than normal & has difficulty in finding the right words to express himself.
(3) The Insula :
 Site : see page 24

 Function : the gustatory cortex (area 43) in the parietal operculum & para-
insular cortex . It receives tase impulses from the thalamus.

IV- The occipital lobe

(1) Visual Sensory area (area 17):
 Site : found mainly in the med. surface of occipital lobe in both banks of calcarine sulcus.
 function : it receives input visual sensation from the lat. geniculate body via the
optic radiation .

 Injury : result in visual field defects e.g contralateral homonymous hemianopi .

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 30

 21UMAS SAMEH DOSS

(2) Visual association are (areas 18,19) :

 Site : in the cuneus & lingual gyrus, surrounding the visual sensory area 17.
 Function: it is responsible for knowing the meaning of the pictures seen.
 Injury : may result in visual hallucinations.

V- the Rhinencephalon or Limbic lobe

 It is the name given to number of cortical & subcortical structures
lying on the medial surface in the form of an arch (limbus).

 The limbic lobe includes the shadowed areas in the figure (cingulate
gyrus, isthmus, hippocampal gyrus & uncus) + other structures .

 It is described in detail in page 97.

 functions :(1) reception of olfactory stimuli.
(2) integration of olfactory, visceral & somatosensory sensations.
(3) influencing the behaviour, emotions & memory .

Internal Structure of cerebral hemisphere : see p.86

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 31

 21UMAS SAMEH DOSS

Basal Ganglia
Lentiform nucleus
• Definition : basal ganglia are collections
of grey matter deeply placed inside
the white matter of the cerebral
hemisphere.

• Components :
1- Caudate nucleus
Extra pyramidal centers
.
2- lentiform nucleus
3- amygdaloid nucleus : ... a smell centre.
4- Claustrum ....... unknown function.

1- The Caudate Nucleus

Ant. Horn of lat.
Vent.

body of
lat. vent

Head of caudate

(the nucleus with a tail)

• Shape : Comma-shaped mass of grey matter
• Parts & Relations : it consists of head, body & tail.
(1) head : it is the large ant. end.
- it forms the lat. wall of the ant. horn of the lat. ventricle.
- it is fused posteriorly with the lentiform nucleus & below with the ant. perforated
substance .
(2) body : arches upwards & backwards above & lat. to the
thalamus forming part of the floor of the central part
of the lat. ventricle .
(3) tail : curves downwards & forwards in the roof of the inf. horn
of lat. ventricle in the temporal lobe . It ends at the amygdaloid nucleus.

2- The Amygdaloid Nucleus

• it is a small rounded mass lying mostly in the uncus of temporal lobe, joined
to the tail of caudate nucleus .
• it is a smell centre .
THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 32
 21UMAS SAMEH DOSS

3- Lentiform Nucleus
(Lens - like)
Shape : it resembles a biconvex lens which consists
of 2parts ,has 2 surfaces & related to 2 capsules .
Parts : it consists of :
(1) Putamen : the larger darker lateral part.
(2) globus pallidus : the smaller, paler medial part.
Surfaces & relations :
(1) medial surface : is highly convex & is related to the
internal capsule which separates the lentiform nucleus
from the head of caudate (anteriorly) & the thalamus (posteriorly) .
(2) Lateral Surface : is slightly convex & is related to the
external capsule which separates the lentiform nucleus from the claustrum & insula .

4- Claustrum
it is a thin layer of grey matter lying between the external capsule (medially) & the
white matter of the insula (laterally). Its antero-inferior part fuses with the
amygdaloid nucleus & ant. perforated substance. Its function is unknown.

The Corpus
Striatum
 it is the name given to :
(1) the Caudate nucleus .
(2) the lentiform nucleus
&
(3) the intervening ant.
limb of internal capsule.

 They are called so because they show a striated

appearance. Coronal section of cerebral hemisphere behind caudate
N. of c.c illustration basal ganglia &int. capsule
The External Capsule
it is a thin layer of white matter which covers the outer surface of the lentiform nucleus
(forming an external capsule to it) & separating the lentiform n. from the claustrum & the
white matter of the insula .Some of its fibres are probably association fibres connecting
the temporal lobe to the frontal & parietal lobes.

 Internal Structure & connections of the basal ganglia : page 96

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 33

 21UMAS SAMEH DOSS

The Lateral Ventricle

Parietal lobe

Frontal lobe

Occipital lobe

Central part (body)

Ant. Horn

Post. Horn

Inferior Horn

Temporal lobe

 Site : it is the cavity present in each cerebral

hemisphere. (there are 2 lat. ventricles).

 Lining : it lined by ependyma (ciliated cubical

epithelium).

 Communications :
- It communicates with the 3rd ventricle
through the interventricular foramen
which lies in the ant. part of the med.
wall of the lat. ventricle .
- the interventricular F. is bounded anteriorly by
the column of the fornix & posteriorly
by the ant. end of the thalamus .

 Shape & Parts : it is an elongated crescentic cavity consisting of body & 3horns:
(a) the body (central part) : lies in the parietal lobe. It extends from the inter-
ventricular F. to the splenium of corpus callosum .It communicates with the 3 horns .
(b) Anterior horn : lies in the frontal lobe . It extends forwards & laterally from
1
the interventricular F. to a point 1 2 inches behind the frontal pole.
(c)Posterior horn : lies in the occipital lobe where it extends backwards & medially .
(d) Inferior horn : lies in the temporal lobe . It extends from the body , first downwards
behind the thalamus then forwards in the temporal lobe to end at the uncus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 34

 21UMAS SAMEH DOSS

 Boundaries & Relations :

(A) the anterior horn : △ in coronal section .
• Roof : the ant. part of the body of corpus callosum .
• Med. wall : the ant. part of septum pellucidum .
• Lat. wall & floor : head of caudate nucleus & rostrum
of corpus callosum.
• Ant. wall (limit) : the genu of corpus callosum.

(B) The Central Part (body):

• Roof : formed by the body of
corpus callosum.

• Med. wall : formed by the post.

part of septum pellucidum .

• Floor : is sloping & formed by the

following structures
(from lat. to medial) :
(1) the body of caudate nucleus
.
(2) the lat. part of the upper
surface of the thalamus.
(3) the body of the fornix which arches above the med.
part of the upper surface of the thalamus.
N.B : the part of the thalamus in the floor of the body of central part is partially hidden
by the choroid plexus.

(C) The Posterior horn :

• the roof , lat. wall & floor : is formed by the tapetum
of corpus callosum which separates the inf. horn from the
optic radiation.

• the Med. Wall : is sloping and shows 2 elevations:

(1) superiorly : bulb of post. horn : produced by the
fibres of the forceps major of the internal capsule.
(2) inferiorly : calcar avis : which is a swelling produced by
the calcarine sulcus which extends deeply into the occipital lobe.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 35

 21UMAS SAMEH DOSS

(D) Inferior horn : has the following boundaries :

• Roof : formed by the tail of caudate as it passes
forwards to end in the amygdaloid nucleus.
• Med. wall : is occupied by the lower part of the choroid
fissure through which the choroid plexus enters the inf.
horn.
• Floor : formed of the following structures (from lat. to
medial) :
(1) Collateral eminence : (produced by the collateral
sulcus).
(2) Hippocampus , covered by a layer of nerve fibres
called the alveus
(3) Fimbria of the hippocampus :
• lateral wall : formed by the tapetum of corpus callosum .

The Septum Pellucidum (lucidum)

 It is a vertical membrane formed of white & grey matter which occupies the gap between
the corpus callosum (above) & the fornix (below).
 It consists of 2 layers with a slit-like cavity inbetween.
 It forms a partition between the ant. horns & the central parts of the 2 lat. Ventricles
 (forming the med. wall of the ant. horn & the central part of each lat. ventricle) .

The Tela Choroidae

 It is a double-layered fold of pia mater intervening
Lat.. ventricle
between :
- the body of the fornix ---------- above.
- the upper surface of the 2 thalami
----- below .
& the roof of the 3rd ventricle
 It contains choroid plexuses which invaginate into:
(1) the body of each lat. ventricle through the choroid
fissure
(between the fornix & the thalamus) . choroid
(2) the 3rd ventricle through its ependymal roof . plexuses of lat.
Vent.
 It also contains the Rt. & Lt. internal cerebral veins (which
drain the choroid plexuses) at its edges.
3rd ventricle

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 36

 21UMAS SAMEH DOSS

DIENCEPHALON

 Site : it is the part of the brain stem which lies above the midbrain & between
the lower parts of the 2 cerebral hemispheres.

 Its Cavity : is the 3rd ventricle.

 Shape : wedge shaped having :
1- apex : is the ant. sharp border .
2- base : directed posteriorly.
3- 2lateral surfaces : each is quadrilateral in outline.
4- upper surface : triangular in outline with its apex directed anteriorly . It is
formed of :
(a) the upper surface of the 2 thalami (on each side of the median plane).
(b) the roof of the 3rd ventricle , the pineal body & the 2 habenular trigones
(in the median plane, arranged from before backwards).
5- the lower surface : is divided into 3 parts :
(a) the hypothalamus : the ant. part which is connected to the pituitary gland .
(b) the subthalamus : the middle & largest part which lies over the midbrain .
(c) the meta thalamus : the post. part which is formed by the med. & lat.
geniculate bodies.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 37

 21UMAS SAMEH DOSS

 Subdivisions of the diencephalon : it is subdivided into 5 parts:

(1) Thalamus (bilateral) : the largest
part.
(2) Subthalamus : the part lying directly
above midbrain.
(3) Hypothalamus : lies infront of the
subthalamus.
(4) Metathalamus (bilateral) : formed metathalamus

by the lat. & medial geniculate

bodies .
(5) Epithalamus : formed of the pineal body , the 2 habenular trigones & the habenular commissure.

1- The Thalamus
It is an ovoid mass of grey matter ( 1.5" long & 1⁄2 inch broad) lying in
the middle of the cerebrum.
 Site : it lies one on each side of the 3rd ventricle, immediately above
the subthalamus & projecting infront & behind it.
 Shape & relations : it is oval in shape having:
(1) narrow ant. end : forming the post. boundary of the interventricular
foramen.
(2) expanded post. end called pulvinar which overhangs the med. & lat.
geniculate bodies & projects behind the post. wall of the 3rd
ventricle .
(3) upper surface :
Lat. ventricle Corpus callosum
- medially : it is covered by tela
choroidae & body of the fornix . Caudate nucleus

- laterally : it forms the floor of

the central part of the lat.
ventricle & is related to body of
caudate N. & stria terminalis .
(4) Lower surface:
- posteriorly : it rests on the
subthalamus separating it from
the tegmentum of the midbrain.
- anteriorly : it rests on the
hypothalamus . Lentiform
(5) Medial surface : nucleus
forms the upper part of the
lat. wall of the 3rd ventricle & is Internal capsule
separated from the hypothalamus Subthalamus
3rd ventricle
below by the hypothalamic sulcus. Hypothalamus

(6) Lateral Surface : related to the post. limb of the internal capsule separating
it from the lentiform nucleus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 38

 21UMAS SAMEH DOSS

Blood supply of thalamus :

(1) mainly from the post. cerebral a.
(2) post. communicating a.
 Internal Structure : see tractology page 98
2- Hypothalamus
 It is the part of the diencephalon which
lies infront of subthalamus & anteroinferior thalamus
Hypothalamic
to the thalamus . sulcus fornix
Habenular
trigone
 it extends from the lamina terminalis anteriorly Pineal body
Lamina
to the mamillary bodies posteriorly. Post.
terminalis
commissure
It includes the following structures :
(1) the lower part of the lat. wall of the 3rd
pons
ventricle (below the hypothalamic sulcus). Infundibulum
Tuber cinereum
(2) the structures forming the floor of the 3rd
Mamillary body
ventricle :
Floor of 3rd ventricle
(a) the infundibulum ,(b) the tuber cinereum
Hypothalamus
(c) mamillary bodies (d) the posterior
perforated substance .

 Internal structure : see tractology page 100

3- Epithalamus
 It lies in the post. end of the upper surface of the diencephalon.
 it consists of : 2 habenular trigones, habenular commissure, pineal body & the post. commissure.
(1) the habenular trigone : is a small triangular depression (one on each side), lying med. to the pulvinar
of the thalamus.
(2) the habenular commissure : is a transverse band between the 2 sides connecting the 2 habenular
trigones & running in the upper root of the stalk of the pineal body .
(3) the Pineal body :
- it is a small conical mass lying inbetween the post. ends of the 2 thalami
- it is overlapped above by the splenium of the corpus callosum but is
separated from it by the great cerebral vein .
- below, it overhangs the depression between the 2 sup. colliculi on the post. Surface
of the midbrain.
- the pineal body is attached to the post. wall of the 3rd ventricle by a hollow
stalk having 2 roots : upper root attached to the habenular commissure.
lower root attached to the post. commissure.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 39

 21UMAS SAMEH DOSS

* Internal structure of Epithalamus : see tractology page 101

4- Metathalamus 3rd ventricle Thalamus

 It is the part of the diencephalon which
is attached to the post. part of the inf.
surface of the thalamus below the
pulvinar.

 It consists of the medial & lateral

geniculate bodies:
(1) Medial geniculate body (M.G.B):
 it is a small ovoid mass lying just lat. to the sup. colliculus of the midbrain.
brachium of
 it is connected to the inferior colliculus by the brachium of inf. colliculus. inf. colliculus
(2) Lateral geniculate body (L.G.B):
 it is a small ovoid mass lying lat. to the M.G.B .
 it is connected posteriorly to the sup. colliculus via the brachium of sup. colliculus.
 it is connected anteriorly to the optic tract.

 Internal structure of the Metathalamus : see tractology page 102

5- Subthalamus
 It is the part of the diencephalon
which intervenes between the
thalamus & the tegmentum of midbrain.

 relations :
- superiorly : ventral nuclei of the
thalamus.
- inferiorly : tegmentum of the midbrain.
- medially : vertical part of the
hypothalamus.
- laterally : the junctional zone between
the internal capsule & the
cerebral peduncle of the midbrain.
Hypothalamus
 Internal Structure : see tractology page : 102

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 40

 21UMAS SAMEH DOSS

THIRD VENTRICLE
Interventricular
foramen
Roof : ependyma

Genu
Habenular
commissure

Posterior wall
Ant. Column
Anterior wall

of fornix
Pineal body
Ant.
Commissure Post.
Commissure
Lamina
terminalis Upper end of
Midbrain aqueduct

Optic chiasma Pons

infundibulum 4th ventricle
Tegmentum
Tuber cinereum
Mamillary bodies Post. perforated substance

Floor
 Definition : it is the cavity of the diencephalon.
 Shape & site : it is a slit like cavity lying in the median plane between the Rt. &
Lt. thalamus. It has an irregular outline.
 Communications :
(1) anterosuperiorly ,on each side, it communicates with each lat. ventricle by an
interventricular foramen which is bounded anteriorly by the ant. column of the
fornix & bounded posteriorly by the ant. end of the thalamus.
(2) posteroinferiorly ,in the median plane , it communicates with the 4th
ventricle through the cerebral aqueduct .
 Boundaries:
(1) Floor : formed :
(a) anteriorly : by the hypothalamus (1) optic chiasma.
(2) infundibulum & tuber cinereum .
(3) mamillary bodies.
(4) post. perforated substance .
(b) posteriorly : by tegmentum of midbrain.

(2) Roof : formed by ependyma lining the undersurface of the tela choroidae .
It stretches between the 2 thalami extending from the interventricular
foramen anteriorly to the habenular commissure posteriorly & is invaginated
by the choroid plexus of the 3rd ventricle.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 41

 21UMAS SAMEH DOSS

(3) Anterior wall : formed of the following structures from above downwards :
(a) the 2 ant. columns of the fornix as they descend to reach the mamillary bodies .
(b) the ant. commissure as it crosses the median plane just infront of the ant. Columns of the fornix.
(c) the lamina terminalis stretching from the rostrum of corpus callosum to the optic chiasma. It represents the
cephalic end of the primitive neural tube.

(4) Posterior wall : formed of the following structures from above downwards:
(a) the habenular commissure .
(b) pineal body.
(c) post. commissure.
(d) the upper end of the aqueduct of the midbrain.

(5) Lateral wall : formed by :

(a) the medial surface of the thalamus in its posterosuperior part .
(b) the hypothalamus in its anteroinferior part.
(c) the hypothalamic sulcus which separates the thalamus from the hypothalamus.
(d) The sulcus extends from the interventricular foramen to the cerebral aqueduct.
(e) the interventricular foramen in the most ant. part of the lat. wall ( at the
junction of the roof with the ant. & lat. walls).

N.B : the interthalamic adhesion connects the medial surfaces of the 2 thalami
across the ventricular cavity .

 Recesses of the 3rd

ventricle :
(1) optic recess : just above & infront
of the optic chiasma.
(2) Infundibular recess : into the
infundibulum .
(3) Supra-pineal recess : just above
the pineal body .
(4) Pineal recess : Into the stalk of the
pineal body.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 42

 21UMAS SAMEH DOSS

Superficial attachment of the cranial nerves

* The 1st & 2nd nerves are
attached to the forebrain .
* The 3rd & 4th nerves are
attached to the Midbrain .
* The middle 4 cranial nerves
(5,6,7&8) are attached to the
Pons.
* The lower 4 cranial
nerves(9,10,11&12) are attached
to the Medulla.

Details :
1) Olfactory n. (1st cranial n.) :
* Consists of about 20 small
filaments on each side .

* they arise from the olfactory

mucosa &pass through the
cribriform plate of ethmoid to
end in the olfactory bulb.

2) Optic nerve (2nd cranial n.) :

* it is not a true peripheral n. but
a tract of the C.N.S .

* It consists of the axons of the

ganglion cells of the retina.

* it ends by joining the anterolateral aspect of the optic chiasma.

3) Oculomotor n. (3rd cranial n.) :
it emerges from a groove on the medial aspect of the cerebral peduncle of midbrain.

4) Trochlear n. (4th cranial n.) :

* it is the smallest cranial n. & the only n. which is attached to the dorsal aspect of the brain stem.
* it emerges from the post. surface of the midbrain just below the inf. colliculus.
* it pierces the sup. medullary velum then winds round the lat. aspect of the midbrain just obove the
pons to reach the interpeduncular fossa.
5) Trigeminal n. (5th cranial n.) :
* it is the thickest cranial n. & arises by 2 roots
> large sensory root .
> small motor root .
* the 2 roots are attached to the lat. aspect of the pons (at its junction with the M.C.P)

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 43

 21UMAS SAMEH DOSS

6) Abducent n. (6th cranial n.) :

emerges at the lower border of the pons (from the groove between the pons & the pyramid of the
medulla close to the middle line).

7) & 8) The facial (7th) & Vestibulocochlear (8th) cranial nerves :

both emerge from the lower border of the pons at the ponto-cerebellar angle (the angle between the
M.C.P. , the medulla & the cerebellum).

N.B :

a) the facial n. lies medial in position & is formed of 2roots

> facial n. proper (motor)
> nervus intermedius(sensory & parasympathetic).

b) the Vestibulo-cochlear n. lies lat. in position & is formed of 2roots

> cochlear (for hearing).
> vestibular (for equilibrium).

9) Glossopharyngeal (9th) cranial n. :

arises by 4-5 rootlets from the posterolateral sulcus of medulla (the groove between the olive & the
I.C.P).

10) The Vagus (10th) cranial n. :

arises by 10 rootlets from the posterolateral sulcus of medulla (below the rootlets of the
glossopharyngeal n.).

11) The Accessory (11th) cranial n. : has 2 roots:

a) cranial root : arising from the posterolateral sulcus of medulla by 5-6 rootlets lying below the
attachment of the vagus n.

b) spinal root : arises from the upper 5 or 6 cervical segments of the spinal cord.
It ascends through the F. magnum to join the cranial root forming together the accessory n.

12) The Hypoglossal n. ( 12th cranial n.) :

arises by 12 rootlets from the anterolateral sulcus of medulla (the groove between the pyramid & the
olive).

* Deep origin (nuclei) of the cranial nerves : see page 103

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 44

 21UMAS SAMEH DOSS

Arterial supply of the brain

* The Brain is supplied by 2 pairs of arteries

A. Rt. & Lt. Internal Carotid Artery (I.C.A)

B. Rt. & Lt. : vertebral arteries .

A. Internal Carotid artery (I.C.A)

 Origin : arises in the neck as one of the 2 terminal branches of the C.C.A

 Course : the I.C.A has 4 parts

1) cervical part

2) intrpetrous part See Head & Neck (page 12)

3) Intracavernous part

4) Intracranial part of I.C.A

* Each I.C.A leaves the cavernous sinus by piercing the dura mater & arachnoid mater, med. to the
ant.clinoid
process .

* It ascends in
the
subarachnoid
space lat. to the optic chiasma.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 45

 21UMAS SAMEH DOSS

* In the subarachnoid space each I.C.A gives off the following branches :
1) Ophthalmic a. : which enters the optic canal below the
optic n. to supply the orbit.
2) post. communicating a. : which joins the post. cerebral a. to establish the Circle of Willis
3) ant. choroidal a. : which supplies the choroid plexus of the lat. ventricle .

* It ends below the ant. perforated substance of the brain by dividing into 2 terminal branches :
1) the ant. cerebral a. (the smaller branch) .
2) the middle cerebral a. (the larger branch & in line with the main trunk of the I.C.A)

Branches of the I.C.A

I. Anterior choroidal a. :
* arises from the I.C.A
just before it divides
into its 2 terminal
branches.
* It passes backwards
along the optic tract
around the cerebral
peduncle as far as the
lat. geniculate body.
* It ends by entering the
inf. horn of lat.
ventricle through the
lower part of the
choroid fissure .
* It supplies : the optic tract, L.G.B., internal capsule (post. part of post. limb, retro- & sublentiform
part). It also supplies the choroid plexus of inf. horn of lat. Ventricle

II. Anterior Cerebral artery (A.C.A) Median

Optic chiasma
longitudinal fissure
* Origin : it arises below the ant.
perforated substance as the
smaller of the 2 terminal
ACA
branches of the I.C.A

* Course :
- it passes forwards & medially
above the optic chiasma to reach
the median longitudinal fissure.
- then it bends forwards in the
fissure where it becomes joined
to its fellow of the opposite side
by the ant. communicating a.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 46

 21UMAS SAMEH DOSS

- Then it turns sharply upwards in the median longitudinal fissure, to reach the med. surface of the cerebral
hemisphere where it lies below the rostrum of corpus callosum.
- It runs in the callosal sulcus, first curving upwards around the genu then passing backwards above the
body of corpus callosum.

* Termination : it ends above the splenium of C. callosum by turning upwards infront of the
parieto-occipital fissure.

* Branches :
A. Cortical branches : to supply :

1) the medial surface of the

hemisphere
from the frontal pole to the parieto-
occipital sulcus.

2) the upper 1" of the lat. surface as

far as the upper

end of parieto-occipital fissure.

3) the med. 1⁄2 of the orbital surface of the frontal

lobe.

B. Central branches : pierce the ant. perforated

substance & lamina terminalis to supply :

1) the ant. part of the corpus striatum .

2) the ant. part of ant. limb of internal capsule.

3) the septal region including the septum lucidum.

C. Callosal branches : to supply all parts of corpus

callosum except the splenium (which is supplied by

the post. cerebral a. ).

* Clinical importance : the A.C.A supplies 3 important regions :

1) The motor & sensory areas of the lower limb in the paracentral lobule .

2) The septal region : where a small lesion may result in prolonged unconsciousness .

3) The Corpus callosum : obliteration of its blood supply may result in apraxia (inability to perform
purposeful movements inspite of intact muscles).

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 47

 21UMAS SAMEH DOSS

Middle Cerebral Artery (M.C.A)

* Origin : arises below the ant.

perforated substance as the larger
of the 2 terminal branches of I.C.A .

* Course & relations :

- It passes laterally in the stem of lat.
sulcus.
- then it turns backwards & upwards
in the post. ramus of the lat. sulcus
crossing over the insula .

* End : it ends on the surface of the

insula by breaking up into many terminal branches.

* Branches of the M.C.A

I. Cortical branches : supply 1 ,2 & 3 : The

whole lat. surface of the C. hemisphere
Except :

a) a narrow strip (1" in breadth) along the sup.

border (which is supplied by the A.C.A ) .

b) the lat. surface of the occipital lobe +

a narrow strip on the lat. surface of temporal

lobe close to the inf. border (which are supplied
by the post. cerebral artery).

1) the lat. 1⁄2 of the orbital surface of the C. hemisphere.

2) the temporal pole & the insula.

II. Central branches : are many branches called striate arterioles

which arise from the M.C.A near its origin &
penetrate the ant. perforated substance to supply :

1) the Corpus striatum (lentiform & Caudate) .

2) the post. 1⁄2 of ant. limb, genu & the ant. part of the post. limb of
the internal capsule.
N.B one of the central branches is larger than the others & is called
the artery of cerebral haemorrhage (Charcots artery) as it is the
most susceptible artery in the brain to rupture.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 48

 21UMAS SAMEH DOSS

Clinical importance of M.C.A : it supplies :

1) the motor & sensory areas for the whole body except
the lower limbs.

2) the auditory area in the sup. temporal gyrus.

3) Motor speech area in the inf. frontal gyrus .

4) Most of the internal capsule (obstruction of its

blood supply ----> hemiplegia)

The Vertebro-basilar System

1. Vertebral artery
* Origin : Each vertebral a. arises in the
root of the neck as
a branch from the 1st part of subclavian a.

* Course :
- the Rt. & Lt. vertebral arteries enter the
cranial cavity through
the foramen magnum.
- inside the skull, the vertebral a. pass
upwards,
forwards & medially in the subarachnoid
space to reach the
ant. aspect of medulla oblongata .

* Termination : the 2 vertebral arteries

unite at the lower border of the pons to
form the basilar a.

* Branches :

1. Posterior inferior cerebellar a. :

- it is the largest & the main branch of the
vertebral a.
- Course : it runs backwards around the medulla just below the olive & the
inf. cerebellar peduncle to reach the inf. surface of the cerebellum
where :
- it ends : by dividing into 2 terminal branches :
1) a med. terminal br. : supplying the inf. vermis of the cerebellum.
2) a lat. terminal br. supplying the post. Part of inf. surface of
cerebellum

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 49

 21UMAS SAMEH DOSS

* Clinical importance : the post. inf. cerebellar a. supplies also the lat. & dorsal parts of the medulla
which contain the spinal lemniscus, the nucleus ambiguus & the spinal nucleus of trigeminal n.
Thrombosis of the artery causes loss of function of these structures (called lat. medullary
syndrome).

2. Posterior spinal a.
- it is the 1st branch of vertebral a. inside the cranial cavity .
- it descends to the spinal cord along the line of the post. roots of the spinal nerves.

3. anterior spinal a. (the longest a. in the body) :

- arises from the upper most part of the vertebral a.
- the 2 ant. spinal arteries unite infront of the medulla to form a single median ant.
spinal a. which descends along the ant. median longitudinal sulcus of the spinal cord down to the filum
terminale . It supplies the ant. part of the medulla & the spinal cord .

4. Medullary branches : to supply the medulla .

2- Basilar Artery

* It begins :
at the lower border of pons by the union of the 2 vertebral arteries.

* Course :
it ascends along the basilar sulcus infront of the pons.

* It ends
at the upper border of the pons by dividing into 2 post. cerebral
arteries .

* Branches :

1) Pontine branches : numerous small twigs supplying the pons & M.C.P

2) ant. inf. cerebellar a. : passes posterolaterally around the lower border of

the pons to supply the ant. part of the inf. surface of the cerebellum.

3) Internal auditory a. : accompany the 7th & 8th cranial nerves through the internal auditory meatus to
supply the internal ear.

4) Sup. cerebellar a. : a large br. arising from the upper part of the basilar a. It passes posterolaterally
around the upper border of the pons to reach the upper surface of the cerebellum supplying it.

5) 2 Post. cerebral arteries : are the 2 terminal branches.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 50

 21UMAS SAMEH DOSS

Posterior Cerebral Artery (P.C.A)

❖ Origin : the Rt. & Lt. post. cerebral a. arise at the upper border of the pons as the 2 terminal
branches of the basilar a.
❖ Course :
- each P.C.A curves laterally & backwards around the cerebral peduncle of the midbrain
parallel to the sup. cerebellar a.
- it then passes below the splenium of corpus callosum on the med. surface of the cerebral
hemisphere .
- Finally it enters the ant. part of the calcarine sulcus where, :
❖ it ends : by dividing into 2 terminal branches which run in the parieto-ocipital
fissure & in the post. part of the calcarine sulcus .
central branches
❖ Branches : cortical branches
post. choroidal a.
(A) Cortical branches : to supply :
(1) the lentorial surface behind the temporal pole.
(2) the med. & lat. surfaces of the occipital lobe.
(3) a narrow strip on the lat. surface of the
temporal lobe along the inf. border .
(B) Central Branches :
(1) short med. group : pierce the post. perforated
substance to supply the cerebral peduncles , the
mammillary bodies , the subthalamic region &
the ant. part of the thalamus .
(2) Long lateral group : curve around the lat. side of
the midbrain to supply the geniculate bodies ,
post. part of thalamus & pineal body .

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 51

 21UMAS SAMEH DOSS

(C) The post. choroidal a. :

- arises below the splenium of
corpus callosum.
- passes forwards inside the
brain in the edge of tela
choroidae to supply the
choroid plexuses of the lat.
& third ventricles.
❖ Clinical importance of P.C.A : it
supplies :
(1) the centre of smell in the
uncus.
(2) the whole visual cortex in
the occipital lobe.
(3) most of the thalamus.
(4) most of the midbrain.
(5) most of the choroid plexus of the 3rd & lat. ventricles.

Circulus arteriosus of Willis

❖ Definition : it is an arterial anastomosis between 9 arteries supplying the brain.
❖ Site : in the interpeduncular
cistern around the inter-
peduncular fossa.
❖ Relations :
- inferiorly : optic chiasma (infront).
cavernous sinus (on each side).
dorsum sellae (behind).
- superiorly the
Circle of Willis surrounds the
following structures (from
before backwards) :
(1) pituitary stalk.
(3) the mammillary bodies.
(2) the tuber cinerium.
(4) the post. perforated substance
❖ Formation : The following
arteries enter in the formation
:
- Rt. & Lt. anterior cerebral arteries.
- the ant. communicating a. connecting the 2 ant. cerebral arteries.
- the Rt. & Lt. int. carotid arteries.
- the Rt. & Lt. post. communtcating a.
- the Rt. & Lt. post. cerebral arteries.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 52

 21UMAS SAMEH DOSS

Veins of the Cerebral hemisphere

Characters:
(1) They are thin walled with no smooth muscle fibres & no valves.
(2) Most of them lie on the surface of the hemisphere (in the subarachnoid space).
Only few veins arise from the inside of the brain.

(1) Veins of the lat. surface of the hemisphere

a) Sup. cerebral veins : 6-12 veins which run upwards to end in the sup. sagittal sinus.

b) Inf. cerebral veins :

- the majority of these veins end in the superficial middle cerebral v. which lies in the

stem of the lat. sulcus & ends in the cavernous sinus .

Some in cerebral veins end in the transverse sinus.

N.B in many cases, a sup. anastomotic vein connects the post. end of the superficial

middle cerebral vein with the sup. sagittal sinus . Also an inferior anastomotic

v. connects the superficial middle cerebral v. with the transverse sinus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 53

 21UMAS SAMEH DOSS

(2) Veins of the medial Surface of the hemisphere

inf. Sag. Sinus Sup. Segit. Sinus

Straight sinus

Lt. ant. Cerebral v.

Straight sinus

a) the veins of the upper part of the med. surface ascend to end in the sup. & inf. sagittal sinuses.
b) the veins of the lower part of the med. surface drain into the ant. cerebral v. which lies in the
callosal sulcus (accompanying the ant. cerebral artery) & ends in the basal v.
N.B: each of the Rt. & Lt. basal vein lies on the base of the brain, & is formed
below the ant. perforated substance by the union of the following 3 veins :
a) ant. cerebral v. which accompanies the ant. cerebral a. on the med. surface.
b) the deep middle cerebral v. : which runs on the surface of the insula accompanying
the middle cerebral a.
c) striate veins which drain the corpus striatum & come out through the ant. perforated
substance.

(3) The deep Veins of the brain

(a) Internal cerebral veins (Rt. & Lt.) : each vein is formed near the interventricular F. by the union
of 2 veins:
> (1) choroid v. draining the choroid plexus of the lateral ventricle.
> (2) thalamostriate v. running in the groove between thalamus & caudate nucleus.

The Rt. & Lt. internal cerebral veins pass backwards in the roof of the 3rd ventricle (between the 2 layers of
the tela choroidea) to end just below splenium of C-Callosum by joining each other to form the great
cerebral vein.

(b) Great cerebral v. :

- it is a short median v. formed by the union of the Rt. & Lt. internal cerebral veins .
- it emerges from beneath the splenium of the corpus callosum.
- it receives the Rt. & Lt. basal veins.
- it ends by joining the inf. sagittal sinus to form the straight sinus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 54

 21UMAS SAMEH DOSS

The Meninges of the brain

- The brain is surrounded by 3 membranes , from inside outwards they are :
(1) pia mater
(2) arachnoid mater
(3) dura mater

I- the Pia mater :

- It is a delicate vascular membrane forming the innermost covering membrane of the brain.
- It closely surrounds the brain & is carried into all sulci by the branches of the cerebral arteries .
- It is invaginated below the body of the fornix to form a double fold called the tela choroidae in which the
choroid plexuses of the 2 lat. ventricles & the 3rd ventricle are formed.
- It sends tubular sheaths around the cranial nerves in the cranial cavity.

II- Arachnoid mater :

- It is a thin delicate membrane lying outside the pia mater.
-It covers the gyri & bridges over the Sulci of the brain .It is only carried into the median longitudinal fissure
by the falx cerebri .
- It sends tubular sheaths around the cranial nerves till their points of exit from the skull .
- It forms small mass called arachnoid villi (microscopic) & arachnoid granulations(marcoscopic) which
project into the sup. sagittal & transverse sinuses pouring the C.S.F into them .
- It is separated from the pia mater by a narrow space called the subarachnoid space containing C.S.F , the
blood vessels on the outer surface of the brain & reticulum of fine fibres connecting the arachnoid mater
to the pia mater .

- The Subarachnoid Cisterns :

These are areas in which the arachnoid & pia are widely separated from each other leading to widening of
the subarachnoid space. These cisterns are:

(1) Cerebello-
medullary
cistern (cisterna
magna) :
- lies between the back of
medulla & the inferior surface
of the cerebellum.
- it communicates with the
4th ventricle by 3 small
openings through which the
C.S.F drains from the 4th
ventricle to this cistern.

(2) The pontine

cistern :
lies infront of the pons &
upper part of medulla .

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 55

 21UMAS SAMEH DOSS

- it contains the vertebral & basilar arteries.

- it is traversed by the roots of the lower 8 cranial nerves .

(3) The interpeduncular Cistern :

- lies below the interpeduncular fossa.
- It contains the arteries forming the circulus arteriosus of Willis.
- It is traversed by the roots of the 3rd & 4th cranial nerves.

(4) Cistern of lateral sulcus :

- it is an extension of the interpeduncular cistern into the stem of the lat. sulcus .
- It contains the middle cerebral a.

(5) The Cistern of corpus callosum :

lies on the upper surface of corpus callosum .
- contains the ant. cerebral a.

(6) the cistern of the great cerebral v. :

- lies between the splenium of corpus callosum & the upper surface of the cerebellum .
- it contains the great cerebral v.

(7) the chiasmatic cistern : lies around the optic chiasma .

III- The Dura mater :

* It is a thick membrane forming the outermost covering of the brain.
* It consists of 2 layers : outer & inner.
(1) outer (endosteal) layer : lines the inner surface of the skull bones.

(2) Inner (meningeal) layer :

- surrounds & protects the brain .
- sends tubular extensions around the cranial nerves which fuse with the epineurium of the nerves outside
the skull.
- sends 4 Septa inwards ( falx cerebri, falx cerebelli ,tentorium cerebelli & diaphragma sellae) which divide
the cranial cavity into compartments .
- The 2 layers of the dura are fused together except in certain places where they separate to form the
venous sinuses

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 56

 21UMAS SAMEH DOSS

The Cerebro-Spinal Fluid (C.S.F)

* It is the fluid which circulates in the ventricles & central canals of the C.N.S and also fills the subarachnoid
space & cisterns .

(1) Production of the

C.S.F :
- it is secreted by the
choroid plexuses present in
the med. walls of the lat.
ventricles , roofs of the 3rd
ventricle & 4th ventricle.
- The choroid plexus : is
formed by a capillary plexus
invaginating a single layer
of cuboidal epithelium
which extracts the fluid
from the capillaries &
secretes it into the
ventricles .

(2) Circulation :
the C.S.F in each lat.
ventricle --->
interventricular foramen ----
> 3d ventricl —> aqueduct
of midbrain —> 4th
ventricle > some fluid enter
the central canal of S.cord .
> the majority passes through the 3 foramina in the roof of the 4th ventricle ----> subarachnoid
space where it flows over the surface of the brain & spinal cord.

(3) Absorption of the C.S.F : the S.C.F. is absorbed by means of the arachnoid villi
and granulations which absorb the C.S.F from the subarachnoid space & pours it into the dural venous
sinuses particularly the sup. sagittal sinus to reach the blood stream .

(4) Functions of the C.S.F :

(a) it takes the place of the lymph in the C.N.S which is devoid of lymphatic vessels .
(b) acts as a protective water cushion to the C.N.S against blows & shocks .
(c) regulation of the intracranial pressure.

(5) Characters of the C.S.F :

(a) amount : 135 c.c
(b) replacment : is continuously produced & absorbed at a rate of 400 - 500 c.c daily (i.e it is replaced
3times per day).
(c) Pressure : 100 mm. of water .
(d) appearance : clear watery fluid .

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 57

 21UMAS SAMEH DOSS

TRACTOLOGY
I- Internal Structure of the Spinal Cord
- A transverse section in the spinal cord shows that it is formed of :
(1) outer white matter .
(2) inner grey matter .
(3) central canal (1 mm. in diameter).
- The 2 halves of the spinal cord are connected by :
(a) grey commissure containing the central canal .
(b) white commissure infront of the grey
commissure .

(A) Grey matter

* Structure : it consists of nerve cells &
unmyelinated nerve fibres.
* Shape : H-shaped formed of :
(a) anterior horns : containing motor nuclei.
(b) 2 posterior horns : containing sensory nuclei.
(c) 2 lat. horns(in the thoracic & sacral regions) : containing autonomic cells.

* Nuclei of the grey matter :

I- Nuclei of the post. horn (sensory)
Nucleus & site afferents efferents

(1) Substantia Pain & its axons cross to the

gelatinosa of temperature opposite side in the
Rolandi impulses via white
(S.G.R) central commissure & ascend
at the apex of processes of in
the post. horn dorsal lat. white matter as
root ganglion the
cells. lat. spinothalamic T.
(2) Nucleus light pressure & its axons cross to the
proprius crude opposite side in the
in the middle touch impulses white
part of the via commissure then
post. horn central processes ascend
of in the ant. white
dorsal root matter as ant.
ganglion cells spinothalamic T.
(3) Clark's proprioceptive its axons ascend in the
dorsal nucleus impulses lat. column of the
at the base of via collaterals same
the post. horn from the side forming the post.
(in the fibres of the post. spine-cerebellar tract
thoracic & column of white
upper lumbar matter .
region only )

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 58

 21UMAS SAMEH DOSS

Ⅱ Nuclei of the Ant. horn (motor)

* The ant. horn cells & their axons which run in
the peripheral nerves the lower motor neurones (L.M.N).
* The A.H.Cs are grouped into 3 groups of motor nuclei
(med. ,lat. & central) as follows: Lateral group
Central group
Medial group
Group Afferent impulses Efferent Fibres (axons)

1) Medial group − pyramidal tract run in the peripheral nerves

(ventromed. & dorsomed. nuclei) impulses. supplying trunk muscles.
found in all segments of the − extrapyramidal
spinal cord . tract impulses.
2) Lateral group − proprioceptive run in the peripheral nerves
(ventrolat. & dorsolat. nuclei) impulses from supplying the limb muscles.
found in all segments of the muscles.
spinal cord. − From short
3) Central group: associative tracts its axons run in :
only present in the cervical (for reflex arc). 1) the phrenic n. (supplying the
region diaphragm) .
2) spinal accessory n. (supplying
steromastoid & trapeziu m. ) .

Ⅲ Nuclei of the lat. horn (autonomic)

Nucleus Afferent Efferent fibers
impulses

* Sympathetic via descending its axons leave the cord through the ventral roots of
present in the lat. autonomic fibres corresponding nerves as pre-ganglionic fibres which relay in
horns of the segments arising from the the corresponding ganglia of the sympathetic chain.
from T1 to L2 or L3 hypothalamus &
visceral centres
in the brain-
stem .

* Parasympathetic its axons leave the cord through the ventarl roots of the
present in the lat. horns corresponding nerves as preganglionic fibres which relay in
of the 2nd , 3rd & 4th terminal ganglia in the organs supplied.
sacral segments of the
spinal cord .

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 59

 21UMAS SAMEH DOSS

 The White Matter

* lt is divided into 3 large columns on each side : post. colmun
1) post. column : lying between the post. median septum &
the attachment of the dorsal nerve root. dorsal nerve root
it contains ascending tracts only. lateral colmun
2) lateral column : lying between the attachments of the dorsal &
ventral nerve roots.
It contains both ascending & descending tracts.
3) anterior column : lying between the ant. median fissure &
the attachment of the ventral nerve root.
It contains descending tracts mainly. ventral nerve root
ant. colmun

* Structure : the white matter contains 3 types of nerve fibres (tracts) :

1) Ascending or afferent (sensory) tracts : carrying sensory impulses from the spinal cord to higher
centres (brain stem & C.cortex) .
2) descending or efferent tracts : carrying motor or autonomic impulses from higher centres to the
spinal cord.
3) associative tracts : containing short ascending & descending fibres which coordinate the function of
the different regions of S.cord.

I- Ascending tracts of the spinal cord

4 tracts carrying conscious sensations 4 tracts carrying unconscious sensations

(1) Gracile (1) dorsal spinocerebellar .
(2) Cuneate (2) ventral spinocerebellar .
(3) Lat. spinothalamic (3) spino-olivary .
(4) ventral spinothalamic (4) spino tectal .

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 60

 21UMAS SAMEH DOSS

1) the 4 tracts which carry conscious sensations :

tract & its position sensation carried Origin Termination

1) Gracile T. proprioceptive & fine cells of the post. gracile nucleus

in the post. column touch sensations from root ganglion whose in closed
close to the middle lower 1/2 of the body. central processes medulla.
line pass in the medial
division of the post.
2) Cuneate T. proprioceptive & fine nerve root & ascend cuneate
in the post. column, touch sens. from the in the post. column nucleus in
lat. to the gracile T. upper 1/2 of the of the spinal cord . closed
body. medulla.

3) lat. spinothalamic pain & temperature axons of S.G.R P.L.V.N. of

T. from all the body which cross to the thalamus

lat. spinothalamic T.
in the lat. column below the head. opposite side

Ant. spinothalamic T.
deep to the ventral infront of the
spinocerebellar T. central canal.

4) Ant.spinothalamic crude touch & light axons of the nucleus P.L.V.N. of

T. pressure from the proprius which thalamus
in the ant. column opposite 1/2 of the cross to the
lying deep to the body below the head. opposite side.
Dorsal root
vestibulocerebellar. ganglia

2) The 4 tracts which carry unconscious sensations :

Tract & its position Sensations carried Origin Termination

1) post. spinocerebellarT. proprioceptive sens. axons of clark's ipsilateral cerebellral

in the lat. from the trunk & L.L nucleus of the hemisphere
M.B.
column just lat. to the cerebellum . same side.
to lissauer T.

2) Ant. proprioceptive axons of large the fibers ascend till the

pons
spinocerebell impulses from the cells at the base midbrain, recross the
ar T. L.Limb to the of the post. middle line again to reach
In the lat. column just cerebellum. horn of the the ipsilateral cerebellar
infront of the post. opposite side hemisphere
spinocerebellar T M.O.
Spinocerebellar T.
Post.

3) spino- proprioceptive axons of the in the inf. olivary nucleus

olivary T. impulses cells of the the pass to the
in the lat. column nucleus cerebellum via the olivo- inf. olivary
nucleus
alongside the proprius which cerebellar fibers
olivospinal tract . cross to the Spinal cord
opposite side

4) Spino-tectal Pain, temp, & touch axons of the in the sup. colliculus of
T. impulses from cells of the the tectum of midbrain Clark 's
nucleus
in the lat. column deep spinal cord to the post. horn
to the ventral tectum of which cross to
Spinal cord
spinocerebellar T midbrain(serving to the opposite
spinovisual side
reflexes).

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 61

 21UMAS SAMEH DOSS

Ⅱ Descending tracts of the spinal cord

A. pyramidal B. Extrapyramidal (page70) C. descending autonomic
(page68)

rubrospinal T.
lat.
reticulospinal
lateral cortico T.
Med.
spinal T.
reticulospinal T.

olivospinal T.
Lat.
Ant. cortico vestibulospinal T.
spinal T. med.
vestibulospinal T.
tectospinal T.
1) lateral cortico spinal 1) rubrospinal T. : descends in the lat. * They arise from autonomic
T. column just ant. to lat. corticospinal T. centres in the hypothalamus &
* consists of crossed 2) olivospinal T. : descends in the lat. brain stem.
pyramidal fibers column near the surface at the site of * they descend in :
* descends in the lat. exit of the ventral roots. A. the lat. column (in close relation
column of the spinal 3) lat. reticulospinal T. : descends in the to the lat. reticulospinal,
cord deep to the post. lat. column deep to the rubrospinal T. rubrospinal & lat. corticospinal
spino-cerebellar 4) tectospinal T. : descends in the ant. tracts .
tract . column superficial to the ant. B. in the ant. column in close
2) Anterior corticospinal corticospinal T. relation to the med. reticulo-
T. 5) vestibulospinal tracts : descend close spinal T.
* consists of uncrossed to the surface of the ant. column as
pyramidal fibres small med. vestspinal T. ( partly
* descends in the ant. crossed) & larger lat. vest spinal T. * they end on the autonomic cells
column alongside the (uncrossed) of the lat. horn of:
ant. median fissure. 6) med. recticulospinal T. : descends as A. thoracic segments
* ends at the scattered fibers in the med. part of B. upper 2 lumber segments
midthoracic region ant. column . C. 2nd, 3rd, 4th sacral segments.

Ⅲ Intersegmental tracts septomargin

* They are short ascending & descending fibres which conect the various al T. comma-
segments together to integrate their activities. They include : shaped T
Lissauer’s T.
1) Fasciculi proprii : lie just outside the grey matter surrounding it
like ring.
2) septomarginal T. are present in the post. column &
contain proprioceptive
3) comma-shaped T. associative fiberes .
4) ant. intersegmental T. : in the ant. column . it is continuous
with
the med. longitudinal bundle of the brainstem.
5) Lissauer’s T. : is a short tract at the apex of the post. horn
formed of very short ascending & descending fibres.
ant.
intersegmental T. 62
THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL
 21UMAS SAMEH DOSS

The Great Afferent (Sensory) Pathways

* General rules :
A. Conscious sensations include 2 types:
a. exteroceptive sensation: are sensation from the skin (pain, temperature&touch)
b. proprioceptive sensations: are sensations From muscles, joints, ligaments & fascia
(sense of position, passive movement & vibrations).

B. All conscious sensations must reach the sensory area in the postcentral gyrus
C. the sensory area of each hemisphere receives sensations from the oppesite 1/2 of the body

D. Each sensation is transmitted from the receptors to the sensory area by 3 neurones as follows :
(1) 1st order neurone : for all sensations without exception : lies in the dorsal root ganglion of the
spinal n. Each neurone has 2 processes :
a. peripheral process which receives the sensation from the receptor.
b. Central process which transmits the sensation to the 2nd order
neurone.

(2) 2nd order neurone : is either in:

a.the spinal cord (in case of pain, simple touch & temperature sensations).
or
b. in the medulla (in case of proprioceptive & complex touch sensations).
N.B : the axons of the second order neurones must cross the middle line
(either in the spinal or in the medulla) to reach the thalamus of the
opposite side

(3) 3rd order neurone : for all sensations without exception : lies in the
postero-lateral ventral nucleus (P.L.V.N) of the thalamus of the opposite
side. The axons of the cells of the P.LV.N. of thalamus finally transmit
the sensation to the Sensory area in the postcentral gyrus.

E. Afferent Sensory Fibres include the following :

1. General somatic Sensory (G-S-S) fibres :Carry exteroceptive proprioceptive Sensations to the C.N.S
2. General Visceral sensory (G.V.S)Fibres : Carry sensations From the viscera to the C.N.S
3. special Somatic Sensory (S.S.S) fibres : carry sensations from the ear (hearing & equilibrium) &
from the eye (vision) to the C.N.S
4. Special Visceral Sensory (S.V.S) fibres : carry taste & smell to the C.N.S

N.B : Efferent motor fibers include the following :

1. General Somatic motor (G.S.M) fibres : carry motor orders from C.N.S to Striated muscles.
2. General visceral motor (G.V.M) fibers : carry autonomic (sympathetic & parasymp.) orders from
the C.N.S to smooth muscles, heart & glands.
3. Special Visceral motor (S.V.M) Fibres : Carry motor orders To special visceral muscles (which are
derived from visceral or branchial arches in the H&N

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 63

 21UMAS SAMEH DOSS

Pain & Temperature Pathways

* Receptors:
1. Free naked nerve endings for pain
2. Ruffini organ for temperature
Corona radiate Internal capsule
3. Krause’ organ for cold.

* 1st order neurone (dorsal

Cells of P.L.V.N.T.
3rd order neuron
root gang. cells):
- the cell bodies are small-sized
cells whose peripheral processes
(thin finely myelinated) receive the
sensation from the receptors while
their central processes enter the
spinal cord in the lat. bundles of
the dorsal roots forming the
Lissauer's tract which ends in the
S.G.R.

* 2nd order neurone (cells

of the S.G.R) :
- the cell bodies lie in the
Substantia gelatinosa of Rolandi Spinal lemniscus
(S.G.R)
in the tip of the post. horn.

Cells of S.G.R.
2nd order neuron
- the axons of these cells cross to
the opposite side in the ant. white
commissure then ascend in the lat.
column of the spinal cord
forming the lateral spino-thaiamic
tract which continues upwards
in the brain stem as the spinal
lemniscus to end in the
posterolateral ventral nucleus of
thalamus ( P.L.V. N.T) . Lat. Spinothalamic T.
* 3rd order neurone (cells
of the P.L.V.N.T) :
- the cell bodies lie in the P.L.V.N.
Dorsal root ganglion cells
1st order neuron

of the thalamus
- their axons form the sensory
radiation which pass
in the post 1/2 of the post. Iimb of the internal capsule .

* Termination : the fibres of the sensory

radiationt finally reach sensory area (areas 3.1.2) in the postcentral gyrus of the parietal lobe

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 64

 21UMAS SAMEH DOSS

Touch Pathways
1) Fine touch ( touch discrimination & stereognosis) :
has the same pathway as proprioceptive sensation (page 66 ).
2) Simple or crude touch : has the
following pathway :
* Receptors:
1) Merkel’s touch corpuscles in the
epidermis.

Cells of P.L.V.N.T.
3rd order neuron
2) Meissner's touch corpuscles in the
papillary layer of dermis
3) Tuft of Bonet : around the hair follicles

* 1st order neurone (dorsal root

ganglion cells):
− the cell bodies are medium-sized cells of
the dorsal root ganglion whose:

Main sensory nucleus

2nd order neuron
− peripheral processes (medium-sized
fibres) receive the sensation from the
receptors.
− Central processes enter the spinal cord
in the dorsal roots & ascend for several
segments in the posterior column to
end in the main sensory nucleus
(M.S.N).

* 2nd order neurone (cells of

M.S.N.)
− the cell bodies lie in the main sensory
nucleus (nucleus proprius) of the post.
horn.
− the axons of these cells cross the middle
line in the ant. white commissure then
ascend in ant. column of the white
matter forming the ventral spina-
thalamic tract which joins the spinal
lemniscus in the brain stem & ends in
the P.L.V.N.T.

* 3rd order neurone (cells of the

P.L.V.N.T) :
1st order neuron
− the cell bodies lie in the P.L.V.N of the thalamus.
Dorsal root ganglion cells
− their axons ascend in the sensory radiation
in the post. 1/2 of the post. limb of the internal capsule .

* Termination : in the sensory area in the postcentral gyrus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 65
 21UMAS SAMEH DOSS

Proprioceptive Pathway to the Cerebral cortex

* Receptors:
1) pacinian corpuscles: in C.T between muscles &
around Capsules of the joints
2) Muscle spindles : in the skeletal muscles.
3) Tendon spindles: in the tendons.

* 1st order neurone (dorsal root

gang. cells)
− the cell bodies are large-sized cells
whose:
peripheral processes (thick, heavily
myelinated) receive the sensation
From the receptors while their
central processes enter the spinal
cord in the med. bundles of the
dorsal roots then ascend in the post
-column forming 2. tracts:
a) the gracile tract which lies
medially carries sensations
From the lower 1/2 of the
body
b) the cuneate tract which lies
laterally & carries sensations
from the upper 1/2 of the
body.
− the Fibres of these 2 tracts relay in
the gracile & cuneate nuclei in the.
medulla.

* 2nd order neurone (cells of gracile

& cuneate nuclei):
− the cell bodies lie in the gracile &
cuneate nuclei of medulla
− the axons of these cells first curve
forwards and medially forming the
internal arcuate fibres which cross
the middle line (in the sensory
decussation) then ascend in the
opposite side forming the med.
lemniscus which ends in the P. L. Y.
N. of thalamus.

* 3rd order neurone (cells of the P.

L. V.NT):
− the cell bodies lie in the P. L. V. N. of thalamus
− their axons pass in the sensory radiation in the post 1/2 of the post-limb of the internal Capsule

* Termination: in the Sensory area (3,1,2) in the postcentral gyrus of the parietal lobe

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 66

 21UMAS SAMEH DOSS

The great efferent (Motor) Pathways

* General rules:
- all voluntary movements are initiated by nerve impulses that arise from the motor areas of the brain &
are transmitted to the striated muscles via a pathway formed of 2 neurones:
(A) Upper motor neurones: the motor cells of the cerebral cortex & subcortical centres whose axons
constitute the pyramidal & extrapyramidal tracts which descend to end around the motor nuclei of cranial
nerves in the brain stem & the A.H.Cs of the spinal cord.
(B) lower motor neurones: include the cells of the motor nuclei of the cranial nerves & the A.H.Cs of
the spinal cord & their axons which constitute the motor fibres of the periphieral nerves that terminate in
the motor end plate of the striated muscles.
(A) Upper motor neurons
Pyramidal tract Extrapyramidal tract
localized (cortical - widely distributed (from
areas) cortical & subcortical areas:
(1) 80% arise from (1) premotor area 6
motor area 4 (2) corpus striatum.
origin

(2) 10% arise from (3) subthalamic centres.

the premotor area 6 (4) red nucleus &
(3) 10% arise from substantia nigra
the area 3,1,2!! (5) inf. olivary nucleus

one neurone carries many neurones

impulses from the carry impulses from the
cerebral cortex to cortical & subcortical
course

the ant. horn cells centers to the A.H.Cs i. e

without multisynaptic,
interruption. multineuronal

in the medulla, the - in the medulla, the

site in the
medulla

pyramidal tract extrapyramidal tracts do

occupies the not occupy the pyramid.
pyramid.

- 80% of fibers cross - some extrapyramidal

crossing of fibers

to the opposite side tracts are direct while

in the medulla others are crossed.
- the remaining crossing occurs at the level
fibers cross to the of the origin of the
opposite side in the extrapyramidal tract.
spinal cord.

(1) on movement: (1) on movements: they

responsible for fine are responsible for gross,
isolated, precise & synergic movement
function

specific movements requiring the activity of

(2) on tone: it large groups of muscles.
increases tone & (2) on tone: some tracts
reflexes (facilitatory) are facilitatory while others
are inhibitory for tone &
reflexes.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 67

 21UMAS SAMEH DOSS

The Pyramidal tract

* Definition:
It is a bundle of nerve fibres arising
from the cerebral cortex & descending
without interruption to relay on the
motor nuclei of cranial nerves in the
brain stem or around the A.H.Cs. of
the spinal cord.

* Subdivisions: it is subdivided into:

(a) corticospinal tract.
(b) Corticobulbar tract.

(A)- the Corticospinal tracts

* it is the part of the pyramidal tract ending
around the A.H.Cs of the spinal cord.

* Origin: it arises as the axons of the giant

pyramid cells of Betz mainly from the upper
2/3 of the motor area 4 in the precentral
gyrus.

* Pathway:
A. In the cerebral hemisphere: the fibres
descend in the corona radiata &
converge towards the int. capsule.
B. In the internal capsule: the fibres
descend in the ant.1/2 of its post. limb
converge towards midbrain.
C. In the midbrain: the fibers descend in
the crus cerebri occupying its middle
3/5.
D. In the pons: the corticospinal fibres
form separate bundles descending in
the basilar part of the pons separated
by the transverse pontine fibres.
E. In the upper part of the medulla:
the separate bundles collect again
forming a compact bundle (the
pyramid) in the ant. part of the
medulla.
F. In the lower part of the medulla:
(a) 75-85% of the fibers of the pyramid cross to the opposite side in the pyramidal decussation &
continue downwards as the crossed pyramidal tract in the spinal cord.
(b) 15-25% of the fibers of the pyramid descend on the same side forming the direct pyramidal
tract in the spinal cord.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 68

 21UMAS SAMEH DOSS

G. In the Spinal cord:

(a) the crossed pyramidal tract descends in the lat. column of the white matter.
Its fibres relay on the A.H.Cs of the same side.
(b) the direct pyramidal tract descends in the ant. column of the white matter.
Its fibres cross the middle line to relay on the ant. horn cells of the opposite side.

B- The Cortico-bulbar fibres (tract):

* It is the part of the pyramidal T. whose fibres relay
on the motor nuclei of the cranial nerves (of
opposite side).

* Subdivisions: the Corticobulbar T. is subdivided

into:
(1) med. cortico-bulbar fibres: ending on the
nuclei of the cranial nerves controlling the
eye movements (3, 4 & 6).
(2) lat. corticobulbar fibres: ending on the
motor nuclei of the other cranial nerves (5,
7, 9, 10 ,11 &12).

1- Med. Cortico-bulbar fibres

* Origin: the fibres arise as axons of the cells of the
area 8 (the frontal motor eye field).

* pathway:
(1) In the cerebral hemisphere: the fibers
descend in corona radiata then the genu of
the internal capsule.
(2) In the midbrain: they descend in the med.
part of the crus cerebri (very close to the
middle line).
(3) they end by relaying on the nuclei of the
cranial nerves 3, 4 &6 of the opposite side (in
midbrain & pons).

2- Lat. Cortico-bulbar fibres

* Origin: the fibres arise as axons of the cells in the
lower 1/3 of the motor area 4.

* Pathway:
(1) In the cerebral hemisphere: the fibres descend in the corona radiata then the genu of the internal
capsule.
(2) In the midbrain: the fibres descend in the ant. part of the crus cerebri (dorso-lateral to the
corticospinal fibres).
(3) In the pons & medulla: the fibres end on the nuclei of the cranial nerves 5,7,9,10, 11&12 of the
opposite side.
N.B: the 5th & 7th nerve motor nuclei receive fibres from both ipsilateral & controlateral corticobulbar
tracts.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 69

 21UMAS SAMEH DOSS

Extrapyramidal System
* The extrapyramidal system includes:
(a) extrapyramidal centres
(b) extrapyramidal tracts.
(A) Extra pyramidal centres
(1) Premotor area of the cerebral cortex (area 6).
(2) Corpus striatum (Caudate & lentiform nuclei).
(3) Subthalamic nucleus in the subthalamus.
(4) Red nucleus (in the midbrain).
(5) Substantia nigra (in the midbrain).
(6) inf. olivary nucleus in medulla.
(7) nuclei of the reticular formation in the brain stem.

To extrapyramidal centers of brainstem

(B) Extra pyramidal tracts of the Sp. cord
(1) Rubrospinal tract:
 arises from the red nucleus &
crosses to the opposite side.
 descends in the lat. column of
the spinal cord.
 function: relays impulses from
the corpus striatum &
cerebellum to the A.H.Cs of
the spinal cord.
(2) Tecto-Spinal tract:
 arises from the sup. colliculus
of midbrain.
 Crosses to the opposite side.
 descends in the ant. column of
the spinal cord.
 function: relays visual reflexes
to the A.H.Cs of sp.cord.
(3) Vestibulo-spinal tract:
 arises from the lat. vestibular
nucleus in the pons (the
majority of its fibres are
uncrossed).
 descends in the ant. column of
the spinal cord.
 Function: convey impulses of equilibrium to the A.H.Cs.
(4) Olivo-spinal tract :
 arises from the inf. olivary nucleus in the medulla.
 descends on the same side (uncrossed) in the lat. column of the spinal cord.
 function: probably it is an intermediate pathway in the strio-olive-spinal connections.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 70

 21UMAS SAMEH DOSS

(5) Lateral reticulo-spinal tract:

 arises from the nuclei of the reticular formation of the brain stem
(mainly medulla) & crosses to the opposite side.
 descends in the lat. column of the spinal cord deep to the rubrospinal &
lat. corticospinal tracts.
 ends on the ant. horn cells of the spinal cord.
Lat. & med.
Reticulospinal
(6) Medial reticulo-spinal tract: tract
 arises from the nuclei of reticular formation of the brain
 stem (mainly pons).
 descends uncrossed in the ant. column of the spinal cord.
 ends on the A.H.Cs.

Connection of the Cerebellum with the extra pyramidal centres

The cerebellum affects the function of the
extra-pyramidal system though its
connections with the following
extrapyramidal Centres:

(1) The premotor area (area 6) of the

cerebral cortex:
the cerebellum receives afferent
impulses from the premotor area 6 via the
corticopontocercbellar pathway

(2) the red nucleus in the midbrain:

receives afferent impulses from the
cerebellum via the dentato-rubral tract.

(3) the inf-olivary nucleus in the

medulla:
the cerebellum is connected to the inf-
olivary nucleus via afferent fibres (olivo-
cerebellar) & efferent fibres (cerebello-
olivary).
(4) Reticular formation of the brain
stem:
the cerebellum is Connected with the
nuclei of the reticular formation of the
brain stem through cerebello -reticular &
reticulo cerebellar Fibres.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 71

 21UMAS SAMEH DOSS

(2) Internal Structure of Medulla

I- Main nuclei
Nucleus Site Affrerent Fibers entering Efferent Fibers emerging

1- Gracile N. most post. Part of fibers of gracile T. carrying eff. fibers of the 2 nuclei cross to the
(proprioceptive) closed medulla close to proprioceptive & fine touch opposite side in the form of arches
middle line. sens. from lower 1/2 of the called internal arcuate fibres
body. decussating with its fellows of the
2- Cuneate N. post. Part of the closed fibers of the cuneate T. carrying opposite side forming the sensory
(proprioceptive) medulla, lateral to the proprioceptive & fine touch decussation then ascend as the med.
gracile nucleus. sens. from the upper 1/2 of the Lemniscus thalamus.
body.
3-Accessory lat. to the cuneate the most lat. fibers of the its efferents constitute the
cuneate N. nucleus in the upper cuneate T. carrying post.ext.arcuate fibers which pass in
(proprioceptive) part of the closed proprioceptive sensation from inf. cerebellar peduncle of the same
medulla. the upper limb. side cerebellum.

4-Inf.olivary N. late.aspect of the open (1) spino-olivary tract. (1) olivo-spinal T.: descends in the
(extrapyramidal) medulla. (2) descending fibers from the lat.column of the spinal cord.
corpus striatum & red nucleus. (2) olivo- cerebellar T.: crosses to the
opposite side & enters cerebellum
via inf.cerebell. ped.
5-Inf.salivary N. upper most part of descending fibers from 1/2 the eff.fibers run in the glossopharyngeal
(parasympath.) medulla in line with the higher autonomic centres. n.as preganglionic parasymp. fibers
dorsal nucleus of which relay in the otic ganglion .
vagus.
6- Spinal N.of in the lat.aspect of the pain & temp. sensation from the eff.fibers cross to the opposite side &
trigeminal n. whole medulla & face & scalp via the trigeminal n. ascend as the trigeminal lemniscus
(general sensory) continuous below with P.L.V.N of thalamus.
S.G.R of spinal cord.
7-Solitary N. dorsal lateral part of (1)taste sensation carried by eff.fibers cross to the opposite side &
(taste sens.) the open medulla . vagus, glossopharyn.& facial ascend to relay in :
nerves (1)P.M.V.N of the thalamus.
(2) ? visceral sensation through (2) hypothalamic nuclei .
vagus & glossoph. nerves .
8-Nucleus lat. part of open pyramidal & extrapyramidal . -its upper part motor fibers of
ambiguous medulla, behind the glossoph.n.
(branchiomotor) inf.olivary nucleus. -its middle part motor f. of vagus.
-its lower part motor f. of
cr.accessory.
9- Dorsal N.of most post. part of open ? visceral aff.sensation via its eff.fibers run in the vagus n. as
vagus n. medulla(undelyine the glossoph. & vagus nerves. preganglionic secerto motor
(parasympath.) vagal trigone) parasymp. fibers.

10-HypoglossalN. most post. part of open pyramidal & extrapyramidal. Its axons form the fibers of the
(motor) medulla close to the hypoglossal n. which passes forwards
middle line (underlying between both med. lemniscus & the
the hypoglossal pyramid (medially) & the inf. olivary
trigone). nucleus ( laterally ) .

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 72

 21UMAS SAMEH DOSS

Middle part of medulla

(level of sensory
decussation)

Lower part of medulla

(level of sensory
decussation)

II- Main tracts of the medulla

(1) Gracile T. ascend in the post. part of the lower 1/2 of medulla. They gradually diminish
(2) Cuneate T. as they relay in their nuclei.
(3) Internal arcuate Fibres & sensory decussation : the axons of the gracile &cuneate nuclei
cross to the opposite side in the form of arches Called internal arcuate Fibres which decussate with
their fellows of the opposite side at the sensory decussation in the middle part of the medulla.
(4) Medial lemniscus: is the upward continuation of the internal arcuate fibres after the decussation.
It ascends paramedially in the open medulla.
(5) Medial longitudinal bundle: it is an association tract present close to the middle line in the open
medulla.
(6) pyramidal tract & motor decussation:
the pyramidal T. descends as a compact bundle lying close to the middle line in the ant.part of the
medulla till its lower part where:
(a) 75-85% of its Fibres cross to the opposite side decussating with their fellows of the
opposite side at the motor decussation then continue downwards in the lat.column of
spinal cord as the crossed pyramidal T.
(b) 15-25%. of its Fibres descend on the same side forming the direct Pyramidal T. which
continues downwards in the ant.column of the spinal Cord.
(7) Spinal tract of the trigeminal n.: present in all levels of the medulla close to its nucleus.
(8) Inferior cerebellar peduncle (I.G.P.): a large bundle of Fibres emerging from theposterolat.
aspect of upper part of medulla & connecting it with the Cerebellum.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 73

 21UMAS SAMEH DOSS

Lower pons

3- Internal Structure of the pons

(A) Basilar (Ventral) part: contains the following structures :
(1) pontine nuclei: scattered among the longitudinal & transverse fibres in the basilar portion of the
pons. They form an important part of the Cortico-ponto-Cerebellar pathway.
(2) Transverse fibres (pontocerebellar) beginning From the pontine nuclei & crossing the middle
line to enter the opposite cerebellar hemisphere via the middle Cerebellar peduncle.
(3) Longitudinal fibres which include:
(a) pyramidal (cortico-spinal & cortico bulbar) fibers.
(b) corticopontine fibers: arising from the cerebral cortex & ending on the pontine nuclei.

(B) Tegmental (Dorsal) part: containing nuclei of the middle 4 cranial nerves.

mainly : 4 lemnisci.

I- Nuclei of the middle 4 cranial nerves

(1) Trigeminal nerve : has 2 nuclei in the tegmentum of the upper part of pons:
(a) motor nucleus (medial In position): its axons form the motor root of the trigeminal n. which Joins
the mandibular n.
(b) main sensory nucleus (just lat. to the motor nucleus): 2nd order neurone:
− receives afferent touch & pressure sens. from the trigeminal area of the face & scalp.
− sends efferent fibres which cross to join the opposite trigeminal lemniscus.
(2) Abducent nerve Nucleus:
* Site: in the post. aspect of the lower part of the pons near the Floor of the 4th ventricle.
− it is encircled by the fibres of the facial n., raising a bulge called the facial colliculus in the Floor of
the 4th ventricle.
− its efferent Fibres pass forward & downwards traversing the med. lemniscus & the Pyramidal T.
bundles to emerge anteriorly at the Junction between pons & medulla

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 74

 21UMAS SAMEH DOSS

(3) facial nerve : has 2 nuclei in the pons :

(a) Motor nucleus: lying in the lower part of the pons below the trigeminal motor nucleus
Its efferent fibres encircle the abducent nucleus then pass anterolaterally to emerge at the junction
between pons & medulla.
(b) sup. salivary nucleus (parasymp.): in the lower pons just above the inf. salivary nucleus. Its efferent
fibres run in the facial n. as preganglionic parasymp. fibres to relay in the sphenopalatine
&submandibular ganglia.
(4) Vestibulo cochlear n.: has the following nuclei:
(a) vestibular nuclei: the sup. , med & lat.vestibular nuclei lie in the lower part of the pons medial to the
inf.cerebellar peduncle (underlying the vestibular trigone in the Floor of the 4th ventricle). These
nuclei, together with the inf. Vestibuler nucleus in the upper part of medulla, receive unconscious
proprioceptive sensation (equilibrium) from the internal ear via the vestibular nerve. They send
efferents to: Cerebellum (vestiloulo-cerbellar), spinal cord (vestibulo spinal) & med. longit- bundle.
(b) Cochlear nuclei: the dorsal & ventral nuclei lying dorsal &ventral to the inferior cerebellar peduncle
in the lower part of the pons. They receive hearing impulses From internal ear via the cochlear n.
There efferent fibres form the trapezoid body.

II- The 4 Lemnisci

* Defiion: they are 4 bands of ascending
sensory fibres in the brain stem. Each lemniscus
starts from a decussation belows & ends in the
thalamus above.
I- Lateral Lemniscus (the most lateral of the 4
lemnisci) :
 Definition: it is a band of ascending Fibres
carrying hearing impulses From both ears
(mainly From the opposite side).
 origin: it begins in the pons by the axons of
the 3rd order neurones of the auditory
pathway which consists of :
(1) 1st order neurone: the cells of the spiral
ganglion whose central processes relay in
the ventral & dorsal cochlear nuclei.
(2) 2nd order neurone: the cells of the
ventral & dorsal cochlear nuclei whose
axons cross to the opposite side in the
tegmentum of the lower part of the pons
forming a big decussation called the
trapezoid body containing trapezoid
nuclei. The axons of the 2nd order
neurones relay in the trapezoid & sup.
olivary nuclei of both sides but mainly on
the opposite side.
(3) 3rd order neurones: the cells of the
trapezoid nuclei & sup. olivary nucleus
whose axons ascend forming the Lateral
lemniscus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 75

 21UMAS SAMEH DOSS

 Course & termination: the lat. lemniscus

ascends in the upper 1/2 of the pons then midbrain
as the most lateral of the lemnisci. Its fibres end as
follows:
(a) few fibres end in the inf. colliculus of midbrain
(centre of auditory reflex)
(b) most of the fibres end in the med. geniculate
body whose cells constitule the 4th order
neurone that transmit the auditory impulses to
the auditory areas 41,42 in the temporal lobe.
II- Spinal lemniscus :( just med.to the lat.lemniscus): Thalamus

 Definition: it is a band of ascending Fibres carrying Midbrain

Med.
pain, temperature & crude touch from the opposite Lemniscus lat. Lemniscus
side of the body below the head. It represents the
axons of the 2nd order neurones of these Trigeminal
Spinal
sensations. lemniscus
lemniscus
 Origin: it is formed in the upper part of the medulla
by the union of the following 2 tracts: Thalamus
(a) Lat. spinothalamic T: ( axons of the substant
gelatinosa, carrying pain & temp. from opposite
sides)
(b) Ventral spinothalamic T: (axons of the nucleus
proprius carrying simple touch from the Medulla
opposite side). Gracile & Lat.
 Course & termination: the spinal lemniscs cuneate n. Spinothalamic
ascends in the pons then in the tegimentum of the T.
midbrain, lying between the trigeminal lemniscus cuneate T. Ventral
medially) & the lateral lemniscus (laterally). it ends spinothalamic
in the P.L.V.N of thalamus. Gracile T. T.
III- Trigeminal lemniscus : (just med.to the spinal
Thalamus
lemniscus).
 Definition: it is a band of ascending fibres carrying
pain,temp.touch & proprioception from the opposite
side of the face & scalp.(it represents the axons of the 2nd order neurones).
 Origin: it begins in the medulla by the axons of the spinal nucleus of trigeminal n. which cross to
the opposite side.
 Course & termination: it ascends lat. to the med.lemniscus to reach the pons where it gets
additional fibres from the main sensory nucleus of trigeminal n.(of the opposite side) .Then it
continues upwards in the midbrain to end in the posteromedial ventral nucleus of thalamus .
IV- Medial lemniscus: ( the most medial of the 4 lemnnisci):
 Definition: it is a band of ascending Fibres carrying proprieceptive & fine touch sensation from
the opposite side of the body below the head. It represents axons of the 2nd order neurones.
 Origin: it begins in the medulla as a continuation of the axons of the gracile &cuneate nuclei which
cross to the opposite side Forming the internal arcuate fibres.
 Course & termination: it ascends close to the middle line in the pons then shifts away from middle
line in the midbrain (just-dorsal to substantia nigra). It ends in the P.L.V.N. of thalamus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 76

 21UMAS SAMEH DOSS

4-Internal Structure of Midbrain

The cerebral aqueduct traversing the midbrain divides it Into 2 main parts:
(I) tectum: the smaller dorsal part behind the aqueduct It is
composed of 4 rounded swellings (colliculi):
(a) 2 sup.colliculi : reflex centres of vision .
(b) 2 inf.colliculi : reflex centres of hearing .
(II) 2 Cerebral peduncles: the larger ventral part infront of the
aqueduct. It consists of 3 parts ,arranged From before
backwards as follows:
(1) crus cerebri : the most ant.part which consists exclusively
of pyramidal& cortico pontine fibers .
(2) substantia nigra: a thick lamina of grey matter formed of
deeply pigmented nerve cells lying behind the crus cerebri.it is an extrapyramidal centre.
(3) Tegmentum: the post. part of the cerebral peduncle. It contains ascending tracts, certain nuclei,
decussations & the reticular formation of the midbrain.

Nuclei of Midbrain
(1) Nucleus of oculomotor n. :
 Site: in the upper part of the midbrain
close to the middle line at the level of
the sup.colliculus.
 efferent fibres: pass forwards
trough the red nucleus & the medial
part of the substantia nigra forming the
oculomotor n. which emerges at the
med. surface of crus cerebri.
(2) Nucleus of the trochlear n.:
 site: in the lower part of midbrain
close to the middle line at the level of
the inf.colliculus.
 efferent fibres: pass backwards &
medially decussating with its fellows of
the opposite side then emerge From
the dorsal aspect of the midbrain below
the inf. colliculus as trochlear n.
N.B: trochlear n. differs From other cranial
nerves , in 2 aspects
(1) its fibers cross the opposite side.
(2) it emerges from the back of midbrain.
(3) Red Nucleus :
 it is a large mass of grey matter
which appears red due to the
presence of iron-containing pigment.
 Site: in the tegmentum of the upper
part of midbrain close to the middle
line.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 77

 21UMAS SAMEH DOSS

 Function : the red nucleus is an important

extrapyramidal centre.
thalamus
 Connections : Ventral tegmental
Cortico.rubral
decussation
(A) It receives Afferent fibres from the following areas : fibers
(a) the cerebral cortex through cortico - rubral fibres. Globus
(b) dentate nucleus of the cerebellum through pollidus
dentatorubralf. Red N.
Subthalamic N.
(c) other extrapyramidal centres as Subtantia
• the subthalamic nucleus. nigra
• globus pallidus. Dentate
• substantia nigra. N.
(B) It sends Efferent fibres to the following areas:
Cerebral
1- nuclei of the brain stem: through rubrobulbar fibres. cortex
2- A - H - Cs of the spinal cord through rubrospinal T.
Reticular
3- the intermediate ventral nucleus of thalamus : through formation
rubro thalamic fibres .
N.B : the rubrobulbar & rubrospinal fibres cross to the opposite Rubro.spinal
side in the tegmentum of the midbrain , decussating with the T.
fibres of the other side forming the ventral tegmental
decussation.
(4) Mesencephalic nucleus of trigeminal n.
• site : in the tegmentum of the lower part of the
midbrain at the level of the Inf . colliculus ,Lat . to the
aqueduct . It extends downwards into the pons .
• function : it receives proprioceptive impulses from the masticatory & ocular muscles .
-It sends efferent fibres to the main sensory nucleus of trigeminal n . ( in pons).
(5) Inferior Colliculus :
• site : a mass of laminated grey matter in the Sup. colliculus Upper part of
lower part of the tectum of midbrain . midbrain
• function : it is a centre of auditory
reflexes . Its neurones Co - ordinate
hearing with the movements of the body
.
• Connections :
(A) It receives afferent fibres from :
1- Lat.lemniscus .
2- Temporal cortex : via brachium of inf
. colliculus . Temporal
(B) It sends efferent fibres to : lobe
1- Inf - colliculus of the opposite side .
Brachium of
2- Med - geniculate body of the same &
inf. Colliculus
opposite sides
3- Sup . colliculus of the same side . Lower part of
4- Tectospinal & tectobulbar tracts of midbrain
the opposite side . Inf. Colliculus

Lat.
Lemniscus
THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 78
 21UMAS SAMEH DOSS

(6) Superior colliculus :

• Site : In the upper part of the
tectum of midbrain .
• Function : a centre for visual
reflexes .
• Connections :
(A) It receives afferent impulses
from :
1- the retina : via the brachium
of sup.colliculus.
2- the occipital cortex : via the
optic radiation & the
brachium of sup.colliculus.
3- the inf . colliculus of the
same side ( for auditory
reflexes).
4- the spinal cord via the
Efferent fibers Afferent fibers
spinotectal tract .
(B) it gives efferent fibres to :
1- to the nuclei of the cranial nerves
supplying the occular muscles ( 3rd,4th &
6th nerves ) & the muscles of the neck (
1st nerve ) via tecto bulbar fibres.
2- A.H - Cs of the spinal cord via the
tectospinal fibres .
N.B . the tecto bulbar & tectospinal fibres cross to
the opposite side in the tegmentum of midbrain in
the dorsal tegmental decussation .
3- to the sup . colliculus of the opposite side .

(7) Pretacal nucleus:

• Site: it lies deep to the superolateral part of the sup.colliculus .
• Function : it is an important part in the pathway of the light & consensual reflexes .
• Connections :
1- it receives afferent light impulses from the retina & occipital cortex .
2- it gives efferents to the Edinger - Westphal nuclei of both sides .

(8) Substantia nigra :

• Site : it is a thick lamina of deeply pigmented grey matter lying just behind the crus cerebri
extending throughout the whole length of the midbrain .
• function : it is an extrapyramidal centre having the following connections:
1- it receives afferents from the motor Cortex ( Corticonigral fibres.
2- it gives efferents to :
a- Corpus striatum ( nigrostriate fibres ) .

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 79

 21UMAS SAMEH DOSS

Tracts of Midbrain
(I) Crus cerebri : Contains the following descending fibres ( From med to lat ) :
1- the med - Cortico - bulbar fibres of the pyramidal tract. In the med 1/5
2- fronto - pontine fibres ( part of the cortico ponto- cerebellar pathway .
3- Cortico - spinal fibres of the pyramidal tract. In the intermediate 3/5
4- temporo - pontine fibres ( part of the cortico - porto - cerebellar pathway .
In the lat 1/5
5- lat - cortico - bulbar fibres of the pyramidal tract .

(II) Tegmentum : Contains the following tracts & decussations :

1- the 4 lemnisci : ascending from the pons to the midbrain . They are arranged from anteromed.
to posterolat. as follows : a-med. Lemniscus
b-trigeminal lemniscus.
c-spinal lemniscus.
d-lateral lemniscus.
N.B: the lat. lemniscus ends at the level of inf - Gelliculus.

2- Superior cerebellar peduncles :

enter the back of the midbrain just below the inf . colliculus - The Constituent fibres are described
with the cerebellum ( page 84 ) .

3- decussation of superior cerebellar peduncles :

the fibres of each peduncle cross to the opposite side in the tegmentum of the lower part of the
midbrain .
After decussation , the fibres divide into : 1-red nucleus of midbrain.
(a) ascending fibres which run upwards to end in. 2-reticular formation of midbrain.
3- intermediate ventral nucli - of thalamus
(b) descinding fibers which run downward to end in: 1- reticular formation of pons & medulla.
2- inf. divary nucleus.
4- Tectospinal tract :
arises as efferent fibres of the sup - colliculus , crosses to the opposite side in the dorsal tegmental
decussation ( at the level of sup - colliculus ) then descends in the tegmentum of lower part of
midbrain .
5- Rubrospinal tract :
arises as efferent fibres of the red nucleus in the upper part of the midbrain , crosses to the
opposite side (at the level of sup. colliculus ) in the ventral tegmental decussation then descends in
the tegmentum of lower part of midbrain .
6- Central tegmental tract :
it is an extrapyramidal T. connecting the corpus striatum with the inf. divary nucleus of medulla . It
descends through the tegmentum of midbrain dorsal to the red nucleus then continues down
through the pons & medulla .
7- Dorsal longitudinal fasciculus :
it is a bundle descending & ascending autonomic fibres connecting the hypothalamus with the
visceral nuclei in the brain stem .
It lies in the central grey matter of the midbrain .
8- Medial Longitudinal bundle : see next page .

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 80

 21UMAS SAMEH DOSS

Medial Longitudinal Bundle Post. Com. Nucl.

• Definition: it is an important associative coordinating bundle Interstitial nucl.

Of cajal
found in all levels of the brain stem.

Upper part of
• Extent: it extends in the brain stem from the floor of the 3rd

midbrain
ventricle above to the lower end of medulla below.

• Beginning: it begins Just above the midbrain (below the floor of

midbrain
Lower part of
the 3rd ventricle) by receiving afferent fibres From 2nuclei:
(1) interstitial nucleus of Cajal.
(2) nucleus of post. Commissure.

• Course: it runs in the post. part of the brain stem close

to the middle line & ventral to the somatic motor nuclei

Pons
of the cranial nerves 3,4,6,7&12.

• Termination: it ends in the lower part of the medulla by

becoming continuous with the ant. intersegmental tract of the spinal
cord.

medulla
• Structure: it is formed of short ascending & descending Fibres
(mainly vestibular & cochlear) derived from the following nuclei: (1)
all vestibular nuclei of both sides.
(2) nucleus of lateral lemniscus (cochlear).
Spinal card

(3) nucleus of trapezoid body (cochlear).

• Connections & functions of the M.L.B:

(1) Vestibular reflex functions:
(a) the M.L.B receives efferent fibres from the vestibular nuclei (equilibrium)&
sends them up to the nuclei of the cranial nerves 3,4&6 which control the eye
movements In this way the eyes move in relation to the movements of the head.
(b) It also receives efferent fibres from the vestibular nuclei &
sends them down to the A.H.Cs of the spinal cord. In this way
the neck & trunk can move in relation to the movements of the head.

(2) Auditory reflex functions:

(a) the M.L.B. receives efferent fibres from the sup. olive & from the lat. lemniscus (Carrying hearing
impulses) & sends them up to the nuclei of the cranial nerves 3,4&6 allowing movements of the eye in
response to sound.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 81

 21UMAS SAMEH DOSS

(b) it also sends auditory impulses down to the A.H.Cs of

the spinal cord allowing the movements of the neck &
trunk in response to sound.

(3) Associative internuclear function:

(a) It Connects the nuclei of the cranial nerves which
move the eye (3,4&6) together allowing Conjugate
deviation of the eyes
(b)it connects the nuclei of the cranial nerves concerned
in the process of speech i-e: facial n. (movements of lips),
cranial accessory (laryngeal muscles) & hypoglossal n.
(tongue muscles) allowing them to work together during
speech.

(4) Extra-pyramidal function:

the M.L.B receives extrapyramidal Fibres From 2 nuclei
(post commissural nucl. &interstitial nucl. of Cajal) &
sends them to the motor nuclei of the cranial nerves
&the A.H.Cs of the spinal cord.

Reticular formation of Brain stem

 Definition: it is a diffuse system of a network of fine
fibres intermingled with numerous poorly defined
nuclei.
 Location: it is placed in the dorsal part of the brain
stem, having a diffuse distribution &ill-defined
boundaries.
 Connections: the reticular formation is connected
to:
(1) the motor neurones of the cerebral cortex,
basal ganglia, cerebellum, extrapyramidal
nuclei, nuclei of cranial nerves & A.H.Cs of spinal cord.
(2) the Sensory neurones of cerebral cortex, thalamus, spinal cord, visual& auditory &
equilibrium pathways through collaterals from the sensory pathways.
(3) the autonomic neurones of the hypothalamus, limbic system &general visceral efferent
Columns.
 Functions:
(1) inhibition or facilitation of motor areas of voluntary & reflex activities of the body.
(2) it is responsible for maintaining the state of wakefulness & alertness.
(3) through its autonomic connections, it can influence respiratory & vasomotor activities by
stimulat or inhibition (according to the needs).

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 82

 21UMAS SAMEH DOSS

5- Internal Structure of cerebellum

 The Cerebellum consists of:

a) outer layer of grey matter on the surface
Fastigial nucleus
forming the cerebellar Cortex which contains Globose nucleus
nerve Cells arranged into 3 layers as follows: Emboliform nucleus
Dentate nucleus
(1) outer molecular layer
(2) intermediate layer of Purkingi cells
(3) inner granular layer
b) Inner core of white matter.

c) Subcortical collection of grey matter nuclei within the white matter core.
 These nuclei include:
1. dentate nucleus (the largest nucleus): it's a folded mass of grey matter situated at the centre of the
white matter. It has a hilum from which most of the fibres of the sup. cerebellar peduncle emerges.
Functionally, it belongs to the neocerebellum.
2. Emboliform nucleus: lies Just medial to the dentate nucleus.It belongs to paleocerebellum.
3. Globose nucleus: lies just medial to the emboliform nucleus. It belongs to paleocerebellum.
4. Fastigial nucleus: is the most med. nucleus. It belongs to the archicerebellum&receives direct
vestibular fibres.

Cerebellar Connections (peduncles)

Sup. Cerebellar peduncle
 The cerebellum is connected with the cerebrum,
the nuclei of the brain stem &the spinal cord by Middle cerebellar peduncle
numerus afferent &efferent tracts.
 vthese afferent & efferent tracts are collected Inf. cerebellar peduncle
into 3 great bundles on each side, Called the Pons

cerebellar peduncle:
1. sup. cerebellar peduncle
2. Middle cerebellar peduncle Medulla
3. Inf. cerebellar peduncle.
I. Inferior cerebellar peduncle (l.C.P):
 there are Rt. &Lt. inf. cerebellar peduncles which connect the medulla with the cerebellum.
 each I.C.P. begins from the dorsolateral aspect of the upper 1/2 of medulla.
 It ascends upwards &laterally along the lat. side of the 4th ventricle to reach the lower border of the
pons where it bends Sharpley backwards at the ant-cerebellar notch to enter the corresponding
cerebellar hemisphere between the M.C.P. (laterally). &The S.C.P. (medially).

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 83

 21UMAS SAMEH DOSS

 Types of fibers in the I.C.P.:

Tracts & its function Origin & termination
1) Post-spino cerebellar T. arises from Clark’s nucleus
Carrying proprioceptive of the spinal Cord& ends
Reticular
sensation from the lower ½ in the ipsilateral n.
of the body cerebellar hemisphere.
2) Post external arcuate arise from the accessory Vestibular
fibers: carrying cuneate N. of medulla& n.
proprioceptive end in the ipsilateral
Sensation from the U. L Cerebellar hemisphere.
Afferent fibers

3) olivo-Cerebellar tract arises from the inf.olivary

Olivery n.
Inf.
(extrapyramidal) nucleus in medulla, cross
to the opposite side to
reach the Contralateral
Arcuate
Cerebellar hemisphere
n.

n.
Arcuate
4) Vestibulo-Cerebellar T. arises from the vestibular
Carrying equillibrium n.& vestibular nuclei (med.) Accessory
impulses. &Passes directly to the cuneate n.
ipsilateral cerebellar hemisphere.
5) Reticulo cerebellar T. arises from the reticular formation in medulla &Passes to the
ipsilateral cerebellar hemisphere.
a) cerebello-olivary tract. arises from the dentate N.& passes to the Contralateral inf. olivary
Efferent fibers

(Extra pyramidal) N.
b) cerebello-reticular T. arises From the Fastigial nuclei of both cerebellar hemispheres& end
in the nuclei of the reticular formation in the pons & medulla.
c) cerebello vestibullar T. arises from the Floccule-nodular lobe& ends in all vestibular nuclei.

II. Middle Cerebellar Peduncle (M.C.P) Rt.& Lt.

 Morphology: It is the thickest of the 3 peduncles.:
− it is formed by the collection of the transverse pontine fibres.
− it emerges from the lat.aspect of the pons then curves backwards pons
to enter the corresponding cerebellar hemisphere lat. to the I.C.P.
SCP
 Types of fibres in the M.C.P.: it contains afferent Fibres only MCP
(Pontine cerebellar fibres) which arise from the pontine nuclei
of the opposite side. These Fibres constitute a part of the
ICP
Cortico-ponto cerebellar pathway (from the cerebral Cortex to
cerebellum).

III. Superior cerebellar peduncle (S.C.P) Rt&Lt

 Morphology: it is the smallest & most medial of the 3 peduncles:
− it is a flattened band that emerges from the back of the midbrain below the inf- colliculus.
− it runs downwards & laterally along the side of the upper part of the 4th ventricle.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 84

 21UMAS SAMEH DOSS

− It enters the Corresponding cerebellar hemisphere med. to the I.C.P.

− the Rt &Lt. S.C. peduncles are connected together by the sup. medullary velum.

 Types of Fibres in the S.C.P.:

a) Afferent Fibres: only 2 tracts:
1. Anterior spinocerebellar T.
− origin &Course: See page 61
− it carries proprioceptive impulses from the
lower limb to the cerebellum.
2. Tecto-cerebellar T.
 arises from the sup. & inf. colliculi of the
tectum of midbrain.
 it Carries auditory& visual impulses to
the Cerebellum.

b) Efferent fibres:(form the mjority of fibres(:

1. Dentato thalamic T.:
 arises from the dentate nucleus, crosses to the
opposite side in the midbrain then ascends
to end in the intermediate ventral nucleus
of thalamus.
2. Cerebello-rubral T.:
 arises from the globose& emboliform nuclei, crosses to
the opposite side in the midbrain then ascends to end
in the red nucleus.
3. Dentato-olivary T.:
 arises from the dentate nucleus, crosses to the opposite
side in the midbrain then descends to the inf. olivary
nucleus in the medulla.
4. Fastigio-reticular:
 arises from the Fastigial nucleus& descends
uncrossed to the reticular formation of the
pons& medulla.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 85

 21UMAS SAMEH DOSS

6- Internal Structure of Cerebral hemisphere

Cerebral cortex
(grey matter)

White matter

Cavity of the
lat. ventricle

Basal ganglia

Each Cerebral hemisphere Consists of:

(1) An outer layer of grey matter (cerebral Cortex) on the Surface.

(2) White matter Forming the Core of the hemisphere.

(3) Basal ganglia (a collection of grey matter) embedded in the white matter Core.

(4) Lateral ventricle (the Cavity of the cerebral hemisphere).

The White matter of the Cerebral hemisphere

 Consists of myelinated nerve fibres which are devoid of neurilemmal sheaths.

 There are 3 types of fibres in the white matter:

1. association Fibres.
2. Commissural Fibres.
3. projection Fibres.

1- Association:

− Definition: they are Fibres which Connect the different cortical areas
in the same hemisphere.
− Function: they interrelate the Functions of the different areas of the cortex& integrate the activities
of cortex as a whole.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 86

 21UMAS SAMEH DOSS

 Types: there are 2 types of association fibres: short& long.

Arcuate fibres
cingulum

Sup. Longitudinal bundle

Corpus callosum

Ant. perforated
substance

Uncinate bundle
Inf. longitudinal
bundle

(A) Short association fibres:

 They Consist of U-Shaped bands Called arcuate Fibres lying just deep to the Cerebral Cortex.
 They connect adjacent gyri with one another
 They are present in all parts of the hemisphere.
(B) Long association fibres:

 They include 4 bundles of long fibres which connect the different lobes of the hemisphere together.
 These 4 bundles include:
(1) the sup.longitudinal bundle.
(2) the inf.longitudinal bundle .
(3) the Cingulum.
(4) the Uncinate bundle.

1. The Superior longitudinal bundle:

 It is the largest association bundle.

 It begins in the ant. part of the frontal lobe.
 Course: it passes backward above the insula (deep to the lat.surface of the cerebral hemisphere) then
divides into 2 bands :
(A)sup. band: enters the occipital lobe
(B) inf. band: turns downwards to enter the temporal lobe.
− Function: it connects the frontal, occipital& temporal Cortical area together.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 87

 21UMAS SAMEH DOSS

2. The Uncinate bundle:

 it is a U-shaped band which is sharply bent over itself.

 It begins at the orbital gyri of the frontal loop

 Course: it arches over the stem of the lat-sulcus to end in the ant.part of the temporal lobe

 Function: It connects the gyri of the orbital surface of the frontal loop

and the Brocha’s speech area with the Cortex of the ant-part of the temporel lobe

3. The Cingulum:
 It is a long-curved bundle of association Fibres Going in the medial aspect of the Cerebral hemisphere

forming an incomplete circle around the Corpus callosum

 it begins below the rostrum of corpus Callosum in the region of the ant-perforated substance.

 Course: it extends backward in the cingulate gyrus then curved downward in the Isthmus then passes

forwards in the hippocampal gyrus to end in the uncus

 Function: throughout its course it gives off Fibres to. & Receive additions from the different Cortical

areas on the med-surface associating them

4. The Inferior longitudinal bundle:

 it is a bundle of association fibres runing horizontally Close to the tentorial surface of the C-hemisphere

 it begins: near the occipital pole (its fibres are derived mainly from areas (18 & 19)

 Course: the fibres sweep forwards close to the inf.surface of the temporal lobe to

end at the temporal pole

 Function: connects the different cortical area of the t entorial surface together

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 88

 21UMAS SAMEH DOSS

2. Commissural fibres
Septum lucidum Corpus callosum

thalamus
Habenular commissure
Ant. commissure

Pineal body

Post. commissure

 A Commissure: is a band of white matter (nerve Fibres) connecting apart of the CNS on one side

with the same part on the opposite side.

 Function: co-ordination of the activities of the right and left cerebral hemispheres

 the Commissural fibres are collected in the following bundles:

(1) The Corpus Callosum

(2) The ant. Commissure

(3) The hippocampal commissure

They are Connect the two cerebral hemispheres

(4) The post-Commissure: between the 2sides of the Midbrain

(5) The Habenular Commissure: between the Rt&Lt habenular nuclei of the Epithalamus

1- The Corpus Callosum

 It is the largest & the main commissure of the brain

 It is fibers connect nearly all the symmetrical areas of the 2 hemispheres (With the exception of the

olfactory bulbs & the temporal poles of both sides)

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 89

 21UMAS SAMEH DOSS

Sagittal section
 Site: it lies at the bottom of the
median longitudinal Fissure- its
inf-surface is attached to the
fornix by the Septum pellucidum.
thalamus

 Part of carpus callosum:

(1) Rostrum: Optic chlasma

− it is that downward tapering part of the c.callosum

− it is connected to the optic chaisma by a thin sheet of gray matter (the lamina terminalis)
− the fibers of rostrum connect the orbital surface of the two frontal loops

(2) Genu:

− it is the most anterior part of the corpus callosum Guns

− Its posterior surface is connected to the septum Forcep minor

pellucidum in the median plane and on each side,
it forms the anterior wall of the anterior horn body
Fibers of C. C.
of lateral ventricle
− the fibrous passing through the genu curve
forwords and middlly on each side to form Splenium Tapatum
an arch called the forcep minor which connects
the anterior part of the two frontal loops together Forcep major

(3) Body (trunk):

− It's the main part of the corpus Callosum
− Its tower surface is attached in the median plane
Corpus callosum (body)
to the Septum pellucidum (anteriorly) and to the
body of the Fornix (posteriorly)
− on each side of the median plane, the lower surface
of the body of C-callosum forms the roof the ant-horn
central part of each lateral ventricle:
− the fibers of the body pass transversely but after
crossing the middle line they diverge upward ,laterally Sup. temporal gyrus

and downward in each hemisphere to connect the

different area of the parietal loop and posterior part of
frontal loop of both sides together

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 90

 21UMAS SAMEH DOSS

(4) Splenium:
 it is the rounded post. end
of the Corpus Callosum.
 it overlies the pineal body & the
dorsal aspect of midbrain & is
separated from the roof of the
3rd ventricle by a thin sheet of
pia matter called tela choroidae.
 Most of the fibres of the splenium curve
backwards & medially on each side through
the occipital lobe forming the
forceps major.
 Some of the fibres of the splenium & the post.
part of the body of c.callesum pass laterally &
downwards forming the roof & lat. wall of the
post. horn of the lat. ventricle. These fibres Post. Horn of lat.
ventricle
constitute the tapetum of corpus callosum.

2- [The Ant. Commissure]

 It is a small rounded bundle which crosses
the median plane behind the lamina terminalis
& infront of the columns of the fornix forming
a part of the ant. wall of the 3rd ventricle.
 Is fibres Connect the olfactory bulbs & the
ant. part of the temporal lobes.

3- [The Habenular Commissure]

 It is a bundle of commissural fibres which cross the median plane above the root
of the pineal body.
 It connects the habenular of the nuclei of the 2 sides of the epithalamus together.

4- [The Post. Commissure]

 It is a rounded bundle of commissural fibres that cross the median plane behind the
upper end of the aqueduct of midbrain.
 it connects the sup. colliculus, the pretectal nucleus & the med. longitudinal bundle
of both sides of the midbrain together.

5- [The Hippocampal Commissure] See the Fornix page 92

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 91
 21UMAS SAMEH DOSS

The Fornix & the Hippocampal Commissure

 The Fornix: Is an arched structure formed by the axons of the cells of the hippocampus.
These axons are projection fibres which will finally end in the mammillary body.

 Structure: Each fornix is formed of the following parts: crus, body, and column
(1) Crus (post. column): posteriorly:
− the axons of hippocampal cells spread to form the alveus.
− the fibres of the alveus collect to form a band of fibres med. the alveus called the Fimbria.
− the fibres of the fimbria curve upwards to form the crus of the fornix which turns round
the post. end of the thalamus.

(2) Body of the fornix:

− the Rt. & Lf. crura pass upwards &
medially
approaching each other beneath the
splenium of c.callosum, then each crus
proceeds as the body of the fornix.
− the bodies of the 2 fornixes are
connected together by the hippocampal
commissure forming a common
triangular body (narrow infront & wide
behind).
− the upper surface of the common body is
attached to
the undersurface of the c.callosum by a membrane called septum pellucidum. On each side of this
septum the body of the fornix lies in the floor of the central part of the lat. ventricle.
− the lower surface of the common body rests on the upper surface of the 2 thalami & the ependymal
roof of the 3rd ventricle.

(3) Column (ant. column):

− Is the downward continuation of each body which descends in front of the interventricular front &
behind the ant. commissure to end in the mammillary body of the hypothalamus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 92

 21UMAS SAMEH DOSS

III- Projection Fibres

* Definition: they are the afferent & efferent fibres of the cerebral cortex which pass through the
internal capsule & connect the cerebral cortex with lower Centres.

* Types: the projection fibres are either:

a) Ascending (afferent) to the cerebral cortex from the thalamus.
b) Descending (efferent) from the cerebral cortex to lower centres.

A. Ascending fibres (thalamic radiations)

* They are the fibres which radiate from the thalamus & metathalamus to the cerebral Cortex:
(1) Ant. thalamic radiation: ascends from ant. & med. nuclei of the thalamus to the frontal lobe.
(2) Superior thalamic (sensory) radiation: ascends from the posterior ventral nucleus of
thalamus to the postcentral gyrus.
(3) Posterior thalamic radiation which consists of:
a) optic radiation : the fibres which arise from the lat. geniculate body & pass to the visual
sensory area of the occipital lobe.
b) auditory radiation : the fibres which arise from the med. geniculate body & pass to the
auditory sensory area of the temporal labe.

B. Descending fibres (mainly pyramidal & extrapyramidal)

* The include:

(1) Corticospinal fibres: arise from the motor area in the precentral gyrus & descend to the A.H.Cs of the
spinal cord.
(2) Cortico-bulbar fibres: arise from the precentral gyrus & descend to the motor nuclei of the cranial
nerves in the brain stem.
(3) Cortico pontine fibres: which constitute a part of the pontocerebellar patway &
include: a) Fronto-pontine fibres.
b) parieto-pontine fibres.
c) occipite-pontine fibres.
d) temporo-pontine fibres

(4) Cortico-rubral fibres: descending from the frontal lobe to the red nucleus in the midbrain.
(5) Cortico -Striate fibres: descending from the cerebral cortex to the corpus striatum.

NB: all the above mentioned projection fibres collect in the Internal Capsule (p.95).

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 93

 21UMAS SAMEH DOSS

The Internal Capsule

* Definition: it is a broad lamina of white matter made up of projection fibres which pass to & from
the cerebral cortex. It is so called because it forms an internal (inner) capsule to the lentiform
nucleus.

* Continuity: it is continuous above with the corona radiata & is Continuous below with the cerebral
peduncle of the midbrain.

* Site: it lies medial to the lentiform nucleus & lat. to the head of caudate nucleus & the thalamus.

* Shape: it is a folded lamine which is V-shaped in transverse section with its concavity directed
laterally.

* Parts & relations: it has the following parts:

(1) A short anterior limb: lies between the head of caudate (medially) & the lentiform nucleus
(laterally) .

(2) A long posterior limb: lies between the thalamus (medially) & the lentiform nucleus (laterally).
(3) Genu (apex): it is the angular junction between the ant. & the post. limbs, it lies between the
head of caudate (anteriorly) & the thalamus (posteriorly).

(4) Retrolentiform part: lies behind the lentiform nucleus.

(5) Sublentiform part: lies below the lentiform nucleus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 94

 21UMAS SAMEH DOSS

* Types of projection fibres passing through the int. capsule:

Part Descending tracts Ascending tracts
Fronto-pontine fibres: from the frontal Anterior thalamic radiation: from tha ant. &
Anterior

lobe to the pontine nuclei med. thalamic nuclei to the frontal lobe.
limb

Cortico-bulbar fibres of the pyramidal -----------------------------

Genu

tract: from the precentral gyrus to the

motor nuclei of the cranial nerves

(1) Cortico-spinal part of the pyramidal Sup. thalamic (sensory) radiation from the
Posterior

T. ( in the ant.1/2 of the post. limb ). P.L.V.N. & P.M.V.N of thalamus to the sensory
limb

(2) Fronto-pontine fibres. area in the post. central gyrus. This sensory
(3) Cortico-rubral fibres radiation passes in the post. 1/2 of the post.
limb.
Parieto-pontine & occipito-pontine Optic radiation: from the L.G.B. to the visual
lentiform

fibres descending to pontine neclei sensory area in occipital lobe.

Retro-

Temporo-pontine fibres from the Auditory radiation: from the M.G.B. to the
lentiform

temporal lobe to the pontine nuclei auditory sensory area in the temporal lobe.
Sub-

* Blood Supply of the Internal Capsule:

(1) The ant. part of ant. limb: supplied by the
ant. cerebral artery.
(2) The post. part of ant. limb+ genu + post.
limb: supplied by the middle cerebral artery.
(3) The retro & sublentiform parts: supplied by
the ant. choroidal artey (branch of int. carotid
artery)

The Corona Radiata

* It is a fan-shaped "radiating" sheet of projection
fibres.
* Its fibres converge inferiorly to form the internal capsule.
* Its fibres diverge superiorly in a fan- like fashion, both antero-posteriorly & transversely, to
reach the cerebral cortex of all lobes of the hemisphere.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 95

 21UMAS SAMEH DOSS

7- Internal Structure of the basal ganglia (Nuclei)

* The basal ganglia include :
(1) Corpus striatum caudate nucleus
putamin
(2) Amydaloid nucleus. lentiform nuclei globus
(3) Claustrum pollidus

(1) Corpus Striatum

Corticostriate
* It is an important extrapyramidal centre. fibers
Coud.
* The coudate nucleus & putamen represent the Nuc.
receptor nuclei which receive most afferent
* fibres.
* The globus pallidus represents the effector
* part giving rise to most efferent fibres.
thalamus
* Connections of Corpus striatum: Med. part
A. Afferent fibres: derived from: Ant. lentiform
nuclei
Post.
(1) cerebral cortex (via corticostriate fibres). Ant. Int.

(2) thalamus (via thalamostriate fibres).

(3) substantia nigra (via nigro striate fibres).
To hypothalamus
Tegmental or
prepuberal field

& interstitial n. of cajal

Nuc. Of darkschewitsch
B. Efferent fibres : emerge from the globus
pallidus in the form of bundles which pass to other Central
tegmental
extrapyramidal centres as follows : tract

(1) ansa lenticularts

(2) fasciculus lentcularis to the subthalamus Rubrospin.
Inf.
Olivospin.
(3) subthalamic fasciculus T. Nuc.
the fibres then proceed from the subthalamus as Ratic. Formation of brain
follows :
- 80% of the fibres descend to the tegmentum of
midbrain, substantia nigra, red nucleus, inf. Raticulospin. T. Olivospin. T.
T. Med. Longitudinal fasciculus
olivary nucleus & reticular formation of the
midbrain.
- 15% form the thalamic fasciculus to the ant. ventral nucleus of the thalamus.
- 5% form the hypothalamic fasciculus which passes to the hypothalamus.

(2) Amygdaloid nucleus (body): part of the limbic lobe:

* Afferents: it receives afferent fibres from the
olfactory tract.
* Efferent: its efferent fibres constitute the stria
terminalis which passes first backwards in the
roof of the inf. horn of lat. ventricle then curves
forwards in the floor of the central part of the
lat. ventricle. The fibres end in:
(1) septal nuclei in the septum lucidum.
(2) ant. nuclei of hypothalamus.
(3) habenular nuclei :The stria terminalis serves
as a pathway for association of olfactory &
visceral functions.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 96

 21UMAS SAMEH DOSS

Limbic System
* Definition: it is the
name applied to
number of cortical &
subcortical structures
lying on the medial
surface of the cerebral
hemisphere in the
form of an arch
(limbus). It was
formerly named
rhinencephalon.

* Structure: it consists
of several olfactory
and non-olfactory
components :
A. Olfactory
components
include:
(1) olfactory bulb & tract which reach the following parts of the limbic system :
a. the ant. perforated substance from which fibres proceed to the amygdaloid nucleus (via stria
terminalis) & to habenular nucleus (via stria medullaris thalami)
b. the piriform area including the uncus & ant. part of the hippocampal gyrus.
(2) hippocampal formation which includes: hippocampus, dentate gyrus, indusium griseum (thin
sheet of grey matter covering the upper surface of corpus callosum) & med. & lateral
longitudinal striae (2 fibres bands on the upper surface of corpus callosum extending from the
dentate gyrus to the paraterminal gyrus).
(3) paraterminal gyrus: a narrow vertical gyrus lying below the rostrum of corpus callosum. It is
continuous above with indusium griseum & below with the medial olfactory stria.
(4) septum pellucidum: lying in the median plane just below the corpus callosum & formed of
nerve fibres in addition to collection of septal nuclei which constitute part of the limbic system.
(5) the fornix (page 92.): it is the efferent pathway of the hippocampus which reaches the mamillary
body (from which fibres are projected to the ant. nucleus of thalamus then to the cingulate
gyrus)

(1) cingulate gyrus.

B. Non-olfactory components include:
(2) parahippocampal gyrus.
* Connections of the limbic Systems: it is interconnected with the following centres:
(1) cerebral cortex.
(2) thalamus.
(3) hypothalamus.
(4) epithalamus.

* Functions of the limbic System:

(1) reception of olfactory stimuli.
(2) integration of olfactory , visceral & somatosensory sensations.
(3) influencing the behaviour emotional reactions & memory of the individual.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 97

 21UMAS SAMEH DOSS

8- Internal Seructure of the Diencephalon

A. Thalamus
* The thalamus is divided by a Y-shaped sheet of white matter
called internal medullary lamina into 3 main parts:
(1) anterior part: between the 2 anterior limbs of the
internal medullary lamina.
(2) medial part: lying med. to the post. limb of the
medullary lamina.
(3) lateral part: lying lat. to the post. limb of the medullary
lamina.

Thalamic Nuclei
* The 3 parts of the thalamus consist of a number of nuclear groups, each of which has its specific
function (sensory, extrapyramidal or non specific).
* The nuclear groups of the thalamus are classified as follows:
(1) medial group: in the medial part of the thalamus.
(2) ant. group: in the ant. part of the thalamus.
(3) lat. group: in the dorsolateral aspect of the lat. part of thalamus & is subdivided into 2. nuclei:
- dorsolateral nuclei
- postero-lateral nuclei.

(4) ventral group: lying in the

ventromedial aspect of the lat.part
of of the thalamus & is further
subdivided into
a) anterior ventral nucleus.
b) intermediate ventral nucleus.
c) posterior ventral nucleus which is
further subdivided into:
- postero-lat. ventral neuclei(P.L.V.N)
- postero-med. ventral neuclei(P.M.V.N)

(5) non-specific nuclei: which

include:
- intralaminar n. (in the internal medullary lamina)
- reticular n. (on the lat. surface)
- middle line n. (on the med. surface close to 3rd ventricle)

Functions of the Thalamus

(1) Sensory function: the thalamus is the great sensory relay station on the pathway of all sensations
(except smell) to the cerebral cortex. It acts like "Secretory" far the cerebral cortex (integrating the sensory
impulses then projecting them to the cortical & subcortical areas)
N.B: The thalamus is capable of appreciating painful & thermal stimuli.
(2) Consciousness: through its connections with the reticalar activating system, the thalamus
participates in maintenance of the state of alertness & wake fulness.
(3) Emotional function: through its connections with the frontal lobe & hypothalamus, the thalamus
appears to be concerned with the emotional content & subjective fee

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 98

 21UMAS SAMEH DOSS

Connections of the Thalamic nuclei

Nucleus Afferent Efferent Function
mammillothalamic tract to the cingulate relay station for hippocampal
Anterior N.

from mamillary body. gyrus (part of the impulses.

limbic lobe)

Ant. Group n.
1) prefrontal cortex of to the same parts relay station for visceral
the frontal lobe, (2) from which impulses.
corpus striatum, (3) afferents are
Medial N.

hypothalamus, (4) received.

other thalamic nuclei.
Mid. Group n.

(1) precuneus & to precuneus &

superior parietal lobule, sup. parietal
Lateral N.

(2) other thalamic lobule.

nuclei.

1) subthalamic to area 6&7 of the relay station for

Anterior Ventral

fasciculus from globus frontal cortex. extrapyramidal impulses.

pallidus, (2) from
reticular formation of
N.

the brain stem.

(1) dentaliothalamic to the motor & relay station for cerebellar

Inter-medial Ventral N.

fibres from the premotor area of impulses concerned with

opposite cerebellar the frontal cortex integration of muscle tone.
hemisphere, (2) (area 4&6).
rubrothalamic fibres
from the red nucleus.

1) spinal lemniscus, (2) to post. central relay station for exteroceptive

postero-lateral

medial lemniscus. gyrus of parietal impulses & proprioceptive

Ventral N.

lobe (area 3,1,2). impulses from the opposite

side of the body below the
head.

trigeminal lemniscus. to the post. relay station for exteroceptive

postero-medial

central gyrus (area & proprioceptive impulses

Ventral N.

3,1,2). from opposite side of head.

Interlaminar from the reticular to all parts of the participate in the arousal
midline & formation of the brain cerebral cortex. reactions of the brain.
reticular N. stem.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 99

 21UMAS SAMEH DOSS

B) Internal structure of the hypothalamus:

* Parts & nuclei:
1) optic part: grey matter immediately
related to optic chiasma, it contains 2 nuclei
a- Supra optic N. : Just above optic
b- paraventricular N. : just above the
supraoptic N.

2) Tuberal part:
tuber cinereum & infundibulum, it contains
3 nuclei:
a- Ventro medial nucleus.
b- dorsomedial nucleus.
c- tuberal nucleus.

3) Mamillary part:
the mamillary bodies, it contains 2 nuclei:
a- posterior nucleus.
b- lateral nucleus.
4) posterior perforated substance.

* Connections of hypothalamus:
A) Afferent fibres:
1) from the brain stem & spinal cord:
aff. fibers carrying visceral sensations
reach the hypothalamus mainly via the
dorsal longitudinal bundle.
2) from the limbic system:
a) From the hippocampus (via the
fornix).
b) From the amygdaloid body (via stria
terminalis).
3) From the prefrontal cortex: either
directly or indirectly (through the med.
nucleus of the thalamus)
(B) Efferent fibres:
1) to the brain stem & spinal cord:
mamillo-tegnental tract to the tegmentum of midbrain.
dorsal longitudinal bundle. to the reticular formation of brain stem.
- from the tegmentum of midbrain & the reticular formation of the brain stem, descending autonomic
fibres descend in the lat-column of the spinal cord to reach the lat- horn cells
2) to the limbic system:
via the mamillothalamic tract & the mamillocortical fibres to
the cingulate gyrus.
3) to the pituitary gland:
axons of the supraoplic & paraventricular nuclei terminate in the post-lobe of the pituitary.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 100

 21UMAS SAMEH DOSS

C- Inrernal structure of epithalamus

The epithalamus occupies the the
post end of the upper surface of
the diencephalon &consists of
Rt&Lt habenular nuclei .habernular
commissure,pineal body
&post.commissure

1) Habenular nucleus:
- Site: each nucleus is a mass of
grey matter which underlies the
habenular trigone on the
med.surface of the pulvinar just
above the sup.colliculus.

- Function: it contitutes a part of the olfactory reflex pathway .

- Connections:
A) Afferent: it receives afferent olfactory fibers via the stria medullaris thalami (a band of fibers arching on
the the upper part of the med.surface of thalamus).Its fibers are derived from the rhinencephalon& the
amygdaloid nucleus.
B) Efferent: it gives efferent fibers to :
1- reticular formation of the midbrain.
2- medial nucleus of the thalamus .

2) Habenular commissure:
it consists of fibers from the stria medullaris thalami
(of both sides)which cross the middle line to reach
the opposite habenular nucleus.This commisure runs
in the uper root of the stalk of the pineal body .

3) Posterior commisure:
- it is formed of transverse decussating fibers which
cross the middle line in the lower stalk of the lower
root of the stalk of the pineal body.
- its constituent fibers are derived from the following
nuclei of both side :
1)post.commissural nuclei .
2) intersitial nuclei .of cayal.
3)Darkschewitsch nucleus.

4) Pineal body :
it is composed of pinealocytes &neuroglial cells with rich network of blood vessels .It fanctiin it probably
enhancing the development of the gonads by influencing the output of gonadotropins through the
hypothalamous.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 101

 21UMAS SAMEH DOSS

D- The Metathalamus
A) Lateral geniculate body : (relay nucleus for visual
impulses):

- Afferents: it receives most of the fibers of the optic tract carrying

visual impulses from the retina.

- Efferents:its efferent fibers pass through the retroletiform part

of the internal capsule&form the optic radiation which ends in the
visual sensory area in the occipital cortex .

B) Medial geniculate body : (relay nucleus for auditory

impulses):
- Afferents: it receive auditory fibers:
-directly :from the lat.lemniscus
-indirectly :from the inf.colliculus of the
midbrain via the brachium of inf.colliculus.

- Efferents: it sends efferent fibers via the

sublenti- form part of the internal capsule
to the auditory sensory area 41,42 in the
sup.temporal gyrus .

E- The subthalamus
it cosists of 2 parts:
A) Post.smaller part : containing 5 bundles :
1- medial lemniscus . 2- spinal lemniscus . 3- trigeminal
leminscus .4- reticulo thalamic T .5- sup.cerebellar peduncle.
B) Ant.larger part :containing 5 structures:
- 3 nuclei :upper end of the red nucleus
Upper end of the substantia nigra
The subthalamic nucleus
- 2 descending bundles : ansa lenticularis
Fascicukus lenticularis
* the ansa letincularis :arises from the globus pallidus ,makes
a"loop" around the ant.border of the internal capsule then
enters the upper end of the red nucleus .
* fasclculus lenticularis : arises from the globus pallidus ,pierces
the post.limb of the int.capsule to reach the upper end of the
red nucleus.
N.B: after reach inf. the red nucleus , the fibers of the ansa &fasculus letincularis pass to :
1) tegmentum of midbrain
2) ant.ventral nucli.of thalamus (thalamic fascuiulan
3) to the hypothalamus (hypothalamic fasciulus)

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 102

 21UMAS SAMEH DOSS

Deep Origin (nuclei) of the crainal nerves

* Oculomotor nerve (3rd cranial

n.)
- Site of nucleus :it lies in the tegmentum
of Midbrain ventral to the aqueduct of the
midbrain at the level of the superior calliculus
.
- Structure: the nucleus is formed of 3 main
parts :
A) the Edinger - Westphal nucleus :
(parasympathatic )which supplies 2 intra-
occular muscles 1)the constrictor papllae m
2) the cilliary m

B) the Lat.cell mass :which is divided into 5 parts which

supply 5 extra occular muscles which are (from above downwards) :
L.p.s ,S.R ,M.R ,I.O , Inf.rectus

C) the Central nucleus of perlia: supplies the 2 med.recti

muscles of the 2 eyes allowing them to contract together
when both eyes converge to look to a near o bject.

* Trochlear nerve (4th cranial n):

- site of nucleus : it lies in the tegmentum of
the Midbrain ventral to aqueduct ofM.B, at the
level of the inferior colliculus .

- Type : It is a motor nucleus , its fibers

constitute the trochlear n. which passes
backwards around the aqueduct to emerge from
the post.surface of the M.B below the
inf.colliculus & pierces the sup.medullary velum.

N.B:the trochlear n.supplies one extra occular muscle:

Colliculi
The superior oblique m.

Trochlear n.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 103

 21UMAS SAMEH DOSS

* Trigeminal nerve (5th cranial n): Trigeminal lemniscus

it has 4 nuclei :3 sensory &1 motor:

Ophtha. N.

1) Main sensory nucleus :lies in the Maxillary n.

middle part of the pons .It receives touch Mandibrain n.

sensation from the face &head via the

branches of the t rigeminal n.

2) spinal nucleus :lies in the medulla

&extends upwards to the pons &downwards
to the spinal cord . It replaces the substantia gelatinosa of Rolandi of the spinal cord .
It receives pain &temperature sensation from the skin of the face &scalp

3) Mesencephalic nucleus : lies in the tegmentum of the midbrain

at the level of the sup.&inf colliculi it receives propriocetion sensation
from the head.

4) Motor nucleus of trigeminal n:

lies in the middle of the pons . It gives motor fibers which forms the
motor root of trigeminal n. That joins the mandibular n. to supply. a)the
4 muscles of mastecation b)4 other mm: mylohyois ,ant.belly of diagatric ,tensorpalati&tensor tympani
N.B: the 1st neurone for propriocetion is found in the mesencephalon nucleus.

* Abducent nerve (6th cranial n.):

- its nucleus lies in the lower part of the pons
close to the middle line & encircled by the
facial nerve producing a swelling in the floor of
4th ventricle called the facial clliculus .
- the nucleous gives the abducent . which
supplies the lat.rectus m .

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 104

 21UMAS SAMEH DOSS

* Facial nerve(7th cranial n.)

it has 3 nuclei: 2 motor &1 sensory
1) Facial motor nucleus : lies in the
lower part of pons &gives rise to the fibers
of the facial n.proper which supplies all
muscles derived from the 2nd pharangeal
arch.

2) Sup.salivary nucleus : lies in the

pons &gives rise to secretomotor
parasympathatic fibers which pass in the
following branches :
a) greater s.petrosal n........>>relay in the
sphenopalatine ganglion
......>>postganglionic fibre supply the
mucous glands of palate.nose &
nasopharynx .

b)chorda tympani n..........>>relay in the submandible ganglion ...........>>postganglionic fibers supply

:submandible salivary gland & sublingual gland.

3) Solitary nucleus : lies in the medulla .It receives taste sensation from ant.2/3 of tongue via the
central procceses of the cells of the geniculate ganglion of facial n.

N.B: fibers from the sup.salivary nucleus & solitary nuclaus constitute the nervus intermedius component
of the facial n.

* Cochlear part of the 8th nerve:

- ends in 2 cochlear nuclei: ventral & dorsal
lying in the lower part of the pons &receive hearing impulses.
(See page 75)

* Vestibular part of the 8th nerve:

its fibers carry equilibrium impulses & end in 4 nuclei lying
in the pons &medulla:
1]sup.vestibular nucleus .......... >>
2]inf.vestibular nucleus ............ >>
3]lat.vestibular nucleus ............ >>
4]med.vestibular nucleus .......... >> see page 75

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 105

 21UMAS SAMEH DOSS

* The Glossopharyngeal nerve (9th n.)

It has 3 nuclei : 2 motor &1 sensory
1) the upper part of nucleus ambigus
(in the medulla):
gives motor fibers to the stylopharyngeus
muscle.

2) the inf.salivary nucleus (in medulla)

gives parasympathatic fibers to the parotid
gland.

3) the salivary nucleus (in medulla)

- receives taste sensation from post.1/3 of
tongue.
- receives general sensations from post.1/3 of
tongue ,pharynx tonsile, eust tube ,carotid
sinus & body .

* The vagus nerve(10th n.)

Has 3 nuclei :2 motor &1 sensory

1) Dorsal motor nucleus of vagus i

medulla:
gives parasympathetic fibers to the
respiratory tract , digestive tract &the
heart.
2) main part of nucleus ambiguous
(in medulla)
gives motor fibers to the muscles of the
larynx , pharynx &palate

3) solitary nucleus : receives taste sensation from the epiglottis & general sensation from
the areas supplied by the parasympathetic fibers .

* The Accessory nerve (11th n.)

its cranial part arises from the lower most part of the nucleus ambiguous .It
contains motor fibers which join the vagus n.& distributed through its branches to
the palate ,larynx, pharynx
- its spinal part : arises from the A.H.Cs of the upper 5 or 6 cervical segmants .Its
fibers supply the sternomastoid & trapezius muscles .

* The hypoglossal nervw (12th n.)

arises from the hypoglossal nucleus in the meduula (in the floor of the 4th ventricle )
.Its fibers are motor to all muscles of the tongue except palatoglossus.

THE SCIENTIFIC COMMITTEE OF THE 5TH BATCH-MEDICAL SCHOOL 106