Functional And Clinical Neuroanatomy. A Guide For Health Care Professionals

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Cover FUNCTIONAL AND CLINICAL NEUROANATOMY A Guide for Health Care Professionals Copyright Dedication About the Authors Preface Acknowledgments 1 Histophysiology Anatomical divisions of the nervous system Functional divisions of the nervous system Neuroglia Neuroglia of the CNS Microglia Astrocytes Oligodendrocytes and myelination Ependymal cells Neuroglia of the PNS Schwann cells Satellite cells Neural responses to injuries Neurons Functional characteristics of neurons The structure of neurons The cell body Neuron processes The classification of neurons Structural classification Functional classification Sensory neurons Motor neurons Interneurons Membrane potential The resting membrane potential The sodium-potassium exchange pump Graded potentials Passive processes: The electrochemical gradient Membrane channels change resting membrane potential Passive ion channels Active ion channels Action potentials Threshold and the all-or-none principle Raheleh.Ahangariucf.edu Generation of action potentials The refractory period Functions of the sodium-potassium exchange pump Action potential propagation Types of propagation Continuous propagation Saltatory propagation Axon diameter and propagation speed Synapses Types of synapses Electrical synapses Chemical synapses Function of chemical synapses Synaptic delay Synaptic fatigue Neuronal integration of excitatory and inhibitory stimuli Postsynaptic potentials Integrating postsynaptic potentials: Summation Spatial summation Temporal summation Summation of EPSPs and IPSPs Presynaptic regulation: Inhibition and facilitation The rate of action potential generation Degeneration and regeneration of nerve cells Clinical considerations Myasthenia gravis Clinical manifestations Diagnosis Treatment Neuroblastoma Astrocytosis Gliomas Astrocytoma Ependymomas Pesticide toxicity Clinical cases Key terms Suggested readings 2 Embryology Development of the neural tube Sensory and motor areas defined by the sulcus limitans Bulges and flexures of the neural tube Primary vesicles Secondary vesicles Neural crest Cranial placodes Medulla spinalis (spinal cord) Myelencephalon (medulla oblongata) Metencephalon Mesencephalon (midbrain) Diencephalon development Telencephalon development Ventricular system Central nervous system malformation Clinical considerations Spina bifida Spina bifida with meningocele Spina bifida with myelomeningocele Clinical manifestations Treatment Anencephaly Encephalocele Pathophysiology Clinical manifestations Treatment Microcephaly Holoprosencephaly Congenital hydrocephalus Clinical cases Key terms Suggested readings 3 Gross anatomy of the brain Brain divisions Cerebral hemispheres Lobes Functions of the cerebrum Hemisphere dominance Cerebral cortex Cerebral white matter Basal nuclei Diencephalon Brainstem Cerebellum Clinical considerations Encephalitis Pathophysiology Clinical manifestations Diagnosis Treatment Brain abscess Pathophysiology Clinical manifestations Diagnosis Treatment Fungal meningoencephalitis Helminthic brain infections Protozoal brain diseases Clinical cases Key terms Suggested readings 4 Meninges and ventricles Meninges Dura mater and dural folds Arachnoid mater Pia mater Barrier function of the arachnoid mater Dural nerve supply Pain sensation in the dura mater Dural arterial supply Dural venous sinuses Meninges of the spinal cord The spinal dura mater The spinal arachnoid mater The spinal pia mater Ventricles Lateral ventricles Third ventricle Fourth ventricle Cerebrospinal fluid Formation and circulation of cerebrospinal fluid Clinical considerations Meningitis Acute bacterial meningitis Pathophysiology Clinical manifestations Diagnosis Treatment Viral meningitis Pathophysiology Clinical manifestations Diagnosis Treatment Chronic meningitis Pathophysiology Clinical manifestations Diagnosis Treatment Chronic bacterial meningoencephalitis Tuberculosis Neurosyphilis Neuroborreliosis (lyme disease) Hydrocephalus Pathophysiology Clinical manifestations Diagnosis Treatment Meningioma Pathophysiology Clinical manifestations Diagnosis Treatment Clinical cases Key terms Suggested readings 5 Blood supply of the CNS Arteries of the brain Carotid arteries Vertebral and basilar arteries Cerebral arterial circle Meningeal arteries Veins of the brain Superficial veins Deep veins Venous dural sinuses Cavernous sinus Arteries of the spinal cord Venous drainage of the spinal cord Clinical considerations Thrombosis Pathophysiology Clinical manifestations Diagnosis Treatment Embolism Pathophysiology Clinical manifestations Diagnosis Treatment Stroke Focal cerebral ischemia Global cerebral ischemia Pathophysiology Clinical manifestations Diagnosis Treatment Ischemic stroke Pathophysiology Clinical manifestations Diagnosis Treatment Transient ischemic attack Pathophysiology Clinical manifestations Diagnosis Treatment Epidural hematomas Subdural hematomas Pathophysiology Clinical manifestations Diagnosis Treatment Spinal epidural or subdural hematomas Pathophysiology Clinical manifestations Diagnosis Treatment Subarachnoid hemorrhage Pathophysiology Clinical manifestations Diagnosis Treatment Intracerebral hemorrhage Pathophysiology Clinical manifestations Diagnosis Treatment Cerebral aneurysm Pathophysiology Clinical manifestations Diagnosis Treatment Spinal cord ischemia Pathophysiology Clinical manifestations Diagnosis Treatment Clinical cases Key terms Suggested readings 6 Cerebral cortex Cerebrum Gross anatomy Cerebral cortex Neocortex Functional cerebral cortex areas Motor areas Sensory areas Association areas Integrative centers and higher mental functions Specialized language areas Prefrontal cortex Hemispheric lateralization Electroencephalogram Brain waves Alpha waves Beta waves Theta waves Delta waves Split-brain syndrome White matter of the cerebrum Higher cortical functions Memory Brain regions used in memory Cellular memory formation and storage States of consciousness Apraxia Aphasia Dysprosodies Clinical considerations Alzheimer's disease Pathophysiology Clinical manifestations Diagnosis Treatment Delirium and dementia Pathophysiology Clinical manifestations Diagnosis Treatment Prion diseases Creutzfeldt-Jakob disease Pathophysiology Clinical manifestations Diagnosis Treatment Gerstmann-Sträussler-Scheinker disease Fatal insomnia Kuru Seizure disorders Pathophysiology Clinical manifestations Diagnosis Treatment Sleep disorders Pathophysiology Diagnosis Treatment Insomnia Pathophysiology Clinical manifestations Diagnosis Treatment Sleep apnea Pathophysiology Clinical manifestations Diagnosis Treatment Narcolepsy Pathophysiology Clinical manifestations Diagnosis Treatment Idiopathic hypersomnia Parasomnias Restless legs syndrome Pathophysiology Clinical manifestations Diagnosis Treatment Headache Pathophysiology Clinical manifestations Diagnosis Treatment Clinical cases Key terms Suggested readings 7 Basal nuclei Structure of the basal nuclei Functional considerations Clinical considerations Parkinson's disease Pathophysiology Clinical manifestations Diagnosis Treatment Parkinsonism Pathophysiology Clinical manifestations Diagnosis Treatment Huntington's chorea Pathophysiology Clinical manifestations Diagnosis Treatment Hemiballismus Pathophysiology Clinical manifestations Diagnosis Treatment Essential tremor Pathophysiology Clinical manifestations Diagnosis Treatment Dystonias Pathophysiology Clinical manifestations Diagnosis Treatment Clinical cases Key terms Suggested readings 8 Diencephalon: Thalamus and hypothalamus Epithalamus Pineal gland Habenular nuclei Thalamus Subthalamus Subthalamic nucleus Zona incerta Hypothalamus Hypothalamic-releasing hormones Neurohypophysis Blood supply to the diencephalon Internal capsule Functions of the thalamic nuclei and their major connections Functional considerations of the hypothalamus Regulation of the autonomic nervous system Clinical considerations Hypothalamic syndromes Pathophysiology Clinical manifestations Diagnosis Treatment Diabetes insipidus Pathophysiology Clinical manifestations Diagnosis Treatment Pituitary insufficiency Pathophysiology Clinical manifestations Diagnosis Treatment Hypothermia and hyperthermia Pathophysiology Clinical manifestations Diagnosis Treatment Cushing disease and Cushing syndrome Pathophysiology Clinical manifestations Diagnosis Treatment Clinical cases Key terms Suggested readings 9 Brainstem The rule of 4 of the brainstem Midbrain Pons Medulla oblongata Reflex centers Sensory and motor nuclei of the cranial nerves Relay stations Corticobulbar tracts Corticospinal tracts Functional considerations Clinical considerations Arnold-Chiari phenomenon Pathophysiology Clinical manifestations Diagnosis Treatment Pontine hemorrhage Pathophysiology Clinical manifestations Diagnosis Treatment Infarctions of the pons Trauma to the midbrain Blockage of the cerebral aqueduct Pathophysiology Clinical manifestations Diagnosis Treatment Weber syndrome Pathophysiology Clinical manifestations Diagnosis Treatment Benedikt syndrome Pathophysiology Clinical manifestations Diagnosis Treatment Clinical cases Key terms Suggested readings 10 Cranial nerves Olfactory nerves (I) Optic nerves (II) Oculomotor nerves (III) Trochlear nerves (IV) Trigeminal nerves (V) Abducens nerves (VI) Movement of the eyes via the abducens nerves Facial nerves (VII) Vestibulocochlear nerves (VIII) Glossopharyngeal nerves (IX) Vagus nerves (X) Accessory nerves (XI) Hypoglossal nerves (XII) Clinical considerations Anosmia Fourth cranial nerve palsy Pathophysiology Clinical manifestations Diagnosis Treatment Sixth cranial nerve palsy Pathophysiology Clinical manifestations Diagnosis Treatment Strabismus Pathophysiology Clinical manifestations Diagnosis Treatment Bell's palsy Hemifacial spasm Glossopharyngeal neuralgia Clinical cases Key terms Suggested readings 11 Trigeminal and facial nerves Trigeminal nerve Trigeminal sensory nuclei Trigeminal motor nucleus Tensor tympani and the stapedius reflex Trigeminocerebellar fibers Trigeminal reflexes Facial nerve Facial motor nuclei Clinical considerations Trigeminal neuralgia Pathophysiology Clinical manifestations Diagnosis Treatment Trigeminal neuropathies Hemifacial spasm Bell's palsy Additional causes of facial palsy Facial hemiatrophy Problems with recovery from facial nerve palsy Additional facial nerve disorders Clinical cases Key terms Suggested readings 12 Auditory system Anatomical structures External ear Middle ear Inner ear Hearing process Organ of Corti Tectorial membrane Vestibule Endolymphatic duct and sac Semicircular canals Cochlea and cochlear duct Cochlear nerve Basilar membrane Bony labyrinth microstructure Internal acoustic meatus Vascular supply Innervation Vestibular nerve Vestibular ganglion Intratemporal vestibular nerve Perceiving sound Pathway of sound waves Neural pathway of hearing Hearing tests Equilibrium Vestibule and semicircular canals Maculae Visual reflexes in equilibrium Static equilibrium Dynamic equilibrium Vestibular system microstructure Clinical considerations Key terms Suggested readings 13 Auditory system lesions and disorders Tinnitus Pathophysiology Clinical manifestations Diagnosis Treatment Hearing loss Pathophysiology Clinical manifestations Diagnosis Treatment Sudden deafness Vertigo Pathophysiology Clinical manifestations Diagnosis Treatment Meniere's disease Pathophysiology Clinical manifestations Diagnosis Treatment Benign paroxysmal positional vertigo Pathophysiology Clinical manifestations Diagnosis Treatment Ramsay Hunt syndrome Pathophysiology Clinical manifestations Diagnosis Treatment Acute vestibular neuronitis Drug-induced ototoxicity Acoustic neuroma Pathophysiology Clinical manifestations Diagnosis Treatment Labyrinthitis Clinical cases Key terms Suggested readings 14 Visual system Anatomy of the eyeball Fibrous layer Vascular layer Inner layer Retinal layers Pigmented layer Neural layer Outer limiting membrane Outer nuclear layer Outer plexiform layer Inner nuclear layer Inner plexiform layer Ganglion cell layer Nerve fiber layer and optic disc Inner limiting membrane Chambers of the eye Aqueous humor Vitreous body Lens Visual acuity Pupillary light reflexes and pathway Visual pathways Retinal processing Central processing Visual field Visual processing in the brainstem Visual pigments Clinical considerations Total blindness Pathophysiology Clinical manifestations Diagnosis Treatment Homonymous hemianopia Pathophysiology Clinical manifestations Diagnosis Treatment Unilateral vision loss and abnormalities Bitemporal hemianopia Localizing the lesion within the visual pathway Hereditary optic neuropathies Pathophysiology Clinical manifestations Diagnosis Treatment Anterior ischemic optic neuropathy Pathophysiology Clinical manifestations Diagnosis Treatment Optic neuritis Pathophysiology Clinical manifestations Diagnosis Treatment Papilledema Pathophysiology Clinical manifestations Diagnosis Treatment Toxic amblyopia Pathophysiology Clinical manifestations Diagnosis Treatment Glaucoma Pathophysiology Clinical manifestations Diagnosis Treatment Cataract Pathophysiology Clinical manifestations Diagnosis Treatment Age-related macular degeneration Pathophysiology Clinical manifestations Diagnosis Treatment Retinal detachment Pathophysiology Clinical manifestations Diagnosis Treatment Central retinal artery occlusion Pathophysiology Clinical manifestations Diagnosis Treatment Central retinal vein occlusion Pathophysiology Clinical manifestations Diagnosis Treatment Diabetic retinopathy Pathophysiology Clinical manifestations Diagnosis Treatment Hypertensive retinopathy Pathophysiology Clinical manifestations Diagnosis Treatment Retinitis pigmentosa Pathophysiology Clinical manifestations Diagnosis Treatment Color blindness Pathophysiology Clinical manifestations Diagnosis Treatment Nyctalopia Pathophysiology Clinical manifestations Diagnosis Treatment Retinoblastoma Pathophysiology Clinical manifestations Diagnosis Treatment Clinical cases Key terms Suggested readings 15 Limbic, olfactory, and gustatory systems Limbic system Anatomy of the limbic system Hippocampal formation Subicular complex Entorhinal cortex Septum pellucidum Amygdala Other amygdala structures Functions of the limbic system Olfactory system Anatomy of the olfactory system Olfactory receptors Olfactory pathways Olfactory bulb Olfactory tract Functions of the olfactory system Gustatory system Anatomy of taste buds Taste bud microstructure Neural pathways Central connections Functions of the gustatory system Autonomic tongue innervation Testing of taste sensation Clinical considerations Emotional disturbances of the limbic structures Emotional disturbances due to hallucinations and pain Emotional lability Spasmodic or pseudobulbar emotional disturbances Anger and violent behaviors Apathy and placidity Alterations in sexuality Differential limbic diagnoses Anosmia Olfactory hallucinations Clinical cases Key terms Suggested readings 16 Cerebellum Anatomy of the cerebellum Cerebellar nuclei Mossy and climbing fibers Cerebellar cortex Cortical interneurons Cerebellar lobules Corticonuclear and olivocerebellar projections Cortico-olivary system Afferent mossy fibers Corticopontocerebellar projection Vestibulo-ocular reflex Functional divisions of the cerebellum Major functions of the cerebellum Clinical considerations Ataxia Dystonias Pathophysiology Clinical manifestations Diagnosis Treatment Dysarthria Pathophysiology Clinical manifestations Diagnosis Treatment Pendular knee jerk Clinical cases Key terms Suggested readings 17 Autonomic nervous system Autonomic outflow Sympathetic division Preganglionic sympathetic fibers Adrenal medulla Postganglionic sympathetic fibers Parasympathetic division Autonomic plexuses Autonomic innervation of the head Visceral afferent pathways Pathways to the brainstem Pathways to the spinal cord Hierarchy of the autonomic nervous system Functional considerations Clinical considerations Horner syndrome Pathophysiology Clinical manifestations Diagnosis Treatment Argyll Robertson pupil Pathophysiology Clinical manifestations Diagnosis Treatment Adie tonic pupil syndrome Pathophysiology Clinical manifestations Diagnosis Treatment Hirschsprung's disease Pathophysiology Clinical manifestations Diagnosis Treatment Clinical cases Key terms Suggested readings 18 Neurotransmitters Classifications of neurotransmitters Types of neurotransmitters Acetylcholine Biogenic amines Dopamine Norepinephrine and epinephrine Histamine Serotonin Amino acids Glutamate, GABA, and Glycine Neuropeptides Purines Dissolved gases Opioid peptides Nonopioid neuropeptides Neuromodulators Functional considerations Synthesis of neurotransmitters Presynaptic release of neurotransmitters into the synaptic cleft Neurotransmitter binding to postsynaptic receptors Clinical considerations Myasthenia gravis Pathophysiology Clinical manifestations Diagnosis Treatment Parkinson's disease Schizophrenia Pathophysiology Clinical manifestations Diagnosis Treatment Obsessive-compulsive disorder Pathophysiology Clinical manifestations Diagnosis Treatment Depression Pathophysiology Clinical manifestations Diagnosis Treatment Bipolar disorder Pathophysiology Clinical manifestations Diagnosis Treatment Cyclothymic disorder Clinical cases Key terms Suggested readings 19 Spinal cord Gross anatomy and protection Spinal nerves Cross-sectional anatomy White matter Innervation of specific body regions Cervical plexus and the neck Brachial plexus and upper limbs Lumbosacral plexus and lower limbs Anterolateral thorax and abdominal wall Innervation of joints Ascending and descending pathways Ascending pathways Somatotopic organization Spinothalamic tract Anterolateral pathway Descending pathways Integrative pathways Reflex activity Components of a reflex arc Spinal reflexes Flexor and crossed-extensor reflexes Superficial reflexes Plantar reflex Abdominal reflexes Muscle tension and motor neuron inhibition Withdrawal reflexes coordinated by painful stimuli Reciprocal and crossed effects of reflexes Sensory processing Regional specializations of gray matter Motor neurons of the anterior horn Autonomic neurons of the intermediate gray matter The layered arrangement of spinal cord gray matter Blood supply of the spinal cord Clinical considerations Key terms Suggested readings 20 Spinal cord lesions and disorders Myelopathies Transverse myelitis Clinical manifestations Diagnosis Treatment Spinal epidural abscess Pathophysiology Clinical manifestations Diagnosis Treatment Guillain-Barré syndrome Pathophysiology Clinical manifestations Diagnosis Treatment Multiple sclerosis Pathophysiology Clinical manifestations Diagnosis Treatment Amyotrophic lateral sclerosis Pathophysiology Clinical manifestations Diagnosis Treatment Radiculopathies Pathophysiology Clinical manifestations Diagnosis Treatment Herniated nucleus pulposus Pathophysiology Clinical manifestations Diagnosis Treatment Spinal muscular atrophies Pathophysiology Clinical manifestations Diagnosis Treatment Thoracic outlet compression syndromes Pathophysiology Clinical manifestations Diagnosis Treatment Cervical spondylosis and spondylotic cervical myelopathy Pathophysiology Clinical manifestations Diagnosis Treatment Spina bifida Pathophysiology Clinical manifestations Diagnosis Treatment Syringomyelia Pathophysiology Clinical manifestations Diagnosis Treatment Spinal cord trauma and compression Pathophysiology Clinical manifestations Diagnosis Treatment Spinal cord tumors Pathophysiology Clinical manifestations Diagnosis Treatment Clinical cases Key terms Suggested readings 21 Complete neurological exam History Neurologic examination Mental status Cranial nerves Olfactory nerve (I) Optic nerve (II) Oculomotor (III), trochlear (IV), and abducens (VI) nerves Trigeminal nerve (V) Facial nerve (VII) Vestibulocochlear nerve (VIII) Glossopharyngeal (IX) and vagus (X) nerves Spinal accessory nerve (XI) Hypoglossal nerve (XII) Motor system Muscle strength Gait, stance, and coordination Sensation Position Pain Coordination Reflexes Babinskis, Chaddocks, and Oppenheim reflexes Stance and gait Screening without neurologic complaints Autonomic nervous system Key terms Suggested readings 22 Neurologic diagnostic procedures Lumbar puncture CT scan Magnetic resonance imaging Cerebral catheter angiography Duplex Doppler ultrasonography Myelography Electroencephalography Electromyography Key terms Suggested readings Glossary Index Back Cover