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Neuroanatomi "Farmakologi, sjukdomslära och läkemedelskemi" Magnus Bengtsson Upplägg • Översikt • Hjärnhinnor och ventrikelsystemet • Storhjärnan • Mellanhjärnan • Öga och Öra • Hjärnstam och lillhjärnan • Ryggmärg och Bansystem • Blodförsörjning CNS • PNS och ANS • Insprängda kliniska fall Översikt Plan Afferens och Efferens Sensory input Integra1on Motor output Indelning CNS/PNS Hjärnhinnor Ventrikelsystemet Lateral ventricle Septum pellucidum Anterior horn Posterior horn Interventricular foramen Inferior horn Third ventricle Inferior horn Cerebral aqueduct Lateral aperture (a) Anterior view Fourth ventricle Median aperture Central canal Lateral aperture (b) Left lateral view Cerebrospinalvätska 4 Superior sagi=al sinus Arachnoid villus Choroid plexus Subarachnoid space Arachnoid mater Meningeal dura mater Periosteal dura mater 1 Interventricular foramen Right lateral ventricle (deep to cut) Third ventricle 3 Cerebral aqueduct Lateral aperture Fourth ventricle Median aperture Central canal of spinal cord (a) CSF circulation Choroid plexus of fourth ventricle 2 1 CSF is produced by the choroid plexus of each ventricle. 2 CSF flows through the ventricles and into the subarachnoid space via the median and lateral apertures. Some CSF flows through the central canal of the spinal cord. 3 CSF flows through the subarachnoid space. 4 CSF is absorbed into the dural venous sinuses via the arachnoid villi. Lober FunkNonella centra Motor areas Central sulcus Primary motor cortex Premotor cortex Frontal eye field Broca’s area (outlined by dashes) Sensory areas and related association areas Primary somatosensory cortex Somatosensory associa1on cortex Gustatory cortex (in insula) Prefrontal cortex Working memory for spa1al tasks Execu1ve area for task management Working memory for object-‐recall tasks Solving complex, mul1task problems Soma1c sensa1on Taste Wernicke’s area (outlined by dashes) Primary visual cortex Visual associa1on area Auditory associa1on area Primary auditory cortex (a) Lateral view, left cerebral hemisphere Primary motor cortex Motor associa1on cortex Primary sensory cortex Sensory associa1on cortex Mul1modal associa1on cortex Vision Hearing FunkNonella centra Premotor cortex Primary motor cortex Cingulate gyrus Central sulcus Corpus callosum Primary somatosensory cortex Frontal eye field Parietal lobe Somatosensory associa1on cortex Parieto-‐occipital sulcus Occipital lobe Prefrontal cortex Processes emo1ons related to personal and social interac1ons Visual associa1on area Calcarine sulcus Orbitofrontal cortex Olfactory bulb Olfactory tract Fornix Primary visual cortex Temporal lobe (b) Parasagittal view, right hemisphere Primary olfactory cortex Uncus Primary motor cortex Motor associa1on cortex Primary sensory cortex Sensory associa1on cortex Mul1modal associa1on cortex Parahippocampal gyrus Homunculus Posterior Anterior Sensory Hip Trunk Leg Hip Trunk Neck Motor lder Shou Motor map in precentral gyrus Foot Knee Brow Eye Toes Genitals Face Lips Jaw Tongue Swallowing Sensory map in postcentral gyrus Primary motor cortex (precentral gyrus) Primary somato- sensory cortex (postcentral gyrus) Teeths Gum Tongue Pharynx Kramper och epilepsi • KorNkala urladdningar • Sekundär Nll skada – – – – Stroke Tumör InfekNon Alkohol • Kryptogen • Symptomen följer anatomin Vit substans, banor Longitudinal fissure Superior Lateral ventricle Basal ganglia Caudate Putamen Globus pallidus Thalamus Corona radiata Fornix Internal capsule Gray ma=er White ma=er Third ventricle Pons Projection fibers Medulla oblongata (a) Frontal section Association fibers Commissural fibers (corpus callosum) Decussa1on of pyramids MulNpel Skleros • Myelinskada à Plaque i vit substans • InflammaNon – Skovvist förlöpande – Progressivt förlöpande • EffekNva immunmodulerande läkemedel Basala kärnorna översikt Basala kärnorna 1 Basala kärnorna 2 Parkinsons sjukdom • DegeneraNon SubstanNa Nigra – ê DA • Motoriska störningar – Hypokinesi – Rigiditet – Tremor • KogniNva och affekNva störningar HunNngtons sjukdom • DegeneraNon Striatum och Kortex (främst frontotemp) – ê GABA, é Glu • Triad – Dominant nedärvning – Choreoathetos – Demens • HunNngNn, CAG-‐repeat Djupa strukturer, limbiska systemet Limbiska systemet Psykiatri • Cerebrala skador ger psykiska symptom • Signalsubstanser påverkar – Seratonin – DA – Na – GABA – Glutamat • Starkt koppling kropp och skäl – Descartes Diencephalon 1 Thalamus Dorsal nuclei Medial Lateral dorsal Lateral posterior Anterior nuclear group Pulvinar Medial geniculate body Lateral geniculate body Re1cular nucleus Ventral anterior Ventral lateral Ventral postero- lateral Ventral nuclei (a) The main thalamic nuclei. (The re1cular nuclei that “cap” the thalamus laterally are depicted as curving translucent structures.) Hypothalamus Paraventricular nucleus Anterior commissure Preoptic nucleus Anterior hypothalamic nucleus Supraop1c nucleus Suprachiasmatic nucleus Op1c chiasma Infundibulum (stalk of the pituitary gland) Fornix (b) The main hypothalamic nuclei Arcuate nucleus Pituitary gland Dorsomedial nucleus Posterior hypothalamic nucleus Lateral hypothalamic area Ventromedial nucleus Mammillary body Endokrinologi • Saltbalans – Diabetes insipidus • Hungerkontroll – Fet-‐musen • Cirkadianska rytmer – Dygnsrytm • Vakenhet – Narkolepsi • Thyroidea • Binjuren • FSH, LH • GH • Oxytosin • Etc etc Örat Hammaren Städet Stigbygeln Mellanörat Ytterörat Innerörat Balansorganet N. VIII Hörselgången Runda Trumfönstret hinnan Ovala fönstret Hörselsnäckan (cochlean) Örontrumpeten KorNska organet Tectorialmembranet Yttre hårceller Tectorialmembranet Retikularmembranet Inre hårcell Hörselceller Basilarmembranet Deitersceller Figur 5.22 Fysiologi © Jan Lännergren, Håkan Westerblad, Mats Ulfendahl oc igur 5.10 Båggångaroch hinnsäcker Semicirkulära båggångar Temporalbenet Subduralrummet Utriculus Sacculus Hörselsnäckan Endolymfa Scala vestibuli Scala media Scala tympani Perilymfa Ovala fönstret med stigbygeln Runda fönstret Ögat Pupill Främre ögonkammare Iris Bakre ögonkammare Cornea (hornhinna) Lins Ciliarkropp med ciliarmuskel Glaskropp Retina (näthinna) Choroidea (åderhinna) Sclera (senhinna) Synnervspapill (blinda fläcken) Fovea centralis Synnerven (N. II) ANS och ögat Sympathetic activation Nearly parallel rays from distant object Lens Ciliary zonule Inverted image Ciliary muscle Parasympathetic activation Divergent rays from close object Inverted image Brytningsfel Myopi (närsynthet) Korrigeras med spridningslins Hyperopi (översynthet) Korrigeras med samlingslins Synbanan N T T N. opticus Synnervskorsning Synfältsbortfall i vä öga hö öga 1 1 Tractus opticus 2 3 2 Laterala knäkroppen Synstrålning Syncortex Figur 5.34 3 Hjärnstam och kranialnerver Mesencephalon Dorsal Tectum Periaqueductal gray ma=er Superior colliculus Cerebral aqueduct Re1cular forma1on Oculomotor nucleus (III) Medial lemniscus Red nucleus Substan1a nigra Fibers of pyramidal tract Ventral (a) Midbrain Crus cerebri of cerebral peduncle Pons Superior cerebellar peduncle Trigeminal main sensory nucleus Fourth ventricle Re1cular forma1on Trigeminal motor nucleus Middle cerebellar peduncle Trigeminal nerve (V) Medial lemniscus (b) Pons Pon1ne nuclei Fibers of pyramidal tract Medulla Oblongata Hypoglossal nucleus (XII) Dorsal motor nucleus of vagus (X) Re1cular forma1on Inferior cerebellar peduncle Lateral nuclear group Medial nuclear group Raphe nucleus Medial lemniscus (c) Medulla oblongata Fourth ventricle Choroid plexus Solitary nucleus Ves1bular nuclear complex (VIII) Cochlear nuclei (VIII) Nucleus ambiguus Inferior olivary nucleus Pyramid Cerebellum Anterior lobe Cerebellar cortex Arbor vitae Cerebellar peduncles Posterior lobe Superior Middle Inferior Medulla oblongata Flocculonodular lobe (b) Illustration of parasagittal section Choroid plexus of fourth ventricle Ryggmärgen Ryggmärgssegment Ryggmärg, gränssträngen Pyramidbanan Primary motor cortex Cerebrum Pyramidal cells Internal capsule Midbrain Cerebral peduncle Cerebellum Pons Ventral corticospinal tract Pyramids Medulla oblongata Decussa1on of pyramid Lateral corticospinal tract Cervical spinal cord Skeletal muscle Lumbar spinal cord Soma1c motor neurons (a) Pyramidal (lateral and ventral corticospinal) pathways ALS • DegeneraNon av övre-‐ och nedre motorneuron – Centrala och perifera motoriska symptom • Med Nden även korNkal degeneraNon – KogniNva symptom Sensoriska banor Smärta, omkopplingar Huvudvärk Blodkärl, främre cirkulaNonen 1 Blodkärl, främre cirkulaNonen 2 Blodkärl bakre cirkulaNonen Blodkärl, ryggmärgen Hjärnans venösa system Stroke Cerebrovaskulär sjukdom med fokal ischemi • Infarkt – Lokalt; embolus eller lakunär infarkt – Artär-‐artär embolus – Kardiell embolus – Annat; venöst, dissekNon, etc • Intracerebral blödning – Hypertoniblödning – Kärlskada • Subarachnoidalblödning – Aneurysm PNS Cervical plexus Brachial plexus Cervical nerves C1 – C8 Cervical enlargement Intercostal nerves Thoracic nerves T1 – T12 Lumbar enlargement Lumbar plexus Sacral plexus Cauda equina Lumbar nerves L1 – L5 Sacral nerves S1 – S5 Coccygeal nerve Co1 Dermatom C2 C3 C5 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L1 S2 S3 L2 L2 C4 T2 C5 C6 C6 C7 C8 L3 L4 L5 S1 (a) Anterior view T2 C5 C6 C8 L3 L4 L5 S1 C6 C7 Guillain-‐Barrés syndrom • Akut inflammatorisk demyeliniserande polyneuropaN (AIDP) • Drabbar perifera nerver och nervrö_er – Progredierande slappa pareser – Parestesier – Autonom dysfunkNon Myasthenia Gravis • Autoimmun neuromuskulär sjukdom – Ak mot ach.rec • U_rö_barhet i muskler • Thymom Smärta ut i armen anatomi. Smärta ut i armen anatomi Smärta ut i benen anatomi ANS parasympaNkus CN III CN VII CN IX CN X Ciliary ganglion Eye Lacrimal gland Pterygopala1ne ganglion Submandibular ganglion O1c ganglion Nasal mucosa Submandibular and sublingual glands Paro1d gland Heart Cardiac and pulmonary plexuses Lung Preganglionic CN Postganglionic Cranial nerve ParasympaNkus Celiac plexus Liver and gallbladder Stomach Pancreas S2 Large intes1ne S4 Small intes1ne Pelvic splanchnic nerves Inferior hypogastric plexus Preganglionic CN Postganglionic Cranial nerve Rectum Urinary bladder and ureters Genitalia (penis, clitoris, and vagina) SympaNkus Pons Nasal mucosa Sympathe1c trunk (chain) ganglia Blood vessels; skin (arrector pili muscles and sweat glands) Superior cervical ganglion Salivary glands Heart Middle cervical ganglion T1 Eye Lacrimal gland Inferior cervical ganglion Cardiac and pulmonary plexuses Lung Greater splanchnic nerve Lesser splanchnic nerve Celiac ganglion Liver and gallbladder L2 Stomach White rami communicantes Superior mesenteric ganglion Spleen Kidney Sacral splanchnic nerves Lumbar splanchnic nerves Adrenal medulla Inferior mesenteric ganglion Small intes1ne Large intes1ne Rectum Preganglionic Postganglionic Genitalia (uterus, vagina, and penis) and urinary bladder Synapser, skillnader Cell bodies in central nervous system SOMATIC NERVOUS SYSTEM Heavily myelinated axon Skeletal muscle SYMPATHETIC Unmyelinated postganglionic axon Blood vessel ACh ACh S1mulatory NE Lightly myelinated Ganglion preganglionic axons Epinephrine and ACh norepinephrine Lightly myelinated preganglionic axon Effect ACh ACh Adrenal medulla PARASYMPATHETIC Peripheral nervous system Two-‐neuron chain from CNS to effector organs AUTONOMIC NERVOUS SYSTEM Neurotransmitter Effector at effector organs Single neuron from CNS to effector organs Ganglion Unmyelinated postganglionic axon Smooth muscle (e.g., in gut), glands, cardiac muscle S1mulatory or inhibitory, depending on neuro-‐ transmi=er and receptors on effector organs Övre styrning ANS Communica1on at subconscious level Cerebral cortex (frontal lobe) Limbic system (emo1onal input) Hypothalamus Overall integra1on of ANS, the boss Brain stem (reticular formation, etc.) Regula1on of pupil size, respira1on, heart, blood pressure, swallowing, etc. Spinal cord Urina1on, defeca1on, erec1on, and ejacula1on reflexes
