Konuri's Approach to Human Anatomy Neuroanatomy

By V.k Konuri

The philosophy of Konuri’s approach is that Anatomy should be explained and not just described. These books achieve the aim of explanation by synthesizing and integrating ‘form, function and development’. The synthetic approach is the hallmark of this book, in contrast to many other books on Neuroanatomy that are just descriptive.

Neuroanatomy is not only very complex but also highly organized. This book not only describes the location of various nuclei and tracts, but also brings out the rationality behind those anatomical details.

The purpose of knowledge is inherently bound with its utilization. The litmus paper test of any acquired knowledge is the ability of the acquirer to use it to advance human life. This book discusses not only the clinical application of Neuroanatomy but also dwells into examining the process of acquiring knowledge by the human brain.

This book considers the human brain as a product of biological evolution. The human brain started thing and after crossing many milestones, today the human brain started investigating itself. I invite the reader to dive into the book with enthusiasm and to float with extreme satisfaction.

• Language: English
• Publisher: One Point Six Technologies Pvt Ltd
• Release date: Feb 28, 2020
• ISBN: 9789389759969

V.k Konuri

Dr. V. K. Konuri, Additional Professor Of Anatomy, All India Institue of Medical Sciences, Raipur, India

Book preview

Contents

1. Introduction to Human Brain

Vegetative nervous system

Two neurons

Tubular Nervous System

Brain and spinal cord

Cranial nerves

Typical spinal nerve

Cells of the Nervous System

Neurons

Neuroglia

Development of Nervous System

Neurulation

Development of Spinal Cord

Spinal Cord too has a History

Development of Brain

Development of Brainstem

Development of Cerebrum

Cortex too had a History

2. SPINAL CORD

External Features

Roots of Spinal Nerves

Cauda Equina

Thickenings of Spinal Cord

Divisions of Spinal Cord

Internal Features

White Matter of Spinal Cord

Posterior Columns

Descending Motor Tracts

Corticospinal tract

Pyramidal and Extrapyramidal Tracts

Rubrospinal Tract

Olivospinal Tract

Reticulospinal Tract

Applied Anatomy

3. BRAINSTEM

The Cranial Nerves

Some points on Cranial Nerves

Central Canal and Ventricles

Long Tracts

The Spinal Lemniscus

Posterior Column – Medial Lemniscal Pathway

Trigeminal Lemniscus

Lateral Lemniscus

Reticular Formation

Connections

Function

Subdivisions of the Brainstem

Structure of Tectum

Structure of Basis

Structure of Tegmentum

MEDULLA OBLONGATA

External Features

Internal Structure

Sections of Medulla Oblongata

PONS

Fourth ventricle

Rhomboid Fossa

Basis Pontis

Tegmentum of Pons

Pontomedullary Junction

Trigeminal Nucleus

MID BRAIN

External Surface

Internal Structure

Trochlear Nucleus

Mesencephalic nucleus of CN V

Substantia nigra

Oculomotor Nucleus

Red nucleus

White Matter of Midbrain

LESIONS OF BRAINSTEM

Lesions in the Medulla

Lesions at the Pontomedullary Junction

Lesions in the Pons

Lesions in the Midbrain

4. Cerebellum

Phylogenesis

Ontogenesis

External Features

Location and Relief

Lobes and Parts

Surfaces and Fissures

Internal structure

Deep Cerebellar Nuclei

Cerebellar cortex

The white mater of Cerebellum

Histology of Cerebellum

Fibers of Cerebellum

To summarize

Lesions of the Cerebellum

5. Forebrain – Diencephalon

Introduction

Thalamus

Ontogenesis

Location and Relations

Capsules and Laminae

Nuclei and Connections

Summary of Thalamic Connections

Epithalamus

Hypothalamus

Nuclei of hypothalamus

Connections of Hypothalamus

6. Forebrain – Internal Capsule and Basal Nuclei

Parts of Internal Capsule

Descending fibers

Ascending fibers

Relations of the Internal Capsule

Blood Supply of Internal Capsule

Applied Anatomy

Basal Nuclei

Development

Caudate Nucleus

Lentiform Nucleus

Claustrum

Pyramidal took over the Extra pyramidal

LESIONS OF THE BASAL NUCLEI

7. Forebrain – Cerebral Cortex

External Relief

Fissures and Sulci

Corticalisation of Nervous Functions

The C shape

Cerebral Ontogenesis

The Cortex also had a History.

Amygdala

Fornix

Papez Circuit

Cortical areas

Visual Area

Auditory Area

Sensory Area

Motor Area

Premotor Area

Structure of Cerebral Cortex

WHITE MATTER OF CEREBRUM

Association fibers

Cingulum

Commissural Fibers

Corpus Callosum

Projection Fibers

Lesions of Cerebral Cortex

The sensory cortex

The auditory cortex

The speech area

Motor cortex

The dominant Angular Gyrus

The Prefrontal Cortex

Cerebral Dominance

Consciousness

Ventricles

Lateral Ventricle

Third Ventricle

Fourth Ventricle

8. Cranial Nerves

Introduction

Olfactory nerve

Optic Nerve

Oculomotor Nerve

Trochlear Nerve

Abducent nerve

Trigeminal nerve

Ophthalmic nerve

Maxillary nerve

Mandibular nerve

Facial Nerve

Vestibulocochlear Nerve

Glossopharyngeal Nerve

Vagus Nerve

Accessory Nerve

Hypoglossal Nerve

Lesions of Cranial Nerves

9. Cranial Cavity

The Meninges of the Brain

The Duramater

The Arachnoid Mater

The Piamater

Dural Folds

Falx Cerebri

Falx Cerebelli

Tentorium Cerebelli

Diaphragma Sellae

Summary

Dural Venous Sinuses

The plan of Venous Sinuses

Cavernous Sinus

Extent

Relations

Structures passing through the Cavernous sinus

Tributaries and Connections to Cavernous Sinus

Blood Vessels of the Brain

Cerebrospinal Fluid

Applied Anatomy

10. Introduction to Head and Neck

Skull

Cranial Nerves

Triangles of neck

Deep cervical fascia

Blood Vessels of Head and Neck

Nerves in Neck

Muscles of the Neck

Glands of the Head and Neck

Development of the Head and Neck

Lymphatic Drainage of Head and Neck

11. Osteology of Head and

Neck

Skull

Norma Verticalis

Norma Occipitalis

Norma Lateralis

Temporal Bone

Norma Frontalis

Orbits

Anterior Nasal Aperture

Nasal Cavity

Ethmoid Bone

Maxilla

Norma Basalis

Anterior Part

Palate

Posterior Part

Middle or Sphenoid Part

Sphenoid bone

Interior of Skull

Anterior Cranial Fossa

Middle Cranial Fossa

Posterior Cranial Fossa

Foramina of the Skull

Fractures of the Skull

Fontanelles

Mandible

Fractures of the Mandible

Hyoid Bone

Cervical Vertebral Column

Common Attachments

Cervical Vertebrae

Typical cervical vertebra

Attachments

Atlas

Axis

Attachments

Joints of the Neck

Intervertebral joints

Atlanto occipital Joint

Atlanto axial Joints

Ligaments between the Head and Neck

Muscles that move the head over the Neck

Attachments

Applied Anatomy

Fractures of the Mandible

Cervical Spine

Cervical rib

12. Scalp, Face and Temporal Regions

Structure of Scalp

Blood Supply

Veins of the Scalp

Lymphatic Drainage

Nerve Supply

Lymphatic Drainage

Applied Anatomy

Face

Muscles of Facial Expression

Extracranial Course of Facial Nerve

Branchiomotor Component

Autonomic Component

Sensory Component

Applied Anatomy

Scalp and Face

Eye lids and Lacrimal Gland

Horner’s Syndrome

13. Triangles of Neck

Deep Cervical Fascia

Investing layer

Prevertebral layer

Applied anatomy

Previsceral layer

Applied Anatomy

Carotid sheath

Applied Anatomy

Posterior Triangle

Contents

Applied anatomy

Anterior Triangle

Muscular triangle

Submental triangle

Digastric triangle

Carotid triangle

Applied Anatomy

14. Blood Vessels of Head and Neck

Introduction

Common Carotid Artery

External Carotid Artery

Course and Relations

Branches of External Carotid

Superior Thyroid Artery

Lingual Artery

Facial Artery

Occipital Artery

Superficial Temporal Artery

Subclavian Artery

Branches

Relations

Vertebral Artery

Branches of Vertebral Artery

Thyrocervical Trunk

Suprascapular Artery

Transverse Cervical Artery

Costocervical Trunk

Dorsal Scapular Artery

Veins of Head and Neck

Internal jugular vein

Relations

Tributaries

External Jugular Vein

Anterior Jugular Vein

Applied Anatomy of Veins of the Neck

Applied Anatomy of Arteries of the Neck

Lymphatic Drainage of Head and Neck

Drainage of Salivary Glands

Drainage of Tongue

Drainage of Thyroid Gland

Drainage of Larynx

Drainage of Scalp

Drainage of Face

Drainage of Nose and Paranasal Sinuses

Submental Nodes

Submandibular Nodes

Parotid Nodes

Superficial Cervical Nodes

Occipital Nodes

Prelaryngeal Nodes

Retropharyngeal Nodes

Deep Cervical Nodes

Jugulo-digastric Nodes

Jugulo-omohyoid Nodes

Applied Anatomy

15. Glands of Head & Neck

Sublingual Gland

Submandibular Gland

Superficial Part

Deep Part

Submandibular Duct

Blood Supply

Lymphatic Drainage

Nerve Supply

Parotid Gland

Parts of Parotid Gland

Surfaces and Borders

Structures passing inside Parotid Gland

Parotid Duct

Blood Supply

Lymphatic Drainage

Nerve Supply

Parotid Lymph Nodes

Thyroid Gland

Dimensions of Thyroid

Lobes of Thyroid

Borders and Surfaces

Capsules of Thyroid

Blood Supply

Lymphatic Drainage

Nerve Supply

Structure of Thyroid

Development of Thyroid

Parathyroid Gland

Pituitary Gland

Applied Anatomy of Glands of the Neck

16. Muscles of Neck

Introduction

Scalene Muscles

Prevertebral muscles

Postvertebral (Back) Muscles of Neck

Suboccipital Muscles

Suboccipital Triangle

17. Nerves in Neck

IX, X, XI, XII Nerves at base of Skull

Cervical Plexus

Ansa Cervicalis

Phrenic Nerve

Cervical Sympathetic Chain

18. Oral Cavity and Pharynx

Tongue

Definition and Location

Parts of Tongue

Muscles of the Tongue

Histology of Tongue

Development of Tongue

Nerve supply of Tongue

Blood Supply of Tongue

Lymphatic drainage

Applied anatomy

Pharynx

Definition and Location

Parts of Pharynx

Interior of Pharynx

Muscles of Pharynx

Nerve Supply

Applied Anatomy

Palate

Introduction

Hard Palate

Soft Palate

Structure of Soft Palate

Nerve Supply

Blood Supply

Lymphatic drainage

Development of Palate

Auditory Tube

Bony Part

Cartilaginous Part

Relations of Auditory Tube

Applied Anatomy

19. Nasal Cavity and Larynx

Introduction

Ethmoid Bone

Nasal Septum

Blood Supply

Nerve Supply

Lateral wall of Nose

Conchae and Meatuses

Blood Supply

Paranasal Air Sinuses

Maxillary Air Sinus

Blood Supply

Nerve Supply

Frontal Air Sinus

Sphenoidal Air Sinus

Ethmoidal Air Cells

Larynx

Skeletal framework of Larynx

Cricoid Cartilage

Thyroid Cartilage

Arytenoid Cartilage

Cuneiform and Corniculate Cartilages

Ligaments and Membranes

Cavity of the Larynx

Mucous Membrane of Larynx

Muscles of the Larynx

Nerve Supply

Blood Supply

Lymphatic Drainage

Trachea

Applied Anatomy

20. Ear

Evolution of Balance and Hearing

External Ear

Middle Ear

Tympanic Membrane

Ear Ossicles

Mastoid Antrum

Internal Ear

Membranous Labyrinth

Bony Labyrinth

21. Orbital Cavity

Bony Orbit

Contents of Orbit

Rectus Muscles

Superior Oblique Muscle

Inferior Oblique Muscle

Nerve supply

Actions of extra ocular muscles

Axes and Movements

Ophthalmic Artery

Branches of Ophthalmic Artery

Ophthalmic Veins

Orbital Fascia and Orbital Fat

Lacrimal Apparatus

Lacrimal Gland

Structure of Lacrimal Gland

Blood Supply

Nerve Supply

Conjunctival Sac

Lacrimal Sac

Nasolacrimal duct

22. EYEBALL

Evolution of the Sense of Vision

Eyeball

Sclera or Fibrous Layer

Cornea

Choroid or Pigment Layer

Choroid

Ciliary Body

Iris

Retina

Refractive Media

Development

23. Infratemporal Region

Temporomandibular Joint

Articular Surfaces

Movements at the TM joint

Muscles causing these Movements

Capsule of TM Joint

Ligaments of TM Joint

Applied Anatomy

Muscles of Mastication

Masseter

Temporalis

Medial pterygoid

Lateral Pterygoid

Infratemporal Fossa

Boundaries

Contents

Pterygomaxillary Fissure

Pterygopalatine fossa

Pterygopalatine ganglion

24. Surface Anatomy of Head

and Neck

Landmarks

Identify the following Midline structures of the neck.

Identify the following structures in front of the neck.

Identify the following structures on the side of the neck

Examine the following muscles of 101 face

Mark the following arteries

Radiological Anatomy

Skull X ray – AP view

Skull X ray – Water’s view

X ray of Cervical Spine

CT Scan of Neck

CT Scan of Head

Introduction to Human

Brain

Nervous system is the system that controls and coordinates all other systems. Nervous system consists of brain and spinal cord and the nerves that emerge out of them. Brain and spinal cord are called central nervous system and the nerves emerging out are called peripheral nervous system.

Three types of nervous systems developed in the course of evolution. The oldest and the simplest form of nervous systems is a network seen first in coelenterates. There is neither centralization nor polarization in this type of primitive nervous system. Later on, a few neurons have accumulated to form ganglia. Most of the invertebrates show a ganglionic nervous system. Two chains ganglia control the invertebrate body in a segmental pattern. Then the most advanced type of tubular nervous system had evolved. Millions of neurons have accumulated to form the neural tube. This type of nervous system is seen not only in vertebrates but all chordates. Chordates are called so because of the presence of notochord in some stage of their life, i.e. either in the embryo or in the adult body. Chordates are characterized by the presence of the tubular nervous system. Notochord is a skeletal element located ventral to and supporting the neural tube. Later in evolution a vertebral column – first cartilaginous and then bony – developed around the notochord.

When newer types of nervous systems have emerged in evolution the older structures did not vanish. They continue to exist but are functioning at a subordinate level. So, we see many nerve plexuses in the human body, the most developed of them seen in the walls of the elementary canal. These nerve plexuses are in turn controlled by the ganglionic nervous system.

The ganglionic nervous system consists of a series of ganglia from head to tail. The ganglionic nervous system of the invertebrates not only became subordinated to the tubular nervous system of the vertebrates, but it itself became specialized into two divisions – sympathetic and parasympathetic. Four ganglia in the head and two to three ganglia in the sacral region became parasympathetic, remaining became sympathetic. The sympathetic ganglia are connected to one another in the form of a chain located on each side of the vertebral column. The sympathetic chains extend from the base of the skull up to the sacrum. A few ganglia are located between the sympathetic chain and the corresponding organs they control.

Fig. 1.1. Three types of Nervous Systems Evolved

Vegetative nervous system

Ganglionic nervous system can also be called vegetative nervous system because it controls those functions (like digestion, respiration, excretion and reproduction) that are common to plants and animals, in some form or other. In contrast, the locomotor functions are peculiar to animals. Invertebrates managed with smooth muscle for locomotion, whereas vertebrates (or chordates) have acquired a new and powerful skeletal muscle.

Fig. 1.2. Ganglionic (Autonomic) Nervous System. (only Parasympathetic shown)

So, the older smooth muscle is controlled by the older ganglionic nervous system while the skeletal muscle is directly controlled by the tubular nervous system. The older smooth muscle and glands are first controlled by the ganglionic nervous system, which is in turn controlled by the tubular nervous system. So, there are two neurons (or links) in the ganglionic nervous system, whereas in the control of the skeletal muscle there is no break or synapse.

Two neurons

The two neurons that control the vegetative functions in a series are called the preganglionic and the postganglionic neurons. The post ganglionic neuron extends from the ganglion to the organ and so old and so forms the gray rami communicans. The preganglionic neuron extends from the neural tube (spinal cord or brainstem) to the ganglion and controls it and so new and so forms the white rami communicans.

The sympathetic ganglia are organized into a chain on each side and are located relatively away from the organs controlled and nearer to the vertebral column, whereas the para-sympathetic ganglia are located nearer or inside the organ controlled and away from the neuraxis.

The main parasympathetic nerve that controls most of the viscera is the vagus nerve, the tenth cranial nerve. Vagus controls most of the thoracic and abdominal viscera up to the splenic flexure