Basic AnatomyHairSCALPSkinConnective tissueAponeurotis (galea aponeurotica)Loose areolar connective tissuePericranium

Basic AnatomySkullFrontal boneParietal boneTemporal bonePetrous partSquamous partMastoid partOccipital bone

Basic AnatomyDura mater (not attach to arachnoid)Subdural space -bridging veinsArrachnoid membraneSubarrachnoid space : CSF, VesselsCSF : Shock absorber, immunological functionPia membraneBrain parenchyma

6/7/12Basic AnatomyTentorium cerebelli Supratentorial compartment Infratentorial compartment

Uncal herniation Kernohans notch syndrome :hemiplegia and dilated pupil on the same side

Basic AnatomyForebrain Frontal lobeParietal lobeTemporal lobeOccipital lobe Diencephalon

Basic AnatomySurface anatomy

Basic AnatomyMidbrain (mesencephalon)

Hindbrain (Rhombencephalon)

Basic AnatomyCranial nerve = Brainstem except CN I and IIReticular activating system :midbrain and upper Pons

Basic AnatomyCranial nerveCN III,IV :midbrainCN V: mid ponCN VI :pontomedullaryCN VII,VIII :CPACN IX-XII :Medulla

Basic AnatomyBrainstemReticular nuclei influence direct by cortexPontine reticular formation : + extensor , - flexorMedullary reticular formation : - extensor, + flexorReceives input from cerebral hemisphereRole of voluntary responseRubral nuclei (red nucleus)Tegmentum of midbrain @ sup. Colliculus+ flexor movement in contralat. UE

Inhibit by higher center

Basic AnatomyLesion at Red nucleiMidbrainDecerebrate (M2)

Lesion at above level ofred nuclei Decorticate (M3)

Size of pupils depending on site of pathologyDepend onPupillary light reflexParasym /Sym Pupillary light reflex - Sym- Both sym and parasym-parasym

Basic AnatomyImpairment of level of consciousnessFocal destruction in the reticular formationDiffuse lesion in both cerebral hemisphereBilateral diencephalon dysfunctionRule out metabolic cause

Basic AnatomyCerebellum

Basic AnatomyMotor system : Pyramidal tractCortico-spinal tractCortex : precentral gyrusCorona radiataPosterior limb of internal capsuleCerebral peduncle

Basic AnatomyPyramidal decussation at caudal third of medullaLateral cortico-spinal tractLE : lateral UE : MedialUncrossed : ventral cortico-spinal tract

Basic Anatomy

6/7/12Sensory level assessmentPain-temp Lateral Spinothalamic tractLight ( Crude ) touch anterior cord Ventral spinothalamic tractProprioception/joint position sense, discriminative touchposterior column medial lemniscusCrossed at Lower medulla

Basic Anatomy

Basic AnatomyBrainstem reflexPupillary light reflexCorneal reflexOculocephalic reflex (dolls eye)Oculovestibular reflex (cold water calorics test)Oropharyngeal reflex (gag)Cough response

ReflexPeripheral reflexBarbinskiClonus

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