Neuroanatomy lecture

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1. Problem Based Approach Dr. Gregory Budiman NEUROANATOMY 2. The aim of the lecture : To help instantly understood neuroanatomy that is essential to this module To give summary of clinically relevant neuroanatomy with examples of medical cases. Stephen Goldberg : Most lecturers provide far more detail than is necessary to applied anatomy. As a result student becomes confused by mazes of unimportant structures. 3. What to do : Before discussion : Watch and study the DVD : Gross Neuroanatomy Basic Neuronatomical Pathways Jaras-jaras Neuroanatomi During the discussion Use Basic Neuroanatomical Pathways (Gregory) and Clinical Neuroanatomy (Snell) as references 4. How can impulse be transmitted in our body? (physiology) What structures supports the transmission of the impluse in our body? 5. Central nervous system BRAIN Spinal cord Ascending tracts Descending tracts Sensory nerve Motor nerve Receptor effector Peripheral Nervous System Aff Eff 6. mesencephalon pons Medulla oblongata Diencephalon (thalamus) Telencephalon 7. What happen if your head got injured? Subcutaneus haematom Epidural haematom Subdural hameatom Subarachnoid bleeding/haemorrhage 8. Protection of CNS : Extracranial protection :SCALP : 1. Skin : 2. Connective tissue: contains a/v/n 3. Aponeurosis (Galea aponeurotica): tendon of frontal and occipital epicranius 4. Loose connective tissue : enabling movement of the above layer 5. Periosteum 9. Intracranial protection : MENINGES duramater arachnoid piamater periosteal meningeal Epidural space (potential) Subdural space (potential) Subarachnoid space (actual) What is the contain of subarachnoid space? Sinus duramatris 10. Epidural Haematom : occurred when a.meningea media is ruptured. The blood will fill the epidural space Subdural haematom : occurred when bridging vein (connects cerebral vein to sinus sagitalis superior) is ruptured.. Subarachnoid bleeding : occurred when an aneurism of large artery of the brain is ruptured. The blood fills the subarachnoid space usually no space occupying lesion (SOL) Intracerebral haemorrhage (cerebrovascular accident) occurred when small branch of artery is ruptured. 11. Have you seen a newborn baby with a very big head? What do you think that cause this abnormality? 12. Ventricles (located inside the brain) Lateral ventricles are located in cerebral hemispheres and have several horns Anterior horn (frontal lobe) Posterior horn (occipital lobe) Inferior horn (temporal lobe) Third ventricle : located in thalamus Aquaductus cerebri Sylvii (cerebral aquaduct) Fourth ventricle foramen luscha and foramen Magendie Central canal : along the spinal cord but usually undergo obliteration * On the wall of each ventricle there are choroidal plexus which produce cerebrospinal fluid/CSF 13. CSF circulation Choroid plexus V.I-II V.III V.IV Subarachnoid space Granulatio arachnoidales Pachioni Sinus duramatris 14. Sinus duramatris 1. Falx cerebri 2. Falx cerebelli . 3. Tentorium cerebelli 4. Diafragma sellae 5. Sinus sagitalis superior 6. Sinus sagitalis inferior 7. Vena cerebri magna Galeni 8. Sinus rectus 9. Confluen sinuum 10. Sinus transversus 11. Sinus sigmoid 12. Vena jugularis 13. Sinus perosus superior 14. Sinus petrosus inferior 15. Sinus cavernosus 16. Vena ophtalmica 17. Menghub. Sinus sphenoparietalis 18. Lacuna lateralis 19. Vena emissaria 20. granulatio aracnoidales 15. In case of meningitis or encephalitis we should examine the CSF. How can we get sample of CSF? 16. The extension of subarachnoid space (cystern) Cisterna cerebellomedullaris (cisterna magna) occipital puncture danger Cisterna pontis Cisterna interpeduncularis (basalis) Cisterna lumbalis lumbal puncture (LIII/IV or LIV/V) 17. Homework: At what level of vertebral bone whould we puncture to get CSF sample in a baby? 18. You know that if a patient get cerebrovascular accident he usually get paralysis. However, can you explain why patient A get arm and facial paralysis meanwhile patient B get leg paralysis only. How can it be? 19. a.carotis internaa.cerebri anterior a.communicans anterior a.cerebri media a.cerebri posterior a.communicans posterior a.basilaris 20. a.cerebelli superior a.cerebelli inferior anterior a.cerebelli inferior posterior a.basilaris a.vertebralis 21. L A H Look at the picture of motor homonculus 22. L A H 23. Homework : Can infection of orbital or facial region affect the brain? Patient A got paralysis of arm, leg, and face on the left side. What area was probably affected? 24. Mr. X fell down in the bathroom and got paralysis of his left arm and left leg. His facial muscles also got paralysis on the right side! Thus, the facial muscles got paralysis on the right side meanwhile the limb muscle got paralysis on the left side. Where is the location of the affected area? Cerebral cortex brainstem spinal cord? 25. lesion 26. Mr. Y ride a motorcycle in a very long distance. After he got off his bike he found that his facial muscle was retracted to the left side. He couldnt close his right eye. What happen to Mr.Y? 27. Homework : Mr. Z got cerebrovascular accident. According to the attendant physician, he got an infarction at the area of left internal capsule. What limbs would get paralysis? Could he close his both eyes? To what side his face should be retracted? If he ordered to protrude his tongue, to what side the tongue would move? 28. Mr. A, fell down the stairs and got a back injury. He complained that his right leg up to his right belly under the navel was numb. It was proven by the absence of pain when the doctor pinched the skin of the affected vigorously. When he was ordere to lift his two legs, he could only lift his right leg meanwhile his left leg was paralized. 29. According to the attending doctor Mr. Amir got hemisection of the spinal cord. Which segment of the spinal cord was injured? Mention the injured pathways! What were the result of the reflect examination of the patient? What were the results of the discriminative tactile examination of his both leg? 30. One day, Anto watched a horror film. When he saw a murderer killed the victim, Antos face became pale, sweated very much, and his heartbeat increased. Can you explain how the visual impulse can be interpreted and influence the autonomic nervous system? 31. Visual impulse Primary visual cortex Secondary visual cortex (association area) Limbic system hypothalamus anterior posterior Sympathetic division Craniosacral outflow Parasympathetic division Thoracolumbal outflow 32. A physician found that Mr.Heru got pupillary constriction, slight ptosis, and decreased sweating. The patient had a history of pancoast tumor, tumor that affect the apex of the lung. What do you think to be the cause of the symptoms? 33. Lecture on peripheral nervous system and its clinical aspects will be given in musculoskeletal module. 34. Thank You! gregorybudiman@yahoo.com http://scele.ui.ac.id fakultas kedokteran modul neuroscience (neuroanatomi) by Deswaty F, M.Biomed