Showing posts with label spine. Show all posts
Showing posts with label spine. Show all posts

Tuesday, March 10, 2009

ms anatomy II: neurocranium part II

[picture courtesy of erica zelfand]
this is the second lecture in the series on the "neurocranium" and dealt with a variety of topics such as structure of the brain, functions of each lobe, blood supply, spinal cord, meninges, glial cells, and the blood brain barrier.

the cerebral portion of the brain is divided up into different lobes, which have been shown to have distinct cognitive and emotional correlates. for example, the frontal lobe is the primary motor area, and is also involved in speech and behavior. the parietal lobes are involved in somatosensory input, prioprioception, sense of self. the temporal lobes are involved in audition, olfaction, and memory. the occipital lobes are involved in vision. cerebellum, midbrain, medulla, are underneath the cerebral portion and are involved more in basic physiological processes. for example, the medulla is involved in autonomic regulation of the cardiovascular system and respiration. the hypothalamus is involved in autonomic, affective, and hormonal activity. the midbrain is involved in motor control. the cerebellum is involved in motor coordination and timing.

the blood supply to the brain comes ultimately from the brachiocephalic branch of the aorta, which branches into the common carotid and the subclavian. the vertebral arteries branch off of the subclavian, travel in the transverse foramen of C1-C6, and penetrate the atlanto-occipital membrane. from there they ascend on the ventral surface of the brainstem and combine to form the basilar artery, from which other arteries branch out (see diagram) such as the pontine and cerebellar arteries. the common carotid artery, on the other hand, branches into the internal and external common carotid; the internal common carotid branches into the anterior and middle cerebral arteries, which supply blood to the lateral and medial cerebral cortex, internal capsule, basal ganglia, and cingulate gyrus. the occlusions in each of these small branches can produce different effects (see diagram).

a few details about the spinal cord: it extends down to L1, beyond which the dura extends until S2. the spinal cord ends at the conus medullaris, a tapering down of the cord which ends in the caudus equinus, which is a splaying out of a horse tail-like arrangement of nerve rootlets. around the spinal cord, there are the three meninge layers: pia, arachnoid, dura mater. denticulate ligaments are pial "projections" into the arachnoid and dura mater which serve to anchor the spinal cord. the filum terminale is the pial strand that connects from the end of the spinal cord (L1) to the end of the dural sac (S2).

a few notes about glial cells and the blood brain barrier. glial cells were covered briefly in histology as the cells that "support" the neurons. in the central nervous system these cells are astrocytes, oligodendrocytes. oligodendrocytes are the cells that produce the myelin sheath that increases the rate of neuronal conduction. whereas schwann cells can only wrap around 1 axon, a single oligodendrocytes can wrap up to 50 different axons. astrocytes provide electrical insulation between neurons, secrete neuronal growth factors and cytokines, and absorb neurotransmitters. they can be further divided into protoplasmic and fibrous- fibrous astrocytes are involved in repairing damaged neuronal tissue. astrocytes also aid in the maintenance of the blood brain barrier, which is made up of astrocyte foot processes, basal lamina, pericytes, and endothelium.

questions
general anatomy and fissures...
1. cerebral hemispheres include...
2. the cerebral cortex is the site for...
3. what are gyri and sulci/fissures?
4. what are the three main fissures in the brain?
5. what does the longitudinal fissure separate?
6. what does the lateral fissure separate?
7. what does the central fissure separate?

functions of...
8. frontal lobe
9. parietal lobe
10. occipital lobe
11. temporal lobe
12. medulla
13. cerebellum
14. pons
15. midbrain
16. thalamus
17. hypothalamus

cerebral arteries...
18. where does the common carotid artery branch off from?
19. where does the common carotid artery split?
20. what does the internal carotid artery split into?
21. what does the internal carotid artery supply blood to?
22. what is the difference between an ischemic and hemorrhagic stroke?
23. where does the middle cerebral artery run?
24. what do the cortical branches supply blood to and what occurs during a stroke of these arteries?
25. what do the lateral striate branches supply blood to and what occurs during a stroke of these arteries?
26. what does the anterior cerebral artery supply blood to?
27. what happens after stroke in the anterior cerebral artery?

basivertebral arteries...
28. describe the passage of the vertebral artery.
29. vertebral arteries unite to form...
30. where is the path of the basilar artery? what does it branch into?
31. what does occlusion in the anterior and posterior spinal branch lead to?
32. what does occlusion in the posterior inferior cerebellar branch lead to?
33. what does occlusion in the anterior inferior and superior cerebellar branch lead to?
34. what does occlusion in the pontine arteries lead to?
35. what does occlusion in the labyrinthine branch lead to?
36. how do occlusions of the vertebral basilar arteries result in deficits in vision?
37. how do occlusions of the vertebral basilar arteries result in problems with balance?

posterior cerebral and circle of willis...
38. where does the posterior cerebral artery project to?
39. what happens when the posterior cerebral artery is occluded?
40. what is the circle of willis?
41. what does the anterior communicating artery connect?
42. what does the posterior communicating artery connect?

spinal cord...
43. how far down does the spinal cord extend?
44. how far down does the spinal dura extend?
45. what is the conus medullaris?
46. what is the cauda equina?
47. where is the junctional zone between the central and peripheral nervous systems?
48. what does the dura turn into at this point?

meninges and spinal veins...
49. how far down does the dura mater extend?
50. what is in the epidural space?
51. what is arachnoid mater?
52. what are denticulate ligaments?
53. what is the filum terminale?
54. where would one extract CSF from the spinal cord?
55. what are the two ways of administering anesthetic to the spinal cord?
56. what does the basivertebral vein do?
57. what is the connection between the basivertebral veins and prostate cancer?
58. describe the vertebral vein's use as a shunt.

glial cells and blood brain barrier...
59. what are oligodendrocytes and what do they do?
60. "unlike schwann cells, oligodendrocytes do not..."
61. what do astrocytes do?
62. what is the difference between protoplasmic and fibrous astrocytes?
63. what are microglia and what do they do?
64. what cell types line the ventricles?
65. what makes up the blood brain barrier?
66. what is the blood brain barrier maintained and induced by?
67. describe the transport of glucose, amino acids, and gases through the blood brain barrier.
68. which brain regions is there no blood brain barrier?

answers
1. white matter, basal ganglia, cerebral cortex.
2. sensorimotor integration, perceptive quality of our experiences
3. gyri are convolutions of the cortex and sulci are divisions or gaps between the gyri.
4. longitudinal, lateral, central.
5. the left and right hemispheres.
6. the frontal and temporal lobes.
7. the frontal and parietal lobes.

8. primary motor area, speech, behavior
9. sensorimotor, prioprioception, association of sensorimotor-audition-vision, formation of egocentric space, sense of self
10. vision
11. audition, olfaction, memory
12. autonomic control over respiration, cardiovascular systems
13. motor coordination and timing
14. cerebellar connection
15. motor control
16. sensorimotor information to cerebral cortex
17. autonomic, hormonal, affective activity

18. the brachiocephalic branch of the aortic arch.
19. at the carotid sinus into the internal and external carotid arteries.
20. anterior and middle cerebral arteries
21. most of the cerebral hemispheres.
22. ischemic is blockage of the cerebral artery via a thrombus or embolus which leads to necrosis. hemorrhagic is rupture of the artery which causes a hematoma, which leads to necrosis.
23. in the lateral fissure; along the lateral surface of the cerebral cortex.
24. lateral surface of cortex. stroke causes sensory, motor, language deficits.
25. internal capsule and basal ganglia. stroke causes hemiplegia.
26. medial surface of cerebral cortex, including cingulated gyrus.
27. sensory, motor, emotional deficits.

28. branches off the subclavian artery, passes through transverse foramina of C1-C6, and penetrates the atlanto occipital membrane.
29. basilar artery on ventral medulla.
30. the ventral surface of the brainstem; branches into cerebellar, pontine, posterior cerebral arteries.
31. loss of spinal cord function
32. Wallenberg syndrome: loss of sensation of pain, heat, muscle coordination.
33. loss of muscle coordination.
34. cranial nerve dysfunction.
35. deafness and vertigo.
36. torsion/compression of vertebral basilar arteries can reduce blood flow to brain stem, cerebellum, occipital lobe- anoxia in the occipital lobe causes loss of vision.
37. anoxia in cerebellum or inner ear can cause problems with balance.

38. temporal and occipital lobes.
39. visual deficits.
40. the anterior and posterior communicating arteries.
41. anterior cerebral arteries.
42. middle and posterior cerebral arteries.

43. down to L1.
44. down to S2.
45. tapered end of the spinal cord.
46. the “horse’s tail”, the end of the spinal cord which branches into nerve roots that extend to lumbar and sacral foramina.
47. the intervertebral foramina
48. the epineurium that covers the dorsal and ventral rami and ganglia.

49. S2
50. veins and fat.
51. the meninge layer in between the dura and pia mater, with trabeculae inside the subarachnoid space.
52. pial connective tissue that suspends spinal cord to the inside of arachnoid / dura mater.
53. a pial strand that connects down to the end of the dural sac.
54. from the subarachnoid space.
55. to the epidural and subdural spaces.
56. drains vertebral bodies.
57. prostate cancer can metastasize into vertebrae through the basivertebral veins.
58. blood shunts from caval veins into vertebral veins if IVC constricted (while coughing, for example)

59. cells in the CNS that myelinate up to 50 axons.
60. "cover unmyelinated axons, which lay bare in the CNS"
61. electrically insulate neurons from each other, uptake neurotransmitters and ions, and secrete neuronal growth factors and cytokines.
62. protoplasmic interconnect neurons, induce early growth and development of the blood/brain barrier, whereas fibrous form astrocytic scars after brain tissue destruction.
63. phagocytic cells related to monocyte/macrophages which consume debris and secrete cytokines during inflammation.
64. ependymal cells.
65. endothelium, pericytes, basal lamina, astrocyte foot processes.
66. maintained by astrocytes.
67. glucose and amino acids pass through BBB via transport proteins, and gases diffuse through lipid membrane.
68. hypothalamus, area postrema, other periventricular regions.

Wednesday, December 3, 2008

MS anatomy: deep back and neck

this lecture covered the anatomy of the spine as well as the muscles of the deep back, head, and neck. the spine is made of 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae and a sacrum at the bottom which is made up of 5 fused vertebrae. notable differences between the three vertebral sections: cervical vertebrae have short, split spines, while thoracic vertebrae have long, downward sloping ones. lumbar vertebrae have extra processes next to the transverse processes called mamillary processes. range of movement is wide for cervical and lumbar sections but narrow for thoracic. the spine has two opposite curves, called kyphotic and lordotic. the sacrum and the thoracic spine are kyphotic, folding the body inwards, while the the lumbar and cervical spine have the lordotic curve which has the opposite shape.

some unique features about the top two vertebrae, the atlas (C1) and axis (C2). the atlas lacks a vertebral body and just has anterior and posterior arch. resting in the anterior arch, secured by the transverse ligament, is an upward protrusion from C2, called the "dens" of the axis, which is actually the fusion of the vertebral bodies of C1 and C2. the dens and the atlas form the atlanto-axis pivot joint and allow for rotational movement of the head. the joint between the atlas and the occiput is called the atlanto-occipital joint and is stabilized by a host of muscles that attach to the occiput around it (more to come) as well as the atlanto occipital membrane, a ligament that spans from the posterior occiput to the spinous process of C1. the joint itself is between the superior articular facets of the atlas and the condyles of the occiput.

we then look at the muscles of the back, neck, and head, starting with the muscles of the deep back. these include the erector spinae, the superficial and larger group of back muscles that span from the sacrum to the base of the skull. these include the spinalis, the longissimus, and the iliocostalis. the transversospinalis are a deeper and more intricate set of back muscles that lie in the groove between the transverse and spinous processes-- originating from transverse processes, inserting into spinous processes. the semispinalis covers the upper 1/3 of the spine and each muscle group has a span of 5-8 vertebrae, the multifidus is prominent near the sacrum and spans 3-4 vertebrae a piece, and the rotatores go all along the spine and cover 1-2 vertebrae each. in general, the erector spinae (the larger muscles) are more involved in extension and the transverospinalis muscles (smaller muscles) are more involved in lateral flexion and rotation.

the muscles that aid in movement of the head can be divided into three sections: suboccipital muscles, anterior neck muscles, and lateral neck muscles. suboccipital muscles include the rectus capitis posterior major and minor, and the inferior and superior oblique. for these muscles, when a muscle is oriented vertically, it is involved in extension, and when it is oriented diagonally or horizontally, it is involved in rotation. the anterior neck muscles include the rectus capitis anterior and longus colli and capitis. the lateral neck muscles are the scalenes and SCM. the suboccipital muscles are innervated by the posterior rami of C1, the anterior neck muscles are innervated by C1-4, and the lateral neck muscles are innervated by C2,3 and cranial nerve XI.


questions

vertebrae anatomy
1. spinous process is formed by...
2. transverse process is formed by...
3. mamillary processes...
4. vertebral canal is formed by...
5. zygapophyseal/facet joint is formed by...
6. what are the primary and secondary curves of the spine called?

cervical, thoracic, lumbar vertebrae:
7. body...
8. spines...
9. costotransverse foramen...
10. range of movement...
11. movements...

12. 5 sacral foramen fuse after...
13. sacral foarmina convey...
14. sacral promontory is...
15. what are the sacral crests and what are they made from?
16. sacral canal ends at...
17. what is the coccyx?

18. what is the sacralization of L5?
19. what is the lumbarization of S1?
20. what type of joint is the intervertebral joint?
21. describe the composition of the intervertebral joint.
22. what are the ligaments that support the intervertebral joints?
23. what is a herniated disc?
24. what type of joint is the facet joint?
25. supraspinous ligament...
26. interspinous ligament...
27. ligamentum flavum...

28. what are the anatomical features of C1?
29. what is unique about C2?
30. what is the atlanto-axis joint?
31. what is the transverse ligament?
32. alar and apical ligaments...
33. what is the atlanto-occipital joint and what movement does it allow?
34. what is the atlanto-occipital membrane penetrated by?

deep back muscles
35. what are the erector spinae muscles and where do they originate from?
36. spinalis...
37. longissimus...
38. iliocostalis...
39. what are the transverospinalis muscles?
40. semispinalis...
41. semispinalis capitis is...
42. multifidus...
43. rotatores...
44. what is the splenius and where do the two types attach?
45. describe the difference in action between the long and short deep back muscles.
46. what are deep back muscles innervated by?

suboccipital muscles- origins, insertions, actions
47. inferior oblique...
48. superior oblique...
49. rectus capitis posterior major...
50. rectus capitis posterior minor...
51. which nerve innervates the suboccipital muscles?

anterior neck muscles
52. rectus capitis anterior and lateralis...
53. longus colli and capitis...
54. which nerve innervates the anterior neck muscles?

lateral neck muscles
55. anterior scalenes...
56. posterior scalenes...
57. SCM...

58. flexion of head is mainly due to which muscles?
59. extension of head is mainly due to which muscles?

answers

1. fusion of two pedicles.
2. fusion of pedicles and laminae.
3. are on lumbar vertebrae and can be confused with transverse processes.
4. column of vertebral foramen and houses the spinal cord.
5. joining of superior and inferior articular facets.
6. primary = kyphotic in the thoracic spine and sacrum. secondary = lordotic in the cervical and lumbar spine.

7. oblong, heart shaped, oblong
8. short / bifid, long / downward sloping, intermediate / horizontal
9. transverse foramen, costotransverse, no foramen
10. wide, narrow, wide
11. flex/extend/abduct/some rotation, rotation, flex/extend/abduct/some rotation

12. 20 years
13. anterior and posterior rami of sacral nerves
14. prominent body of S1
15. median crest made from fused SP's, lateral crest from fused TVP's.
16. sacral hiatus
17. 4 small fused vertebrae at the bottom of the sacrum which serve as the origin for pelvic muscles and ligaments.

18. total or partial fusion of L5 to sacrum.
19. total or partial separation of S1 from sacrum.
20. symphysis joint.
21. outer layer is fibrous CT called annulus fibrosus, gelatinous center called nucleus pulposus.
22. anterior and posterior longitudinal ligaments.
23. when pressure between the vertebrae causes the nucleus pulposa to herniate out of the annulus fibrosus and potentially compress spinal nerves against the articular processes.
24. synovial joint.
25. joins tips of vertebral spines
26. spans between vertebral spines
27. elastic CT helps extend vertebral column

28. the "atlas" has an anterior and posterior arch and no vertebral body.
29. the "axis" has an upward protrusion called the "dens" which is the fusion of the bodies of the atlas and axis.
30. the joint that is formed by the dens and the anterior arch of the atlas which allows for the rotation of the head.
31. anchors the dens to the anterior arch.
32. anchor dens to margin of foramen magnum and limits rotational movement.
33. joint between the occipital condyles of the head and the superior articular facets of the atlas. permits flexion and extension of head.
34. C1, vertebral artery.

35. iliac crest and sacrum.
36. interconnects thoracic spinous processes.
37. runs along costovertebral region, also has a capitis portion.
38. goes from iliac crest to ribs.
39. semispinalis, multifidus, rotatores- muscles that span from sacrum to base of skull. lie within groove between transverse and spinous processes and go from TP's to SP's.
40. semispinalis spans 5-8 vertebrae, are in the upper 1/2 of vertebral column.
41. strongest extensor of the skull.
42. spans 3-4 vertebrae, thickest over sacrum
43. span 1-2 vertebrae throughout spine.

44. muscle that goes from spinous processes to TP's or to skull. capitis attaches to mastoid process, cervicis attaches to TP's.
45. long deep back muscles more extension, short deep back muscles more rotation and lateral flexion.
46. posterior rami of spinal nerves.

47. O: spine of axis I: TP of axis A: rotate
48. O: TP of axis I: occiput A: extend
49. O: spine of axis I: occiput A: extend and rotate
50. O: posterior tubercle of atlas I: occiput A: extend
51. posterior ramus of C1

52. O: TP of atlas I: occiput A: flexion and lateral flexion and stabilization of altantoocciptal joint.
53. O: body and TP's of cervical vertebrae I: same, plus occiput A: flexion
54. C1-4

55. O: upper TP's I: 1st rib A: flexion of head, raise ribs N: lower cervical nerves
56. O: upper TP's I: 2nd rib A: flexion of head, raise ribs N: lower cervical nerves
57. O: manubrium, clavicle I: mastoid process A: flexion, lateral flexion, rotation, raise ribs N: motor-spinal accessory (cranial nerve XI), C2,3

58. SCM, rectus capitis anterior, longus capitis / colli
59. trapezius, rectus capitis posterior, superior oblique