Clinical Neuroanatomy and Neuroscience: With STUDENT CONSULT Access, 6e

432 Pages·2011·27.92 MB·English

Clinical Neuroanatomy
and Neuroscience
Sixth Edition
Cover picture kindly provided by Dr. Alexander Leemans, Image Sciences Institute, University
Medical Center, Utrecht, The Netherlands, via Dr. Dara Cannon, Co-Director, Clinical
Neuroimaging Laboratory, Department of Psychiatry, National University of Ireland, Galway.
Commissioning Editor: Madelene Hyde
Development Editor: Joanne Scott
Editorial Assistant: Rachael Harrison
Project Manager: Alan Nicholson
Design: Charles Gray
Illustration Manager: Gillian Richards
Marketing Manager (US, ROW): Jason Oberacker/Ian Jordan
S I X T H E D I T I O N
Clinical Neuroanatomy
and Neuroscience
M J Turlough FitzGerald,
MD, PhD, DSc, MRIA
Emeritus Professor of Anatomy
Department of Anatomy
National University of Ireland
Galway, Ireland
Gregory Gruener,
MD, MBA
Director, Leischner Institute for Medical Education
Leischner Professor of Medical Education
Senior Associate Dean, Stritch School of Medicine
Professor of Neurology, Associate Chair of Neurology
Loyola University Chicago
Maywood, IL, USA
Estomih Mtui,
MD
Associate Professor of Clinical Anatomy in Neurology and Neuroscience
Director, Program in Anatomy and Visualization
Weill Cornell Medical College
New York, NY, USA
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Main Edition
ISBN: 978-0-7020-3738-2
International Edition
ISBN: 978-0-7020-4042-9
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Fitzgerald, M. J. T.
Clinical neuroanatomy and neuroscience. – 6th ed.
1. Neuroanatomy. 2. Neurosciences. 3. Nervous system-Diseases. 4. Nervous system-Pathophysiology.
I. Title II. Gruener, Gregory. III. Mtui, Estomih.
611.8-dc22
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Printed in China
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Contents
Preface vii
Clinical Perspectives viii
Panel of Consultants ix
Student Consultants ix
Acknowledgement xi
1 EMBRYOLOGY 1
2 CEREBRAL TOPOGRAPHY 7
3 MIDBRAIN, HINDBRAIN, SPINAL CORD 30
4 MENINGES 45
5 BLOOD SUPPLY OF THE BRAIN 55
6 NEURONS AND NEUROGLIA: OVERVIEW 70
7 ELECTRICAL EVENTS 83
8 TRANSMITTERS AND RECEPTORS 93
9 PERIPHERAL NERVES 112
10 INNERVATION OF MUSCLES AND JOINTS 120
11 INNERVATION OF SKIN 129
12 ELECTRODIAGNOSTIC EXAMINATION 134
13 AUTONOMIC NERVOUS SYSTEM AND VISCERAL AFFERENTS 148
14 NERVE ROOTS 165
15 SPINAL CORD: ASCENDING PATHWAYS 176
16 SPINAL CORD: DESCENDING PATHWAYS 186
17 BRAINSTEM 198
18 THE LOWEST FOUR CRANIAL NERVES 216
19 VESTIBULAR NERVE 223
20 COCHLEAR NERVE 229
21 TRIGEMINAL NERVE 234
22 FACIAL NERVE 240
23 OCULAR MOTOR NERVES 245
24 RETICULAR FORMATION 253
vvv
CONTENTS
25 CEREBELLUM 267
26 HYPOTHALAMUS 277
27 THALAMUS, EPITHALAMUS 284
28 VISUAL PATHWAYS 289
29 CEREBRAL CORTEX 299
30 ELECTROENCEPHALOGRAPHY 313
31 EVOKED POTENTIALS 323
32 HEMISPHERIC ASYMMETRIES 331
33 BASAL GANGLIA 342
34 OLFACTORY AND LIMBIC SYSTEMS 352
35 CEREBROVASCULAR DISEASE 377
Glossary 392
Index 406
vi
Preface
This textbook is designed as a vade mecum (‘go with me’) The Visual pathways chapter (Ch. 28) lays out the largest
for medical students. While based on campus, the gross and of all horizontal pathways, stretching from the very front end
microscopic structures of the nervous system take prece- of the brain – the retina – to the very back – the occipital
dence, along with their great diversity of functions. A strong cortex. Its clinical significance is obvious.
stimulus to understand normal structure and function is pro- Chapter 29 examines the histological structure of the cer-
vided by clinical examples of the consequences of break- ebral cortex, and provides a summary functional account of
downs of diverse kinds. While hospital-based, consultation the different cortical areas. Electrical activities are examined
of the book in a clinical setting recalls the functional anatomy by means of electroencephalogrophy (Ch. 30) and evoked
studied on campus. Sequential fusion of descriptive structure, potentials (Ch. 31). Functional inequalities between the left
function, and malfunction is known as vertical integration and right sides of the brain are the subject of Chapter 32,
and is highly recommended owing to its manifest logic. hemispherical asymmetries.
The basal ganglia (Ch. 33) are a group of nuclei at the base
Chapters and Pages of the brain primarily involved in the control of movement.
Following a brief account of nervous system development The most frequent failure of control takes the form of Par-
in Chapter 1, the topography of the brain and spinal cord kinson’s disease.
and their meningeal surrounds occupies Chapters 2–4. Next The final anatomic structures, analyzed in Chapter 34, are
(Ch. 5) comes the clinically very important blood supply. the olfactory (smell) system and the limbic system, the latter
Microscopic and ultramicroscopic anatomy of neurons (nerve being of major emotional significance.
cells) and neuroglia (their surrounding ‘nerve glue’) come to Chapter 35 is about cerebrovascular disease. The main
the fore in Chapter 6, along with some compression effects purpose of this chapter is to highlight the functional defects
of expanding neuroglial tumors. that follow cerebral hemorrhage or thrombosis.
Chapter 7 changes the context by describing electrical
events underlying the impulses that are triggered at the point
Chapter title pages feature:
of origin of axons and speed along the axons and their
Chapter Summary A list of the items to be dealt with in
branches to liberate excitatory or inhibitory molecules onto
the chapter.
target neurons. These molecules, pillars of the science of
Boxes Contain titles of structures/functions to be exam-
neuropharmacology, are examined in Chapter 8. Chapters
ined in detail.
9–11 explore the structure and distribution of the peripheral
Clinical Panels Functional disorders related to this
nerves attached to the spinal cord and innervating the
material.
muscles and skin of the trunk and limbs. Electrical activity
Study Guidelines A running commentary on the subject
returns in Chapter 12 in the form of electromyography, a
matter, stressing features of clinical importance.
technique widely used in the detection of neuromuscular
disorders of various kinds.
The autonomic nervous system (Ch. 13) controls the
Website features
smooth musculature of the vascular system and of the ali-
Tutorials Each chapter contains a ‘Web tutorial’ notification
mentary, urinary, and reproductive tracts. The spinal nerves
at an appropriate point. Clicking the appropriate button will
(Ch. 14) attached to the whole length of the spinal cord, are
deliver a slide show on the relevant topic, with a script
‘mixed’ (both motor and sensory) and innervate all of the
and optional voiceover commentary. Particular attention is
voluntary muscles and skin in the trunk and limbs. Descrip-
drawn to ‘Nuclear magnetic resonance (Web tutorial 2)’ in
tion of the contents of the spinal cord itself occupies Chapters
Chapter 2 (55 slides) and ‘Arterial supply of the forebrain
15 and 16.
(Web tutorial 5)’ in Chapter 5 (27 slides).
The brainstem (medulla oblongata, pons, and midbrain)
connects the spinal cord to the cerebral hemispheres, as
MCQs Website MCQs are available for each chapter. All
described by means of transverse sections in Chapter 17. The
200 are in USMLE format. Half contain an illustration, half
cranial nerves attached to it (nerves III to XII) are described
are text only.
in Chapters 19–23. Chapter 24 is devoted to the reticular
formation of the brainstem which, inter alia, links cranial
Case studies 30 case studies (127 slides) demonstrating the
nerves to one another.
clinical consequences of physical or inflammatory damage to
The cerebellum (Ch. 25) occupies the posterior cranial
nervous tissues.
fossa. Its afferent (L. ‘carry to’) connections from voluntary
muscles and its efferent (‘carry out’) connections with the
motor cortex in the brain are vital for control the smoothness Faculty resources
of all voluntary movements. An image bank is available to help you prepare lectures via
The hypothalamus (Ch. 26) can be traced back in nature our Evolve website. Contact your local sales representative
as far as the reptiles. It still operates basic survival controls, for more information, or go directly to the Evolve website to
including food and fluid intake, temperature control, and request access: http://evolve.elsevier.com
sleep. Above it are the thalamus and epithalamus (Ch. 27),
the former having numerous vital connections to cerebral TF, GG, EM
vvviiiiii
cortex and spinal cord. 2010
The table below lists the main clinical perspectives covered in the book
CLINICAL PERSPECTIVES
Chapters Perspectives
1 Embryology (Explanatory layout)
2 Cerebral topography (Explanatory layout)
3 Midbrain, hindbrain, spinal cord (Explanatory layout)
4 Meninges Extradural hematoma. Subdural hematoma. Hydrocephalus. Meningitis. Spinal
tap.
Epidural analgesia. Caudal analgesia.
5 Blood supply of the brain Blood–brain barrier pathology.
6 Neurons and neuroglia: overview Brain tumors. Multiple sclerosis. Neuronal transport disorders.
7 Electrical events (Explanatory layout)
8 Transmitters and receptors Some general clinical applications concerning malfunctions and pharmacology.
9 Peripheral nerves Degeneration and regeneration.
10 Innervation of muscles and joints (Explanatory layout)
11 Innervation of skin Neurogenic inflammation. Leprosy.
12 Electrodiagnostic examination Peripheral neuropathies, including entrapment syndromes.
Myasthenia gravis.
13 Autonomic nervous system and Horner’s syndrome. Raynaud syndrome. Stellate block. Lumbar sympathectomy.
visceral afferents Visceral pain. Drug actions on the sympathetic and parasympathetic systems.
14 Nerve roots Spina bifida. Cervical spondylosis. Prolapsed intervertebral disc.
15 Spinal cord: ascending pathways Syringomyelia
16 Spinal cord: descending pathways Upper motor neuron disease. Lower motor neuron disease. Spinal cord injury.
17 Brainstem (Explanatory layout)
18 The lowest four cranial nerves Supranuclear, nuclear, infranuclear lesions.
19 Vestibular nerve Vestibular disorders. Lateral medullary syndrome.
20 Cochlear nerve Conduction deafness. Sensorineural deafness.
21 Trigeminal nerve Trigeminal neuralgia. Referred pain in diseases of the head and neck.
22 Facial nerve Lesions of the facial nerve.
23 Ocular motor nerves Several well-known ocular palsies.
24 Reticular formation Cardiovascular, respiratory, urinary, locomotor controls. Spinal and supraspinal
antinociception.
25 Cerebellum Characteristic clinical pictures associated with lesions of vermis, of anterior lobe
and of neocerebellum. Cerebellar cognitive affective syndrome.
26 Hypothalamus Hypothalamic disorders, including major depression.
27 Thalamus, epithalamus (Explanatory layout)
28 Visual pathways Detection of lesions of the visual pathways, segment by segment.
29 Cerebral cortex (Explanatory layout)
30 Electroencephalography Narcolepsy. Seizures of several kinds and their EEG detection.
31 Evoked potentials Use of visual, auditory, somatosensory and motor evoked potentials in disease
detection. Clinical neurophysiology in relation to acupuncture.
32 Hemispheric asymmetries The aphasias. Developmental dyslexia. Frontal lobe dysfunction. Parietal lobe
dysfunction.
33 Basal ganglia Parkinson’s disease. Cerebral palsy. Huntington’s disease. Hemiballism.
34 Olfactory and limbic systems Alzheimer’s disease. Schizophrenia. Drug addiction.
35 Cerebrovascular disease Eight Clinical Panels about strokes of various kinds.
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Panel of Consultants
Kamal Asaad MBBCH, MSc, PhD Pearse Morris MB, BCh
Professor of Anatomy and Embryology Professor of Radiology
Department of Anatomy Wake Forest University School of Medicine,
Faculty of Medicine Winston-Salem, NC, USA
Ain Shams University
Cairo, Egypt Masao Norita MD, PhD
Professor and Chair
Nadir E Bharucha MD, FAMS, FRCP Division of Neurobiology and Anatomy
Professor and Head Department of Sensory and Integrative Medicine
Department of Neurology Niigata University Graduate School of Medical
Bombay Hospital Institute of Medical Sciences; and Dental Sciences
Head, Department of Neuroepidemiology, MRC, Bombay Asahimachi, Niigata, Japan
Hospital
Mumbai, India Wei-Yi Ong BDS, PhD
Associate Professor
Jagjit S Chopra FRCP, Phd, FAMS, FIAN Department of Anatomy and
Professor Emeritis Aging
Postgraduate Institute of Medical Education and Research Neurobiology Research Programme
Chandigarh, India National University of Singapore
Singapore
Timothy J Counihan MD, FRCPI
Honorary Senior Lecturer in Medicine (Neurology) Hugh Staunton BSc, FRCPI, FRCP, PhD
National University of Ireland Senior Lecturer
Galway, Ireland Department of Clinical Neurological Sciences
Royal College of Surgeons in Ireland
Brian E Leonard PhD, DSc Dublin, Ireland
Emeritus Professor of Pharmacology, National University
of Ireland, Mario Rende MD
Galway, Ireland; Professor of Human Anatomy
Honorary Professor, Department of Psychiatry and Section of Anatomy,
Psychotherapy Department of Experimental Medicine and
Ludwig Maximilian University Biochemical Sciences,
Munich, Germany University of Perugia School of Medicine,
Perugia, Italy
Richard Knight BA, BM BCh, MRCP, FRCP(E)
Professor of Clinical Neurology David T Yew PhD, DSc, Dr med (habil)
Department of Neurology Professor of Anatomy,
University of Edinburgh School of Biomedical Sciences,
Edinburgh, UK Chinese University of Hong Kong,
Hong Kong, SAR
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