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Thomas A. Woolsey MD, lecturer in Biology; George H. and Ethel R. Bishop Scholar in Neuroscience Emeritus; Professor Emeritus of Experimental Neurological Surgery, of Experimental Neurology, of Anatomy and Neurobiology, of Cell Biology and Physiology and of Biomedical Engineering, Washington University School of Medicine, St Louis, MO, USA. Dr Woolsey a world-renowned neurobiologist best known for his discovery of the cortical barrels in rodents. During his nearly forty years at Washington University School of Medicine, he has won numerous awards for teaching medical students, residents, graduate students, and undergraduates in psychology and life sciences.
Joseph Hanaway, MD, retired Clinical Assistant Professor of Neurology, Washington University School of Medicine, St Louis, MO, USA. Dr Hanway has practiced neurology for over thirty years and has taught basic and clinical neuroanatomy at Harvard University, the University of Virginia, Washington University, and the University of Missouri Medical School.
Mokhtar H. Gado, MD, formerly Professor of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA. Dr Gado was an internationally known neuroradiologist with more than thirty-five years of clinical, research, and teaching experience at Washington University School of Medicine and the Mallinckrodt Institute of Radiology.
Preface xi
Acknowledgments xii
About the Digital Companion xiii
Part I Introduction
Overview 4
The Nervous System 5
Cells 5
Gray Matter/White Matter 5
Connections 7
CNS/PNS 7
Constitution of the CNS 7
Principal Divisions of the Brain 8
Cranial Nerves and Spinal Segments 8
Cerebrospinal Fluid and Its Circulation 9
Cortical Areas 10
Using this Book 10
Terminology 10
Terms of Relation-The Special Case of the Human Head 12
Labels 12
Image Groups 13
Pathways 14
Navigation 14
Materials and Methods 14
Subjects 14
Brain Specimens 15
Radiological Imaging 16
References 17
Part II The CNS and Its Blood VesselsnBrain 20
Cerebral Hemisphere and Brain Stem; Sulci and Gyri-Lateral Aspect 20
Cerebral Hemisphere and Brain Stem Arteries; Arteries of the Insula and Lateral Sulcus; Arterial Territories-Lateral Aspect 22
Cerebral Hemisphere and Brain Stem; Sulci and Gyri-Mesial Aspect 24
Cerebral Hemisphere and Brain Stem Arteries; Arterial Territories-Mesial Aspect 26
Cerebral Hemisphere and Brain Stem Arteries; by Conventional Angiography; by MRA-Lateral Projection 28
Dural Venous Sinuses and Folds (Diagrammatic); by Conventional Angiography; by MRV-Lateral Projection 30
Cerebral Hemispheres, Brain Stem, and Arteries; by MRA-Anterior Aspect 32
Cerebral Hemisphere and Brain Stem Arteries and Veins by Conventional Angiography and Veins by MRV-Posteroanterior Projections 34
Cerebral Hemispheres and Brain Stem; Sulci and Gyri--Inferior Aspect 36
Cerebral Hemispheres and Brain Stem: Arteries and Cranial Nerves; Arterial Territories; Axial MRA-Inferior Aspect 38
Brain Stem 40
Brain Stem, Diencephalon, Basal Ganglia, and Cerebellum-Anterolateral Aspect 40
Brain Stem, Diencephalon, Basal Ganglia, and Cerebellum; Arteries and Cranial Nerves-Anterolateral Aspect 41
Brain Stem, Diencephalon, Basal Ganglia, and Cerebellum; Arterial Territories - Anterolateral Aspect 42
Brain Stem, Thalamus, and Striatum- Anterior Aspect 43
Brain Stem, Thalamus, and Striatum- Posterior Aspect 44
Brain Stem, Thalamus, and Striatum- Lateral Aspect 45
Cerebellum 46
Cerebellum-Superior Surface 46
Cerebellum-Inferior Surface 47
Spinal Cord 48
Arteries to Spinal Cord (Diagrammatic) 48
Segmental Arterial Supply of Spinal Cord (Diagrammatic) 49
Fiber Bundles 50
Principal Fiber Bundles in Cerebral Hemisphere and Brain Stem (Semi-Schematic)-Lateral and Mesial Aspects 50
Principal Fiber Bundles in Coronal, Axial, and Sagittal Brain Sections (Semi-Schematic) 51
Part III Brain Slices Coronal Sections 54
Coronal Section Through Rostral Wall of Lateral Ventricle with Vessel Territories 54
Coronal Section Through Anterior Limit of Putamen with MRI 56
Coronal Section Through Head of Caudate Nucleus and Putamen with MRI 58
Coronal Section Through Anterior Limit of Amygdala with Vessel Territories 60
Coronal Section Through Tuber Cinereum with MRI 62
Coronal Section Through Interventricular Foramen (Foramen of Monro) with Vessel Territories 64
Coronal Section Through Anterior Nucleus of Thalamus with MRI 66
Coronal Section Through Mamillothalamic Tract (Fasciculus) with Vessel Territories 68
Coronal Section Through Mamillary Bodies with MRI 70
Coronal Section Through Subthalamic Nucleus with Vessel Territories 72
Coronal Section Through Posterior Limit of Interpeduncular Fossa with MRI 74
Coronal Section Through Posterior Commissure with Vessel Territories 76
Coronal Section Through Commissure of Superior Colliculi with MRI 78
Coronal Section Through Quadrigeminal Plate with Vessel Territories 80
Coronal Section Through Fourth Ventricle (IV) with MRI 82
Coronal Section Through Posterior Limit of Hippocampus with Vessel Territories 84
Coronal Section Through Posterior Horns of Lateral Ventricles with MRI 86
Sagittal Sections 88
Sagittal Section Through Superior, Middle, and Inferior Temporal Gyri with Vessel Territories 88
Sagittal Section Through Insula with MRI 90
Sagittal Section Through Claustrum and Lateral Putamen with Vessel Territories 92
Sagittal Section Through Lateral Putamen with MRI 94
Sagittal Section Through Termination of Optic Tract with MRI 96
Sagittal Section Through Pulvinar with Vessel Territories 98
Sagittal Section Through Ambient Cistern with MRI 100
Sagittal Section Through Olfactory Tract with Vessel Territories 102
Sagittal Section Through Inferior Cerebellar Peduncle (Restiform Body) with Vessel Territories 104
Sagittal Section Through Superior Cerebellar Peduncle (Brachium Conjunctivum) with MRI 106
Sagittal Section Through Red Nucleus with Vessel Territories 108
Sagittal Section Through Cerebral Aqueduct (Aqueduct of Sylvius) with MRI 110
Axial Sections 112
Axial Section Through Superior Caudate Nucleus with MRI 112
Axial Section Through Inferior Corpus Callosum with Vessel Territories 114
Axial Section Through Superior Putamen with MRI 116
Axial Section Through Putamen with Vessel Territories 118
Axial Section Through Frontoparietal Opercula with MRI 120
Axial Section Through Midlevel Diencephalon with Vessel Territories 122
Axial Section Through Anterior Commissure with MRI 124
Axial Section Through Habenular Commissure with Vessel Territories 126
Axial Section Through Superior Colliculi with MRI 128
Axial Section Through Anterior Perforated Substance with Vessel Territories 130
Axial Section Through Inferior Colliculi with MRI 132
Part IV Histological Sections Cerebellum 136
Horizontal Section Through Fastigial Nucleus with Vessel Territories 136
Horizontal Section Through Dentate Nucleus with MRI 137
Brain Stem 138
Transverse Section Through Superior Colliculus with Vessel Territories 138
Transverse Section Through Oculomotor Nucleus with MRI 139
Transverse Section Through Inferior Colliculus with Vessel Territories 140
Transverse Section Through Superior Pons and Isthmus with MRI 141
Transverse Section Through Middle Pons with Vessel Territories 142
Transverse Section Through Facial Genu with MRI 143
Transverse Section Through Vestibulocochlear Nerve Root with Vessel Territories 144
Transverse Section Through Glossopharyngeal Nerve Root with MRI 145
Transverse Section Through Fourth Ventricle with Vessel Territories 146
Transverse Section Through Hypoglossal Nucleus with MRI 147
Transverse Section Through Inferior Olive with Vessel Territories 148
Transverse Section Through Decussation of Pyramids with MRI 149
Spinal Cord 150
Transverse Section Through Upper Cervical Level with Vessel Territories 150
Transverse Section Through Cervical Enlargement with MRI 151
Transverse Section Through Thoracic Level with Vessel Territories 152
Transverse Section Through Lumbar Enlargement with Vessel Territories 153
Transverse Section Through Sacral Level 154
Basal Ganglia and Thalamus 155
Coronal Section Through Nucleus Accumbens 155
Coronal Section Through Optic Chiasm 156
Coronal Section Through Anterior Commisure 157
Coronal Section Through Anterior Thalamic Tubercle 158
Coronal Section Through Mamillothalamic Tract 159
Coronal Section Through H Fields of Forel 160
Coronal Section Through Dorsal Lateral Geniculate Nucleus 161
Coronal Section Through Pulvinar 162
Hypothalamus 163
Coronal Section Through Optic Chiasm; Coronal Section Through Pituitary Stalk 163
Coronal Section Through Interthalamic Adhesion; Coronal Section Through Mamillary Bodies 164
Basal Forebrain 165
Coronal Section Through Olfactory Trigone and Nucleus Basalis 165
Hippocampus 166
Coronal Section Through Body of Hippocampus 166
Part V Pathways Brain Stem 170
General Organization of Spinal Cord Gray Matter 170
General Organization of Cranial Nerve Gray Matter 172
Sensory Cranial Nerves and Nuclei 174
Motor Cranial Nerves and Nuclei 175
Organization of Cranial Nerve Nuclei into Columns-Posterior Aspect 176
Organization of Cranial Nerve Nuclei into Columns-Anterior Aspect 177
Thalamus 178
Organization of the Thalamus 178
Hypothalamus 180
Organization of the Hypothalamus 180
Sensory Systems 182
Touch and Position Sense Pathways: Posterior (Dorsal) Column/Medial Lemniscus and Trigeminal Main Sensory Nucleus 182
Touch Pathways: Anterior and Lateral Spinothalamic Tracts and Trigeminal Spinal Nucleus 184
Pain Pathways 186
Touch Pathways: Head and Face 188
Taste Pathways 190
Visual Pathways 192
Olfactory Pathways 194
Auditory Pathways 196
Sensory/Motor Systems 198
Vestibular Pathways 198
Motor Systems 200
Corticospinal (Pyramidal) and Corticobulbar Pathways 200
Rubrospinal and Tectospinal Pathways 202
Reticulospinal Pathways 204
Cerebellum 206
Cerebellar Pathways: Somatic Afferents 206
Cerebellar Pathways: Afferents (Non-Somatic) 208
Cerebellar Pathways: Efferents 210
Basal Ganglia 212
Basal Ganglia Pathways 212
Hippocampus 214
Hippocampal Pathways: Afferents 214
Hippocampal Pathways: Efferents 216
Amygdala 218
Amygdalar Pathways: Afferents 218
Amygdalar Pathways: Efferents 220
Hypothalamus 222
Hypothalamic Pathways: Afferents 222
Hypothalamic Pathways: Efferents 224
Arousal and Sleep Pathways 226
Hunger and Feeding Pathways 228
Circumventricular Organs 230
Autonomic Systems 232
Autonomic Pathways: Afferents 232
Autonomic Pathways: Sympathetic Efferents 234
Autonomic Pathways: Parasympathetic Efferents 236
Modulatory Systems 238
Cholinergic and Dopaminergic Pathways 238
Noradrenergic and Serotonergic Pathways 240
Index 243
The human nervous system is complex and sophisticated. It is the most remarkable system in biology. A major challenge for neuroscience, psychology, medicine, and, indeed, for civilization is to understand the nervous system at the same fundamental levels at which we now understand other organ systems. Early in the 21st century, only 50 years after the discovery of the genetic "alphabet," the complete human genome has been mapped. Likewise, new knowledge about the brain and diseases that afflict the nervous system is exploding. One goal for future work on the human brain is to reach a level of detailed understanding similar to that now possible for the genome.
An anchor in this quest is information about the structure and organization of the central nervous system (CNS). The Brain Atlas: A Visual Guide to the Human Central Nervous System was prepared to help students and professionals understand the normal human brain and guide interpretation of clinical and experimental work.
Clear charts and maps of biological structures have been teaching aids from the earliest times. In the biological sciences, the first detailed and illustrated text based on direct observation was the De Fabrica Humani Corporis (1543) and its synoptic Epitome (1543) by Andreas Vesalius (1514-1564). Those books have been said to "mark the beginning of modern science." Publication of the Fabrica also was a major landmark in book publishing. The highly popular Epitome was intended as a primer but served very much as a modern day atlas. Such works have evolved and today are used in the same way maps are used to plan travel and understand geographic relationships.
In the mid to late 19th century, instructional programs in universities and medical schools were developed to teach students to make accurate observations from specimens. This skill enables students to generate and retain mental conceptualizations of complex three-dimensional (3D) structures in the body. In part, this was to prepare students to interpret observations that could be made only at the surfaces of living organisms. Experience with these teaching aids was so positive that, even today, instruction at nearly every level now uses charts and atlases to aid the study of gross anatomy, embryology, histology, and neuroscience. Atlases have been developed for a wide range of other related disciplines, such as pathology, radiology, and surgery. These books support varied and flexible learning plans, styles, and objectives. At their best, such works are ready references for efficient recall and lifelong study-rapidly accessible sources of information. The Brain Atlas is intended to be such a work: a reference serving different needs for students learning about the human brain and a resource for rapid clarification in self-directed study, in the classroom, in the laboratory, and in the clinic.
Because of recent stunning advances in imaging, the information included in The Brain Altas is more crucial than ever for medical practice, human and animal brain research, and certain branches of psychology. For example, strokes (brain attacks) resulting from insufficient blood supply to parts of the CNS are the leading cause of disability in adults and the third leading cause of death in the United States. Intense efforts are now directed at reducing risk and improving therapy for this disease. The quick access to information on the brain and its blood supply in The Brain Atlas is crucial for such efforts. Other forms of "brain disease," such as mental illness, dementia, substance abuse, and a host of genetic syndromes, can be investigated and understood only by reference to the detailed organization of the human brain. Alterations in brain function, such as learning difficulties or speech problems, have also now been directly linked to altered brain structures. In the future, access to basic information about brain structure will be even more essential for evaluating patients at risk for specific diseases and for monitoring and assessing the effects of therapeutic interventions.
New imaging and other innovative techniques have spurred a revolution in the study of the way in which the brain works. Functional imaging of healthy individuals at all ages provides a wide range of new and compelling information on how the brain executes different tasks, from speaking different languages to reacting to pain. Such imaging promises to reveal, for example, the ways in which the brains of individuals with special talents may differ. The human brain is no longer a "black box" from which one only rarely and fortuitously records activity. Instead, the precise locations in the brain associated with many uniquely human tasks can be specified. Therefore, ready anatomical reference works are crucial for cognitive psychologists and research scientists.
The Brain Atlas is divided into five parts, with key features summarized at the beginning of each. This introduction (Part I) summarizes several general aspects of the brain to help the novice get started or refresh the knowledge of advanced students and practicing professionals. The balance of this overview outlines terminology used in this volume, as well as special features designed to assist in identification, study, and navigation. Information on the sources and preparation of the anatomical images that appear in this book is provided. The main parts of the volume (Parts II-V) are designed to flow logically and progressively, from overall surface anatomy of the CNS (Part II), through cross-section-al gross anatomy (Part III) and selected regional histology (Part IV), and ending with diagrams of the major neuronal systems that are responsible for the brain's magnificent array of functions (Part V). Because each part illustrates a different aspect of the structure and organization of the CNS, the book is arranged so that users can navigate easily between topics for efficient learning and comprehension.
The cells of the nervous system are of two principal types: nerve cells or neurons, which are directly responsible for conveying and processing information; and glial cells (Gr., glia, glue), that support the neurons and make them more efficient and effective. Neurons exhibit a wide range of shapes, sizes, functional characteristics, and chemical attributes. Most neurons are not visible without magnification. Neurons differ from all other cells in that they have numerous microscopic processes extending for great distances from the cell body (soma; Fig. 1). All neurons are polarized, that is, different parts are specialized to receive or send information. For most nerve cells, these functions are segregated in two different classes of processes. Dendrites, shorter processes (~1 mm or less) that are tapered and branched much like limbs on a tree, receive and integrate incoming information. Most neurons have several dendrites. Axons (usually only one per neuron) have a relatively uniform diameter, can be highly branched, and extend for considerable distances, up to almost 2 m in tall people. Axons distribute signals to other cells (neurons, muscle cells, secretory cells, etc.) without attenuation. The principal mode of communication between neurons and from neurons to other tissues, such as muscle, is through specialized contacts called synapses (Gr., syn + haptein, clasp). Synapses are small and require magnification under a microscope to be seen. Axons convey information through synapses throughout the brain to activate specific targets.
Figure 1 Schematic illustration of major elements of the central nervous system that are sources and targets of connections that facilitate different functions. Gray matter is rich in neurons, connecting axons, and contact points called synapses. For example, a gray matter area, the cerebral cortex, connects to a gray matter nucleus via a myelinated axon of a nerve cell. The full extent of the axon is not shown (//) but could extend for more than 1 m. One synapse is enlarged. Some but not all of the neurons in the gray matter are diagrammed as they would appear with cell body stains (blue circles and triangles; see pp. 165 and 166). Note the scale bars for the gray matter and the enlarged depiction of a synapse. These can be compared with actual images of gray and white matter in Figure 2.
Different parts of the brain and spinal cord have distinctive appearances. These anatomical distinctions can be correlated almost without exception to specific functional attributes, such as the sense of touch, language understanding, or the ability to execute complex movements such as dancing. Because of the appearance of fresh brain tissue, areas rich in neurons, synapses and glia are called gray matter, and areas containing mainly axons and glia are called white matter (Figs. 1 and 2). This distinction is useful in understanding anatomical studies from normal or autopsy specimens and, increasingly, from images of living individuals.
Figure 2 Differences between gray matter (regions that are neuron and synapse rich) and white matter (regions rich in myelinated axons and surrounding glia) are shown with three different...
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