Neuroanatomi. "Farmakologi, sjukdomslära och läkemedelskemi" Magnus Bengtsson

Transkript

1 Neuroanatomi "Farmakologi, sjukdomslära och läkemedelskemi" Magnus Bengtsson

2 Upplägg Översikt Hjärnhinnor och ventrikelsystemet Storhjärnan Mellanhjärnan Öga och Öra Hjärnstam och lillhjärnan Ryggmärg och Bansystem Blodförsörjning CNS PNS och ANS Insprängda kliniska fall

3 Översikt

4 Plan

5 Afferens och Efferens Sensory input Integra1on Motor output

6 Indelning CNS/PNS

7 Hjärnhinnor

8 Ventrikelsystemet Lateral ventricle Septum pellucidum Inferior horn Lateral aperture Anterior horn Interventricular foramen Third ventricle Cerebral aqueduct Fourth ventricle Central canal Posterior horn Inferior horn Median aperture Lateral aperture (a) Anterior view (b) Left lateral view

9 Cerebrospinalvätska 4 Superior sagi=al sinus Arachnoid villus Choroid plexus Interventricular foramen Third ventricle (a) CSF circulation 3 Cerebral aqueduct Lateral aperture Fourth ventricle Median aperture Central canal of spinal cord 1 2 Subarachnoid space Arachnoid mater Meningeal dura mater Periosteal dura mater Right lateral ventricle (deep to cut) Choroid plexus of fourth ventricle 1 CSF is produced by the choroid plexus of each ventricle. 2 CSF flows through the ventricles and into the subarachnoid space via the median and lateral apertures. Some CSF flows through the central canal of the spinal cord. 3 CSF flows through the subarachnoid space. 4 CSF is absorbed into the dural venous sinuses via the arachnoid villi.

10 Lober

11 FunkNonella centra Motor areas Primary motor cortex Premotor cortex Frontal eye field Broca s area (outlined by dashes) Prefrontal cortex Working memory for spa1al tasks Execu1ve area for task management Working memory for object- recall tasks Solving complex, mul1task problems (a) Lateral view, left cerebral hemisphere Central sulcus Sensory areas and related association areas Primary somatosensory cortex Somatosensory associa1on cortex Gustatory cortex (in insula) Wernicke s area (outlined by dashes) Primary visual cortex Visual associa1on area Auditory associa1on area Primary auditory cortex Soma1c sensa1on Taste Vision Hearing Primary motor cortex Primary sensory cortex Motor associa1on cortex Sensory associa1on cortex Mul1modal associa1on cortex

12 Frontal eye field Prefrontal cortex Processes emo1ons related to personal and social interac1ons Orbitofrontal cortex Premotor cortex Corpus callosum Olfactory bulb Olfactory tract Fornix Temporal lobe Cingulate gyrus (b) Parasagittal view, right hemisphere FunkNonella centra Primary olfactory cortex Primary motor cortex Central sulcus Uncus Primary somatosensory cortex Parietal lobe Somatosensory associa1on cortex Parieto- occipital sulcus Occipital lobe Visual associa1on area Calcarine sulcus Primary visual cortex Parahippocampal gyrus Primary motor cortex Primary sensory cortex Motor associa1on cortex Sensory associa1on cortex Mul1modal associa1on cortex

13 Hip Homunculus Posterior Motor map in precentral gyrus Shoulder Motor Anterior Leg Sensory Hip Trunk Neck Sensory map in postcentral gyrus Trunk Face Lips Eye Jaw Brow Tongue Swallowing Primary motor cortex (precentral gyrus) Knee Foot Toes Genitals Primary somato- sensory cortex (postcentral gyrus) Teeth Gums Tongue Pharynx

14 Kramper och epilepsi KorNkala urladdningar Sekundär Nll skada Stroke Tumör InfekNon Alkohol Kryptogen Symptomen följer anatomin

15 Vit substans, banor Longitudinal fissure Lateral ventricle Basal ganglia Caudate Putamen Globus pallidus Thalamus Third ventricle Pons Medulla oblongata (a) Frontal section Superior Association fibers Commissural fibers (corpus callosum) Corona radiata Fornix Internal capsule Gray ma=er White ma=er Projection fibers Decussa1on of pyramids

16 MulNpel Skleros Myelinskada à Plaque i vit substans InflammaNon Skovvist förlöpande Progressivt förlöpande EffekNva immunmodulerande läkemedel

17 Basala kärnorna översikt

18 Basala kärnorna 1

19 Basala kärnorna 2

20 Parkinsons sjukdom DegeneraNon SubstanNa Nigra ê DA Motoriska störningar Hypokinesi Rigiditet Tremor KogniNva och affeknva störningar

21 HunNngtons sjukdom DegeneraNon Striatum och Kortex (främst frontotemp) ê GABA, é Glu Triad Dominant nedärvning Choreoathetos Demens HunNngNn, CAG- repeat

22 Djupa strukturer, limbiska systemet

23 Limbiska systemet

24 Psykiatri Cerebrala skador ger psykiska symptom Signalsubstanser påverkar Seratonin DA Na GABA Glutamat Starkt koppling kropp och skäl Descartes

25 Diencephalon 1

26 Thalamus Dorsal nuclei Medial Lateral dorsal Lateral posterior Anterior nuclear group Pulvinar Medial geniculate body Re1cular nucleus Ventral anterior Ventral lateral Lateral geniculate body Ventral postero- lateral Ventral nuclei (a) The main thalamic nuclei. (The re1cular nuclei that cap the thalamus laterally are depicted as curving translucent structures.)

27 Hypothalamus Paraventricular nucleus Anterior commissure Preoptic nucleus Anterior hypothalamic nucleus Supraop1c nucleus Suprachiasmatic nucleus Op1c chiasma Infundibulum (stalk of the pituitary gland) Fornix Arcuate nucleus Pituitary gland Dorsomedial nucleus Posterior hypothalamic nucleus Lateral hypothalamic area Ventromedial nucleus Mammillary body (b) The main hypothalamic nuclei

28 Endokrinologi Saltbalans Diabetes insipidus Hungerkontroll Fet- musen Cirkadianska rytmer Dygnsrytm Vakenhet Narkolepsi Thyroidea Binjuren FSH, LH GH Oxytosin Etc etc

29 Örat Hammaren Städet Stigbygeln Ytterörat Mellanörat Innerörat Balansorganet N. VIII Örontrumpeten Hörselgången Trumhinnan Ovala fönstret Runda fönstret Hörselsnäckan (cochlean)

30 KorNska organet Tectorialmembranet Yttre hårceller Retikularmembranet Tectorialmembranet Inre hårcell Hörselceller Basilarmembranet Deitersceller Figur 5.22 Fysiologi Jan Lännergren, Håkan Westerblad, Mats Ulfendahl oc

31 Båggångaroch hinnsäcker Semicirkulära båggångar Temporalbenet Subduralrummet Utriculus Sacculus Endolymfa Perilymfa Hörselsnäckan Scala vestibuli Scala media Scala tympani Ovala fönstret med stigbygeln Runda fönstret gur 5.10

32 Ögat Bakre ögonkammare Iris Pupill Främre ögonkammare Cornea (hornhinna) Ciliarkropp med ciliarmuskel Lins Glaskropp Retina (näthinna) Choroidea (åderhinna) Sclera (senhinna) Synnervspapill (blinda fläcken) Fovea centralis Synnerven (N. II)

33 ANS och ögat Nearly parallel rays from distant object Sympathetic activation Lens Ciliary zonule Ciliary muscle Inverted image Divergent rays from close object Parasympathetic activation Inverted image

34 Brytningsfel Myopi (närsynthet) Korrigeras med spridningslins Hyperopi (översynthet) Korrigeras med samlingslins

35 Figur 5.34 Synbanan N T T N. opticus Synnervskorsning 1 Synfältsbortfall i vä öga hö öga Tractus opticus Laterala knäkroppen 3 Synstrålning Syncortex

36 Hjärnstam och kranialnerver

37 Mesencephalon Tectum Periaqueductal gray ma=er Oculomotor nucleus (III) Medial lemniscus Red nucleus Substan1a nigra Fibers of pyramidal tract (a) Midbrain Dorsal Ventral Superior colliculus Cerebral aqueduct Re1cular forma1on Crus cerebri of cerebral peduncle

38 Pons Trigeminal main sensory nucleus Trigeminal motor nucleus Middle cerebellar peduncle Trigeminal nerve (V) Medial lemniscus (b) Pons Superior cerebellar peduncle Fourth ventricle Re1cular forma1on Pon1ne nuclei Fibers of pyramidal tract

39 Medulla Oblongata Hypoglossal nucleus (XII) Dorsal motor nucleus of vagus (X) Inferior cerebellar peduncle Re1cular forma1on Lateral nuclear group Medial nuclear group Raphe nucleus Medial lemniscus Fourth ventricle Choroid plexus Solitary nucleus Ves1bular nuclear complex (VIII) Cochlear nuclei (VIII) Nucleus ambiguus Inferior olivary nucleus Pyramid (c) Medulla oblongata

40 Cerebellum Anterior lobe Cerebellar cortex Arbor vitae Cerebellar peduncles Superior Middle Inferior Medulla oblongata Flocculonodular lobe Posterior lobe Choroid plexus of fourth ventricle (b) Illustration of parasagittal section

41 Ryggmärgen

42 Ryggmärgssegment

43 Ryggmärg, gränssträngen

44 Pyramidbanan Primary motor cortex Pyramidal cells Internal capsule Cerebrum Cerebral peduncle Midbrain Cerebellum Pons Ventral corticospinal tract Pyramids Decussa1on of pyramid Lateral corticospinal tract Medulla oblongata Cervical spinal cord Skeletal muscle Lumbar spinal cord Soma1c motor neurons (a) Pyramidal (lateral and ventral corticospinal) pathways

45 ALS DegeneraNon av övre- och nedre motorneuron Centrala och perifera motoriska symptom Med Nden även kornkal degeneranon KogniNva symptom

46 Sensoriska banor

47 Smärta, omkopplingar

48 Huvudvärk

49 Blodkärl, främre cirkulanonen 1

50 Blodkärl, främre cirkulanonen 2

51 Blodkärl bakre cirkulanonen

52 Blodkärl, ryggmärgen

53 Hjärnans venösa system

54 Stroke Cerebrovaskulär sjukdom med fokal ischemi Infarkt Lokalt; embolus eller lakunär infarkt Artär- artär embolus Kardiell embolus Annat; venöst, disseknon, etc Intracerebral blödning Hypertoniblödning Kärlskada Subarachnoidalblödning Aneurysm

55 PNS Cervical plexus Brachial plexus Cervical nerves C 1 C 8 Cervical enlargement Intercostal nerves Thoracic nerves T 1 T 12 Lumbar enlargement Lumbar plexus Lumbar nerves L 1 L 5 Sacral plexus Cauda equina Sacral nerves S 1 S 5 Coccygeal nerve Co 1

56 Dermatom C6 C5 C6 C7 T2 C8 L1 L2 C4 C5 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 S2 S3 C2 C3 L1 L2 C8 T2 C6 C5 C6 C7 L3 L3 L4 L4 L5 L5 S1 S1 (a) Anterior view

57 Guillain- Barrés syndrom Akut inflammatorisk demyeliniserande polyneuropan (AIDP) Drabbar perifera nerver och nervrö_er Progredierande slappa pareser Parestesier Autonom dysfunknon

58 Myasthenia Gravis Autoimmun neuromuskulär sjukdom Ak mot ach.rec U_rö_barhet i muskler Thymom

59 Smärta ut i armen anatomi.

60 Smärta ut i armen anatomi

61 Smärta ut i benen anatomi

62 ANS

63 parasympankus CN III CN VII CN IX CN X Ciliary ganglion Pterygopala1ne ganglion Eye Lacrimal gland Nasal mucosa Submandibular ganglion O1c ganglion Submandibular and sublingual glands Paro1d gland Cardiac and pulmonary plexuses Heart Lung CN Preganglionic Postganglionic Cranial nerve

64 ParasympaNkus Celiac plexus Liver and gallbladder Stomach Pancreas S 2 S 4 Large intes1ne Pelvic splanchnic nerves Inferior hypogastric plexus Rectum Small intes1ne CN Preganglionic Postganglionic Cranial nerve Genitalia (penis, clitoris, and vagina) Urinary bladder and ureters

65 SympaNkus T 1 Pons Superior cervical ganglion Middle cervical ganglion Inferior cervical ganglion Sympathe1c trunk (chain) ganglia Cardiac and pulmonary plexuses Greater splanchnic nerve Lesser splanchnic nerve Celiac ganglion Eye Lacrimal gland Nasal mucosa Blood vessels; skin (arrector pili muscles and sweat glands) Salivary glands Heart Lung Liver and gallbladder L 2 White rami communicantes Preganglionic Postganglionic Sacral splanchnic nerves Superior mesenteric ganglion Lumbar splanchnic nerves Inferior mesenteric ganglion Stomach Spleen Adrenal medulla Kidney Small intes1ne Large intes1ne Rectum Genitalia (uterus, vagina, and penis) and urinary bladder

66 Synapser, skillnader Cell bodies in central nervous system Peripheral nervous system Effect SOMATIC NERVOUS SYSTEM AUTONOMIC NERVOUS SYSTEM PARASYMPATHETIC SYMPATHETIC Heavily myelinated axon ACh Unmyelinated Lightly myelinated postganglionic axon Ganglion preganglionic axons Epinephrine and ACh norepinephrine Lightly myelinated preganglionic axon Single neuron from CNS to effector organs Two- neuron chain from CNS to effector organs Adrenal medulla ACh Ganglion Blood vessel Unmyelinated postganglionic axon Neurotransmitter Effector at effector organs ACh NE ACh Skeletal muscle Smooth muscle (e.g., in gut), glands, cardiac muscle S1mulatory S1mulatory or inhibitory, depending on neuro- transmi=er and receptors on effector organs

67 Övre styrning ANS Communica1on at subconscious level Cerebral cortex (frontal lobe) Limbic system (emo1onal input) Hypothalamus Overall integra1on of ANS, the boss Brain stem (reticular formation, etc.) Regula1on of pupil size, respira1on, heart, blood pressure, swallowing, etc. Spinal cord Urina1on, defeca1on, erec1on, and ejacula1on reflexes