Gilman, Newman (2002 ) Manter and Gatz’s Essentials of Clinical Neuroanatomy and Neurophysiology (10e) Ch. 20 LUD061318 PDF

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EDITION 10 Manter and Gatz’s Essentials of Clinical Neuroanatomy and Neurophysiology

EDITION 10 Manter and Gatz’s Essentials of Clinical Neuroanatomy and Neurophysiology Sid Gilman, MD, FRCP William J. Herdman Professor and Chair Department of Neurology University of Michigan Medical School Ann Arbor, Michigan

Sarah Winans Newman, PhD Professor Emerita Department of Anatomy and Cell Biology University of Michigan Medical School Courtesy Professor Psychology Department Cornell University Ithaca, New York Illustrations by Margaret Croup Brudon

F.A. Davis Publishers Philadelphia

F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright  2003 by F. A. Davis Company Copyright  1958, 1961, 1966, 1970, 1975, 1982, 1987, 1992, and 1996 by F.A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor: Margaret Biblis Developmental Editor: Anne Seitz Production Editor: Nwakaego Fletcher-Perry Cover Designer: Louis Forgione As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Gilman, Sid. Manter and Gatz’s essentials of clinical neuroanatomy and neurophysiology.—10th ed. / Sid Gilman, Sarah Winans Newman. p. ; cm. Includes bibliographical references and index. ISBN 0-8036-0772-5 (paper cover) 1. Neuroanatomy. 2. Neurophysiology. [DNLM: 1. Nervous System—anatomy & histology. 2. Nervous System Physiology. WL 100 G487m 2003] I. Title: Essentials of clinical neuroanatomy and neurophysiology. II. Manter, John Tinkham, 1910- III. Gatz, Arthur John, 1907- IV. Newman, Sarah Winans. V. Title. QM451 .G47 2003 612.8—dc21 2002067443 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is:8036-0772/03 + $.10.

Preface to the 10th Edition

In the six years since the ninth edition of this book was published, neuroscience has continued to progress at an astonishingly rapid rate. Moreover, the remarkable advances in basic neuroscience of the past three decades have been translated into clinical advances that have begun to change the management of many neurological diseases. We now have means of treating disorders that previously defied even symptomatic benefit. For example, we have an array of medications available for Parkinson’s disease, epilepsy, stroke, sleep disorders, multiple sclerosis, migraine headache, and neuromuscular disorders such as myasthenia gravis, myositis, and peripheral neuropathy. We also have symptomatic treatments for Alzheimer’s disease, and from the current pace of research in this disorder, it appears that preventive therapies will become available within the next decade. The armamentarium for diagnosis of neurological disorders has also advanced, including an array of imaging studies for examining the structure and function of the nervous system. These approaches have proved invaluable not only in the diagnosis of neurological disorders, but also in understanding some of the most complex functions of the normal brain. We undertook the present revision to update the book scientifically. To this end, we added considerable new material concerning neuroanatomy, neurophysiology, and neuropharmacology, and yet attempted to keep the book short and succinct. To accomplish this, we shortened and consolidated some of the existing material, including the presentations of the structure and function of the brain stem and thalamus. We have rewritten literally every chapter. We changed

many of the illustrations in keeping with the new information presented, and added several new illustrations. We also added two new features in keeping with our longstanding aim of making the book relevant to clinical practice. We present a clinical case briefly at the beginning of many chapters to illustrate the practical utility of the information contained in that chapter. These real cases pose problems of localization of disease process, type of pathology causing the symptoms, and management of the patient. We present follow-up material on these cases at the end of the chapter. We also added magnetic resonance images taken from neurologically normal adult humans, both to illustrate structural relationships and to give our readers experience in viewing clinical imaging studies. Throughout the current revision we have emphasized physiological concepts within the context of the anatomic organization of the nervous system and pointed out the clinical relevance of the major anatomic structures. We kept the book focused on the student who seeks a brief, clinically oriented overview of neuroanatomy and neurophysiology that summarizes the material in more comprehensive textbooks. We intended the book to be helpful to house officers in neurology, neurosurgery, otolaryngology, psychiatry, and physical medicine and rehabilitation who wish to update their knowledge. We also provided an approach that will be useful to physical therapists, speech pathologists, and nurses. Sid Gilman, MD, FRCP Sarah Winans Newman, PhD

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Acknowledgments: Consultants for the 10th Edition

We thank the colleagues listed below who graciously gave us their valuable time to review manuscript sections, suggest revisions, and advise us on appropriate references for updating this edition. We do not hold these individuals responsible for any material in the final revision of this book. The authors take full responsibility. We give special thanks to the Department of Radiology of the University of Michigan and to Dr. Diana Gomez-Hassan, who not only contributed her time and expertise, but also selected the magnetic resonance images of neurologically normal individuals and prepared them for our use. We also thank Margaret Croup Brudon, who revised some of her previous illustrations and provided new illustrations, all of which are superb. Harold P. Adams, MD Department of Neurology University of Iowa Hospitals

Susan Hickenbottom, MD Department of Neurology University of Michigan Medical School

James W. Albers, MD, PhD Department of Neurology University of Michigan Medical School

Jaideep Kapur, MD, PhD Department of Neurology University of Virginia HSC

Roger L. Albin, MD Department of Neurology University of Michigan Medical School

Golda Kevetter Leonard, PhD Department of Otolaryngology University of Texas Medical Branch, Galveston

Robert W. Baloh, MD Reed Neurological Research Center University of California, Los Angeles

Richard J. Krauzlis, PhD Salk Institute

Louis R. Caplan, MD Department of Neurology Beth Israel Deaconess Medical Center Antonio R. Damasio, MD, PhD Department of Neurology University of Iowa Norman L. Foster, MD Department of Neurology University of Michigan Medical School Diana Gomez-Hassan, MD, PhD Department of Radiology University of Michigan Medical School

Allan I. Levey, MD, PhD Department of Neurology Emory University William Z. Rymer, MD, PhD Rehabilitation Institute of Chicago Jeremy D. Schmahmann, MD Department of Neurology Massachusetts General Hospital Steven Telian, MD Department of Otolaryngology University of Michigan Medical School Roy Twyman, MD R.W. Johnson Pharmaceutical Research Institute

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Contents

Section 1 BASIC PRINCIPLES

1

Chapter 1 Introduction to the Nervous System 1

The Autonomic Nervous System Has Two Divisions 33 Sympathetic Nervous System 34 Parasympathetic Nervous System 36 Autonomic Innervation of the Genitourinary System 36 Autonomic Reflexes of Other Pelvic Viscera 38

Nerve Cells and Nerve Fibers 1 Organization of Cells and Fibers in the Nervous System 3 Functionally Defined Fiber Groups in the Peripheral Nerves 3 Overview of the Gross Anatomy of the Nervous System 4 Internal Anatomy of the Spinal Cord 9 Development of the Nervous System 11 Chapter 2 Physiology of Nerve Cells

Section 3 ASCENDING AND DESCENDING PATHWAYS 15

Resting Membrane Potential 15 Ion Channels Control Membrane Potential 16 Action Potential 16 Action Current 18 Afterpotentials and Refractory Periods Follow the Action Potential 18 Synapses 19 Neuromuscular Junction 21 Section 2 PERIPHERAL NERVOUS SYSTEM

Chapter 5 Autonomic Nervous System 33

23

Chapter 3 Fibers of the Spinal Nerves 23

Functional Classification 23 Physiologic Classification 25 Chapter 4 Spinal Reflexes and Muscle Tone 27

Spinal Reflexes 27 Muscle Spindles 27 Alpha, Beta, and Gamma Motoneurons of the Spinal Cord 29 Stretch Reflex 30 Golgi Tendon Organs and Their Reflexes 30 Muscle Tone 31 Reflexes of Cutaneous Origin 31

Chapter 6

41

Pain and Temperature

41

Somatic Sensation 41 Overview of the Pathways for Pain, Thermal Sense, and Touch 42 Dorsal Roots of the Spinal Nerves Supply Dermatomes 42 Adjacent Spinal Nerves Form Peripheral Nerves 42 Pain-Temperature Pathways 42 Perception of Pain 47 Temperature Sense 47 Visceral Pain Pathways and Referred Pain 47 Effect of Cutting the Spinothalamic Tract 48 Sensory Effects of Dorsal Root Irritation 48 Endogenous Analgesia 49 Central Pain (Thalamic Syndrome) 49 Chapter 7 Proprioception, Touch, and Tactile Discrimination 51

Central Nervous System Pathways 51 Physiologic Aspects of Tactile Discrimination 57 Effect of Spinal Cord Lesions on Touch Sensation 58 Chapter 8 Motor Pathways

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Motor Areas of the Cerebral Cortex

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x CONTENTS

Descending Fibers from the Cerebral Cortex and Brain Stem Influence Motor Activity 61 Role of Lateral, Medial, and Propriospinal Pathways in Spinal Cord Function 66 Chapter 9 Lesions of the Peripheral Nerves, Spinal Nerve Roots, and Spinal Cord 68

Degeneration and Regeneration of Nerve Cells and Fibers after Injury 68 Clinical Consequences of Peripheral Nerve Lesions 69 Lower Motoneuron Lesions: Hypotonic Paralysis of Muscles 69 Lesions of Dorsal Roots 69 Upper Motoneuron Lesions: Spastic Paralysis of Muscles 70 Abnormal Reflexes Associated with Lesions of the Motor Pathway 72 Transection of the Spinal Cord 73 Hemisection of the Spinal Cord (BrownSe´quard Syndrome) 73 Lesions of the Central Gray Matter of the Spinal Cord 75 Lesions Involving the Ventral Horns and the Corticospinal Tracts 75 Lesions Involving Dorsal and Lateral Funiculi 75 Thrombosis of the Anterior Spinal Artery 75 Tumors of the Spinal Cord 76 Section 4 BRAIN STEM AND CEREBELLUM

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Chapter 10 Organization of the Brain Stem and Cranial Nerves 77

Surface Anatomy of the Brain Stem 77 Internal Structures at the Transition from Spinal Cord to Brain Stem 82 Classification of Cranial Nerve Nuclei and Fibers according to their Functions 83 Functionally Distinct Cranial Nerve Cell Columns 84 Reticular Formation 86 Atlas of the Brain Stem: Transverse Sections 88 Blood Supply to the Brain Stem and Cerebellum 95 Chapter 11 Cranial Nerves of the Medulla 97

Hypoglossal Nerve (XII) 97 Accessory Nerve (XI) 97

Vagal System: Nervus Intermedius (VII), Glossopharyngeal (IX), Vagus (X) and Cranial Accessory (XI) Nerves 98 Chapter 12 Cranial Nerves of the Pons and Midbrain 104

Abducens Nerve (VI) 104 Trochlear Nerve (IV) 105 Oculomotor Nerve (III) 105 Facial Nerve (VII) 106 Trigeminal Nerve (V) 107 Chapter 13 Lesions of the Brain Stem 111

Principles of Localization 111 Lesions of the Medulla 112 Lesions of the Pons 114 Lesions of the Midbrain 116 Brain Stem Lesions Causing Coma and ‘‘Locked-in’’ Syndrome 118 Chapter 14 Hearing

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Ear 119 Central Auditory Pathways 122 Diagnosing Hearing Deficits from Nerve Damage and from Conductive Defects 124 Auditory Reflexes 125 Chapter 15 Vestibular System

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Vestibular Portion of the Inner Ear 127 Vestibular Nerve and Its Central Connections 129 Vestibulocerebellar Connections 130 Vestibulospinal Tracts 130 Vestibulo-ocular Systems 131 Vestibulothalamocortical Pathway 133 Sensory Aspects of Vestibular Stimulation 133 Chapter 16 Cerebellum

135

Overview of Cerebellar Function 135 Cerebellar Anatomy 135 Peduncles 139 Major Circuits 141 Integration of the Cerebellum and Cerebral Cortex in Movement and Cognition 143 Clinical Signs of Cerebellar Dysfunction 144 Diseases 145 Section 5 FOREBRAIN Chapter 17 Basal Ganglia

Overview

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147 147

CONTENTS Components 149 Connections of the Dorsal Striatum and Pallidum with the Cerebral Cortex 150 Connections of the Pallidum with the Brain Stem 154 Ventral Striatum and Pallidum 154 Function and Dysfunction 154 Chapter 18 Vision

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Overview of the Visual Pathways 158 Retina 158 Visual Pathways 161 Information Processing in the Visual Pathways 163 Effects of Lesions Interrupting the Visual Pathway 164 Chapter 19 Optic Reflexes and Eye Movements 167

Light Reflexes 167 Reflexes Associated with the Near-Point Reaction 168 Disorders of Pupillary Function 168 Eye Movements 169 Chapter 20 Cerebral Cortex and Thalamocortical Connections 174

Cerebral Cortex 174 Cortical Cell Layers: The Basis for Structure and Function Relationships within and between Cortical Areas 174 Cortical Networks and Information Processing 177 Thalamus 177 Thalamocortical Connections 180 Functional Cortical Regions 182 Disorders of Cortical Networks 189 Chapter 21 Limbic System

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Overview 193 Telencephalic Limbic System 193 Hypothalamus 197 Hypothalamic Functions 200 Epithalamus 202 Chapter 22 Olfaction

204

Olfactory Receptors 204 Olfactory Bulbs and Their Projections 204 Olfactory Cortical Areas 206 Damage to Olfactory Structures 206

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Chapter 23 Chemical Neuroanatomy 207

Characteristics of Neurotransmitter Molecules 207 Functional Characterization of Neurotransmitter Receptors 207 Acetylcholine 208 Monoamines 209 Neuropeptides 214 Amino Acids 218 Section 6 CIRCULATION OF BLOOD AND CEREBROSPINAL FLUID 221 Chapter 24 Cerebral Arteries Supplying the Forebrain 221

Anterior Circulation 221 Internal Carotid Artery and Its Branches 221 Posterior Cerebral Artery and Its Branches 223 Formation of the Circle of Willis and Its Central Branches 225 Chapter 25 Cerebrospinal Fluid

227

Formation and Circulation 227 Composition and Function 228 Blood-Brain Barrier 229 Pressure 229 Section 7 APPROACHES TO PATIENTS WITH NEUROLOGIC SYMPTOMS 233 Chapter 26 Clinical Evaluation of Neurologic Disorders 233

Patient History 234 Physical Examination 236 Neurologic Examination 236 Chapter 27 Neurologic Diagnostic Tests 241

Cerebrospinal Fluid Analysis 241 Electroencephalography and EvokedPotential Studies 242 Nerve Conduction Studies, Electromyography, and Muscle and Nerve Biopsy 243 Anatomic Imaging Studies 244 Physiologic Imaging Studies 245 Suggested Readings 247 Index 249

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Cerebral Cortex and Thalamocortical Connections

Case Study A 55-year-old man suddenly develops weakness of his right arm and leg while at work. When he attempts to tell a coworker about his weakness, he can speak only slowly and can produce single words or brief phrases. He feels frustrated about his inability to communicate and frightened about the sudden weakness of his limbs. His coworker takes him immediately to hospital, where a neurologist sees him promptly. On examination, the man can speak only single words such as ‘‘weak’’ or short phrases such as ‘‘no pain head.’’ Nevertheless, he understands complex language, as shown by his ability to carry out multiple tasks on command such as ‘‘touch your left index finger to your right ear, then close your eyes, then open your mouth.’’ The lower right side of his face appears weak, and his right arm and leg have approximately 25% of the strength of his left arm and leg. Deep tendon reflexes on the right side are decreased compared with the left, and the right plantar response is extensor, the left flexor. Sensory testing with pinprick, light touch, cold, vibration sense, and position sense reveals no abnormalities. Where in the nervous system does this patient have a lesion causing his speech difficulty and right-sided weakness? What would cause this? Is treatment available?

Cerebral Cortex The human brain possesses the capacity to undertake a vast number of intellectual and 174

cognitive functions. Performing these functions requires the circuits of the cerebral cortex to be engaged and to interact with other parts of the nervous system. The cerebral cortex participates in many aspects of memory storage and recall. It is necessary for the comprehension and execution of language and for certain special talents such as musical and mathematic abilities. It participates in processes responsible for attention, and it contributes to the perception and conscious processing of all sensations, as well as to the integration of sensory inputs from several modalities, providing recognition of individuals, objects, and places. The cortex is necessary for the planning and execution of complex motor activities such as fine digit, hand, and phonatory movements and for the planning of complex behavior. The cerebral cortex is a mantle of gray matter on the surface of the cerebral hemispheres. With limited exceptions, the thalamus provides the input to the cortex, and corticothalamic projections uniformly reciprocate the thalamocortical connections. This chapter therefore includes an overview of the organization of the thalamus and some details of the thalamocortical relationships.

Cortical Cell Layers: The Basis for Structure and Function Relationships within and between Cortical Areas Cells arranged in layers that follow the contours of the gyri and sulci densely populate the cerebral cortex. The cortex can be divided into regions

CHAPTER 20

CEREBRAL CORTEX AND THALAMOCORTICAL CONNECTIONS

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based on differences in the number of cell layers. Isocortex contains six layers; allocortex has three; and mesocortex, which forms a zone between isocortex and allocortex, varies from three to six layers. The zone of mesocortex that borders isocortex contains five to six layers, and the mesocor...