dr. Nuke Ariyanie, Sp.

S
FK UNSWAGATI
BRAIN & BRAIN STEM
 Neural Plate  Neural
Groove  Neural Tube

 The anterior end of the

neural tube expands and
constricts to form the three
primary brain vesicles
 Prosencephalon – the
forebrain
 Mesencephalon – the midbrain
 Rhombencephalon – hindbrain
 In week 6 of embryonic
development, secondary
brain vesicles form
 Telencephalon and
diencephalon arise from
the forebrain
 Mesencephalon remains
undivided
 Metencephalon and
myelencephalon arise from
the hindbrain
 Fates of the secondary
brain vesicles:
 Telencephalon – cerebrum:
cortex, white matter, and
basal nuclei
 Diencephalon – thalamus,
hypothalamus, and
epithalamus
 Mesencephalon – brain
stem: midbrain
 Metencephalon – brain
stem: pons
 Myelencephalon – brain
stem: medulla oblongata
 The brain is one of the largest organs in the body
 Male brain is about 1600 gm
 Female brain is about 1450 gm
(equivalent in terms of size/body wt)
 Folded surface increases surface area
 Elevated ridges (gyri)
 Shallow depressions (sulci)
 Deep grooves (fissures)
The brain has 4 main areas:

1. Brain stem
2. Diencephalon
3. Cerebellum
4. Cerebrum
Consists of:
1. Medulla Oblongata
2. Pons
3. Midbrain
 Connects brain and spinal cord
▪ contains reticular formation- responsible for
arousal and consciousness
▪ filters out extraneous sensory input
 contains autonomic reflex centers essential for
survival:
cardiac centre
vasomotor centre
respiratory centre
 links cerebrum and medulla; also brainstem
& cerebellum

 contains some respiratory centres

 contains ascending & descending tracts

 mediates auditory & visual reflexes

 Located under cerebrum and cerebellum
 Links cerebrum with brain stem
 Consists of:

Thalamus
▪ principal relay station for sensory impulses
Hypothalamus
▪ control of homeostasis

▪ integration centre for Autonomic

nervous System

▪ centre for emotional responses

Epithalamus
 contains Pineal gland - involved
in Circadian rhythms (sleep/wake cycles)

• control of sexual functioning

 Second largest part of brain

 Paired lobes posterior to brainstem

 Coordinates body movements, posture

& balance

 Covered with cerebellar cortex

 Enables awareness of self, sensation,
communication, memory, understanding
and movement.
Structure:
 2 hemispheres divided by the longitudinal fissure

further subdivided into 4lobes

 frontal
 parietal
 temporal
 occipital
consists of:

 cortex (grey matter) – forms outer covering,

characterised by folds (gyri) and grooves
(sulci)

 white matter – internal structure

Functionally:

 sensory areas – conscious perception of various

sensations

 motor areas – control of voluntary movements

 association areas – integration of diverse

information
1. Association fibers
 Connections within 1
hemisphere
2. Commissural fibers
 Bands of fibers connecting 2
hemispheres
3. Projection fibers
 Link cerebral cortex with
diencephalon, brain stem,
cerebellum, and spinal cord
4 AREAS: (in frontal lobe)
(1)Primary motor cortex
control of skeletal muscles
(2)Pre-motor cortex
motor skill patterns
(3)Broca’s area
speech
(4) Frontal eye field.
eyeball movements
1) Primary (somatic) motor cortex:
 Located in the pre-central gyrus.

 Allows us to control voluntary movements of our

skeletal muscles.

 The entire body is mapped in the primary motor

cortex (called a homunculus)
Several Areas:

1)Primary somatosensory cortex (post –central gyrus);

2)Somatosensory association area;
3)Primary sensory and association areas for each of the
special senses

 Function is conscious awareness of sensation.

1. Primary somatosensory cortex:
 Located in the post-central gyrus.
 Receives info from somatic receptors in the skin and
proprioceptors in muscles.
 Identifies body region stimulated (spatial
discrimination or localisation)

As with the primary motor cortex it is mapped.

 Association areas communicate with other
association areas
 To analyze and recognize sensory inputs in
light of past experience.
 Visual cortex: occipital lobe
 information from sight receptors
 Auditory cortex: temporal lobe
 information from sound receptors
 Olfactory cortex: frontal & medial temporal
lobe
 information from odor receptors
 Gustatory cortex: insula (deep to temporal
lobe)
 information from taste receptors
Other structures:
 ventricles
 cerebrospinal fluid
 meninges
 Blood brain barrier
 cerebral blood supply – Circle of Willis
 Arteries
 External carotid arteries and branches
▪ Tissues of head & face, skin, muscles
▪ Middle meningeal a. = brain
▪ Boxers!

 Internal carotid arteries and branches

▪ Opthalmic a. = Eye & Orbits
▪ Ant & Middle Cerebral arts = Cerebrum

 Vertebral arteries
▪ Posterior brain
▪ Vertebrae & Cervical Spinal Cord
▪ Branches form Cerebral Arterial Circle = Anastomosis
The Circle of Willis
Consists of
 A specialised set of arteries that circles the
brain stem to ensure that blood flow is always
maintained
 A form of inbuilt bypass (arterial
anastamosis)
 Brain stem

 Basilar Artery

 Vertebral Arteries

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 Two Vertebral Arteries enter skull through
Foramen Magnum
 Join to form the Basilar Artery and then Circle
of Willis
 Numerous small branches
 Supplies the brainstem and cerebellum
 Posterior Inferior Cerebellar Artery (PICA) is
one that serves cerebellum.

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 Common Carotid Artery
 Divides into two branches
 External Branch
▪ Supply blood to facial muscles, forehead and oral, nasal and orbital
cavities
 Internal Branch (enters the skull through the carotid
foramen)
▪ Anterior choroidal artery (supplies optic tract, posterior limb of
internal capsule, branches to midbrain,and lateral geniculate
nucleus).
▪ Ophthalmic artery (Supplies blood to the eyeball and ocular muscles)
 Major source of blood to the brain
 After joining Circle of Willis becomes anterior cerebral and
middle cerebral arteries
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49
 Wreath-shaped circle of Willis located at
ventral surface of brain
 Connects Carotid and Vertebral Basilar
Systems
 Middle and Anterior Cerebral Arteries
 Anterior Communicating Artery
 Posterior Cerebral Artery
 Posterior Communicating Artery

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  ACA: Medial Frontal Perfusion
 MCA: Lateral Perfusion
 PCA: Posterior medial Perfusion, cerebellum
 Watershed Areas: overlap between major arteries
Major Arteries
 Carotid
 Anterior Cerebral
 Middle Cerebral
Posterior Cerebral

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 Cortical (Circumferential) Branches
 Supply External Brain Structures
 Central (Penetrating) Branches
 Small
 Penetrate ventral surface to supply internal brain
structures

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 Supplies Orbital and Medial
Surfaces of Frontal and Parietal
Lobes
 Interruption causes
 Cortical Arteries
 Paralysis of legs and feet
 Difficulty in prefrontal lobe functions
of cognitive thinking, judgment,
motor initiation and self monitoring

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 Direct continuation of carotid artery
 Cortical Branches
 Temporal
 Parietal
 Frontal

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 Supplies blood to entire lateral surface of brain
 Somatosensory Cortex
 Motor Cortex
 Broca's Area
 Heschl’s Gyrus
 Wernicke’s Area
 Therefore, symptoms include
 Aphasia
 Motor deficits
 Neglect (right hemisphere)
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 Supplies basal ganglia
and diencephalon
 Interruption causes
 Contralateral hemiplegia
 Impaired sensory
systems
 Touch
 Pain and temperature

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 Arise from cortical arteries or from Circle of Willis
 Penetrate inferior surface of brain
 Can form channels to facilitate blood supply
 Central (Penetrating) Arteries
 Supply
 Thalamus
 Hypothalamus
 Basal Ganglia
 Internal capsule
 Choroid Plexus

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 Supplies blood to anterior and inferior
temporal lobes, uncus, inferior temporal gyri,
inferior and medial occipital lobe
 Watersheds with middle cerebral artery
 Interruption causes
 Homonymous hemianopsia
 Possible total blindness
 Cerebellar symptoms

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 Redundant arteries provide alternative supply
when primary supply is lost
 Small, normally closed arteries open up after
occlusion, connecting two larger arteries or
different parts of the same artery.
 Dependent on location and severity of blockage
 Better collateral circulation if blockage is near main
trunk
 Better if blockage occurs gradually

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 Veins
 Dural sinuses
▪ Intracranial-receive blood from veins in brain, bring to
Internal Jugular

 Internal jugular
▪ Drains brain

 External jugular
▪ Drains scalp and face (superficial)

 Vertebral
▪ Drains cervical vertebrae, cervical spinal cord, small neck
muscles