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Brain and Neurological Disorders

Definition

The central nervous system (CNS) is composed of the brain and spinal cord. The brain receives sensory information from the nerves that pass through the spinal cord, as well as other nerves such as those from sensory organs involved in sight and smell. Once received, the brain processes the sensory signals and initiates responses. The spinal cord is the principle route for the passage of sensory information to and from the brain.

Information flows to the central nervous system from the peripheral nervous system, which senses signals from the environment outside the body (sensory-somatic nervous system) and from the internal environment (autonomic nervous system). The brain's responses to incoming information flow through the spinal cord nerve network to the various effector organs and tissue regions where the target responsive action will take place.

Brain

The brain is divided into three major anatomical regions, the prosencephalon (forebrain), mesencephalon (midbrain), and the rhombencephalon (hindbrain). The brain also contains a ventricular system, which consists of four ventricles (internal cavities): two lateral ventricles, a third ventricle, and a fourth ventricle. The ventricles are filled with cerebrospinal fluid and are continuous with the spinal canal. The ventricles are connected via two interventricular foramen (connecting the two lateral ventricles to the third venticle), and a cerebral aqueduct (connecting the third ventricle to the fourth ventricle).

The brain and spinal cord are covered by three layers of meninges (dura matter, arachnoid matter, and pia mater) that dip into the many folds and fissures. The meninges are three sheets or layers of connective tissue that cover all of the spinal cord and the brain. Infections of the meninges are called meningitis. Bacterial, viral, and protozoan meningitis are serious and require prompt medical attention. Between the arachnoid and the pia matter is a fluid called the cerebrospinal fluid. Bacterial infections of the cerebrospinal fluid can occur and are life-threatening.

GROSS ANATOMY OF THE BRAIN The prosencephalon is divided into the diencephalon and the telencephalon (also known as the cerebrum). The cerebrum contains the two large bilateral hemispherical cerebral cortex that are responsible for the intellectual functions and house the neural connections that integrate, personality, speech, and the interpretation of sensory data related to vision and hearing.

The midbrain, or mesencephalon region, serves as a connection between higher and lower brain functions, and contains a number of centers associated with regions that create strong drives to certain behaviors. The midbrain is involved in body movement. The so-called pleasure center is located here, which has been implicated in the development of addictive behaviors.

The rhombencephalon, consisting of the medulla oblongata, pons, and cerebellum, is an area largely devoted to lower brain functions, including autonomic functions involved in the regulation of breathing and general body coordination. The medulla oblongata is a cone-like knot of tissue that lies between the spinal cord and the pons. A median fissure (deep, convoluted fold) separates swellings (pyramids) on the surface of the medulla. The pons (also known as the metencephalon) is located on the anterior surface of the cerebellum and is continuous with the superior portion of the medulla oblongata. The pons contains large tracts of transverse fibers that serve to connect the left and right cerebral hemispheres.

The cerebellum lies superior and posterior to the pons at the back base of the head. The cerebellum consists of left and right hemispheres connected by the vermis. Specialized tracts (peduncles) of neural tissue also connect the

cerebellum with the midbrain, pons, and medulla. The surface of the cerebral hemispheres (the cortex) is highly convoluted into many folds and fissures.

The midbrain serves to connect the forebrain region to the hindbrain region. Within the midbrain a narrow aqueduct connects ventricles in the forebrain to the hindbrain. There are four distinguishable surface swellings (colliculi) on the midbrain. The midbrain also contains a highly vascularized mass of neural tissue called the red nucleus that is reddish in color (a result of the vascularization) compared to other brain structures and landmarks.

Although not visible from an exterior inspection of the brain, the diencephalon contains a dorsal thalamus (with a large posterior swelling termed the pulvinar) and a ventral hypothalamus that forms a border of the third ventricle of the brain. In this third ventral region lies a number of important structures, including the optic chiasma (the region where the ophthalmic nerves cross) and infundibulum.

Obscuring the diencephalon are the two large, well-developed, and highly convoluted cerebral hemispheres that comprise the cerebrum. The cerebrum is the largest of the regions of the brain. The corpus callosum is connected to the two large cerebral hemispheres. Within each cerebral hemisphere lies a lateral ventricle. The cerebral hemispheres run under the frontal, parietal, and occipital bones of the skull. The gray matter cortex is highly convoluted into folds (gyri) and the covering meninges dip deeply into the narrow gaps between the folds (sulci). The divisions of the superficial anatomy of the brain use the gyri and sulcias anatomical landmarks to define particular lobes of the cerebral hemispheres. As a rule, the lobes are named according to the particular bone of the skull that covers them. Accordingly, there are left and right frontal lobes, parietal lobes, an occipital lobe, and temporal lobes.

In a reversal of the pattern found within the spinal cord, the cerebral hemispheres have white matter tracts on the inside of the hemispheres and gray matter on the outside or cortex regions. Masses of gray matter that are present within the interior white matter are called basal ganglia or basal nuclei.

Spinal cord

The spinal cord is a long column of neural tissue that extends from the base of the brain, downward (inferiorly) through a canal created by the spinal vertebral foramina. The spinal cord is between 16.9 and 17.7 inches (43 and 45 centimeters) long in the average woman and man, respectively. The spinal cord usually terminates at the level of the first lumbar vertebra.

The spinal cord is enclosed and protected by the vertebra of the spinal column. There are four regions of vertebrae. Beginning at the skull and moving downward, there are the eight cervical vertebrae, 12 thoracic vertebrae, five lumbar vertebrae, five sacral vertebrae, and one set of fused coccygeal vertebra.

Along the length of the spinal cord are positioned 31 pairs of nerves. These are known as mixed spinal nerves, as they convey sensory information to the brain and response information back from the brain. Spinal nerve roots emerge from the spinal cord that lies within the spinal canal. Both dorsal and ventral roots fuse in the intervertebral foramen to create a spinal nerve.

Although there are only seven cervical vertebra, there are eight cervical nerves. Cervical nerves one through seven (C1–C7) emerge above (superior to) the corresponding cervical vertebrae. The last cervical nerve (C8) emerges below (inferior to) the last cervical vertebrae from that point downward the spinal nerves exit below the corresponding vertebrae for which they are named.

In the spinal cord of humans, the myelin-coated axons are on the surface and the axon-dendrite network is on the inside. In cross-section, the pattern of contrasting color of these regions produces an axon-dendrite shape that is reminiscent of a butterfly.

The nerves of the spinal cord correspond to the arrangement of the vertebrae. There are 31 pairs of nerves, grouped as eight cervical pairs, 12 thoracic pairs, five lumbar pairs, five sacral pairs, and one coccygeal pair. The nerves toward the top of the cord are oriented almost horizontally. Those further down are oriented on a progressively upward slanted angle toward the bottom of the cord.

Toward the bottom of the spinal cord, the spinal nerves connect with cells of the sympathetic nervous system. These cells are called pre-ganglionic and ganglionic cells. One branch of these cells is called the gray ramus communicans and the other branch is the white ramus communicans. Together they are referred to as the rami. Other rami connections lead to the pelvic area.

The bi-directional (two-way) communication network of the spinal cord allows the reflex response to occur. This type of rapid response occurs when a message from one type of nerve fiber, the sensory fiber, stimulates a muscle response directly, rather than the impulse traveling to the brain for interpretation. For example, if a hot stove burner is touched with a finger, the information travels from the finger to the spinal cord and then a response to move muscles away from the burner is sent rapidly and directly back. This response is initiated when speed is important.

Development and histology of the CNS

Both the spinal cord and the brain are made up of structures of nerve cells called neurons. The long main body extension of a neuron is called an axon. Depending on the type of nerve, the axons may be coated with a material called myelin. Both the brain and spinal cord components of the central nervous system contain bundles of cell bodies (out of which axons grow) and branched regions of nerve cells that are called dendrites. Between the axon of one cell body and the dendrite of another nerve cell is an intervening region called the synapse. In the spinal cord of humans, the myelin-coated axons are on the surface and the axon-dendrite network is on the inside. In the brain, this arrangement is reversed.

The brain begins as a swelling at the cephalic end of the neural tube that ultimately will become the spinal cord. The neural tube is continuous and contains primitive cerebrospinal fluids. Enlargements of the central cavity (neural tube lumen) in the region of the brain become the two lateral, third, and forth ventricles of the fully developed brain.

The embryonic brain is differentiated in several anatomical regions. The most cephalic region is the telencephalon. Ultimately, the telencephlon will develop the bilateral cerebral hemispheres, each containing a lateral ventricle, cortex (surface) layer of gray cells, a white matter layer, and basal nuclei. Caudal (inferior) to the telecephalon is the diencephalon that will develop the epithalamus, thalamus, and hypothalamus

Caudal to the diencephalon is the mesencephalon, the midbrain region that includes the cerebellum and pons. Within the myelencephalon region is the medulla oblongata.

Neural development inverts the gray matter and white matter relationship within the brain. The outer cortex is composed of gray matter, while the white matter (myelinated axons) lies on the interior of the developing brain.

The meninges that protect and help nourish neural tissue are formed from embryonic mesoderm that surrounds the axis established by the primitive neural tube and notochord. The cells develop many fine capillaries that supply the highly oxygen-demanding neural tissue.

Diseases and disorders of the CNS

Diseases that affect the nerves of the central nervous system include rabies, polio, and sub-acute sclerosing pan-encephalitis. Such diseases affect movement and can lead to mental incapacitation. The brain is also susceptible to disease, including toxoplasmosis and the development of empty region due to prions. Such diseases cause a wasting away of body function and mental ability. Brain damage can be so compromised as to be lethal.

BOOKS

Bear, M., et al. Neuroscience: Exploring the Brain. Baltimore: Williams & Wilkins, 1996.

Goetz, C. G., et al. Textbook of Clinical Neurology. Philadelphia: W.B. Saunders Company, 1999.

Goldman, Cecil. Textbook of Medicine, 21st ed. New York: W.B. Saunders Co., 2000.

Guyton & Hall. Textbook of Medical Physiology, 10th ed. New York: W.B. Saunders Company, 2000.

Tortora, G. J., and S. R. Grabowski. Principles of Anatomy and Physiology, 9th ed. New York: John Wiley and Sons Inc., 2000.

Brian Douglas Hoyle, PhD

Paul Arthur

Toptop

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