Central Nervous System Physiology

1. Carlos Darcy Alves Bersot TSA.SBACarlos Darcy Alves Bersot TSA.SBA
MD RESPONSÁVEL PELO CET H.F.LAGOAMD RESPONSÁVEL PELO CET H.F.LAGOA
Médico Anestesiologista do Hospital Federal da Lagoa-SUSMédico Anestesiologista do Hospital Federal da Lagoa-SUS
Médico Anestesiologista do Hospital Pedro Ernesto-UERJMédico Anestesiologista do Hospital Pedro Ernesto-UERJ

3. animalanimal
organismorganism
Nervous systemNervous system
sensory sensory
neuronneuron
stimulusstimulus reactionreaction
effectoreffector
Inter-Inter-
neuronneuron
receptorreceptor
MotorMotor
neuronneuronNNN
NNN
PCvmuIsNbysaC3NNNNNNNNNNNNNNNNNN
PCvmuIsNbysaC3NNNNNNNNNNNNNNNNNN
saD3IoIsNrRANvCrSaDuRN
saD3IoIsNrRANvCrSaDuRN
Nervous System Nervous System stimulus and reaction stimulus and reaction

4. Nervous SystemNervous SystemNervous SystemNervous System
• Central Nervous SystemCentral Nervous System
brain, spinal cord: brain, spinal cord: nervous tissuenervous tissue
meninges, choroid plexusmeninges, choroid plexus: : connective tissueconnective tissue
• Peripheral Nervous SystemPeripheral Nervous System
nerve, ganglion, nerve plexusnerve, ganglion, nerve plexus::

5. Nervous TissueNervous TissueNervous TissueNervous Tissue
Cellular ElementsCellular Elements
ŸŸ Neuron (Nerve Cell)Neuron (Nerve Cell)
ŸŸ Neuroglial Cells Neuroglial Cells
central neurgliacentral neurglia
astrocyte, oligodendrocyte, microglia andastrocyte, oligodendrocyte, microglia and
ependymal cellependymal cell
peripheral neurogliaperipheral neuroglia
Schwann cell Schwann cell in nerve and ganglionin nerve and ganglion
satellite (capsular) cell satellite (capsular) cell in ganglionin ganglion

6. NeuronNeuronNeuronNeuron
Neuronal MorphologyNeuronal Morphology
Neuronal Cell Body (Soma)Neuronal Cell Body (Soma)
ŸŸ Nucleus Nucleus

Neuronal ProcessesNeuronal Processes
ŸŸ AxonAxon
ŸŸ DendritesDendrites
Diversity of Neuronal Size and MorphologyDiversity of Neuronal Size and Morphology

8. Diversity ofDiversity of
NeuronalNeuronal
MorphologyMorphology

9. NeuronNeuronNeuronNeuron
Neuronal FunctionNeuronal Function
CommunicationCommunication
Receptor - Neuron - Effector Receptor - Neuron - Effector

- - Excitability (Irritability)Excitability (Irritability)
- - ConductivityConductivity
through membrane through membrane in intraneuronal conductionin intraneuronal conduction
via via synapsesynapse in in interneuronal conductioninterneuronal conduction
neurotransmittersneurotransmitters

10. SYNAPSESYNAPSESYNAPSESYNAPSE
ŸŸ Presynaptic Portion: Synaptic Button Presynaptic Portion: Synaptic Button
- synaptic vesicle- synaptic vesicle
- mitochondria- mitochondria
- presynaptic membrane: tubulin- presynaptic membrane: tubulin
ŸŸ Synaptic Cleft Synaptic Cleft
- 20-30 nm- 20-30 nm
ŸŸ Postsynaptic PortionPostsynaptic Portion
- postsynaptic membrane: actin, fodrin, spectrin- postsynaptic membrane: actin, fodrin, spectrin
- mitochondria- mitochondria

11. SYNAPSESYNAPSESYNAPSESYNAPSE

13. Myelin Sheath - MYELINMyelin Sheath - MYELIN
Schwann sheathSchwann sheath
• formed by wrapped plasma membrane offormed by wrapped plasma membrane of
OligodendrocyteOligodendrocyte in CNS in CNS
Schwann CellSchwann Cell in PNS in PNS
• Node of RanvierNode of Ranvier - Saltatory Conduction - Saltatory Conduction

- - conduction velocityconduction velocity
MyelinMyelinMyelinMyelin

14. MyelinMyelin
Structure of fast nerve conductionStructure of fast nerve conduction

15. Multiple Slerosis Multiple Slerosis – disease of the myelin– disease of the myelin
Jacqueline Du PreJacqueline Du Preoligodendrocyteoligodendrocyte

16. ORGANIZAÇÃO DO SNORGANIZAÇÃO DO SNORGANIZAÇÃO DO SNORGANIZAÇÃO DO SN
Central Nervous SystemCentral Nervous System
Gray MatterGray Matter
Nucleus and CortexNucleus and Cortex
White MatterWhite Matter
TractsTracts
Peripheral Nervous SystemPeripheral Nervous System
Nerve (Peripheral Nerve)Nerve (Peripheral Nerve)
GanglionGanglion

17.  Nerve FiberNerve Fiber
Myelinated Nerve FiberMyelinated Nerve Fiber
Axon,Axon, Myelin sheathMyelin sheath, Schwann cell, Schwann cell
Unmyelinated Nerve Fiber Unmyelinated Nerve Fiber
Axon, Schwann cellAxon, Schwann cell
 Connective Tissue SheathConnective Tissue Sheath
EndoneuriumEndoneurium
Perineurium – blood vesselsPerineurium – blood vessels
EpineuriumEpineurium
SISTEMA NERVOSO PERIFÉRICOSISTEMA NERVOSO PERIFÉRICOSISTEMA NERVOSO PERIFÉRICOSISTEMA NERVOSO PERIFÉRICO

18. Receptor Receptor
EndingsEndings

19. TERMINAÇÕES EFERENTESTERMINAÇÕES EFERENTES
Somatic Efferent EndingsSomatic Efferent Endings
Neuromuscular JunctionNeuromuscular Junction
(Myoneural Junction, Motor End (Myoneural Junction, Motor End
Plate)Plate)
Autonomic Efferent Autonomic Efferent
EndingsEndings
Endings on smooth muscle Endings on smooth muscle
and blood vesselsand blood vessels

20. NeuromuscularNeuromuscular
JunctionJunction
(Myoneural Junction,(Myoneural Junction,
Motor End Plate)Motor End Plate)
NMJNMJ
MM
NN

21. Myasthenia GravisMyasthenia Gravis
• muscle weaknessmuscle weakness

• autoimmune disease autoimmune disease
with autoantibodieswith autoantibodies
against against Ach receptorAch receptor
• treated withtreated with
AchT inhibitorsAchT inhibitors, ,
thymectomy, and thymectomy, and
corticosteroidscorticosteroids
Defects in NMDefects in NM
TransmissionTransmission
before treatment after treatmentbefore treatment after treatment

22. Autonomic Efferent EndingsAutonomic Efferent Endings

25. Brain RegionsBrain Regions
1.Cerebrum
2.Diencephalon
3.Brainstem
4.Cerebellum
Cerebellum

26. CerebrumCerebrum
•O cérebro humano
contém cerca de 100
bilhões de neurônios,
ligados por mais de
10,000 conexões
sinápticas .
•Corpo caloso
•Massa Cinzenta e
Branca.
•Giros e Sulcos

27. •Deeper grooves called fissures separate large regions of the brain.
–The median longitudinal fissure separates the cerebral hemispheres.
–The transverse fissure separates the cerebral hemispheres from the
cerebellum below.
•Deep sulci divide each hemisphere into 5 lobes:
–Frontal, Parietal, Temporal, Occipital, and Insula

28. •The central sulcus separates the frontal lobe from the parietal
lobe.
–Bordering the central sulcus are 2 important gyri, the precentral
gyrus and the postcentral gyrus.
•The occipital lobe is separated from the parietal lobe by the
parieto-occipital sulcus.
•The lateral sulcus outlines the temporal lobe.
–The insula is buried deep within the lateral sulcus.

29. Where’s the
insula?

31. Cerebral Cerebral
CortexCortex
•3 types of functional areas:
1.Motor  Control voluntary
motor functions
2.Sensory  Allow for conscious
recognition of stimuli
3.Association  Integration

32. Cortical Motor AreasCortical Motor Areas
1.Primary Motor
Cortex
2.Premotor Cortex
3.Broca’s Area

33. Primary motor
cortex
Broca’s Area
Premotor cortex
Frontal Eye
Field

34. Primary (Somatic) Motor CortexPrimary (Somatic) Motor Cortex
•Located in the precentral
gyrus of each cerebral
hemisphere.
•Contains large neurons
(pyramidal cells) which
project to SC neurons
which eventually
synapse on skeletal
muscles
–Allowing for voluntary
motor control.
–These pathways are known
as the corticospinal tracts
or pyramidal tracts.

35. Panfiled?

36. Premotor CortexPremotor Cortex
•Located just anterior
to the primary motor
cortex.
•Involved in learned
or patterned skills.
•Involved in planning
movements.
•How would damage
to the primary motor
cortex differ from
damage to the
premotor cortex?

37. Broca’s AreaBroca’s Area
•Typically found in only
one hemisphere (often
the left), anterior to the
inferior portion of the
premotor cortex.
•Directs muscles of
tongue, and throat that
are used in speech
production.
•Involved in planning
speech production and
possibly planning other
activities.

38. Sensory AreasSensory Areas
•Found in the parietal, occipital, and
temporal lobes.
1.Primary somatosensory cortex
2.Somatosensory association cortex
3.Visual areas
4.Auditory areas
5.Olfactory cortex
6.Gustatory cortex
7.Vestibular cortex

40. Primary Somatosensory CortexPrimary Somatosensory Cortex
•Found in the postcentral
gyrus.
•Neurons in this cortical area
receive info from sensory
neurons in the skin and from
proprioceptors which monitor
joint position.
•Contralateral input.

42. Somatosensory Association Somatosensory Association
CortexCortex
•Found posterior to the
primary somatosensory
cortex
•Synthesizes multiple
sensory inputs to create
a complete
comprehension of the
object being felt.
–How would damage to
this area differ from
damage to the primary
somatosensory cortex?

43. Primary Visual CortexPrimary Visual Cortex
•Found in the
posterior and medial
occipital lobe.
•Largest of the
sensory cortices.
–What does this
suggest?
•Contralateral input.

44. Association Association
AreasAreas
•Allows for analysis of
sensory input.
•Multiple inputs and
outputs. Why?
1.Prefrontal cortex
2.Language areas
3.General interpretation
area
4.Visceral association
area

45. Prefrontal Prefrontal
CortexCortex
•Anterior frontal lobes
•Involved in analysis,
cognition, thinking,
personality, conscience,
& much more.
•What would a
frontal lobotomy
result in?
•Look at its
evolution

46. Phineas Gage’s lesion reconstructedPhineas Gage’s lesion reconstructed
(H. Damasio and R. Frank, 1992)(H. Damasio and R. Frank, 1992)

47. Language AreasLanguage Areas•Large area for
language
understanding and
production
surrounding the
lateral sulcus in the
left (language-
dominant)
hemisphere
•Includes:
–Wernicke’s area 
understanding
oral/written words
–Broca’s area 
speech production
NEGLIGENCIA

48. Basal NucleiBasal Nuclei
•Components of the extrapyramidal system which provides
subconscious control of skeletal muscle tone and
coordinates learned movement patterns and other somatic
motor activities.
•Doesn’t initiate movements but once movement is
underway, they assist in the pattern and rhythm (especially
for trunk and proximal limb muscles
•Set of nuclei deep within the
white matter.
•Includes the:
–Caudate Nucleus
–Lentiform Nucleus
•Globus pallidus
•Putamen

49. ffff
Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components Basal Ganglia Components

50. Muhammad Ali in Alanta OlympicMuhammad Ali in Alanta Olympic
Parkinson’s Parkinson’s
DiseaseDisease
Disease of mesostriatal Disease of mesostriatal
dopaminergic systemdopaminergic system
PDPD
normalnormal

51. SYDENHAM’S CHOREASYDENHAM’S CHOREASYDENHAM’S CHOREASYDENHAM’S CHOREA
- Complication of- Complication of
Rheumatic FeverRheumatic Fever
- Fine, disorganized , and - Fine, disorganized , and
random movements ofrandom movements of
extremities, face andextremities, face and
tonguetongue
- Accompanied by - Accompanied by
Muscular HypotoniaMuscular Hypotonia
--
Clinical FeatureClinical Feature
Principal Pathologic Lesion: Principal Pathologic Lesion: Corpus StriatumCorpus Striatum

52. Clinical FeatureClinical Feature
Principal Pathologic Lesion:Principal Pathologic Lesion:
Corpus Striatum (esp. caudate nucleus)Corpus Striatum (esp. caudate nucleus)
and Cerebral Cortexand Cerebral Cortex
- Predominantly - Predominantly autosomal dominantlyautosomal dominantly
inherited chronic fatal diseaseinherited chronic fatal disease
(Gene: chromosome 4)(Gene: chromosome 4)
HUNTINGTON’S CHOREAHUNTINGTON’S CHOREA

53. DiencephalonDiencephalon
•Forms the
central core of
the forebrain
•3 paired
structures:
1.Thalamus
2.Hypothalamu
s
3.Epithalamus

54. ThalamusThalamus
•80% of the
diencephalon
•Sensory retransmission
station where sensory
signals can be edited,
sorted, and routed.
•Also has profound input
on motor (via the basal
ganglia and cerebellum)
and cognitive function.

55. HypothalamusHypothalamus
•Functions:
–Autonomic regulatory center
•Influences HR, BP, resp. rate,
GI motility, pupillary diameter.
•Can you hold your
breath until you die?
–Emotional response
•Involved in fear, loathing, pleasure
•Drive center: sex, hunger
–Regulation of body temperature
–Regulation of food intake
•Contains a satiety center
–Regulation of water balance and thirst
–Regulation of sleep/wake cycles
–Hormonal control
•Releases hormones that influence hormonal
secretion from the anterior pituitary gland.
•Releases oxytocin and vasopressin

56. EpithalamusEpithalamus
•Above the thalamus
•Contains the pineal
gland which releases
melatonin (involved in
sleep/wake cycle and
mood).

57. CerebellumCerebellum
•Lies inferior to the cerebrum and
occupies the posterior cranial fossa.
•2
nd
largest region of the brain.
•10% of the brain by volume, but it
contains 50% of its neurons
•Has 2 primary functions:
1.Adjusting the postural muscles of the body
•Coordinates rapid, automatic adjustments, that maintain balance
and equilibrium
2.Programming and fine-tuning movements controlled at
the subconscious and conscious levels
•Refines learned movement patterns by regulating activity of both
the pyramidal and extrapyarmidal motor pathways of the cerebral
cortex

58. CerebellumCerebellum
•The cerebellum can
be permanently
damaged by trauma
or stroke or
temporarily affected
by drugs such as
alcohol.
•These alterations
can produce ataxia
– a disturbance in
balance.

59. Cerebellar Cerebellar
AtaxiaAtaxia
ROMBERGROMBERG
a b c
d

61. PonsPons
·The bulging center part of the brain
stem
·Mostly composed of fiber tracts
·Includes nuclei involved in the control of
breathing

62. Medulla OblongataMedulla Oblongata
·The lowest part of the brain stem
·Merges into the spinal cord
·Includes important fiber tracts
·Contains important control centers
·Heart rate control
·Blood pressure regulation
·Breathing
·Vomiting

63. Spinal segment Spinal segment
C8, T12, L5, S5, Cx1C8, T12, L5, S5, Cx1
Anterior (Ventral) RootAnterior (Ventral) Root
Posterior (Dorsal) RootPosterior (Dorsal) Root
Dorsal Root (Spinal) GanglionDorsal Root (Spinal) Ganglion

64. Periosteum of VertebraPeriosteum of Vertebra
- - Epidural Space Epidural Space ----------------- ----------------- epidural anesthesiaepidural anesthesia
Dura Mater Spinalis Dura Mater Spinalis
Arachnoid MembraneArachnoid Membrane
- - Subarachnoid Space --------Subarachnoid Space -------- Lumbar Puncture Lumbar Puncture
Spinal AnesthesiaSpinal Anesthesia
Pia Mater SpinalisPia Mater Spinalis

Periosteum of VertebraPeriosteum of Vertebra
- - Epidural Space Epidural Space ----------------- ----------------- epidural anesthesiaepidural anesthesia
Dura Mater Spinalis Dura Mater Spinalis
Arachnoid MembraneArachnoid Membrane
- - Subarachnoid Space --------Subarachnoid Space -------- Lumbar Puncture Lumbar Puncture
Spinal AnesthesiaSpinal Anesthesia
Pia Mater SpinalisPia Mater Spinalis

Spinal Cord MeningesSpinal Cord Meninges Spinal Cord MeningesSpinal Cord Meninges

65. Arterial SupplyArterial Supply
- Spinal Arteries- Spinal Arteries
Anterior (1) & Posterior (2) Spinal ArteryAnterior (1) & Posterior (2) Spinal Artery
from from Vertebral arteryVertebral artery
- Radicular Arteries ----- Segmental arteries- Radicular Arteries ----- Segmental arteries
from from Vertebral, Ascending Cervical, Intercostal andVertebral, Ascending Cervical, Intercostal and
Lumbar Artery Lumbar Artery

Arterial SupplyArterial Supply
- Spinal Arteries- Spinal Arteries
Anterior (1) & Posterior (2) Spinal ArteryAnterior (1) & Posterior (2) Spinal Artery
from from Vertebral arteryVertebral artery
- Radicular Arteries ----- Segmental arteries- Radicular Arteries ----- Segmental arteries
from from Vertebral, Ascending Cervical, Intercostal andVertebral, Ascending Cervical, Intercostal and
Lumbar Artery Lumbar Artery

Spinal Cord Spinal Cord Vascular SupplyVascular Supply Spinal Cord Spinal Cord Vascular SupplyVascular Supply

66. anterior spinal arteryanterior spinal artery segmental arteries segmental arteries
5. Adamkiwicz artery5. Adamkiwicz artery

67. Spinothalamic TractSpinothalamic Tract

Modality: Modality: Pain & Temperature Sensation, Light Touch Pain & Temperature Sensation, Light Touch
Receptor: Receptor: Free Nerve Ending Free Nerve Ending
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion)
Posterior Root Posterior Root
2nd Neuron: 2nd Neuron: Dorsal Horn Dorsal Horn (Lamina I, IV, V)(Lamina I, IV, V)
Spinothalamic Tract - (Spinal Lemniscus)Spinothalamic Tract - (Spinal Lemniscus)
3rd Neuron: 3rd Neuron: Thalamus (VPL) Thalamus (VPL)
Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata
Termination: Termination: Primary Somesthetic Area (S I) &Primary Somesthetic Area (S I) &
Diffuse Widespread Cortical RegionDiffuse Widespread Cortical Region
Spinothalamic TractSpinothalamic Tract

Modality: Modality: Pain & Temperature Sensation, Light Touch Pain & Temperature Sensation, Light Touch
Receptor: Receptor: Free Nerve Ending Free Nerve Ending
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion)
Posterior Root Posterior Root
2nd Neuron: 2nd Neuron: Dorsal Horn Dorsal Horn (Lamina I, IV, V)(Lamina I, IV, V)
Spinothalamic Tract - (Spinal Lemniscus)Spinothalamic Tract - (Spinal Lemniscus)
3rd Neuron: 3rd Neuron: Thalamus (VPL) Thalamus (VPL)
Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata
Termination: Termination: Primary Somesthetic Area (S I) &Primary Somesthetic Area (S I) &
Diffuse Widespread Cortical RegionDiffuse Widespread Cortical Region
Spinal Cord Ascending TractsSpinal Cord Ascending Tracts Spinal Cord Ascending TractsSpinal Cord Ascending Tracts

68. Spinothalamic TractSpinothalamic TractSpinothalamic TractSpinothalamic Tract
spinothalamicspinothalamic
tracttract
anterior whiteanterior white
commissurecommissure
posterior rootposterior root
decussationdecussation
- - contralateralcontralateral loss of pain and temperature loss of pain and temperature
sensation sensation below below the level of lesionthe level of lesion

69. Spinocerebellar TractSpinocerebellar Tract

Modality: Modality: Unconscious Proprioception Unconscious Proprioception
Receptor: Receptor: Golgi tendon organ, muscular fuseGolgi tendon organ, muscular fuse
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion)
Posterior Root , Posterior Root ,
2nd Neuron: 2nd Neuron: 1. Clarke’s column 1. Clarke’s column
Posterior Spinocerebellar TractPosterior Spinocerebellar Tract
2. Accessory Cuneate Nucleus2. Accessory Cuneate Nucleus
Cuneocerebellar Tract Cuneocerebellar Tract
3. Posterior Horn3. Posterior Horn
Anterior Spinocerebellar r TractAnterior Spinocerebellar r Tract
Termination: Termination: Cerebellar CortexCerebellar Cortex
Spinocerebellar TractSpinocerebellar Tract

Modality: Modality: Unconscious Proprioception Unconscious Proprioception
Receptor: Receptor: Golgi tendon organ, muscular fuseGolgi tendon organ, muscular fuse
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion)
Posterior Root , Posterior Root ,
2nd Neuron: 2nd Neuron: 1. Clarke’s column 1. Clarke’s column
Posterior Spinocerebellar TractPosterior Spinocerebellar Tract
2. Accessory Cuneate Nucleus2. Accessory Cuneate Nucleus
Cuneocerebellar Tract Cuneocerebellar Tract
3. Posterior Horn3. Posterior Horn
Anterior Spinocerebellar r TractAnterior Spinocerebellar r Tract
Termination: Termination: Cerebellar CortexCerebellar Cortex
Spinal Cord Ascending TractsSpinal Cord Ascending Tracts Spinal Cord Ascending TractsSpinal Cord Ascending Tracts
FUNCTION?FUNCTION?FUNCTION?FUNCTION?

70. Corticospinal TractCorticospinal Tract
Origin: Origin: Cerebral CortexCerebral Cortex
Brodmann Area 4 (Primary Motor Area, M I)Brodmann Area 4 (Primary Motor Area, M I)
Brodmann Area 6 (Premotor Area, PM )Brodmann Area 6 (Premotor Area, PM )
Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I)
Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule) Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)
Corona RadiataCorona Radiata
lnternal Capsule, Posterior Limblnternal Capsule, Posterior Limb
Longitudinal Pontine FiberLongitudinal Pontine Fiber
Pyramid - pyramidal decussationPyramid - pyramidal decussation
Corticospinal Tract - Lateral and AnteriorCorticospinal Tract - Lateral and Anterior
Termination: Termination: Spinal Gray (Rexed IV-IX)Spinal Gray (Rexed IV-IX)
Corticospinal TractCorticospinal Tract
Origin: Origin: Cerebral CortexCerebral Cortex
Brodmann Area 4 (Primary Motor Area, M I)Brodmann Area 4 (Primary Motor Area, M I)
Brodmann Area 6 (Premotor Area, PM )Brodmann Area 6 (Premotor Area, PM )
Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I)
Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule) Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)
Corona RadiataCorona Radiata
lnternal Capsule, Posterior Limblnternal Capsule, Posterior Limb
Longitudinal Pontine FiberLongitudinal Pontine Fiber
Pyramid - pyramidal decussationPyramid - pyramidal decussation
Corticospinal Tract - Lateral and AnteriorCorticospinal Tract - Lateral and Anterior
Termination: Termination: Spinal Gray (Rexed IV-IX)Spinal Gray (Rexed IV-IX)
Spinal Cord Descending TractsSpinal Cord Descending Tracts Spinal Cord Descending TractsSpinal Cord Descending Tracts

71. - - ipsilateralipsilateral UMN syndrome UMN syndrome
atat the level of lesion the level of lesion
Corticospinal TractCorticospinal TractCorticospinal TractCorticospinal Tract
Corona Radiata Corona Radiata
lnternal Capsule, lnternal Capsule,

Longitudinal Pontine Longitudinal Pontine
Pyramid Pyramid
Pyramidal DecussationPyramidal Decussation
Corticospinal Tract Corticospinal Tract
- Lateral and Anterior- Lateral and Anterior
CR
IC
LPF
Pyr
PD
LCST
ACST

72. Spinal CordSpinal Cord
SyndromeSyndrome
AmyotrophicAmyotrophic
Lateral SclerosisLateral Sclerosis
(ALS)(ALS)
Lou Gherig’sLou Gherig’s
DiseaseDisease
Spinal CordSpinal Cord
SyndromeSyndrome
AmyotrophicAmyotrophic
Lateral SclerosisLateral Sclerosis
(ALS)(ALS)
Lou Gherig’sLou Gherig’s
DiseaseDisease
Stephen Haking (1946- )Stephen Haking (1946- )
British Physicist, A Brif History of Time