研究生。N传导脑膜CSF

Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,1,THE NERVOUS PATHWAYS (神经传导路),A. The Sensory (Ascending) Pathways (感觉传导通路)B. The Visual and Pupillary Reflexes Pathways (视觉传导通路和瞳孔对光反射通路)C. The Acoustic Pathway (听觉传导通路)D. The Equilibratory Pathway (平衡觉传导通路)E. The Motor (Descending) Pathways (运动传导通路),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,2,A. The Sensory (Ascending) Pathways,1. Deep & discriminatory sensation Proprioceptive (deep) sense (本体感觉): body posture, movement, vibration and pressure. discriminatory sense (精细触觉): size, shape, texture and two point discrimination.,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,3,Receptorsmuscle spindlestendon spindlesPacinis corpuscles(肌梭,腱梭,P小体),I,II,Med. Lemniscus (内侧丘系),III,丘脑皮质束(丘脑中央辐射,cerebral centers Cortex of the sup. and middle parts of postcentral gyrus. Posterior part of paracentral lobule (中央后回上中部皮质,中央旁小叶后部),Spinal nn.(脊N) (薄束T4,楔束T4),(内侧丘系交叉),(薄束核,楔束核),(脊神经节),(丘脑腹后外侧核),(内囊后肢),(内弓状纤维),1) Conscious proprioceptive sensory pathways (意识性本体感觉传导通路),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,4, 1) Conscious proprioceptive sensory pathways,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,5,Receptorsmuscle spindlestendon spindlesPacinis corpuscles(肌梭,腱梭,P小体),(脊N) (后根),I (脊神经节),II (后角核层),cerebellar center cortex of cerebellum(小脑皮质),ant. white commissure (脊髓白质前连合) ,thoracicnucleus(胸核),sup. cerebellar peduncle (小脑上脚),脊髓小脑前束,(小脑下脚) (脊髓小脑后束),2) unconscious proprioceptive sensory pathway (非意识性本体感觉传导通路),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,6,Receptorsfree n. endings (痛)Krauses end bulbs (冷)Ruffini end organs (热),I,II,(脊髓丘系) (脊髓丘脑侧束),III,丘脑皮质束 (丘脑中央辐射),cerebral centers Cortex of the sup. and middle parts of postcentral gyrus. Posterior part of paracentral lobule (中央后回上中部皮质,中央旁小叶后部),Spinal nn.(脊N) 上升1-2节后外侧束,(脊髓前白连合),(脊髓后角固有核),(脊神经节),(丘脑腹后外侧核),(内囊后肢),2. Superficial sensation 1) Pathway of Pain & Thermal sensation of the Trunk & Limbs(躯干和四肢痛温觉传导通路),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,7,1) Pathway of Pain & Thermal sensation of the Trunk & Limbs,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,8,Receptorsfree n. endings (痛)Krauses end bulbs (冷)Ruffini end organs (热),I,II,trigeminal lemniscus (三叉丘系),III,int.cap.内囊后肢,cerebral centers cortex of the inferior part of postcentral gyrus. (中央后回下部皮质),(三叉神经脊束核) ,(V神经节),(丘脑腹后内侧核),(三叉神经) (三叉神经脊束),丘脑中央辐射(丘脑皮质束), 2) Pain & Thermal Sensation of Head and Face (头面部痛温觉),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,9, 2) Pain & Thermal Sensation of Head and Face (头面部痛温觉),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,10,(损伤部位),感觉障碍表现,Peripheral NS(周围神经),Spinal Cord(脊髓),Internal capsule(内囊),Centers(中枢),Thalamus(丘脑),(脑干延髓),subcutaneous nerve (皮神经): 全部感觉消失,无汗mixed nerve (混合神经): 全部感觉消失,支配肌肉软瘫posterior root 后根): 节段性全部感觉消失,(交叉性痛温觉消失:同侧面部,对侧躯体),(偏身,多伴有自发性痛疼),(对侧三偏: 硬瘫,痛、温、本体、精细触觉消失, 视觉同向消失),(对侧相应区感觉消失),posterior horn (后角): 同侧节段低1-2节痛温觉消失,Ant. commissure (白质前连合): 对称节段性痛温觉消失Tract (传导束): 分离性感觉消失),Summary of Sensory Disturbance(感觉障碍小结),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,11,RECEPTORSfree n. endings (毛囊周围神经末梢tactile corpuscles (触觉小体),I,II,III,丘脑中央辐射(丘脑皮质束),内囊后肢,CEREBRAL CENTERS cortex of the sup. and middle parts of postcentral gyrus. Posterior part of paracentral lobule (中央后回上中部皮质,中央旁小叶后部),spinal nn.(脊N),(脊髓白质前连合),(脊髓后角固有束核),(脊神经节),(丘脑腹后外侧核),(脊髓丘系) (脊髓丘脑前束),3) Tactile Pathway of Trunk and Limbs (躯干四肢触觉),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,12,RECEPTORSfree n. endings (毛囊周围神经末梢tactile corpuscles (触觉小体),I,II,trigem. lemniscus(三叉丘系),III,丘脑中央辐射(丘脑皮质束),CEREBRAL CENTERS cortex of the inferior part of postcentral gyrus. (中央后回下部皮质),trigeminal n.(三叉N),(脑桥内交叉),(三叉神经脑桥核),(V神经节),(丘脑腹后内侧核),内囊后肢,4) Tactile Pathway of Head and Face (头面部触觉),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,13,RECEPTORSrod cells (视杆细胞)cone cells(视锥细胞),II,鼻侧,optic tract (视束),III,视辐射(膝距束),CEREBRAL CENTERS banks of the calcarine sulcus ( lingual gyrus & cuneus) (距状沟两侧皮质) (舌回和楔叶),bipolar c. (双极细胞),(视交叉),(节细胞),(双极细胞),(外侧膝状体) ,颞侧,I,optic n. (视N) ,内囊后肢后部,3. Visual & pupillary reflexes 1) The visual pathway (视觉传导通路),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,14,3. Visual & pupillary reflexes 1) The visual pathway,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,15,视觉传导通路及瞳孔对光反射通路：,双极细胞,外侧膝状体,距状沟两侧,节细胞,视束,视锥细胞视杆细胞,视神经,颞 侧,鼻 侧,顶盖前区,动眼神经副核 （双侧）,动眼神经,睫状神经节（双侧）,瞳孔括约肌睫状肌（双侧）,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,16,视觉传导通路及瞳孔对光反射通路：1. 视觉传导通路： 视网膜中光感受器细胞视锥、视杆细胞，第一级神经元为双级细胞、第二级神经元节细胞，轴突成视神经、经视神经管入颅、经视交叉（视网膜鼻侧半交叉、视网膜颞侧半不交叉），入同侧视束，终止外侧膝状体、外侧膝状体内第三级神经元组成视辐射经内囊后肢投射到端脑距状沟两侧视区，产生视觉。2. 瞳孔对光反射通路：视束纤维经上丘臂于顶盖前区、由此到双侧动眼神经副核，动眼神经副核到睫状神经节换元，节后纤维支配瞳孔括约肌收缩，瞳孔缩小 。Wilbrand前袢：其中来自视网膜鼻侧半下象限的纤维，向腹侧经视交叉前缘至对侧视神经，向前可达3mm作袢状弯曲，沿视交叉外侧缘后行至对视束。Wilbrand后袢：其中来自视网膜鼻侧半上象限的纤维，经视交叉向后至同侧视束吻端，作袢状弯曲，经视交叉后缘上方交叉至对侧视束。,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,17,视觉传导通路：Wilbrand前袢：其中来自视网膜鼻侧半下象限的纤维，向腹侧经视交叉前缘至对侧视神经，向前可达3mm作袢状弯曲，沿视交叉外侧缘后行至对视束。Wilbrand后袢：其中来自视网膜鼻侧半上象限的纤维，经视交叉向后至同侧视束吻端，作袢状弯曲，经视交叉后缘上方交叉至对侧视束。,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,18,RECEPTORSrod cells (视杆细胞cone cells(视锥细胞,IIganglion cell(节细胞),鼻侧,bipolar c. (双极细胞),Optic chiasma (视交叉) ,颞侧,I,Optic n. (视n) ,EW核(III副核),ciliary ganglion睫状N节,Short ciliary nn(睫短神经),Effectors sphincter pupillae ciliary muscle (瞳孔括约肌,睫状肌),oculomotor n.(动眼N),lat. br.,侧支,optic tract (视束),pretectal area(顶盖前区), 2) Pathway of the Pupillary Reflexes (瞳孔对光反射传导通路),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,19,RECEPTORSspiralorgans(螺旋器),IIcochlear nuclei(蜗n前,后核),lat. lemniscus (外侧丘系),III,acoustic radia.(听辐射),内囊后肢,CEREBRAL CENTERS transverse temporal gyri (颞横回),下部,螺旋N节 (蜗神经),(斜方体交叉),(内侧膝状体) ,斜方体,I,trapezoid body (斜方体) ,4. The acoustic pathway (听觉传导通路),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,20,外侧外侧丘系,外侧丘系 lateral lemniscus,外侧丘系,斜方体,前庭神经核 vestibular nuclei：在前庭区深面， 内侧核、外侧核、上核、下核。,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,21,Receptorscristae ampullares (壶腹嵴) maculae of utricle & saccule(球椭圆囊斑),II前庭N核,med.longit.fasciculus(内侧纵束),vestibulospinal tract (前庭脊髓束),Effectors (效应器),inf. cerebellar peduncle(小脑下脚),Cerebellar cortex(小脑皮质),sup. temporal gyrus cortex(颞上回皮质),I,相应 神经,Effectors(效应器),vestibular ganglion (前庭N节),III ventral nucleus of thalamus(丘脑腹侧核),III,IV,VI,XI核,5. The equilibratory pathway (平衡觉传导通路),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,22,内侧纵束 medial longitudinal fasciculus,前庭脊髓束 vestibulospinal tract,前庭脊髓束,内侧纵束,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,23,B. The Motor (Descending) Pathways (运动传导通路),1. The pyramidal system (锥体系): 1) corticospinal tract (皮质脊髓束) 2) corticonuclear tract (皮质核束)2. The extrapyramidal system (锥体外系),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,24,(内囊后肢) post.limb of int. Capsule,大脑脚中3/5, pyramidal decussation(锥体交叉),spinal nn.(脊N),Effectors limbs mm.(四肢肌),spinal nn.(脊N),Effectors trunk mm.(躯干肌),脊髓白质前连合,前角内侧核,前角外侧核,85%皮质脊髓侧束,15%皮质脊髓前束, LOWER MOTOR,UPPER MOTOR中央前回2/3旁中央小叶pyramidal cells (锥体细胞),1. The pyramidal system (锥体系统) 1) Corticospinal Tract (皮质脊髓束),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,25, 1) Corticospinal Tract (皮质脊髓束),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,26, 2) Corticonuclear Tract (皮质核束),(内囊膝部) genu of internal capsule,大脑脚中3/5内侧, 脑干内交叉,Effectors全部头面肌咽喉肌,Effectors除舌肌,下面肌外全部肌,XII核VII核1/3外,全部脑干内运动N核除XII和VII下1/3,皮质核束双侧支配,皮质核束单侧支配, LOWER MOTOR NEURONS ,相应脑N,相应脑N,UPPER MOTOR NEURONS中央前回1/3pyramidal cells (锥体细胞),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,27,Summary of Paralysis of Pyramidal System (锥体系瘫痪小结),Centres (中枢),Internal capsule(内囊),(对侧单肌群硬瘫),(对侧三偏: 硬瘫,痛、温、本体、精细触觉消失, 视觉消失),(损伤部位),(瘫痪类别),Brain stem(脑干),Spinal cord(脊髓),Peripheral nn.(周围神经),(交叉性瘫痪: 同侧面肌软瘫,对侧四肢硬瘫),Lat. funiculus(侧索): 同侧伤面以下硬瘫,Ant. Horn (前角): 同侧伤平面软瘫),(单肌软瘫,感觉消失),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,28,2. The Extrapyramidal System (锥体外系),1) Definition: All the somatic motor tracts to skeletal muscles except pyramidal system (除锥体系以外的全部躯体运动束).2) Functions: a. to regulate the tonicity of the muscles (调节肌张力),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,29,The Extrapyramidal System (锥体外系),b. coordinate the muscular activities (协调肌肉活动) c. maintain the normal body posture (维持体态姿势) d. produce habitual and rhythmic movements (产生习惯性动作),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,30,3) The corpus striatum-substantia-corpus striatum circuit (system) (纹状体-黑质-纹状体环路),Cerebral Cortex frontal lobe (额叶) parietal lobe (顶叶),Neo-striatum(新皮质),纹状体苍白球纤维,globus pallidus(苍白球),Int.Caps.内囊,ventral anterior nuc. ventral lateral nucleus(腹前核,腹外侧核),苍白球丘脑纤维,caudate nucleus + putamen(尾状核,壳),皮质纹状体纤维,Function: feedback regulation (反馈调节),Brodmann 4, 6 areas,黑质,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,31,4) The cortico-ponto-cerebellar circuit (system) (皮质-脑桥-小脑环路),CEREBRAL CORTEX(额叶,顶叶,颞叶),(Brodmann 4,6),pontine nuc.(脑桥核),cerebellar cortex(小脑皮质),dentate nuc.(齿状核),丘脑腹前核丘脑腹外侧核,red nuc.(红核),前角运动核,EFFECTORSskeletal mm.(屈侧骨骼肌),皮质脑桥纤维,小脑中脚,脊神经,小脑上脚,内囊,红核脊髓束,脑桥臂交叉,结合臂交叉,被盖前交叉,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,32,MENINGES & BLOOD VESSELS OF THE BRAIN & SPINAL CORD; & THE CEREBROSPINAL FLUID (CSF),A. The Meninges of the Brain and Spinal Cord (脑和脊髓的被膜)B. The Blood Vessels of the Brain and Spinal Cord (脑和脊髓的血管)C. The Circulation of the Cerebrospinal Fluid (CSF) (脑脊液循环)D. The Brain Barriers (脑屏障),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,33,A. The Meninges of the Brain and Spinal Cord,1. Meninges of the spinal cord (脊髓的被膜) 1) spinal dura mater (spinal dura) (硬脊膜) a. epidural space (硬膜外隙) b. subdural space (硬膜下隙) peridural anesthesia 硬膜外麻醉 extradural tumor 硬膜外肿瘤,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,34,A. The Meninges of the Brain and Spinal Cord,2) spinal arachnoid mater: (脊髓蛛网膜) a. subarachnoid space (蛛网膜下隙) b. terminal cistern (终池) lumbar puncture 腰椎穿刺 3) spinal pia mater (软脊膜) denticular ligament (齿状韧带),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,35,A. The Meninges of the Brain and Spinal Cord,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,36,A. The Meninges of the Brain and Spinal Cord,2. Meninges of the brain (脑的被膜) 1) cerebral dura mater (硬脑膜) a. cerebral falx (大脑镰),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,37,B. The Blood Vessels of the Brain,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,38,A. The Meninges of the Brain and Spinal Cord,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,39,hernia of tentorial incisure 小脑幕切迹疝,A. The Meninges of the Brain and Spinal Cord,b. cerebellar tentorium: (小脑幕) tentorial incisure (小脑幕切迹) c. cerebellar falx (小脑镰)d. diaphragma sellae (鞍隔),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,40, e. sinuses of dura mater (硬脑膜窦),sup. sagittal s.(上矢状窦),inf. sagittal s.(下矢状窦),straight sin.(直窦),confluence of sinus(窦汇),transverse sin.(横窦),sig-moidsin.(乙状窦),int. jugular v. (颈内静脉),Cavernoussinus (海绵窦),sup. petrosal sin. (岩上窦),inf. petrosal sin. (岩下窦),cavernous sinus thrombosis 海绵窦血栓形成,A. The Meninges of the Brain and Spinal Cord,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,41,A. The Meninges of the Brain and Spinal Cord,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,42,A. The Meninges of the Brain and Spinal Cord,2) cerebral arachnoid mater (脑蛛网膜) a. subarachnoid space (蛛网膜下隙),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,43,A. The Meninges of the Brain and Spinal Cord,b. subarachnoid cisterns (蛛网膜下池) i. cerebellomedullary cistern (小脑延髓池) cisternal puncture 小脑延髓池穿刺 ii. interpeduncular cistern (脚间池) iii. chiasmatic cistern (交叉池),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,44,A. The Meninges of the Brain and Spinal Cord,iv. pontine cistern (桥池) v. circular cistern (环池) c. arachnoid granulations (蛛网膜粒),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,45,A. The Meninges of the Brain and Spinal Cord,3) cerebral pia mater (软脑膜) choroid plexus (脉络丛) meningitis 脑膜炎,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,46,B. The Blood Vessels of the Brain,1. Arteries of the brain (脑的动脉): Volume of blood flow (血流量): 心脑:15%. 成人: 50-60ml/100g/min 儿童: 96-126 ml/100g/min. O2 consumption (耗氧量): 20%.,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,47,B. The Blood Vessels of the Brain,cortical branches (皮质支) 1) internal carotid a. (颈内动脉) a. posterior communicating a. (后交通动脉) b. anterior choroidal a. (脉络膜前动脉),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,48,B. The Blood Vessels of the Brain,c. anterior cerebral a. (大脑前动脉) anterior communicating a. (前交通动脉) central branches (中央支),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,49,B. The Blood Vessels of the Brain,d. middle cerebral a. (大脑中动脉) central branches (中央支) aa. of lentiform nucleus and corpus striatum (豆状核纹状体动脉) (“bleeding a. 出血动脉” ) cerebrovascular spasm 脑血管痉挛 cerebrovascular accident 脑血管意外 cerebral hemorrhage 脑出血 cerebral embolism 脑血管栓塞,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,50,B. The Blood Vessels of the Brain,2) vertebral a. (椎动脉) a. anterior spinal a. (脊髓前动脉) b. posterior spinal a. (脊髓后动脉),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,51,B. The Blood Vessels of the Brain,c. posterior inferior cerebellar a. (小脑下后动脉) d. basilar a. (基底动脉) i. anterior inferior cerebellar a. (小脑下前动脉) ii. labyrinthine a. (迷路动脉) iii. pontine aa. (脑桥动脉) iv. superior cerebellar a. (小脑上动脉),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,52,B. The Blood Vessels of the Brain,v. posterior cerebral a. (大脑后动脉) 3) cerebral arterial circle (Willis circle) (大脑动脉环),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,53,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,54,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,55,海绵窦cavernous sinus 位置 穿经结构动眼神经外侧壁滑车神经眼神经上颌神经窦腔内：颈内动脉展神经,海绵窦,展神经,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,56,大脑中动脉,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,57,The Blood Vessels of the Brain,middle cerebral a. (大脑中动脉) central branches (中央支) aa. of lentiform nucleus and corpus striatum (豆状核纹状体动脉) (“bleeding a. 出血动脉” ) cerebrovascular spasm 脑血管痉挛 cerebrovascular accident 脑血管意外 cerebral hemorrhage 脑出血 cerebral embolism 脑血管栓塞,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,58,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,59,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,60,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,61,B. The Blood Vessels of the Brain,2. Veins of the brain (脑的静脉) 1) superficial veins (浅静脉) a. superior cerebral vv. (大脑上静脉) superior sagittal sinus (上矢状窦) b. middle cerebral vv. (大脑中静脉) cavernous sinus (海绵窦),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,62,B. The Blood Vessels of the Brain,c. inferior cerebral vv. (大脑下静脉) transverse sinus (横窦) 2) deep vein (深静脉) great cerebral v.(大脑大静脉) straight sinus (直窦),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,63,C. Blood Vessels of the Spinal Cord (脊髓的血管),1. Arteries a. anterior spinal a. (脊髓前动脉) vertebral a. (椎动脉) b. posterior spinal a. (脊髓后动脉) vertebral a. (椎动脉) c. posterior intercostal aa. (肋间后动脉) d. lumbar aa. (腰动脉),Systematic Anatomy,Dept of Anatomy, Medical Col