优秀英语课件WorkshopinTeachingofAnatomyNeuroanatomy端脑的定义和特点Cerebrum

1、Workshop in Teaching of Anatomy Neuroanatomy端 脑的定义和特点Cerebrum第一节 人端脑的形态结构与功能一、人脑的组成概述脑(Brain)主要包括延髓、脑桥、 小脑、中脑、 间脑、大脑等六个部分。人的大脑(Cerebrum)包括左、右两个半球及连接两个半球的部分（胼胝体等corpus callosum） 。大脑半球表面被覆灰质，称大脑皮质，其深部为白质（髓质）。端脑 telencephalon (大脑 cerebrum) 二、大脑的形态结构大脑的表面形态和皮质分区大脑的内部结构额 极枕 极颞 极 三 面 三 极 两 沟、三 裂、五 叶大脑的表面形

2、态和皮质分区上外侧面内 侧 面下 面1、大脑皮质2、大脑髓质3、基底核4、侧脑室大脑的内部结构1. 大脑皮质原皮质：3层，海马，齿状回旧皮质：36层，海马回钩，海马旁回新皮质：6层，90%大脑皮质2.基底核 basal nuclei纹状体corpus striatum苍白球壳豆状核lentiform n.尾状核caudate n.：旧纹状体屏状核claustrum杏仁体amygdaloid body新纹状体neo-striatum锥体外系:边缘系统:功能不明尾状核体尾状核头豆状核背侧丘脑尾状核尾杏仁体amygdaloid body基底核basal nuclei尾状核豆状核杏仁核屏状核头体尾壳苍

3、白球caudatecaudateputamenglobus pallidusthalamus & hypothalamuskwhBasal Ganglia: In fact, a collection of nucleiInternal capsuleant. limbgenupost. limbkwhKWHcerebral peduncleinternal capsuleCaudatePutamenGlobus palliduskwhThalamus Subthalamic nu底丘脑核Substantia nigra黑质ventriclesthalamus脑室、核团与内囊投射纤维的空间位置

4、关系侧面投影kwhcaudateinternal capsulecorona radiatacerebral peduncleventriclesthalamusRelationshipskwhcaudateinternal capsulecorona radiatacerebral peduncleLentiform nu.Putamen + Globus pallidusBasal nuclei of cerebrumcorpus striatum claustrumamygdaloid bodycaudate nucleuslentiform nucleus ( putamen, glo

5、bus pallidus)3.侧脑室 lateral ventricle位置 大脑半球内， 围绕尾状核形态：C形,四部 中央部、前角、 后角、下角交通 前角室间孔第三脑室脑室的铸型侧脑室 lateral ventricle4. 大脑髓质 medulla大脑髓质 medulla联络系 associated fibers连合系 commissural fibers 投射系 projection fibers 胼胝体Medulla of cerebrum Nerve fibers commissural fibers： corpus callosum, fornix associated fiber

6、s projection fibers internal capsule : area between caudate nucleus, thalamus and lentiform nucleus联络系 associated fibers弓状纤维钩束上纵束下纵束扣带扣带连合系 commissural fibers 胼胝体corpus callosum：联系两侧额、顶、枕、颞叶前连合：联系两侧嗅球和颞叶穹窿fornix连合： 联系两侧 海马和齿 状回胼胝体干胼胝体膝胼胝体嘴胼胝体压部前连合穹窿胼胝体上面观胼胝体 前连合 后连合穹隆穹隆连合海马和穹窿投射系 projection fibers 投

7、射纤维 projection fibers位于背侧丘脑、尾状核和豆状核之间的白质板（上、下行传导束）内囊投射系projection fibers 内囊 internal capsule A.位置 B.形态 C.分部 内囊前肢 anterior limb内囊膝 genu内囊后肢 posterior limb尾状核头丘脑前辐射额桥束苍白球壳豆状核皮质红核束顶枕颞桥束听辐射视辐射外侧膝状体内侧膝状体背侧丘脑丘脑上辐射皮质脊髓束皮质核束D. 各部纤维束丘脑尾状核头壳苍 白球豆状核内囊前肢额桥束 frontopontine tract 皮质核束 corticonuclear听辐射 acoustic ra

8、diation丘脑前辐射anterior thalamic radiation皮质脊髓束 corticospinal皮质红核束 corticorubral顶枕颞桥束丘脑上辐射视辐射 optic radiation内囊膝内囊后肢壳putamen屏状核claustrum背侧丘脑脑的冠状切面苍白球globus pallidus尾状核caudate n.豆状核lentiform n.corpus callosumcorpus striatuminternal capsule内 囊 internal capsuleHemiballismSubthalamic nucleusVascular lesion

9、 on contralateral sideFrom W. Blackwood et al: Atlas of neuropathologyThe two lateral ventricles *cerebral hemispheres *connected with the third ventricle through the interventricular foramen *anterior, inferior, posterior horns and the body.思考题下列部位损伤后，可出现哪些功能障碍？（1）右侧大脑半球中央前回的上1/3和中央旁小叶；（2）左侧颞上回后部；（

10、3）左侧额下回后部；（4）左侧角回。为什么？若一侧内囊受损（如中风引起脑血管破裂出血压迫损伤内囊膝和后肢）可出现哪些严重后果？为什么？三、大脑对运动的调控kwhMotor componentscortex / UMN反质上运动元basal n.基底核pyramidal tract锥体束motor neurons / LMN(下)运动元cerebellum小脑123456背侧丘脑脑桥Site1Muscle2NMJ3LMN4UMN5Basal gang.6CerebellumKWHkwh123456Special featuresMuscular dystrophy 肌营养不良Myasthenia

11、 gravis 重肌无力Nerve lesion 神经损伤Cerebral or capsular stroke 大脑 / 内囊中风Extrapyramidal dis. (Parkisons etc) 锥体外系病(帕金逊等)Cerebellar diseases (ataxia etc) 小脑病(共济失调等)Motor components4UMN5Basal gang.6Cerebellumkwh123456Ipsil./Contr.x Voluntary movementContralateral x Unwanted move(at rest)Ipsilateralx Range &

12、precisionMotor componentsCerebral cortex 皮质Brainstem / Spinal cord LOWER MOTOR NEURONS 下运动元CEREBELLUM小脑Pontine nuclei 脑桥核ThalamusBASAL GANGLIA基底神经节Thalamus 丘脑Brain-stem areas 脑干各区Musclescaudatekwhcaudateputamenglobus pallidusthalamussubthalamic nured nu.substantia nigraCerebral cortexNeo-StriatumTha

13、lamusSNcSNrGPmGPlSubthalamic nuConnections黑质(密)黑质(网)苍白球(内)苍白球(外)Cerebral cortexTo cranial & spinal motor neuronsThalamusSNcSNrGPmGPlSubthalamic nu+-Connections黑质(密)黑质(网)苍白球(内)苍白球(外)Neo-Striatum常见运动性异常症状的神经解剖学基础Hyperkinesia / Dyskinesia (Marsden)运动过度（运动机能亢进），运动障碍（动作困难） Ballism/ Hemiballism 投掷/偏身抽搐，偏身

14、颤抽 subthalamic nu. Tics 抽搐 Chorea 舞蹈病 striatum, cortex Athetosis 手足徐动症 striatum, cortex, (g.p.) Dystonia 肌张力障碍 lentiform nu. (If affecting fingers & toes is Athetosis - Marsden) Tourette syndrome （秽语、抽动综合症）：basal n.? Akinesia运动不能 Parkinsonism subs. nigra pars compacta, (cortex, g.p.) Wilsons disease

15、 lentiform nu.EXTRAPYRAMIDAL SYSTEM DISORDERSHemiballism偏身抽搐，偏身颤抽 Sudden forceful and rapid flinging movement投掷样、突踹式动作Marked hypotonia肌张力减退 From JA Spillane: An atlas of clinical neurologyCerebral cortexTo cranial & spinal motor neuronsThalamusSNcSNrGPmGPlSubthalamic nuInterpretation of ballism黑质(密)

16、黑质(网)苍白球(内)苍白球(外)Neo-Striatum+-Huntingtons diseaseCeaseless jerky irregular movement.*si:slis 不断地抽筋 From JA Spillane: An atlas of clinical neurology是一种IT15基因上CAG重复序列异常扩展所致常染色体显性遗传性神经退行性疾病。中年发病，逐渐丧失说话、行动、思考和吞咽的能力。 Chorea（舞蹈病 ）：Athetosis手足徐动症 Ceaseless slow, sinuous movement esp. in hands不断、迂回地手脚徐动 Fr

17、om JA Spillane: An atlas of clinical neurologyDystonia 肌张力障碍 Sustained contraction持续的收缩/挛缩Unusual posture for a prolonged duration-Twisting and repetitive movement持久、重复地螺旋状扭动From M Swah: Color Guide - NeurologyCerebral cortexTo cranial & spinal motor neuronsThalamusSNcSNrGPmGPlSubthalamic nuXInterpr

18、etation of Huntingtons disease黑质(密)黑质(网)苍白球(内)苍白球(外)+-Neo-StriatumParkinsons diseaseNormalSubstantia nigraParkinsonianFrom H. MerrittJ: A textbook of neurologyNormalSubstantia nigraParkinsonianParkinsons diseaseFrom W. Blackwood et al: Atlas of neuropathologyParkinsons diseaseFrom H. MerrittJ: A textbook of neurology; (right fig.) M Swah: Color Guide - Neurology1. Tremor (at rest) 震颤2. Akinesia 运动迟缓/不能， 小碎步前进3. Rigidity 肌肉僵直， “冻僵” Cerebral cortexTo cranial & spinal motor neuronsThalamusSNcSNrGPmGPlSubthalamic nu+-Interpretation of Parkinsons disease黑质(密)黑质(网)苍白球(内)苍白球(外)Neo-Striatu