研究生。n傳導腦膜csf

1、Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,1,THE NERVOUS PATHWAYS (神經傳導路),A. The Sensory (Ascending) Pathways (感覺傳導通路)B. The Visual and Pupillary Reflexes Pathways (視覺傳導通路和瞳孔對光反射通路)C. Th

2、e Acoustic Pathway (聽覺傳導通路)D. The Equilibratory Pathway (平衡覺傳導通路)E. The Motor (Descending) Pathways (運動傳導通路),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,2,A. The Sensory (Ascending) Pathways

3、,1. Deep & discriminatory sensation ? Proprioceptive (deep) sense (本體感覺): body posture, movement, vibration and pressure. discriminatory sense (精細觸覺): size, shape, texture and two point discrimination.,System

4、atic Anatomy,Dept of Anatomy, Medical College, Qingdao University,3,,Receptorsmuscle spindlestendon spindlesPacini’s corpuscles(肌梭,腱梭,P小體),I,II,,Med. Lemniscus (內側丘系),,III,丘腦皮質束(丘腦中央輻射,cerebral centers Cortex of the

5、 sup. and middle parts of postcentral gyrus. Posterior part of paracentral lobule (中央后回上中部皮質,中央旁小葉后部),,Spinal nn.(脊N) (薄束T4?,楔束T4?),(內側丘系交叉)?,(薄束核,楔束核)?,(脊神經節(jié)),?(丘腦腹后外側核),?(內囊后肢),(內弓狀纖維)?,1) Conscious proprioceptiv

6、e sensory pathways (意識性本體感覺傳導通路),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,4,? 1) Conscious proprioceptive sensory pathways,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao Univ

7、ersity,Receptorsmuscle spindlestendon spindlesPacini’s corpuscles(肌梭,腱梭,P小體),(脊N) (后根),I (脊神經節(jié)),,II (后角核ⅤⅥⅦ層),cerebellar center cortex of cerebellum(小腦皮質),ant. white commissure (脊髓白質前連合) ?,thoracicnucleu

8、s(胸核),,,sup. cerebellar peduncle (小腦上腳),,,脊髓小腦前束,(小腦下腳) (脊髓小腦后束),,,2) unconscious proprioceptive sensory pathway (非意識性本體感覺傳導通路),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,6,,Receptors

9、free n. endings (痛)Krause's end bulbs (冷)Ruffini end organs (熱),I,,II,,(脊髓丘系) (脊髓丘腦側束),,III,丘腦皮質束 (丘腦中央輻射),,cerebral centers Cortex of the sup. and middle parts of postcentral gyrus. Posterior part of paracentr

10、al lobule (中央后回上中部皮質,中央旁小葉后部),,Spinal nn.(脊N) 上升1-2節(jié)后外側束,(脊髓前白連合)?,(脊髓后角固有核)?,(脊神經節(jié))?,?(丘腦腹后外側核),?(內囊后肢),2. Superficial sensation ? 1) Pathway of Pain & Thermal sensation of the Trunk & Limbs(軀干和四肢痛溫覺傳導通路)

11、,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,,R

12、eceptorsfree n. endings (痛)Krause's end bulbs (冷)Ruffini end organs (熱),I,,II,,trigeminal lemniscus (三叉丘系),,III,int.cap.內囊后肢,cerebral centers cortex of the inferior part of postcentral gyrus. (中央后回下部皮質)

13、,,(三叉神經脊束核) ?,(V神經節(jié))?,?(丘腦腹后內側核),(三叉神經) (三叉神經脊束),丘腦中央輻射(丘腦皮質束),? 2) Pain & Thermal Sensation of Head and Face (頭面部痛溫覺),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,9,? 2) Pain & Therm

14、al Sensation of Head and Face (頭面部痛溫覺),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,10,(損傷部位),感覺障礙表現(xiàn),Peripheral NS(周圍神經),Spinal Cord(脊髓),Internal capsule(內囊),Centers(中樞),Thalamus(丘腦),(腦干延髓),

15、subcutaneous nerve (皮神經): 全部感覺消失,無汗mixed nerve (混合神經): 全部感覺消失,支配肌肉軟癱posterior root 后根): 節(jié)段性全部感覺消失,(交叉性痛溫覺消失:同側面部,對側軀體),(偏身,多伴有自發(fā)性痛疼),(對側三偏: 硬癱,痛、溫、本體、精細觸覺消失, 視覺同向消失),(對側相應區(qū)感覺消失),posterior horn (后角): 同側節(jié)段低1-2節(jié)痛溫覺消失,An

16、t. commissure (白質前連合): 對稱節(jié)段性痛溫覺消失Tract (傳導束): 分離性感覺消失),Summary of Sensory Disturbance(感覺障礙小結),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,11,RECEPTORSfree n. endings (毛囊周圍神經末梢tactile corp

17、uscles (觸覺小體),I,,II,,,III,丘腦中央輻射(丘腦皮質束),內囊后肢,CEREBRAL CENTERS cortex of the sup. and middle parts of postcentral gyrus. Posterior part of paracentral lobule (中央后回上中部皮質,中央旁小葉后部),,spinal nn.(脊N),(脊髓白質前連合)?,(脊髓后角固有束核

18、)?,(脊神經節(jié))?,?(丘腦腹后外側核),,(脊髓丘系) (脊髓丘腦前束),3) Tactile Pathway of Trunk and Limbs (軀干四肢觸覺),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,12,RECEPTORSfree n. endings (毛囊周圍神經末梢tactile corpuscles (

19、觸覺小體),I,,II,,trigem. lemniscus(三叉丘系),,III,丘腦中央輻射(丘腦皮質束),CEREBRAL CENTERS cortex of the inferior part of postcentral gyrus. (中央后回下部皮質),,trigeminal n.(三叉N),(腦橋內交叉)?,(三叉神經腦橋核)?,(V神經節(jié))?,?(丘腦腹后內側核),,內囊后肢,4) Tactile Path

20、way of Head and Face (頭面部觸覺),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,13,,RECEPTORSrod cells (視桿細胞)cone cells(視錐細胞),II,鼻側,optic tract (視束),,III,視輻射(膝距束),CEREBRAL CENTERS banks of the

21、 calcarine sulcus ( lingual gyrus & cuneus) (距狀溝兩側皮質) (舌回和楔葉),,bipolar c. (雙極細胞),(視交叉)?,(節(jié)細胞)?,(雙極細胞)?,(外側膝狀體) ?,顳側,I,optic n. (視N) ?,內囊后肢后部,3. Visual & pupillary reflexes 1) ? The visual pathway

22、(視覺傳導通路),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,

23、視覺傳導通路及瞳孔對光反射通路：,雙極細胞Ⅰ,Ⅱ,Ⅲ,外側膝狀體,距狀溝兩側,節(jié)細胞,視束,視錐細胞視桿細胞,,,,視神經,,顳 側,,,鼻 側,,,,Ⅲ,頂蓋前區(qū),,,,,動眼神經副核 （雙側）,Ⅳ,動眼神經,睫狀神經節(jié)（雙側）,Ⅴ,,瞳孔括約肌睫狀?。p側）,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,16

24、,視覺傳導通路及瞳孔對光反射通路：1. 視覺傳導通路： 視網膜中光感受器細胞視錐、視桿細胞，第一級神經元為雙級細胞、第二級神經元節(jié)細胞，軸突成視神經、經視神經管入顱、經視交叉（視網膜鼻側半交叉、視網膜顳側半不交叉），入同側視束，終止外側膝狀體、外側膝狀體內第三級神經元組成視輻射經內囊后肢投射到端腦距狀溝兩側視區(qū)，產生視覺。2. 瞳孔對光反射通路：視束纖維經上丘臂于頂蓋前區(qū)、由此到雙側動眼神經副核，動眼神經副核到睫狀神經節(jié)換元，節(jié)后纖維

25、支配瞳孔括約肌收縮，瞳孔縮小 。Wilbrand前袢：其中來自視網膜鼻側半下象限的纖維，向腹側經視交叉前緣至對側視神經，向前可達3mm作袢狀彎曲，沿視交叉外側緣后行至對視束。Wilbrand后袢：其中來自視網膜鼻側半上象限的纖維，經視交叉向后至同側視束吻端，作袢狀彎曲，經視交叉后緣上方交叉至對側視束。,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao Unive

26、rsity,17,視覺傳導通路：Wilbrand前袢：其中來自視網膜鼻側半下象限的纖維，向腹側經視交叉前緣至對側視神經，向前可達3mm作袢狀彎曲，沿視交叉外側緣后行至對視束。Wilbrand后袢：其中來自視網膜鼻側半上象限的纖維，經視交叉向后至同側視束吻端，作袢狀彎曲，經視交叉后緣上方交叉至對側視束。,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao Unive

27、rsity,18,RECEPTORSrod cells (視桿細胞cone cells(視錐細胞,,IIganglion cell(節(jié)細胞),鼻側,,bipolar c. (雙極細胞),Optic chiasma (視交叉) ?,顳側,I,Optic n. (視n) ?,,,,,EW核(III副核),ciliary ganglion睫狀N節(jié),,Short ciliary

28、nn(睫短神經),Effectors sphincter pupillae ciliary muscle (瞳孔括約肌,睫狀肌),oculomotor n.(動眼N),lat. br.,側支,optic tract (視束),pretectal area(頂蓋前區(qū)),? 2) Pathway of the Pupillary Reflexes (瞳孔對光反射傳導通路),Systematic Anatomy,Dept

29、of Anatomy, Medical College, Qingdao University,19,RECEPTORSspiralorgans(螺旋器),,IIcochlear nuclei(蝸n前,后核),,lat. lemniscus (外側丘系),,III,acoustic radia.(聽輻射),內囊后肢,CEREBRAL CENTERS transverse temporal gyri (顳橫回),下部,螺

30、旋N節(jié) (蝸神經),(斜方體交叉)?,(內側膝狀體) ?,斜方體,I,trapezoid body (斜方體) ?,4. The acoustic pathway (聽覺傳導通路),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,20,外側外側丘系,外側丘系 lateral lemniscus,,外側丘系,,,斜方體

31、,前庭神經核 vestibular nuclei：在前庭區(qū)深面， 內側核、外側核、上核、下核。,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,21,Receptorscristae ampullares (壺腹嵴) maculae of utricle & saccule(球

32、橢圓囊斑),II前庭N核,,,med.longit.fasciculus(內側縱束),vestibulospinal tract (前庭脊髓束),,Effectors (效應器),inf. cerebellar peduncle(小腦下腳),Cerebellar cortex(小腦皮質),,sup. temporal gyrus cortex(顳上回皮質),,I,相應 神經,Effectors(效應器),vestibula

33、r ganglion (前庭N節(jié)),,III ventral nucleus of thalamus(丘腦腹側核),III,IV,VI,XI核,5. The equilibratory pathway (平衡覺傳導通路),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,22,內側縱束 medial longitudinal fasc

34、iculus,前庭脊髓束 vestibulospinal tract,,前庭脊髓束,,內側縱束,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,23,B. The Motor (Descending) Pathways (運動傳導通路),1. The pyramidal system (錐體系): 1) corticospinal tra

35、ct (皮質脊髓束) 2) corticonuclear tract (皮質核束)2. The extrapyramidal system (錐體外系),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,24,(內囊后肢) ? post.limb of int. Capsule,?大腦腳中3/5,? pyramidal decussa

36、tion(錐體交叉),spinal nn.(脊N),Effectors limbs mm.(四肢肌),spinal nn.(脊N),Effectors trunk mm.(軀干肌),脊髓白質前連合?,前角內側核,前角外側核,85%皮質脊髓側束,15%皮質脊髓前束,,,? LOWER MOTOR,UPPER MOTOR中央前回↑2/3旁中央小葉pyramidal cells (錐體細胞),1

37、. The pyramidal system (錐體系統(tǒng))? 1) Corticospinal Tract (皮質脊髓束),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,25,? 1) Corticospinal Tract (皮質脊髓束),Systematic Anatomy,Dept of Anatomy, Medical Colle

38、ge, Qingdao University,26,? 2) Corticonuclear Tract (皮質核束),(內囊膝部) ? genu of internal capsule,?大腦腳中3/5內側,? 腦干內交叉,Effectors全部頭面肌咽喉肌,Effectors除舌肌,下面肌外全部肌,XII核VII核?1/3外,全部腦干內運動N核除XII和VII下1/3,皮質核束雙側支配,皮質核束單側

39、支配,,? LOWER MOTOR NEURONS ?,相應腦N,,,相應腦N,UPPER MOTOR NEURONS中央前回?1/3pyramidal cells (錐體細胞),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,27,Summary of Paralysis of Pyramidal System (錐體系癱瘓小結),

40、Centres (中樞),Internal capsule(內囊),(對側單肌群硬癱),(對側三偏: 硬癱,痛、溫、本體、精細觸覺消失, 視覺消失),(損傷部位),(癱瘓類別),Brain stem(腦干),Spinal cord(脊髓),Peripheral nn.(周圍神經),(交叉性癱瘓: 同側面肌軟癱,對側四肢硬癱),Lat. funiculus(側索): 同側傷面以下硬癱,Ant. Horn (前角): 同側傷平

41、面軟癱),(單肌軟癱,感覺消失),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,28,2. The Extrapyramidal System (錐體外系),1) Definition: All the somatic motor tracts to skeletal muscles except pyramidal sys

42、tem (除錐體系以外的全部軀體運動束).2) Functions: a. to regulate the tonicity of the muscles (調節(jié)肌張力),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,29,The Extrapyramidal System (錐體外系),b. coordinate the mus

43、cular activities (協(xié)調肌肉活動) c. maintain the normal body posture (維持體態(tài)姿勢) d. produce habitual and rhythmic movements (產生習慣性動作),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,30

44、,3) The corpus striatum-substantia-corpus striatum circuit (system) (紋狀體-黑質-紋狀體環(huán)路),Cerebral Cortex frontal lobe (額葉) parietal lobe (頂葉),,Neo-striatum(新皮質),紋狀體蒼白球纖維,globus pallidus(蒼白球),,,Int.Caps.內囊,ventral ant

45、erior nuc. ventral lateral nucleus(腹前核,腹外側核),蒼白球丘腦纖維,?caudate nucleus + putamen(尾狀核,殼),皮質紋狀體纖維?,Function: feedback regulation (反饋調節(jié)),Brodmann 4, 6 areas,黑質,,,Systematic Anatomy,Dept of Anatomy, Medical College, Qing

46、dao University,31,4) The cortico-ponto-cerebellar circuit (system) (皮質-腦橋-小腦環(huán)路),CEREBRAL CORTEX(額葉,頂葉,顳葉),(Brodmann 4,6),pontine nuc.(腦橋核),cerebellar cortex(小腦皮質),dentate nuc.(齒狀核),丘腦腹前核丘腦腹外側核,red nuc.(紅核),前角運動核?

47、,EFFECTORSskeletal mm.(屈側骨骼肌),皮質腦橋纖維,小腦中腳,,脊神經,小腦上腳,,,,內囊,紅核脊髓束,,?腦橋臂交叉,結合臂交叉?,被蓋前交叉?,,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,32,MENINGES & BLOOD VESSELS OF THE BRAIN & SPINAL

48、 CORD; & THE CEREBROSPINAL FLUID (CSF),A. The Meninges of the Brain and Spinal Cord (腦和脊髓的被膜)B. The Blood Vessels of the Brain and Spinal Cord (腦和脊髓的血管)C. The Circulation of the Cerebrospinal Fluid (CSF) (腦脊液循環(huán))D

49、. The Brain Barriers (腦屏障),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 (spina

50、l 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 硬膜外腫瘤],Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao Univ

51、ersity,34,A. The Meninges of the Brain and Spinal Cord,2) spinal arachnoid mater: (脊髓蛛網膜) a. subarachnoid space (蛛網膜下隙) b. terminal cistern (終池) [lumbar puncture 腰椎穿刺] 3) spinal pia mater

52、 (軟脊膜) denticular ligament (齒狀韌帶),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

53、College, Qingdao University,36,A. The Meninges of the Brain and Spinal Cord,2. Meninges of the brain (腦的被膜) 1) ? cerebral dura mater (硬腦膜) a. cerebral falx (大腦鐮),Systematic Anatomy,Dept of Anatomy, Medical C

54、ollege, 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,

55、 Medical College, Qingdao University,39,,[hernia of tentorial incisure 小腦幕切跡疝],A. The Meninges of the Brain and Spinal Cord,b. cerebellar tentorium: (小腦幕) tentorial incisure (小腦幕切跡) c. cerebellar falx (小腦鐮)d. d

56、iaphragma sellae (鞍隔),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,40,? e. sinuses of dura mater (硬腦膜竇),sup. sagittal s.(上矢狀竇),inf. sagittal s.(下矢狀竇),straight sin.(直竇),,,confluence of sinus

57、(竇匯),,transverse sin.(橫竇),,,,sig-moidsin.(乙狀竇),int. jugular v. (頸內靜脈),Cavernoussinus (海綿竇),,,sup. petrosal sin. (巖上竇),inf. petrosal sin. (巖下竇),,,,[cavernous sinus thrombosis 海綿竇血栓形成],A. The Meninges of the Bra

58、in 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

59、 Meninges of the Brain and Spinal Cord,2) ? cerebral arachnoid mater (腦蛛網膜) a. subarachnoid space (蛛網膜下隙),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,43,A. The Meninges of the Brain and Spin

60、al Cord,b. subarachnoid cisterns (蛛網膜下池) i. cerebellomedullary cistern (小腦延髓池) [cisternal puncture 小腦延髓池穿刺] ii. interpeduncular cistern (腳間池) iii. chiasmatic cistern (交叉池),S

61、ystematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,44,A. The Meninges of the Brain and Spinal Cord,iv. pontine cistern (橋池) v. circular cistern (環(huán)池) c. arachnoid granulations (蛛網膜粒),Systemati

62、c Anatomy,Dept of Anatomy, Medical College, Qingdao University,45,A. The Meninges of the Brain and Spinal Cord,3) cerebral pia mater (軟腦膜) choroid plexus (脈絡叢) [meningitis 腦膜炎],Systematic Anatomy,Dept of Anatomy,

63、 Medical College, Qingdao University,46,B. The Blood Vessels of the Brain,1. Arteries of the brain (腦的動脈): Volume of blood flow (血流量): 心?腦:15%. 成人: 50-60ml/100g/min 兒童: 96-126 ml/100g/min. O2 co

64、nsumption (耗氧量): 20%.,Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,47,B. The Blood Vessels of the Brain,cortical branches (皮質支) 1) ? internal carotid a. (頸內動脈) a. posterior communicati

65、ng a. (后交通動脈) b. anterior choroidal a. (脈絡膜前動脈),Systematic Anatomy,Dept of Anatomy, Medical College, Qingdao University,48,B. The Blood Vessels of the Brain,c. anterior cerebral a. (大腦前動脈) anterior communicatin

66、g a. (前交通動脈) 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. (大腦中動脈) central branches (中央支) aa.

67、 of lentiform nucleus and corpus striatum (豆狀核紋狀體動脈) (“bleeding a. 出血動脈” ) [cerebrovascular spasm 腦血管痙攣] [cerebrovascular accident 腦血管意外] [cerebral hemorrhage 腦出血] [cerebral embolism 腦血管栓塞],Systematic Anatomy,D

68、ept of Anatomy, Medical College, Qingdao University,50,B. The Blood Vessels of the Brain,2) ? vertebral a. (椎動脈) a. anterior spinal a. (脊髓前動脈) b. posterior spinal a. (脊髓后動脈),Systematic Anatomy,Dept of Anatomy, Medic

69、al College, Qingdao University,51,B. The Blood Vessels of the Brain,c. posterior inferior cerebellar a. (小腦下后動脈) d. basilar a. (基底動脈) i. anterior inferior cerebellar a. (小腦下前動脈) ii. labyrinthine a. (