Conjunctiva 1. Thin membrane 2. Covers posterior surface of each eye lid and reflects onto the sclera 3. Attaches to the eye ball at the junction of sclera and cornea 4. Forms conjuntival sac when eyes are closed. Forms the superior and inferior conjunctival fornices Lacrimal apparatus 1. Involved in the production, movement (lateral medial) and drainage of fluid from the surface of the eyeball 2. Made up of a. Lacrimal gland in anterior superolateral region of orbit b. Lacrimal canaliculi c. Lacrimal sac between anterior and posterior lacrimal crest d. Nasolacrimal duct 3. Levator palpebrae superioris divides the gland into 2 parts: a. Orbital in the lacrimal fossa of frontal bone b. Palpebral inferior to the muscle in the superolateral part of eyelid 4. Fluid accumulates meadially (lacrimal lake) & drained by lacrimal canaliculi (at lacrimal punctum) lacrimal sac 5. Innervation a. Sym postganglionic from superior cervical ganglion b. Para i. Preganglionic in grater petrosal nerve nerve of pterygopalatine canal pterygopalatine ganglion ii. Postganglionic in zygomatic zygomatico temporal nerve lacrimal nerve c. Sensory lacrimal nerve of V1. Hippocampal formation

Formed by hippocampus, dentate gyrus and parahippocampal gyrus. Grey mater extending through the floor of inferior horn of lateral ventricle. Pes hippocampus- the anterior end Alveus

o Thin layer of white mater under the ependymal of ventricle o Contains the fimbria nerve fibers originating from hippocampus

Hippocampus terminates below splanchnium of corpus callosum. Dentate gyrus

o Lies between fimbula of hippocampus and parahippocampal gyrus. o Becomes continuous with indusium griseum grey mater covering superior surface of corpus callosum.

Medial and lateral longitudinal striae are embedded on superior surface of indusium gresium. o Continuous with the uncus anteriorly.

Parahippocampal gyrus o Lies between collateral sulcus and hippocampal fissure

Hippocampus 3 layers o Molecular nerve fibers and scattered small neurons o Pyramidal large pyramid cells o Polymorphic

Dentate gyrus 3 layers o Molecular o Granular axons terminates in pyramidal dendrites in hippocampus o Polymorphic 1. Afferents a. Cingulate gyrus b. Septal nuclei via fornix c. Commissure of fornix hippo to hippo d. Indusium gresium via longitudinal stria e. Entorhinal area f. Dentate and parahippocampal gyri 2. Efferents fimbria continues as crus of fornix a. Medial nucleus of mammillary body via anterior commissure b. Anterior nuclei of thalamus via anterior commissure c. tegmentum via anterior commissure d. Septal nuclei, lateral preoptic area and anterior part of hypothalamus. e. Joins medullary thalamic stria to reach habenular nuclei Middle ear

Tympanic cavity: 1.1. is filled with air 1.2. borders posterior wall: mastoid process 1.2.1. access to the mastoid antrum: connects the tympanic cavity and the mastoid cells 1.2.2. pyraminal eminence: a bony cone that encloses the stapedius 1.2.3. facial and lateral semicircular canals forming the prominence of the facial canal and the prominence of the lateral semicircular canal anterior wall: ICA 1.2.1. superiorly has the opening of the auditory tube and the canal for tensor tympani

superior wall: tegmen tympani of the anterior part of the petrous part of the temporal bone inferior wall: IJV medial wall: = labyrinth wall 1.2.1. oval window 1.2.2. promontory of the cochlea (basal convolution) 1.2.3. round window lateral wall: tympanic membrane (membranous wall)

Auditory ossicles: 1.1. malleus: head + neck + manubrium 1.1.1. the manubrium (handle) is attached to the tympanic membrane 1.1.2. the head lies in the epitympanic recess 1.1.3. the manubrium is connected by the neck to the head 1.1.4. the tendon of the tensor tympani inserts on the handle 1.1.5. the chorda tympani crosses the medial surface of the neck 1.1.6. the head articulates with the body of the incus 1.2. incus: body + short & long limbs + lenticular process 1.2.1. the body lies in the epitympanic recess and is articulated with the head of the malleus 1.2.2. the short limb is connected to the posterior wall of the tympanic cavity 1.2.3. the lenticular process attached to the long limb carries the articular surface for the head of the stapes 1.3. stapes: head + posterior & anterior crura + footplate 1.3.1. the head is connected to the lenticular process of the incus 1.3.2. the footplate (base) fits into the oval window They transmit the vibration of the eardrum to the inner ear. The malleus and incus act like an angular lever and the stapes performs a tilting movement. Tympanic muscles: 1.1. tensor tympani: 1.1.1. origin: cartilaginous wall of the auditory tube, the greater wing of the sphenoid 1.1.2. insertion: manubrium of the malleus 1.1.3. innervation: tensor tympani nerve ( V/3) 1.1.4. function: tenses the tympanic membrane and pushes the stapes toward the oval window 1.2. the stapedius: 1.2.1. origin: in the apex of the pyramidal prominence on the posterior wall 1.2.2. insertion: the neck of the stapes 1.2.3. innervation: stapedius nerve ( CN VII) 1.2.4. function: pulls the footplate out of the oval window

Auditory tube: 1.1. = pharyngotympanic tube, Eustachian tube 1.2. connects the tympanic cavity to the nasopharynx 1.3. opens on the posterior pharyngeal wall on the pharyngeal opeing 1.4. the posterolateral 1/3 is bony, anteromedial 2/3 is cartilaginous 1.5. function: equalize the pressure in the middle ear with the atmospheric pressure Blood supply: 1.1. mastoid branches of the occipital and posterior auricular arteries (ECA) 1.2. posterior tympanic artery ( post. auricular artery) 1.3. inferior tympanic artery (ascending pharyngeal artery ECA) 1.4. superior tympanic artery(middle meningeal artery maxillary artery) 1.5. anterior tympanic artery ( maxillary artery) 1.6. caroticotympanic artery (ICA) Innervation: tympanic plexus (CN IX) Brachial and cubital region o Medial bicipital groove

o Between ventral and dorsal muscle groups o Contents

Basilica vein Medial antebrachial cutaneous nerve

o Lateral bicipital groove o Between ventral and dorsal muscle groups o Contents

Cephalic vein o Cubital fossa

o Proximal biceps brachi o Lateral - brachioradialis o Medial pronator teres o Contents

basilic, cephalic and median cubital vein radial nerve brachial artery median nerve

o Pronator canal o Between 2 head of pronator teres and 2 heads of flexor digitorum superficialis o Content

Ulnar nerve o Supinator canal

o Supinator muscle seperastes radial nerve to radial nerve and recurrent radial nerve. o Cubital canal

o Between 2 heads of flexor carpi ulnaris o Contents ulnar nerve Direct sensitive pathways. Lemniscal system

Lemnicsus system: pathway of dorsal funiculum 1.1. 3 neuronal pathway: 1st order neuron: dorsal spinal root ganglion 2nd order neuron: nucleus gracilis and cuneatus. The fibers form the internal arcuate fibers as they cross in the midline, and ascend as the medial lemniscus 3rd order neuron: VPL of thalamus. Fibers ascend in the posterior limb of the internal capsule and the corona radiata to terminate in the primary somatosensory cortex. 1.2. = spino-bulbo-thalamo-cortical tract 1.3. carry impulses: proprioception from joints, muscles, tendons touch vibration pressure 1.4. fasciculus gracilis: consists of the fibers that join the cord at sacral, lumbar

and lower thoracic levels 1.5. fasciculus cuneatus: consists of the fibers that join the cord at upper thoracic and cervical regions o Kinetic part

from spinal ganglia of C & T via cuneate fasciculus to accessory cuneate nuclei. from acc. Cuneate nuclei cuneocerebellar tract and medial lemniscus from spinal ganglia of C7-L3 via cuneate fasciculus to Thoracicus nucleus. uncrossed in dorsal spinocerebellar tract via inf. Cerebellar peduncle as mossy. crossed in ventral spinocerebellar tract via sup. Cerebellar peduncle as mossy. Retina

o 2 layers firmly attaches to each other only in the retinal regigions of papilla and ora serrata o Outer pigmented layer o Inner neural layer

o Neuroepithelial photoreceptors (1st neuron). Cell nuclei lies in the external nuclear layer. Rest on and rely on the pigment layer. o Ganglionic Bipolar neurons (2nd neuron). Nuclei forms the inner nuclear layer. The synapses lie in the outer and inner plexiform layer. o Ganglionic layer of optic nerve multipolar neurons (3rd neuron) unmyelinated axons extends to papilla and form the optic nerve. Dendritic synapse with 3rd neuron lies in the inner plexiform layer o Vitrous humer /(internal limiting membrane) / ganglion cells / bipolar cells /rods / cones / (external limiting membrane) / pigment epithelium o The supporting cells of muller expands between the 2 layers. o Photoreceptors

Rods: night vision Cones: color vision Forms the external layer

o Retina o Optic part

Covers fundus of the eye Contains photoreceptors

o Ciliary part

In the ciliary body and separated by the ora serrate Blind part, double layered epithelium

o Iridial part Blind part, double layered epithelium

o Macula and central fovea o No rods o Thicker ganglionic layerof retina and optic nerve. o Highest visual acuity

o Visual pathway: 1.1. 4 neuronal pathway: 1st: photoreceptors (interneurons are horizontal cells) 2nd: bipolar cells (interneurons are amacrine cells) 3rd: multipolar cells: 1.1.1. axons form the optic nerve 1.1.2. and then bifurcate to form the optic chiasm 1.1.3. after bifurcation, continue as the optic tract 1) lateral root: to lateral geniculate body 2) medial root: to superior colliculi 3) mesencephalic root: to RF of midbrain, pretectal area 4) hypothalamic root: to suprachiasmatic and supraoptic nucleus 4th: lateral geniculate body from lateral geniculate body, fibers pass through the retrolenticular part of the internal capsule as optic radiation, and terminate in primary and secondary visual areas

Pupillary reflex: 1.1. Miosis: pupil constriction, PASY 1st: rods and cones 2nd: bipolar cells 3rd: multipolar cells 4th: pretectal nucleus (the reflex center) 5th: accessory oculomotor nucleus (Edinger-Westphal) 6th: ciliary ganglion the postganglion fibers run as short ciliary nerve to the sphincter of the pupil 1.2. Mydriasis: pupil dilation, SY 1st: rods and cones 2nd: bipolar cells 3rd: multipolar cells 4th: pretectal nucleus. Fibers run via tectoreticular tract to the RF of midbrain 5th: RF of midbrain and rostral pons. Fibers run as reticulospinal tract 6th: intermediolateral nuclei of C8-T1 7th: superior cervical ganglion. Postganglionic fibers ascend as internal

carotid plexus cavernous plexusophthalmic plexus to the ciliary ganglion. Then from ciliary ganglion, the fibers run in short ciliary nerve to the dilator of pupil 1.3. Accommodation: accompanies the pathway of miosis axons from the 3rd neurons are relayed in the interstitial nucleus(4th neurons) from the 4th neurons, the fibers run to the accessory oculomotor nucleus( 5th neuron) and then preganglionic PASY fibers run to the ciliary ganglion. The postganglionic fibers run in the short ciliary nerve to the ciliary body 1.4. Convergence: accompanies the pathway of accommodation as far as the interstitial nucleus after being relayed in the interstitial nucleus, fibers continue via medial longitudinal fasciculus to motor nuclei III, IV, VI Parotideomasseteric region. Prestyloid space.

Parotideomasseteric region: 1.1. borders: 1.1.1. anterior: anterior margin of masseter 1.1.2. superior: zygomatic arch and external acoustic meatus 1.1.3. inferior: lower edge of the mandible 1.1.4. posterior: angle of the mandible--external acoustic meatus 1.2. deeper in this region is continuous with the infratemporal fossa 1.3. contents: 1.3.1. parotid plexus of the facial nerve 1.3.2. parotid gland: in front of the sternocleidomastoid, behind ramus of mandible superficial part: lies in front and below the external acoustic meatus deep part: extends deeper to the medial pterygoid muscle and the ramus of mandible is covered by the parotideomasseteric fascia structures passing through the parotid gland: 1) ECA 2) superficial temporal artery ( ECA) 3) superficial temporal vein ( retromandibular vein) 4) retromandibular vein (EJV) 5) auriculotemporal nerve ( V/3) 6) maxillary artery and vein 7) transverse facial artery (superficial temporal artery)

8) transverse facial vein( superficial temporal vein) 9) parotid plexus parotid duct runs parallel to the zygomatic arch 1.3.3. masseter muscle origin: inferior border and medial surface of zygomatic arch insertion: lateral surface of the ramus of mandible and the angle of the mandible function: elevation of mandible 1.4. is separated by the stylomandibular ligament ( tractus angularis) from the submandibular space

Prestyloid space: 1.1. borders: 1.1.1. superior: cranial base 1.1.2. anterior: opens into the infratemporal fossa 1.1.3. posterior: styloid space 1.1.4. inferior: opens into the carotid triangle 1.1.5. lateral: medial surface of the medial pterygoid muscle 1.1.6. medial: pharyngeal wall, buccopharyngeal fascia 1.2. contents: 1.2.1. ascending palatine artery ( facial artery) 1.2.2. ECA 1.2.3. parotid gland 1.2.4. retromandibular vein 1.2.5. branches of facial nerve Medial longitudinal fasciculus: Runs from the rostral midbrain as far as the cervical spinal cord Contains both ascending & descending fibers internuclear part 1.1. connections of motor nuclei of cranial nerves III-IV-VI-VII: coordination of the mimetic and oculomotor muscles

V-VII-IX-X-XII: coordination of mimetic and masticatory muscles; muscles of the tongue and pharynx in swallowing and speech vestibular part: 1.1. mainly from the superior and medial vestibular nuclei 1.2. most of the fibers end in the extraocular nuclei (CN III, IV, VI) 1.3. some fibers proceed over the extraocular nuclei and end in the interstitial nucleus of Cajal(mainly), nucleus of Darkschewitsch, and the nucleus of posterior commissure interstitiospinal part: descending

1.1. fibers end in either the medial vestibular nucleus or to the lamina VII,VIII of the cervical spinal cord (also to the paramedian RF of pons) 1.2. inputs to the interstitial nucleus are from the vestibular nuclei, frontal eye field, motor & sensory cortices, pretectal area, and from the superior colliculus Fascia of neck o Subcutaneous layer

o Platysma muscle o Lesser occipital nerve o Greater auricular nerve o Supraclavicular nerve o Transverse cervical nerve o External jugular vein

o Superficial layer (investing layer) of cervical fascia o Separates subcutaneous layer from the deep layer o Cranially fixed to mandibular margin and hyoid bone o Caudally countinous with the periosteum of sternum and clavicle o Encloses all structures except platysma o Continues dorsally as nuchal fascia o Sternocleidomastoid and trapezius muscles are embedded in this o Suprasternal space caudally to this fascia contains jugular venous arch

o Pretrachial layer of cervical fascia o Embeds the infrahyoid muscles o External branch of accessory nerve o Trapezius branch of cervical plexus o Superficial cervical vein external jugular vein o Superficial cervical lymph nodes o Suprasternal space : Caudally is the jugular venous arch left and right anterion jugular vein

o Visceral space o (para) thyroid gland o Larynx o Trachea o Caudal portion of pharynx

o Retropharyngeal space o Continues caudally into dorsal mediastinum o Between dorsal wall of esophagus and prevertebral layer Submandibular ganglion

o Lies together with small secondary ganglia in the floor of the mouth o Abouve submandibular gland o Below lingual nerve connect to it via several ganglionic branches

o Preganglionic parasympathetic fibers from superior salivatory nucleus, runs in the nerve and leave it along with chorda tympani (taste) and synapse o Postganglionic sympathetic fibers forms plexus of external carotid artery and reach the ganglion via sympathetic branch from the plexus of facial artery. Passes via but does not synapse. o Postganglionic of both sy and pasy pass to submandibular and sublingual glands and glands of distal 2/3rd of tongue. Pterygopalatine ganglion o Lies at the anterior wall of pterygopalatine fossa o Below the maxillary nerve gives off pterygopalatine nerves o Pasy secretory fibers of superior salivatory nucleus and branch off as greater petrosal nerve and passes via foramen lacerum pterygoid canal to the parasympathetic root.

o Sy fibers from the deep petrosal nerve, + the greater petrosal nerve = nerve of pterygoid canal o Postganglionic branches to lacrimal and nasal cavity glands via zygomatic nerve of maxillary nerve. Lateral ventricle: Anterior horn: 1.1. superior: corpus callosum 1.2. medial: septum pellucidum 1.3. lateral: head of the caudate nucleus Central part: 1.1. superior: corpus callosum 1.2. inferior: stria terminalis, lamina affixa 1.3. medial: taenia choroidea thalami, choroid plexus, and taenia of the fornix 1.4. lateral: body of the caudate nucleus Posterior horn: 1.1. superior: corpus callosum 1.2. inferior: collateral eminence 1.3. medial: calcar avis Inferior horn: 1.1. superior: caudate nucleus and its taenia choroidea, white matter of hemisphere

1.2. inferior: white matter of the hemisphere, collateral eminence 1.3. medial: tela choroidea of lateral ventricle, fimbria of hippocampus, hippocampus 1.4. lateral: white matter of the hemisphere Thyroid gland, parathyroid glands, suprarenal glands Thyroid gland: 1.1. contains 2 lobes: right & left they lie on either side of the larynx and trachea they are connected by the isthmus of thyroid gland the pyramidal lobe: usually projects from the right lobe, representing (may be absent) the remnant of the thyroglossal duct 1.2. is surrounded by the fibrous capsule which has 2 layers: 1.2.1. the internal capsule: thin and adheres closely to the parenchyma of the gland it sends the connective tissue septa into the gland which separate the gland into lobules 1.2.2. external capsule: the surgical capsule is tough is part of the pretracheal layer of the deep cervical fascia 1.2.3. the space between 2 layers is filled with loose connective tissue and contains the parathyroid glands 1.3. arterial supply: 1.3.1. superior thyroid artery ( ECA): sup, ant, and lateral parts of gland superior laryngeal artery: to the upper pole of the lateral lobes 1.3.1. inferior thyroid artery ( thyrocervical trunk)

ascends to the level of C7 supplies inf, post, and medial parts of the gland 1.3.1. thyroid ima artery: occasionally present 1.4. venous drainage: 1.4.1. upper part superior thyroid vein IJV 1.4.2. lower part: unpaired thyroid plexus inferior thyroid veins brachiocephalic trunk 1.5. innervation: 1.5.1. SY: postganglionic fibers come from the superior cervical ganglion 1.5.2. PASY: vagus nerve 1.6. lymphatic vessels: 1.6.1. upper part lateral cervical nodes (along IJV) 1.6.2. lower part anterior mediastinal lymph nodes

Parathyroid glands: 4 in number 1.1. lie in the space between 2 layers of the fibrous thyroid capsule 1.2. arterial supply: parathyroid arteries ( inferior thyroid artery)

1.3. venous drainage thyroid veins 1.4. lymphatic vessels paratracheal lymph nodes 1.5. innervation: middle and inferior cervical ganglia Suprarenal glands: 2 in number 1.1. lies in the retroperitoneal space 1.2. is enclosed in the peritoneal fat capsule 1.3. on the posterior aspect is the hilum of the gland, allowing the veins and lymphatic vessels to leave 1.4. topography: 1.4.1. the right gland:

triangular in shape when viewed from anterior the base lies directly on the superior pole of the kidney the lateral part lies against the medial crus of the diaphragm, overlying both the greater splanchnic nerve and the right parts of the celiac ganglion anterior surface is covered by the right lobe of liver and part of the inferior vena cava 1.4.2. the left gland: crescent-shaped lies on the upper, medial margin of the kidney covers the greater splachnic nerve anteriorly is in contact with the posterior wall of the stomach 1.5. arterial supply: 1.5.1. superior suprarenal artery ( inferior phrenic artery) 1.5.2. middle suprarenal artery (abdominal aorta) 1.5.3. inferior suprarenal artery( renal artery) 1.6. venous drainage: 1.6.1. left suprarenal vein left renal vein 1.6.2. right suprarenal vein inferior vena cava 1.7. lymphatic drainage: 1.7.1. paraortic lymph nodes 1.7.2. lumbar lymph nodes 1.7.3. posterior mediastinal lymph nodes 1.8. the cortex is under influence of hypothalamus-hypophysis system except for the zona glomerulosa, which is under influence of the renin-angiotensin system of the kidney 1.9. the medulla is under influence of the SY system Knee region. Popliteal fossa. Crural, malleolar, and retromalleolar regions

Popliteal fossa: 1.1. borders:

1.1.1. medial and proximal: semimembranousus, semitendinosus 1.1.2. lateral and proximal: biceps femoris 1.1.3. lateral and distal: lateral head of gasctrocnemius, plantaris 1.1.4. medial and distal: medial head of gastrocnemius 1.1.5. floor: popliteus 1.2. content: 1.2.1. sciatic nerve: divides into tibial and common fibular nerves 1.2.2. popliteal vein 1.2.3. popliteal artery 1.2.4. deep popliteal lymph nodes Tendinous arch of soleus 1.1. in the origin of the soleus, from fibula to the posterior surface of the tibia above the interosseous membrane 1.2. content: 1.2.1. tibial nerve 1.2.2. posterior tibial artery 1.2.3. posterior tibial vein Musculofibular canal: 1.1. borders: 1.1.1. lateral: fibula 1.1.2. medial: flexor halluces longus 1.2. content: 1.2.1. fibular vein 1.2.2. fibular artery Tarsal canal: behind the medial malleolus 1.1. borders: 1.1.1. medial: flexor retinaculum 1.1.2. anterior: medial malleolus 1.1.3. posterior: calcaneal tuberosity 1.2. content: T D VAN HA 1.2.1. tendon of posterior tibialis 1.2.2. tendon of flexor digitorum longus 1.2.3. posterior tibial artery 1.2.4. posterior tibial vein 1.2.5. tibial nerve 1.2.6. tendon of flexor hallucis longus In front of the medial malleolus: 1.1. borders: 1.1.1. anterior: extensor retinaculum 1.1.2. posterior: medial malleolus 1.2. content: 1.2.1. great saphenous vein 1.2.2. saphenous nerve 1.2.3. anterior tibialis (beneath the extensor retinaculum) Behind the lateral malleolus: 1.1. borders:

1.1.1. superior and inferior fibular retinaculum 1.1.2. anterior: lateral malleolus 1.1.3. posterior: calcaneal tuberosity 1.2. content: 1.2.1. small saphenous vein 1.2.2. sural nerve 1.2.3. tendons of fibularis longus and brevis in common tendon sheath cerebellum- structure: White matter: 1.1. corpus medullare: the interior white substance of cerebellum 1.2. laminae albae: layers of white substances seen on the section of the cerebellum 1.3. abor vitae = Tree of life. It brings the sensory and motor information to and from the cerebellum cerebellar nuclei lie within it 1.4. inferior cerebellar peduncle: restiform bod dorsal spinocerebellar tract

cuneocerebellar tract rostral spinocerebellar tract reticulocerebelllar tract trigeminocerebellar tract olivocerebellar tract 1.5. middle cerebellar peduncle: brachium pontis transverse pontine fibers 1.6. superior cerebellar peduncle: brachium conjunctivum ventral spinocerebellar tract tectocerebellar 1.7. Mossy fibers: from spinal cord, reticular formation, pontine nuclei they synapse in granular layer of the cerebellar cortex with Golgi and granular cells 1.8. climbing fibers: from inferior olivary nucleus (olivocerebellar tract) they synapse with the Purkinje cells

Grey matter: 1.1. cerebellar cortex: 3 layers molecular layer: stellate & basket (inner stellate) cells ganglionic layer: Purkinje cells granular layer: granular & Golgi cells

** parallel fibers: the axons of the granular cells pass to the molecular layer, bifurcating to form 2 parallel cells, which are connected to the dendrites of the Purkinje cells 1.2. cerebellar nuclei: dentate nucleus: 1) the largest nucleus in cerebellum 2) receives input from inferior olive 3) projects to red nucleus of the midbrain, contralateral thalamus (VL, VA, intralamina) fastigial nucleus: projects to vestibular nuclei, reticular formation globose & emboliform nuclei: project to reticular formation, red nucleus, and thalamus 7. cerebellum- description

Superior & inferior surfaces Anterior & posterior cerebellar notch It is connected to the brain stem via superior, middle and inferior cerebellar peduncles Consists of 2 lateral hemispheres, which are joined in the midline by vermis the folds of the cerebellum folia, so called cerebellar gyri, are oriented approximately transversely primary fissure: separates the anterior lobe from the posterior lobe posteriolateral fissure: separates the flocculonodular lobe from the rest functional division: 1.1. archicerebellum: oldest; = vestibulocerebellum = flocculonodular lobe and the associated fastigial nucleus is primarily concerned with maintenance of balance receives vestibular information from the vestibular nuclei through the inferior cerebellar peduncle to the cortex as vestibulocerebellar tract the efferent fibers (from Purkinje cells) project to the fastigial nucleus, which in turn projects back to the vestibular nucleus ** vestibulocerebellar tract:

direct (primary) fibers: axons of the vestibular ganglion cells 1) to the flocculus, the nodulus, the ventral part of the uvula, and the fastigial nucleus 2) the fibers end as mossy fibers 3) ipsilaterally

indirect (secondary) fibers: 1) via vestibular nuclei ( medial and descending ) to the flocculonodular lobe and vermis 2) also end as mossy fibers 3) bilaterally the influence upon the lower motor system is bilateral, and principally mediated by the descending vestibulospinal, and reticulospinal projections ** cerebellovestibular pathways: the vestibular nuclei receive afferent fibers from the cerebellar nuclei as well as the cerebellar cortex ( anterior & posterior parts of the vermis and the vestibulocerebellum) the fibers from the anterior vermis mainly end in the ipsilateral lateral vestibular nucleus. The projection is somatotopically arranged the fibers from posterior vermis also end in the lateral vestibular nucleus but are not organized somatotopically the vermis can also influence the vestibular nuclei indirectly, via a relay in the fastigial nucleus. The fibers from the rostral part of the fastigial nucleus supply all four main vestibular nuclei ipsilaterally The fibers from the caudal part of the fastigial nucleus are crossed The ipsilateral fibers from the rostral part of the fastigial nucleus supply the dorsal half of the lateral vestibular nucleus (of Deiters) The cerebellovestibular pathways from the vestibulocerebellum supply mainly the parts of the vestibular nuclei which are related to be the vestibular influences on oculomotor mechanisms. The fibers from the vermis, projecting onto the lateral vestibular nucleus directly, exert their main influence on the spinal cord and are related to the control of postural mechanism. 1.2. paleocerebellum: = spinocerebellum Influences the muscle tone and posture Afferents consist principally of ventral & dorsal spinocerebellar tracts Fibers terminate mainly in the cortex of the ipsilateral vermis and paravermis Efferents from the vermis & paravermis pass to globose & emboliform nuclei The globos & emboliform nuclei in turn project to the contralateral red nucleus of the midbrain, where they influence the activity of cells giving rise to the rubrospinal tract 1.3. neocerebellum: youngest Is concerned with muscular coordination The principal afferent pathway consists of pontocerebellar fibers Efferent is directed to the dentate nucleus, which in turn, projects to the contralateral red nucleus and VL nucleus of thalamus

the efferents (detatorubral, detatothalamic) form the major part of the superior cerebellar peduncle. they cross in the caudal midbrain just before they reach the red nucleus . The 10th cranial nerve vagus nerve

contain SVE, GSA, GVE, SVA fibers 1.1. SVE: arise from the nucleus ambiguus, innervate the larynx and pharynx 1.2. GSA: to the spinal sensory nucleus of CN V, from the small area of auricle 1.3. GVE: arise from the dorsal nucleus of the vagus, innervate the heart, kidney, GIT, respiratory, gonads, till the left colic flexure (Cannon-Bohm point) 1.4. SVA: end in the gustatory part of the solitary nucleus, from the epiglottis extends through the jugular foramen, then passes into the carotid sheath between ICA and the IJV main branches: 1.1. head region: 1) meningeal branch: to the dura mater 2) auricular branch: to the auricle; also carries the branch from the facial nerve 1.2. cervical region: 1) pharyngeal branches: arise at the level of the inferior ganglion combine in the pharynx with the pharyngeal branches of the CN IX and SY forming the pharyngeal plexus the sensory part innervates the mucosa of trachea, esophagus and the epiglottis the motor part innervates the muscle of the soft palate and pharynx 1.2.1. levator veli palatine 1.2.2. palatoglossus 1.2.3. palatopharyngeus 1.2.4. musculus uvulae 1.2.5. constrictors of the pharynx 1.2.6. salpingopharyngeus 2) superior laryngeal nerve:

originates below the inferior ganglion divides at the level of hyoid bone into 1.2.1. external branch: motor innervation of the cricothyroid 1.2.2. internal branch: sensory innervation for the mucosa of the larynx as far as vocal folds

3) recurrent laryngeal nerve: the left one loops around the aortic arch the right one loops around the right subclavian artery and ascends behind it gives off: 1.2.1. tracheal branches 1.2.2. esophageal branches 1.2.3. inferior laryngeal nerve: motor to all laryngeal muscles except the cricothyroid. Sensory to laryngeal mucosa below the vocal cords 4) cervical cardiac branches: PASY upper part: communicate with the cardiac branches of SY forming the deep part of the cardiac plexus lower part: the right ones go distribute to the deep part of the cardiac plexus; left ones to the superficial 1.3. thoracic & abdominal regions: 1) pulmonary plexus: at the hilum of the lung formed by the pulmonary branches of the vagus nerve and the SY trunk supplies the bronchial tree and the visceral pleura 2) esophageal plexus: PASY: from vagus 1.3.1. efferents: have their cell bodies located in the dorsal motor nucleus of the vagus and they will synapse on the terminal ganglia in the walls of the esophagus 1.3.2. afferents: are primarily concerned with autonomic reflexes and they have their cell bodies in the inferior ganglion of the vagus SY: 1.3.1. efferents: The cell bodies of the preganglionic fibers, the first are located in the intermediolateral cell column of the thoracic spinal cord. And those of the postganglionic fibers lie in the ganglia of SY chain 1.3.2. afferents: These fibers are primarily concerned with pain and have cell bodies located in the dorsal root ganglion 3) anterior vagal trunk: formed by the left vagus hepatic branches

PASY fibers to the celiac plexus anterior gastric branches to the stomach 4) posterior vagal trunk: formed by the right vagus PASY to celiac plexus posterior gastric branches Topography of duodenum and pancreas

Duodenum: 1.1. superior part: 1.1.1. intraperitoneal 1.1.2. is ventrally in contact with the gallbladder and the visceral surface of the liver ( hepatoduodenal ligament) 1.2. the descending part: 1.2.1. the upper part is intraperitoneal 1.2.2. the lower part is secondary retroperitoneal 1.2.3. is traversed by the transverse mesocolon from right to left 1.2.4. is located ventrally to the right kidney 1.2.5. on the left side, it fuses with the head of pancreas 1.3. horizontal part: 1.3.1. secondary retroperitoneal 1.3.2. is in contact with the head of pancreas by its superior surface 1.3.3. ventral surface is crossed by the root of mesentery 1.3.4. the superior mesenteric artery and vein pass in the groove between the pancreas and the horizontal part, continuing further into the root of mesentery 1.3.5. dorsally: from right to left right ureter inferior vena cava aorta 1.4. the ascending part: 1.4.1. secondary retroperitoneal 1.4.2. rises obliquely upward to the left from aorta and the spine 1.4.3. becomes the jejunum at duodenojejunal flexure 1.4.4. the duodenojejunal flexure is attached to the diaphragm by the suspensory ligament of duodenum and is where the root of mesentery starts and extends caudally to the right 1.4.5. dorsally: left renal vessels left spermatic vessels left SY trunk

Pancreas: 1.1 the head: 1.1.1. secondary retroperitoneal 1.1.2. crossed by the transverse mesocolon from right to left 1.1.3. is fused with the duodenum at the duodenal cap 1.1.4. the bile duct passes in the back between it and the descending part duodenum 1.1.5. the portal vein is formed by the connection of the splenic and superior mesenteric veins behind the head of pancreas

1.1.6. the IVC lies most dorsally behind the head 1.1.6. the posterior surface is coverd by the Treitz membrane 1.2. the body: secondary retroperitoneal 1.2.1. superiorly a smooth continuation of the head 1.2.2. inferiorly at the junction is the pancreatic notch superior mesenteric artery and vein 1.2.3. the omental eminence forms the omental tuberosity in the omental bursa 1.2.4. the left part lies in front of the left kidney 1.3. the tail: intraperitoneal 1.3.1. runs over the anterior surface of the left kidney to the splenic hilum 1.3.2. the splenorenal ligament containing the splenic artery and vein runs from the hilum of the spleen to the left kidney and embeds the tail of pancreas Connections of the limbic system

Limbic system: 1.1. cortical part: paleocortex: primary olfactory cortex archicortex: hippocampal formation 1) hippocampus 2) subiculum 3) dentate gyrus mesocortex (transitional) 1) entorhinal area 2) presubiculum neocortex: 1) cingulate gyrus 2) parahippocampal gyrus 3) subcollsal area 1.2. subcortical part: septum verum: nucleus accumbens, medial septal nucleus amygdala basal nucleus of Meynert diagonal band of Broca 1.3. diencephalic part: anterior thalamic nuclei habenular nuclei hypothalamus: mammillary bodies, preoptic nucleus 1.4. mesencephalic part: nuclei of ventral tegmental area of Tsai dorsal raphe nucleus, superior central nucleus, dorsal tegmental nucleus interpeduncular nucleus substantia nigra-pars compacta 1.5. pontine part: lateral & medial parabrachial nuclei locus coeruleus

Fornix: 1.1. columnae: pars tecta: 1) precommissural fibers: to the septum verum, cingulate gyrus 2) retrocommissural fibers: to mammillary bodies, anterior thalamic nuclei pars libera 1.2. body 1.3. crura: commissure of the fornix 1.4. fimbria of the hippocampus: is continuous with the crura

Mammillothalamic tract: 1.1. from the mammillary body to the anterior thalamic nuclei 1.2. lies within the medial medullary lamina of the thalamus Mammillotegmental tract: 1.1. from the mammillary body to the midbrain tegmentum and the RF Stria terminalis: efferents from the amygdala= dorsal amygdaloid fascicle Ventral amygdaloid fascicle: 1.1. connections of amygdala, preoptic area,hypothalamus, septum verum and the orbitofrontal cortex Stria medullaris thalami: 1.1. from the hypothalamus & septum verum to the lateral habenular nuclei Habenulointerpeduncular fasciculus: 1.1. from the habenular nuclei to the interpeduncular nucleus Anterior commissure Medial and lateral longitudinal striae of the corpus callosum 1.1. from septum verum and subcallosal area to the dentate gyrus and hippocampus Cingulum: association fibers of the cingulate gyrus Mammary region Corresponds to female breast Is the subregion of the pectoral region On the skin surface is a pigmented circle, the areola mammae; in the middle of this circle lies the nipple The premammary fat (subcutaneous layer) fills the groove between the lobes of the glandular stroma (mammary gland) The retromammary fat lies behind the gland, loosely attached to the pectoralis fascia The arterial supply is provided by the perforating branches of the internal thoracic artery ( subclavian artery) and lateral thoracic artery ( axillary artery) The venous drainage is through the medial mammary branches( internal thoracic vein brachiocephalic vein) and lateral mammary

branches (lateral thoracic vein axillary vein) The lymph drains into lymph nodes arranged in axillary, parasternal, interpectoral and supraclavicular groups Sensory innervation is provided by intercostal nerves of the 4th to 6th intercostal spaces ( thoracic nerves) Oral cavity innervation

o Lips o Upper infraorbital V3 o Lower V3 o Motor facial nerve

o Cheeks o Sensory buccal nerve V3 o Motor facial motor branches

o Tongue o Sensory: 1.1. anterior 2/3 by lingual nerve 1.2. posterior 1/3 by glossopharyngeal nerve 1.3. epiglottic valleculae by the vagus o Special sensory: 1.1. anterior 2/3 by chorda tympani carried in lingual nerve 1.2. posterior 1/3 by the glossopharyngeal nerve 1.3. epiglottic region by the vagus o Motor: all extrinsic and intrinsic musles are innervated by hypoglossal nerve except for the palatoglossus, which is by the vagus nerve

o Palate o Sensory ganglionic branches of V2

o Teeth and gum o Infraorbital superior dental plexus o Inferior alveolar

o Salivary glands o Parotid

Para from otic ganglion. Sym enter the auriculotemporal nerve via communicating branch of VII

o Submandibular In the glandular branches

o Sublingual gland In lingual nerve along with glands of posterior 2/3rd of tongue

Vestibular pathway. Pathways of archicerebellum Vestibular pathway: 1.1. 3 neuronal pathway: 1) 1st: bipolar cells of vestibular ganglion 2) 2nd: vestibular nuclei superior & medial receive from cristae ampullares of semicircular canals inferior & lateral receive from the macula of the saccule and utricle 3) 3rd: VL of thalamus 1.2. fibers from thalamus terminate in primary vestibular area (area3) in the lower part of the postcentral gyrus 1.3. collaterals of the vestibular pathway: 1) from superior & medial nuclei: medial longitudinal fasciculus: to the extraocular muscle nuclei to elicit compensatory ocular movements triggered by movements of the head medial vestibulospinal tract: to the cervical spinal cord to elicit suitable head movements 2) from lateral nucleus:

lateral vestibulospinal tract: to the motorneurons and interneurons at all spinal cord levels to make postural adjustment 3) from inferior nucleus: vestibuloreticular tract indirect vestibulocerebellar tract 4) from vestibular gangliondirect vestibulocerebellar tract

Pathways of archicerebellum: 1.1. direct vestibulocerebellar tract: axons from the vestibular ganglion enter the cerebellum via inferior cerebellar peduncle and then to the vestibulocerebellum as mossy fibers 1.2. indirect vestibulocerebellar tract: axons from the vestibular ganglion run to vestibular nuclei from the vestibular nuclei, the fibers enter the cerebellum via inferior cerebellar peduncle, and then to the vestibulocerebellum as mossy fibers 1.3. cerebellovestibular tract: from the fastigial nucleus and the cerebellar cortex fibers project mainly onto the lateral vestibular nucleus exert their

main influence on the spinal cord and are related to the control of posture Innervation of nasal cavitysensory, special sensory, autonomic, the terminal nerve Sensory: 1.1. nasociliary nerve (V/1): anterior and superior parts of mucosa anterior and posterior ethmoidal nerves infratrochlear nerve: supplies the skin of the bridge of the nose 1.2. nasopalatine nerve (V/2): posterior and inferior parts of mucosa and skin

posterior nasal branches 1.3. infraorbital nerve ( V/2): posterior and inferior parts of mucosa and skin external nasal branch 1.4. supraorbital nerve (frontal nerve of V/1): frontal sinus 1.5. infraorbital nerve ( V/2): maxillary sinus anterior superior alveolar middle superior alveolar posterior superior alveolar 1.6. posterior ethmoidal nerve ( nasociliary nerve of V/1): sphenoid sinus, ethmoid sinus

Special sensory: the olfactory nerve sends microscopic fibers from the olfactory bulb through the foramina on the cribriform plate to reach the olfactory region of the nasal cavity Autonomic: 1.1. PASY: postganglionic fibers come from the pterygopalatine ganglion, innervating the 1.1.1. nasal glands, carried in the nasal branches of nasopalatine nerve 1.1.2. palatine glands, carried in the lesser and greater palatine nerves 1.2. SY: postganglionic fibers come from the superior cervical ganglion, innervating the blood vessels in the mucosa and cause them to constrict

nuclei of thalamus and its pathways All thalamic nuclei project to the ipsilateral cerebral cortex (except for reticular nucleus) all the thalamic nuclei also receive corticoefferent fibers specific nuclei all lie within the ventral part of the lateral nuclear group nonspecific nuclei receive less functionally distinct afferent input that does not include overtly sensory or motor pathways; however, they connect widely with associative and limbic areas Lateral nuclear group: contains all specific thalamic nuclei 1.1. ventral posterior nucleus: VP lies between the ventrolateral and pulvinar nuclei

termination of all ascending pathways from the spinal cord and brain stem that carry general sensory information from the contralateral half of the body including spinothalamic tracts, medial lemniscus, trigeminothalamic tracts the lateral portion of VP receives information from the trunk & limbs via spinothalamic tracts and medial lemniscus VPL the medial portion of VP receives information from the head via trigeminothalamic tracts; also receives taste information from solitary nucleus and vestibular information from the vestibular nuclei VPM it projects to the primary somatosensory cortex in the postcentral gyrus of parietal lobe(area 3,1,2) 1.2. ventral anterior nucleus: VA 2 subdivisons: 1) principal part: receives fibers from medial segment of globus pallidus VApc (larger) 2) magnocelluar part: receive fibers from substantia nigra pars reticulata VAmc (smaller) neurotransmitter of the afferents to this region is inhibitory GABA output goes to the premotor and supplementary motor cortices of the frontal lobe 1.3. ventral lateral nucleus: VL 3 subdivisions: 1) pars oralis: receives input from ipsilateral pallidum and substantia nigra VLo 2) pars medialis: receives input from ipsilateral pallidum and substantia nigra VLm 3) pars caudalis: receives input from contralateral dentate nucleus have reciprocal connections with motor area of the frontal lobe,

especially the primary motor cortex in the precentral gyrus (area 4) 1.4. lateral dorsal nucleus: is nonspecific part of the limbic system receives input from the hippocampus sends output to the cingulate gyrus has connections with sensory association cortex of the parietal lobe 1.5. pulvinar: is the most posterior part of the thalamus lateral & inferior divisions have widespread connection with the visual cortical area the dorsal part of the lateral pulvinar has predominately connection with posterior parietal cortex the medial pulvinar has widespread connection with cingulate, posterior parietal, premotor areas also receives input from superior colliculus, which seems to be important for the initiation and compensation of the saccade, as well as the regulation of the visual attention 1.6. lateral geniculate body: part of the visual system ( contains the 4th neurons of the visual pathway) each nucleus receives axons that have originated in the ipsilateral temporal hemiretina and the contralateral nasal hemiretina sends fibers to the primary visual cortex of the occipital lobe via retrolentiform part of the internal capsule 1.7. medial geniculate body: is part of the auditory system ( contains the 4th neurons of the auditory pathway) projects to the primary auditory cortex of the temporal lobe (transverse temporal gyri) via retrolentiform part of the internal capsule

Anterior nuclear group: 1.1. 3 subdivisions: anteroventral, anteromedial, and anterodorsal nuclei 1.2. is part of the limbic system 1.3. receives a large input from mammillary body via mammillothalamic tract: arises from the cells both in medial and lateral nuclei of the mammillary body and from the fibers from the fornix 1.4. projects principally to the cingulate gyrus 1.5 is involved in the control of instinctive drives, and in the emotional aspect of the behavior and memory

Medial nuclear group: 1.1. forms a large region consisting primarily of the mediodorsal nucleus and some much smaller nuclei like nucleus reuniens 1.2. receives input from the hypothalamus, amygdala, the intralaminar nuclei, and the lateral nuclear group 1.3. projects to the prefrontal cortex 1.4. is concerned mainly with the control of mood and emotions Intralaminar nuclei: 1.1. is nonspecific 1.2. including the centromedian, and parafascicular nuclei 1.3. receive input from the medial group of the reticular formation of the brain stem, spinothalamic tract, and the trigeminothalamic trcat 1.4. project to the widespread cerebral cortex and the striatum via thalamostriatal projection 1.5. are part of the mechanism for activation of the cerebral cortical mantle 1.6. when they are stimulated, alpha rhythm activity( associated with the repose and sleep) is disrupted and the EEG becomes desynchronized 1.7. lesion leads to the reduce of pain perception, and the level of consciousness Reticular nucleus: 1.1. is a thin layer of cells located on the lateral aspect of thalamus between external and internal capsule 1.2. are GABAergic 1.3. receives input from cerebral cortex. Most of them come from the collaterals of fibers passing through the reticular nucleus 1.4. primary output goes to the other thalamic nuclei the only thalamic nucleus that does not project to the cerebrum 1.5. it modulates the information from other nuclei in the thalamus. Its function is modulatory on signals going through thalamus VA, VLo and the centromedial nucleus of the intralaminar nuclei receive the information from the medial segment of the pallidum via pallidothalamic fibers, using GABA as neurotransmitter. The VA and VL in turn project to the excitatory fibers to the motor regions of the frontal lobe, using glutamate as neurotransmitter Parasympathetic system feed & breed, rest & digest preganglionic neurons are located in the PASY nuclei of CN III, VII, IX, X and the spinal cord (S2-S4) craniosacral system they have long preganglionic axons, and synapse in the ganglia located near the target structures

the accessory nucleus of CN III contributes to the miosis via synapses in the ciliary ganglion (pupil constriction) the PASY nucleus of the CN VII (superior salivatory nucleus) innervates the submandibular and sublingual gland via the submandibular ganglion; and to the lacrimal gland via pterygopalatine ganglion the PASY nucleus of the CN IX (inferior salivatory nucleus) innervates the parotid gland via synapses in the otic ganglion the PASY nucleus of the CN X (dorsal nucleus of the vagus nerve): 1.1. innervates the heart (cardiac plexus) 1.2. lungs (pulmonary plexus) 1.3. esophagus (esophageal plexus) 1.4. GIT till Cannon-Bohm point 1.5. kidneys, gallbladder, pancreas, and upper ureters the pelvic splanchnic nerves: 1.1. arise from the anterior rami of the sacral nerves S2-S4 1.2. they travel to their side's corresponding inferior hypogastric plexus, located bilaterally on the walls of the rectum. 1.3. from the inferior hypogastric plexus, they contribute to the innervation of the pelvic( urinary bladder), genital organs and large intestine from the Cannon-Bohm point (left 1/3 of the transverse colon, descending colon, sigmoid, rectum, anal canal) . Inframesocolic compartment of peritoneal cavity Below the transverse mesocolon Is covered by the greater omentum anteriorly The transverse colon is attached to the greater omentum by the gastrocolic ligament Is divided into 2 parts by the attachment of the root of mesentery at the duodenojejunal flexure 1.1. right inframesocolic compartment: smaller 1.2. left inframesocolic compartment: larger Content : 1.1. jejunum: occupies the upper left part 1.2. ileum: occupies the lower right part 1.3. caecum: lies in the right iliac fossa. ** retrocaecal recess 1.4. appendix: projects onto the abdominal wall at McBurneys point or Lanz point 1.5. superior ileocaecal recess: 1.5.1. is located above the ileocaecal junction 1.5.2. anterior: vascular fold of the caecum, which contains anterior caecal artery (ileocolic) 1.5.3. posterior: mesentery of the last loop of ileum 1.6. inferior ileocaecal recess: 1.6.1. below the ileocaecal junction 1.6.2. anterior: ileocaecal fold 1.6.3. posterior: upper part of meso-appendix 1.7. sigmoid colon

. Pathways of paleo- and neocerebellum Paleocerebellum: = spinocerebellum (vermal part of anterior lobe, the pyramis, the uvula and paraflocculus)influences the muscle tone and posture 1.1. anterior spinothalamic tract: proprioception of lower trunk and legs

1storder neuron: spinal ganglia 2nd order neuron: thoracic nucleus (Clarkes column) fibers cross in the spinal cord, and then ascend and enter the cerebellum via superior cerebellar peduncle fibers then again cross in the cerebellum 1.2. posterior spinocerebellar tract: proprioception of lower trunk and legs 1st order neuron: spinal ganglia 2nd order neuron: thoracic nucleus (Clarkes column) fibers are uncrossed, and enter the cerebellum through inferior cerebellar peduncle 1.3. cuneocerebellar tract: proprioception of upper limbs and upper trunk 1st order neuron: spinal ganglia C1-T5 2nd order neuron: accessory cuneate nucleus fibers are uncrossed, and enter the cerebellum via inferior cerebellar peduncle 1.4. rostral spinocerebellar tract: proprioception from upper limbs & trunk 1st order neuron: spinal ganglia C1-C3 2nd order neuron: in the intermediate gray zone fibers are crossed, and enter the cerebellum partly via superior and partly via inferior cerebellar peduncles all fibers terminate as the mossy fibers mainly to the vermis and paravermis efferents pass to the emboliform and globose nuclei, which in turn project to the red nucleus (magnocellular part) of the midbrain, influencing the rubrospinal tract

Neocerebellum: = cerebrocerebellum 1.1. is concerned with muscular coordination 1.2. pontocerebellar tract: inputs to the pontine nuclei come from the frontal lobe (area 4,6), the temporo-parieto-occipital(area 3,1,2,5,7,17,18,19) from the pontine nuclei, axons run as the transverse pontine fibers, and enter the cerebellum via middle cerebellar peduncle 1.3. corticocerebellar tract:

accompanies the pyramidal tract to medulla oblongata and then via the inferior cerebellar peduncle to the cerebellum

Other tracts: 1.1. trigeminocerebellar tract: 1st order neuron: trigeminal ganglion 2nd order neuron: 1) spinal trigeminal nucleus: to inferior cerebellar peduncle 2) pontine trigeminal nucleus: to middle cerebellar peduncle 3) mesencephalic trigeminal nucleus: to superior cerebellar peduncle 1.2. bulbocerebellar tract: from nucleus gracilis and cuneatus to the cerebellum via inferior cerebellar peduncle 1.3. olivocerebellar tract: are crossed fibers entering the cerebellum via inf.cerebellar peduncle from the main nucleus to hemisphere from the accessory to the vermis as the climbing fibers 1.4. rubrocerebellar tract: from red nucleus 1.5. tectocerebellar tract: from the midbrain tectum enters the cerebellum via the superior cerebellar peduncle crosses within the superior medullary velum 1.6. reticulocerebellar tract: from the precerebellar nuclei and RF of medullar oblongata, fibers are uncrossed and enter the cerebellum via inferior cerebellar peduncle to the vermis fibers from the pontine RF (pontine tegmental reticular nucleus) are both crossed and uncrossed. They enter via middle cerebellar peduncle to the vermis 1.7. raphecerebellar and ceruleocerebellar tracts: from the monoaminergic nuclei of the RF, via superior cerebellar peduncle 1.8. hypothalamocerebellar tract: from posterior hypothalamic nucleus and lateral hypothalamic area passes through middle cerebellar peduncle to the cerebellum Sensory innervation of head and neck 1. opthalmic 1. Lacrimal nerve lateral corner of eye 2. supratrochlear nerve medial corner of eye 3. supraorbital nerve upper eyelid and skin of forehead 4. inf ratrochlear nere medial corner of eye

5. external nasal branch dorsum and tip of nose 1. maxillary a. zygomaticotemporal temple b. zygomaticofacial skin over zygomatic arch c. infraorbital nerve between lower eyelid and upper lip 2. mandibular a. auriculotemporal temporal skin, external acustic meatus and tympanic membrane b. mental nerve chin, lower lips and skin over body of mandible Scalenovertebral triangle o inferior superior thoracic aperture o superiorly carotid tubercle of C2 o Medially Longus colli o Laterally anterior scalene o Cervical viscera rests medially o Contents

o Cupulae plurar o Subclavian vein o Internal jugular vein o Brachiocephalic trunk o Thoracic duct and left venous angle o Right lymphatic duct o Vagus nerve o Phrenic nerve o Sympathetic trunk o Stellate ganglion reticular formation and its pathways:

Consists of a substantial part of the dorsal pat of the brain stem, containing a group of neurons and fibers Does not contain the nuclei of the cranial nerve or long tracts The function includes the sleep arousal cycle, perception of pain, control of movement, and the regulation of visceral activity The nuclei are arranged in 3 columns: median(raphe), medial, and lateral rows Precerebellar nuclei: 1.1. including the lateral reticular nucleus, paramedian reticular nucleus, amd the pontine reticulotegmental nucleus 1.2. all of their projections go to the cerebellum! Raphe nuclei: serotonergic 1.1. medullary raphe nuclei: nucleus raphes magnus + nucleus raphes pallidus + nucleus raphe obscurus afferents are from the spinal cord, the gracile and cuneate nuclei, trigeminal sensory nucleus, and the periaqueductal grey

efferents go to the cerebellum, dorsal and ventral horns of the spinal cord, to trigeminal nucleus and to the preganglionic autonomic neurons of the brain stem and spinal cord responsible for suppressing the pain awareness 1.2. raphe nuclei of the rostral pons and midbrain nucleus raphes pontis, superior central nucleus, nucleus raphes dorsalis, and dorsal tegmental nucleus afferents are from precentral gyrus, and limbic system efferents project to the corpus striatum, cerebellum and noradrenergic nuclei of the RF have function on the pain awareness and sleep pattern(decrease the arousal level)

Medial (central) group: 1.1. medulla: central medullary nucleus, giganocellular nucleus pons: caudal and oral pontine reticular nucleus midbrain: cuneiform and subcuneiform nuclei 1.2. afferent fibers: spinothalamic tract, trigeminothalamic tract gustatory and auditory system visual information that is carried by the tectoreticular fibers (from the superior colliculus, part of mydriasis reflex) fastigial nucleus of the vestibulocerebellum RF of the midbrain, cholinergic reticular nuclei premotor cortex 1.3. efferent fibers: to other reticular nuclei constitute the medial(pontine) and lateral(medullary) reticulospinal tracts!

Cholinergic nuclei: 1.1. pedunculopontine nucleus, and pontine periventricular grey matter 1.2. afferents: from pallidum and substantia nigra 1.3. efferents: medial group of medullary and pontine reticular nuclei subthalamic nucleus corpus striatum 1.4. functions: locomotion, consciousness and arousal

Catecholamine nuclei: A1-A10 1.1. they use adrenalin, noradrenalin, and dopamine as neurotransmitter 1.2. locus coeruleus (A6) 1.3. afferents: medial group of the RF nucleus preprositus hypoglossi

periaqueductal grey hypothalamus, amygdala, and prefrontal cortex 1.4. efferents: most of them travel in the central tegmental tract some end in the thalamus, habenular nuclei(medial part), olfactory bulb, hippocampus, and the neocortex 1.5. function: modulator of synapses between neurons, and also effect on the alertness and reflexes

Parvocellular reticular area: 1.1. afferents: sensory nucleus of CN.V cerebral cortex 1.2. efferents: spread out medially to the giganocellular nucleus motor nuclei of CN.XII, VII, and III 1.3. function: reflexes with feeding

Parabrachial area 1.1. lateral & medial parabrachial area + Kolliker-Fuse nucleus 1.2. afferents: solitary nucleus insula, and adjacent parietal lobe 1.3. efferents: hypothalamus(preoptic area), and intralaminar nuclei of thalamus The eyeball description. Fibrous and nervous layers

Fibrous layer: = sclera + cornea 1.1. the outermost layer 1.2. sclera: the white of the eye 1) covers the posterior 5/6 of the eye 2) consists mainly of the collagen fibers 3) maintains the shape of the eyeball 1.3. cornea: transparent 1) covers the anterior 1/6 of the eye 2) from the outer to inner: epithelium Bowmans membrane corneal stroma Descemets membrane endothelium 3) contains unmyelinated nerve fibers supplied by ophthalmic nerve Nervous layer: retina 1.1. 2 regions: junction is at the ora serrata 1) pars optica: contains both pigmented and neural layers 2) pars caeca: contains only the pigmented layer 1.2. 10 layers: from inner to outer 1) inner limiting membrane: separates it from the vitreous body 2) optic nerve fibers layer: afferent fibers of the retina 3) ganglion cell layer: perikarya of multipolar ganglionic cells

4) inner plexiform layer: synapses of the multipolar and bipolar ganglionic cells 5) inner nuclear layer: perikarya of the bipolar cells 6) outer plexiform layer: synapses of the bipolar cells and rods & cones 7) outer nuclear layer: nuclei of rods & cones 8) external limiting membrane 9) outer and inner segments of rods & cones 10) pigmented layer 1.3. rods are for the night vision and contains rhodopsin 1.4. cones are responsible for the color vision and contains iodopsin . Female pelvic cavity. Infraperitoneal space of female pelvis. Male pelvic cavity. Infraperitoneal space of male pelvis Female pelvis: 1.1. the central organ is the uterus, covered by the peritoneum 1.2. anterior to the uterus lies the urinary bladder: uterovesical pouch 1.3. posterior to the uterus is the rectum: Douglas pouch 1.4. broad ligament of the uterus: frontally oriented peritoneal fold 1.4.1. its basal portion is the cardinal ligament of the uterus 1.4.2. runs from the cervix to the lateral wall of lesser pelvis 1.4.3. is divided by the suspensory and proper ligaments of the ovary into:

upper part: mesosalpinx, the peritoneal duplicature of the uterine tube lower part: mesometrium, the peritoneal duplicature of the uterus 1.5. the uterine tube lies in the superior margin of the broad ligament 1.6. the ovary is located on the posterior wall, hanging on the mesoovarium 1.7. the proper ligament of the ovary: runs from the lower pole of the ovary to the uterine horn 1.8. the suspensory ligament of ovary: 1.8.1. passes from the upper pole of the ovary to the pelvic wall 1.8.2. contains ovarian vessels 1.9. uterovesical pouch: 1.9.1. laterally bordered by the peritoneal fold caused by the round ligament of uterus 1.9.2. the fold runs from the uterine horn to above the external iliac vessels to the deep inguinal ring 2.0. Douglas pouch: rectouterine pouch 2.0.1. bordered on both sides by the rectouterine(sacrouterine)fold, formed by the sacrouterine ligament, which runs from the cervix to the sacrum 2.0.2. between this pouch and the pelvic floor is an oblique, frontally oriented plate peritoneoperineal fascia (rectovaginal septum) 2.1. the vagina touches anteriorly the dorsal surface of the urinary bladder and urethra; while the rectum lies posterior to it 2.2. the vagina is embedded by the urethrovaginal sphincter as it passes

through the urogenital diaphragm 2.3. the urethra is enveloped bellow its exit from the urinary bladder by external urethral sphincter Male pelvis: 1.1. rectovesicle pouch: between the urinary bladder and the rectum 1.2. the rectovesicle septum= peritoneoperineal fascia: 1.2.1. passed down from the inferior surface of the rectovesicle pouch to the pelvic diaphragm 1.3. pelvic part of the ureter: passes anteriorly to the external iliac vessels down to the pelvis 1.4. the ductus deferens

after leaving the deep inguinal ring, it turns posteriorly and mediocaudally, crossing the inferior epigastric vessels and passes down to the infraperitoneal space it crossed anteriorly to the ureter, external iliac vessels and the obturator nerve and vessels then it crosses ventrally to the ureter at the posterior wall of the urinary bladder widens into the ampulla which is located medially to the seminal vesicles the ejaculatory duct opens to the prostatic part of the urethra 1.5. the prostate: attached to the urinary bladder by its base the apex rests on the urogenital diaphragm contains the prostatic part of the urethra . hypothalamus and subthalamus: -Hypothalamus:

the hypothalamic input is circulatory and neural in origin 1.1. the circulating blood provides physiclal, chemical and hormonal signals of the state of the body 1.2. the neural signal come from: nucleus solitaries: conveys information collected by ANS concerning the pressure within the smooth-muscled walls of organs (baroreceptors) and the chemoreceptors

midbrain RF via direct and indirect(by relay in thalamus) routes, and the monoaminergic nuclei via medial forebrain bundle the hypothalamus is capable of generating responses to the input by circulatory and neural means 1.1. via circulatory mean, the hypothalamus can influence the pituitary gland on its hormonal synthesis and release 1.2. the neural output: the hypothalamus is capable of initiating appropriate motor behavioral through its connection with the limbic system the connections with RF are also capable of influencing the state of wakefulness and sleep Medial hypothalamic nuclei: 1.1. anterior hypothalamus: medial preoptic nucleus: 1.1.1. regulates the release of gonadotropic hormones from adenohypophysis 1.1.2. contains the sexually dimorphic nucleus, which releases GnRH, differential development between sexes is based upon in the utero testosterone levels

supraoptic nucleus: contains the omsosensitive neurons that are activated by the osmolality of circulating blood. An increase in osmolality causes release of vasopressin (ADH). paraventricular nucleus: 1.1.3. thyrotropin-releasing hormone 1.1.4. corticotropin-releasing hormone 1.1.5. oxytocin 1.1.6. somatostatin ** The axons of cells in the supraoptic and paraventricular nuclei pass to neurohypophysis in the hypothalamohypophysial tract. The neuroendocrine products are transported in this tract to the neurohypophysis, where they are released into the capillaries, therefore reach the general circulation. anterior hypothalamic nucleus: 1.1.7. thermoregulation 1.1.8. panting 1.1.9. sweating 1.1.10. thyrotropin inhibition suprachiasmatic nucleus: circadian rhythms(diurnal rhythms and sleep/waking cycle). It receives some fibers

from the retina. lateral preoptic nucleus 1.2. tuberal: dorsomedial hypothalamic nucleus: 1.2.1. blood pressure 1.2.2. heart rate 1.2.3. stimulation of digestion ventromedial hypothalamic nucleus: 1.2.4. satiety center 1.2.5. neuroendocrine control arcuate nucleus: 1.2.6. growth hormone-releasing hormone 1.2.7. feeding 1.2.8. dopamine tuberal nuclei 1.3. posterior hypothalamus: mammillary body: memory, part of limbic system. It receives inputs from hippocampus and projecting to the anterior nuclei of the thalamus and the brain stem. posterior nucleus: 1.3.1. increase blood pressure 1.3.2. pupillary dilation 1.3.3. shivering 1.3.4. vasopressin release

The lateral hypothalamus: ventral and medial to the subthalamus 1.1. is traversed by medial forebrain bundle 1.2. is important in the control of food and water intake (thirst and hunger) 1.3. is equivalent to the physiologically defined feeding center The white matter of hypothalamus: 1.1. median forebrain bundle:

is the tract connecting fibers from the basal olfactory regions, periamygdaloid and the septal nuclei, as well as fibers from the reticular formation of brain stem passes through the lateral hypothalamus contains both ascending and descending fibers also represents a part of mesolimbic (dopaminergic) pathway, carrying information between the ventral tegmentum of the midbrain and accumbens nucleus. involved in the integration of reward and pleasure 1.2. dorsal longitudinal fasciculus: bidirectional coordination of the ANS! it travels through periaqueductal grey ascending fibers:

1.2.1. originate in parabrachial area of reticular formation 1.2.2. fibers synapse onto the hypothalamus and carry visceral information to the brain descending fibers: 1.2.3. originate in hypothalamus (paraventricular, supraoptic) 1.2.4. descend through the periaqueductal grey along the base of 4th ventricle 1.2.5. they then continue into the spinal cord where they synapse with preganglionic autonomic neurons 1.2.6. they send information to: midbrain: pain modulation

medullary autonomic centers: heart rate, blood pressue, respiration ventral tegmental area brain stem PASY nuclei (dorsal motor nucleus of X, salivatory nuclei) thoraco-lumbar preganglionic SY neurons lumbo-sacral perganglionic PASY neurons 1.3. fonix: the principal efferent of hippocampus

is a C-shaped fascicle of fibers links the hippocampus with mammillary body its crura is continuous with the fimbria of the hippocampus 2 crura unite to form the body of the fornix, and the divides again into 2 columns, terminating in the mammillary body some fibers cross to the opposite side through hippocampal commissure the mammillary body in turn projects to the anterior nuclear group of thalamus via mammillothalamic tract and to the brain stem via mammillotegmental tract it has been found to most closely correlate with recall memory rather than recognition memory 1.4. stria terminalis: serves as the major output of amygdala runs from the centromedial division of the amygdaloid body to the ventromedial nucleus of the hypothalamus it covers the thalamostriate vein, marking a line of separation between the thalamus and the caudate nucleus The activity of the bed nucleus of the stria terminalis correlates with anxiety in response to threat monitoring.[1]

It is thought to act as a relay site within the hypothalamic-pituitary- adrenal axis and regulate its activity in response to acute stress It is also thought to promote behavioral inhibition in response to unfamiliar individuals, by input from the orbitofrontal cortex 1.5. stria medullaris thalami: contains afferent fibers form the septal nuclei, lateral preoptic area of hypothalamus, and anterior thalamic nuclei to the habenula it forms a horizontal ridge on the medial surface of the thalamus 1.6. princeps mammillary fasciculus: mammillothalamic fasciculus: 1.6.1. arises from cells in both medial and lateral nuclei of the mammillary body 1.6.2. projects to the anterior nuclear group of thalamus mammillotegmental fasciculus: 1.6.3. passes caudally to dorsal and ventral tegmental nuclei in the midbrain and RF of the pons 1.7. mammillary peduncle: consists of fibers from the dorsal and ventral tegmental nuclei of the midbrain ascending to the mammillary body - Subthalamus:

Subthalamic nucleus(of Luy) 1.1. ventrolateral part of the subthalamus 1.2. medial to the internal capsule 1.3. biconvex in coronal section 1.4. important in the control of movement 1.5. input: external pallidum (inhibitory) motor and premotor cortices (excitatory) intralaminar nucleus of thalamus (excitatory) 1.6. output: globus pallidus (excitatory) basal ganglia substantia nigra

Zona incerta: 1.1. rostral extension of the brain stem RF 1.2. visuomotor coordinator 1.3. input: brain stem (RF, periaqueductal grey, superior colliculi) intralaminar nuclei of thalamus frontal cortex 1.4. output: brain stem

hypothalamus thalamus cortex

White matter of subthalamus 1.1. ansa lenticularis: from lateral pallidum to thalamus 1.2. lenticular fasciculus: from medial pallidum through H2 to thalamus 1.3. thalamic fasciculus: H1 pallidothalamic fibers: uncrossed cerebellothalamic fibers: crossed medial lemniscus spinothalamic tract ansa lenticularis + lenticular fasciculus 1.4. subthalamic fasciculus: globus pallidus subthalamic nucleus through the posterior limb of internal capsule The eyeball vascular layer

Choroid: 1.1. highly vascularized 1.2. is the posterior part of the vascular layer 1.3. inner surface is attached to the pigmented layer of the retina = choriocapillary layer is responsible for the nutrition of the retina 1.5. the outer surface is separated by the perichoroidal space from the sclera Ciliary body: 1.1. lies anterior to the ora serrata at the level of lens 1.2. suspends the lens by the suspensory ligament of the lens 1.3. 2 zones: 1) orbiculus ciliaris: ciliary disk

radially folded ring extending from the ora serrata to the ciliary processes anterior part is occupied by the ciliary muscles 1.3.1. longitudinal fibers 1.3.2. radial fibers 1.3.3. zonular fibers: suspensory ligament of the lens 2) ciliary processes: protrude from the ciliary disk on the posterior surface of the ciliary body the epithelial lining secretes the humor aqueous (by clear cells)

Iris: 1.1. forms the aperture in front of the lens the pupil 1.2. 3 layers: 1) anterior layer: pigmented epithelium 2) stroma: contains 2 smooth muscles dilator and sphincter pupilae 3) posterior layer: pigmented epithelium Position and relations of urinary bladder. Position and relation of uterus Urinary bladder: 1.1. infraperitoneal in the lesser pelvis 1.2. the retropubic space:

1.2.1. = prevesicle space of Retzius 1.2.2. between the urinary bladder and the posterior surface of the symphysis 1.2.3. is filled by the fatty tissue 1.2.4. extends superiorly between the transversalis fascia and the vesicoumbilical fascia 1.2.5. ends in the pubovesical ligaments ** 1.3. is surrounded by the fibrous tissuepericystium, which anteriorly and superiorly forms the vesicoumbilical fascia (paracystium) 1.3.1. lies posteriorly to the transversalis fascia 1.3.2. at the level of the semicircular (arcuate) line, it fuses with the tranversalis fascia Associative pathways. Commissural pathways Associative pathways: 1.1. short fibers: interconnect adjacent gyri = arcuate fibers= U fibers 1.2. long fibers: 1) superior longitudinal fascicle:

above the insula connects the frontal, parietal, occipital lobes, and turns into the temporal lobe 2) inferior longitudinal fascicle: connection of temporal and occipital lobes 3) superior fronto-occipital fascicle = subcallosal fascicle 4) inferior fronto-occipital fascicle: under the insula and lentiform nucleus 5) uncinate fascicle: connection of the orbital gyrus of the frontal lobe with the temporal lobe 6) vertical occipital fascicle: within the occipital lobe 7) cingulum: connection of the cingulate and parahippocampal gyri

Commissural pathways: connect the right and left hemispheres 1.1. corpus callosum: 1) connects all regions but only the auditory part of temporal lobe 2) 4 parts : rostrumgenubodysplenium 3) forceps anterior (minor), forceps posterior (major) 1.2. commissure of the fornis (hippocampus): transverse fibers linking the crura of the fornix 1.3. anterior commissure: 1) anterior part: connects the olfactory bulbs 2) posterior part: connects regions of the temporal lobe except the auditory and hippocampal part 1.4. habenular commissure: connects the habenular nuclei 1.5. posterior commissure: 1) = epithalamic commissure

2) connects the posterior nucleus of thalamus, superior colliculi and pretectal nuclei 1.6. supraoptic commissures: above and behind the optic chiasm 1) anteriorof Gudden 2) posteriorof Meynert 3) supremeof Ganser 1.7. Probsts commissure: connection of the lateral lemniscus on both side Spinal ganglion, sensory ganglia of cranial nerves Spinal ganglion: 1.1. = dorsal root ganglion 1.2. pseudounipolar cells 1.3. the dendrites of the neurons receive the information from the receptors 1.4. the axons may run as the tracts to the CNS or run to the motor neurons for the reflex Sensory ganglia of the cranial nerves: 1.1. trigeminal ganglion: 1.1.1. is located near the apex of the pyramidal part of the temporal bone 1.1.2. gives off ophthalmic, maxillary, and mandibular nerves 1.2. spiral ganglion: 1.2.1. is located in the modiolus of the cochlea 1.2.2. contains the cell bodies of the bipolar cells (1st order neuron) 1.2.3. receives hearing information from the hair cells 1.3. vestibular ganglion: 1.3.1. contains the cell bodies of bipolar neurons (1st order) 1.3.2. receive vestibular information from the hair cells of the macula of the saccule & utricle and the ampullar crest of the semicircular ducts 1.4. geniculate ganglion: 1.4.1. is locates in the facial canal 1.4.2. contains special sensory neurons of the facial nerve for the taste

the fibers from the tongue run as the chorda tympani fibers from the palate run in the greater petrosal nerve 1.4.3. sensory fibers (from the small region of auricle)are carried to the geniculate ganglion by theintermediate nerve 1.5. superior ganglion of CN IX: = jugular ganglion 1.5.1. very small, usually is regarded as the detached part of the inferior one 1.6. inferior ganglion of CN IX: = petrous ganglion

1.6.1. is situated in the depression in the lower border of the petrous part of the temporal bone 1.6.2. contains the bodies of general somatic sensory neurons(GSA fibers) that innervate the pharynx, tonsils, tongue, middle ear, auditory tube and the ear canal 1.6.3. also contains the neurons (GVA)that innervate the carotid sinus (mechanoreceptors)and carotid body (chemoreceptors) through the carotid nerve 1.6.4. also the taste neurons (SVA) 1.7. superior ganglion of CN X: rostral ganglion, near jugular foramen 1.7.1. inputs come from the auricular branch of the vagus, cranial meninges, 1.7.2. postganglionic fibers synapse in the sensory nucleus of CN V 1.8. inferior ganglion of CN X: nodose ganglion 1.8.1. is located at the level of atlas (C1 vertebra) 1.8.2. chiefly visceral afferent in function concerning sensation of heart, larynx, lungs and GIT from the pharynx to the transverse colon 1.8.3. also contains fibers coming fro the epiglottis for taste . Lines and planes of thorax. Topography of thoracic wallcostal region Lines: 1.1. midsternal line: the middle line of sternum median plane (midsagittal plane) 1.2. sternal line: lateral margin of the sternum 1.3. parasternal line: between sternal and medioclavicular lines 1.4. midclavicular line: midpoint of the clavicle 1.5. anterior axillary line: vertical continuation of anterior axillary fold 1.6. posterior axillary line: vertical extension of posterior axillary fold 1.7. scapular line: through inferior angle of scapula 1.8. paravertebral line: tips of the transverse processes of vertebrae 1.9. midvertebral line: spinous processes Planes: 1.1. suprasternal plane: transverse plane at the level of superior margin of manubrium 1.2. Ludwigs plane: transverse plane at the junction of manubrium and the body of sternum 1.3. thoracic plane: passes through the sternal angle, the body of T4, separating the superior and inferior mediastinum 1.4. sternoxiphoid plane: at the junction of body and the xiphoid process Thoracic wall: 1.1. layers: from superficial to deep 1.1.1. skin 1.1.2. subcutaneous tissue

1)thoracoepigastric veins lateral intercostal vein 2) lateral cutaneous branches of the intercostal nerves 3) anterior cutaneous branches of intercostal nerves 4) peripheral branches of the supraclavicular nerve 1.1.3. superficial common thoracic fascia covers: 1) pectoralis: anteriorly 2) serratus anterior and the origin of external oblique: laterally 3) latissimus dorsi: posterolaterally 1.1.4. external intercostal muscle 1.1.5. internal intercostal muscle 1.1.6. intercostal vein, artery and nerve (superiorinferior) 1.1.7. innermost intercostal muscle 1.1.8. endothoracic fascia 1.1.9. parietal pleura