神经解剖与影像对照图谱 英文版.pdf
神经解剖与影像对照图谱 英文版.pdf
Contents
Preface to Sixth Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Preface to the First Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Chapter 1 Introduction and Reader’s Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Including Rationale for Labels and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Chapter 2 External Morphology of the Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
The Spinal Cord: Gross Views and Vasculature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
The Brain: Lobes, Principle Brodmann Areas, Sensory-Motor Somatotopy . . . . . . . . . . . 13
The Brain: Gross Views, Vasculature, and MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
The Cranial Nerves in MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
The Insula: Gross View and MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
The Meninges, Cisterns, and Meningeal and Cisternal Hemorrhages . . . . . . . . . . . . . . . . 46
The Ventricles and Ventricular Hemorrhages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Chapter 3 Dissections of the Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Lateral, Medial, and Ventral Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Overall Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Chapter 4 Internal Morphology of the Brain in Slices and MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Brain Slices in the Coronal Plane Correlated with MRI . . . . . . . . . . . . . . . . . . . . . . . . . 63
Brain Slices in the Axial Plane Correlated with MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Chapter 5 Internal Morphology of the Spinal Cord and Brain in Stained Sections . . . . . . . . . 83
The Spinal Cord with CT and MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Arterial Patterns Within the Spinal Cord With Vascular Syndromes . . . . . . . . . . . . . . . . 94
The Degenerated Corticospinal Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
The Medulla Oblongata with MRI and CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Arterial Patterns Within the Medulla Oblongata With Vascular Syndromes . . . . . . . . . . . 110
The Cerebellar Nuclei . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
The Pons with MRI and CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Arterial Patterns Within the Pons With Vascular Syndromes . . . . . . . . . . . . . . . . . . . . . 124
The Midbrain with MRI and CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Arterial Patterns Within the Midbrain With Vascular Syndromes . . . . . . . . . . . . . . . . . . 136
The Diencephalon and Basal Nuclei with MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Arterial Patterns Within the Forebrain With Vascular Syndromes . . . . . . . . . . . . . . . . . 158
Chapter 6 Internal Morphology of the Brain in Stained Sections:
Axial–Sagittal Correlations with MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Axial–Sagittal Correlations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Chapter 7 Synopsis of Functional Components, Tracts, Pathways, and Systems . . . . . . . . . . . . 173
Components of Cranial and Spinal Nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Sensory Pathways . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Motor Pathways . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
Cerebellum and Basal Nuclei . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
Optic, Auditory, and Vestibular Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
Limbic System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
xi
Chapter 8 Anatomical–Clinical Correlations: Cerebral Angiogram, MRA, and MRV . . . . . . 239
Cerebral Angiogram, MRA, and MRV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240
Blood Supply to the Choroid Plexi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Overview of Vertebral and Carotid Arteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
Chapter 9 Q&A’s: A Sampling of Study and Review Questions, Many in the USMLE Style,
All With Explained Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Sources and Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
xii Contents
Preface to the Sixth Edition
Previous editions of Neuroanatomy have endeavored 1) to provide astructural basis for understanding the function of the central ner-
vous system; 2) to emphasize points of clinical relevance through use
of appropriate terminology and examples; and 3) to integrate neuro-
anatomical and clinical information in a format that will meet the edu-
cational needs of the user. The goal of the sixth edition is to continue
this philosophy and to present structural information and concepts in
an even more clinically useful and relevant format. Information learned
in the basic science setting should flow as seamlessly as possible into the
clinical setting.
I have received many constructive suggestions and comments from
my colleagues and students. This is especially the case for the modifi-
cations made in Chapters 2, 5, 7, 8, and 9 in this new edition. The
names of the individuals who have provided suggestions or comments
are given in the Acknowledgments. This thoughtful and helpful input
is greatly appreciated and has influenced the preparation of this new
edition.
The major changes made in the sixth edition of Neuroanatomy are as
follows:
First, recognizing that brain anatomy is seen in clear and elegant de-
tail in MRI and CT, and that this is the primary way the brain is viewed
in the health care setting, additional new images have been incorporated
into this new edition. Every effort has been made to correlate the MRI
or CT with brain or spinal cord anatomy by relating these images on the
same page or on facing pages. New MRI or CT have been introduced
into chapter 2 (spinal cord, meningeal hemorrhages correlated with the
meninges, cisterns, hemorrhage into the brain, hemorrhage into the
ventricles correlated with the structure of the ventricles), chapter 5
(spinal cord and brainstem), and chapter 8 (vascular).
Second, the structure of the central nervous system should be avail-
able to the student (or the medical professional for that matter) in a for-
mat that makes this information immediately accessible, and applica-
ble, to the requirements of the clinical experience. It is commonplace
to present brain structure in an anatomical orientation (e.g., the colli-
culi are “up” in the image and the interpeduncular fossa is “down”).
However, when the midbrain is viewed in an axial MRI or CT, the re-
verse is true: the colliculi are “down” in the image and the interpedun-
cular fossa is “up”. There are many good reasons for making brainstem
images available in an anatomical orientation and for teaching this view
in the academic setting. These reasons are recognized in this book. On
the other hand, the extensive use of MRI or CT in all areas of medi-
cine, not just the clinical neurosciences, requires that students be
clearly aware of how brain and spinal cord structure is viewed, and used, in
the clinical environment. To address this important question, a series of
illustrations, including MRI or CT, are introduced in the spinal cord
and brainstem sections of chapter 5. These images are arranged to show
1) the small colorized version of the spinal cord or brainstem in an
anatomical orientation; 2) the same image flipped bottom-to-top into
a clinical orientation; and 3) the clinical orientation of the colorized
line drawing followed by T1 and T2 MRI and/or CT at levels compa-
rable to the line drawing and corresponding stained section. This ap-
proach retains the inherent strengths of the full-page, colorized line
drawing and its companion stained section in the anatomical orienta-
tion. At the same time, it introduces, on the same set of pages, the im-
portant concept that CNS anatomy, both external and internal, is ori-
ented differently in MRI or CT. It is the clinical orientation issue that
will confront the student/clinician in the clinical setting. It is certainly
appropriate to introduce, and even stress, this view of the brain and
spinal cord in the basic science years.
Third, new images have been included in chapter 8. These include,
but are not limited to, new examples of general vessel arrangement in
MRA, examples of specific vessels in MRI, and some additional exam-
ples of hemorrhage.
Fourth, additional examples of cranial nerves traversing the sub-
arachnoid space are included. In fact, the number of MRI showing cra-
nial nerves has been doubled. In addition, each new plate starts with a
gross anatomical view of the nerve (or nerves) shown in the succeed-
ing MRI in that figure.
Fifth, additional clinical information and correlations have been in-
cluded. These are in the form of new images, new and/or modified fig-
ure descriptions, and changes in other portions of the textual elements.
Sixth, in some instances, existing figures have been relocated to im-
prove their correlation with other images. In other instances, existing
figures have been repeated and correlated with newly added MRI or
CT so as to more clearly illustrate an anatomical-clinical correlation.
Seventh, a new chapter (chapter 9), consisting of approximately 240
study and review questions and answers in the USMLE style, has been
added. All of these questions have explained answers keyed to specific
pages in the Atlas. Although not designed to be an exhaustive set, this
new chapter should give the user of this atlas a unique opportunity for
self-assessment.
Two further issues figured prominently in the development of this
new edition. First, the question of whether to use eponyms in their
possessive form. To paraphrase one of my clinical colleagues “Parkin-
son did not die of his disease (Parkinson disease), he died of a stroke;
it was never his own personal disease.” There are rare exceptions, such
as Lou Gehrig’s disease, but the point is well taken. McKusick
(1998a,b) has also made compelling arguments in support of using the
non-possessive form of eponyms. It is, however, acknowledged that
views differ on this question—much like debating how many angels
can dance on the head of a pin. Consultation with my neurology and
neurosurgery colleagues, a review of some of the more comprehensive
neurology texts (e.g., Rowland, 2000; Victor and Ropper, 2001), and
the standards established in The Council of Biology Editors Manual for
Authors, Editors, and Publishers (1994) and the American Medical As-
sociation’s Manual of Style (1998) clearly indicate an overwhelming
preference for the non possessive form. Recognizing that many users
of this book will enter clinical training, it was deemed appropriate to
encourage a contemporary approach. Consequently, the non posses-
sive form of the eponym is used.
The second issue concerns use of the most up-to-date anatomical
terminology. With the publication of Terminologia Anatomica (Thieme,
New York, 1998), a new official international list of anatomical terms
for neuroanatomy is available. This new publication, having been
v
adopted by the International Federation of Associations of Anatomists,
supersedes all previous terminology lists. Every effort has been made
to incorporate any applicable new or modified terms into this book.
The number of changes is modest and related primarily to directional
terms: posterior for dorsal, anterior for ventral, etc. In most cases, the
previous term appears in parentheses following the official term, i.e.,
posterior (dorsal) cochlear nucleus. It is almost certain that some changes
have eluded detection; these will be caught in subsequent printings.
Last, but certainly not least, the sixth edition is a few pages
longer than was the fifth edition. This results exclusively from the
inclusion of more MRI and CT, a better integration of anatomical-
clinical information, including more clinical examples (text and il-
lustrations), and the inclusion of Study/Review and USMLE style
questions with explained answers.
Duane E. Haines
Jackson, Mississippi
References:
Council of Biology Editions Style Manual Committee. Scientific Style and
Format—The CBE Manual for Authors, Editors, and Publishers. 6th Ed.
Cambridge: Cambridge University Press, 1994.
Federative Committee on Anatomical Terminology. Terminologia Ana-
tomica. Thieme, Stuttgart and New York, 1998.
Iverson, MA et al. American Medical Association Manual of Style—A Guide
for Authors and Editors. 9th Ed. Baltimore: Williams & Wilkins, 1998.
McKusick, VA. On the naming of clinical disorders, with particular ref-
erence to eponyms. Medicine 1998;77: 1–2.
McKusick, VA. Mendelian Inheritance in Man, A Catalog of Human Genes
and Genetic Disorders. 12th Ed. Baltimore: The Johns Hopkins Uni-
versity Press, 1998.
Rowland, LP. Merritt’s Neurology. 10th Ed. Baltimore: Lippincott Williams
& Wilkins, 2000.
Victor, M and Ropper, AH. Adams and Victor’s Principles of Neurology. 7th
Ed. New York: McGraw-Hill, Medical Publishing Division, 2001.
vi Preface to the Sixth Edition
Preface to the First Edition
This atlas is a reflection of, and a response to, suggestions from pro-fessional and graduate students over the years I have taught human
neurobiology. Admittedly, some personal philosophy, as regards
teaching, has crept into all parts of the work.
The goal of this atlas is to provide a maximal amount of useful in-
formation, in the form of photographs and drawings, so that the initial
learning experience will be pleasant, logical, and fruitful, and the re-
view process effective and beneficial to longterm professional goals. To
this end several guiding principles have been followed. First, the entire
anatomy of the central nervous system (CNS), external and internal,
has been covered in appropriate detail. Second, a conscientious effort
has been made to generate photographs and drawings of the highest
quality: illustrations that clearly relay information to the reader. Third,
complementary information always appears on facing page. This may
take the form of two views of related structures such as brainstem or
successive brain slices or a list of abbreviations and description for a
full-page figure. Fourth, illustrations of blood supply have been in-
cluded and integrated into their appropriate chapters. When gross
anatomy of the brain is shown, the patterns of blood vessels and rela-
tionships of sinuses appear on facing pages. The distribution pattern of
blood vessels to internal CNS structures is correlated with internal
morphology as seen in stained sections. Including information on ex-
ternal vascular patterns represents a distinct departure from what is
available in most atlases, and illustrations of internal vessel distribution
are unique to this atlas.
There are other features which, although not unique in themselves,
do not usually appear in atlas format. In the chapter containing cross-
sections, special effort has been made to provide figures that are accu-
rate, clear, and allow considerable flexibility in how they can be used
for both teaching and learning. The use of illustrations that are one-half
photograph and one-half drawing is not entirely novel. In this atlas,
however, the sections are large, clearly labeled, and the drawing side
is a mirror-image of the photograph side. One section of the atlas is de-
voted to summaries of a variety of major pathways. Including this ma-
terial in a laboratory atlas represents a distinct departure from the stan-
dard approach. However, feedback over the years strongly indicates
that this type of information in atlas format is extremely helpful to stu-
dents in the laboratory and greatly enhances their ability to grasp and
retain information on CNS connections. While this atlas does not at-
tempt to teach clinical concepts, a chapter correlating selected views
of angiograms and CT scans with morphological relationships of cere-
bral arteries and internal brain structures is included. These examples
illustrate that a clear understanding of normal morphological relation-
ships, as seen in the laboratory, can be directly transposed to clinical
situations.
This atlas was not conceived with a particular audience in mind. It
was designed to impart a clear and comprehensive understanding of
CNS morphology to its readers, whoever they may be. It is most obvi-
ously appropriate for human neurobiology courses as taught to med-
ical, dental, and graduate students. In addition, students in nursing,
physical therapy, and other allied health curricula, and psychology as
well, may also find its contents helpful and applicable to their needs.
Inclusion and integration of blood vessel patterns, both external and in-
ternal, and the summary pathway drawings may be useful to the indi-
vidual requiring a succinct, yet comprehensive review before taking
board exams in the neurological, neurosurgical, and psychiatric spe-
cialties.
The details in some portions of this atlas may exceed that found in
comparable parts of other atlases. If one is to err, it seems more judi-
cious to err on the side of greater detail than on the side of inadequate
detail. If the student is confronted with more information on a partic-
ular point than is needed during the initial learning process, he or she
can simply bypass the extra information. However, once the initial
learning is completed, the additional information will be there to en-
hance the review process. If students have inadequate information in
front of them it may be difficult, or even impossible, to fill in missing
points that may not be part of their repertoire of knowledge. In addi-
tion, information may be inserted out of context, and, thereby, hinder
the learning experience.
A work such as this is bound to be subject to oversights, and for such
foibles, I am solely responsible. I welcome comments, suggestions, and
corrections from my colleagues and from students.
Duane E. Haines
vii
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