Section 3 THE NERVOUS PATHWAYS ( 神经传导路 )

Systematic Anatomy Dept of Anatomy, Medical College, Qingdao University 1

Section 3 THE NERVOUS PATHWAYS ( 神经传导路 )

A. The Sensory (Ascending) Pathways

( 感觉传导通路 )

B. The Visual and Pupillary Reflexes Pathways ( 视觉传导通路和瞳孔对光反射通路 )

C. The Acoustic Pathway ( 听觉传导通路 )

D. The Equilibratory Pathway ( 平衡觉传导通路 )

E. The Motor (Descending) Pathways ( 运动传导通路 )


A. The Sensory (Ascending) Pathways

1. Deep & discriminatory sensation

Proprioceptive (deep) sense ( 本体感觉 ): body posture, movement, vibration and pressure.

discriminatory sense ( 精细触觉 ): size, shape, texture and two point discrimination.


Receptorsmuscle spindlestendon spindles

Pacini’s corpuscles( 肌梭 , 腱梭 ,P 小体 )

III

Med. Lemniscus ( 内侧丘系 )III丘脑皮质束 ( 丘脑中央辐射 )

cerebral centers Cortex of the sup. and middle parts of postcentral gyrus.

Posterior part of paracentral lobule ( 中央后回上中部皮质 ,中央旁小叶后部 )

Spinal nn.( 脊 N) ( 薄束 T4, 楔束 T4)

( 内侧丘系交叉 )

( 薄束核 ,楔束核 )( 脊神经节 )

( 丘脑腹后外侧核 )( 内囊后肢 )

(内弓状纤维 )

1) Conscious proprioceptive sensory pathways

( 意识性本体感觉传导通路 )


1) Conscious proprioceptive sensory pathways


Receptorsmuscle spindlestendon spindles

Pacini’s corpuscles( 肌梭 , 腱梭 ,P 小体 )

( 脊 N) ( 后根 )

I ( 脊神经节 )

II ( 后角固有核 )

cerebellar center cortex of

cerebellum( 小脑皮质 )

ant. white commissure ( 脊髓白质前连合 )

thoracicnucleus( 胸核 )

sup. cerebellar peduncle ( 小脑上脚 )脊髓小脑前束

( 小脑下脚 ) ( 脊髓小脑后束 )

2) unconscious proprioceptive sensory pathway

( 非意识性本体感觉传导通路 )


Receptorsfree n. endings ( 痛 )

Krause's end bulbs ( 冷 )Ruffini end

organs ( 热 )

I

II

( 脊髓丘系 ) ( 脊髓丘脑侧束 )III丘脑皮质束 ( 丘脑中央辐射 )

cerebral centers Cortex of the sup. and middle parts of postcentral gyrus.

Posterior part of paracentral lobule ( 中央后回上中部皮质 , 中央旁小叶后部 )

Spinal nn.( 脊 N) 上升 1-2 节后外侧束

( 脊髓前白连合 )( 脊髓后角固有核 )( 脊神经节 )

( 丘脑腹后外侧核 )( 内囊后肢 )

2. Superficial sensation 1) Pathway of Pain & Thermal sensatio

n of the Trunk & Limbs( 躯干和四肢痛温觉传导通路 )


1) Pathway of Pain & Thermal sensation of the Trunk & Limbs


Receptorsfree n. endings ( 痛 )

Krause's end bulbs ( 冷 )Ruffini end

organs ( 热 )

I

II

trigeminal lemniscus ( 三叉丘系 )III

int.cap.

内囊后肢

cerebral centers cortex of the inferior part of postcentral gyrus.

( 中央后回下部皮质 )

( 三叉神经脊束核 ) (V 神经节 )

( 丘脑腹后内侧核 )

( 三叉神经 ) ( 三叉神经脊束 )

丘脑中央辐射 ( 丘脑皮质束 )

2) Pain & Thermal Sensation of Head and Face ( 头面部痛温觉 )


2) Pain & Thermal Sensation of Head and Face ( 头面部痛温觉 )


( 损伤部位 ) 感觉障碍表现 Peripheral NS

( 周围神经 )Spinal Cord

( 脊髓 )

Internal capsule

( 内囊 )

Centers( 中枢 )

Thalamus( 丘脑 )

( 脑干延髓 )

subcutaneous nerve ( 皮神经 ): 全部感觉消失 , 无汗mixed nerve ( 混合神经 ): 全部感觉消失 , 支配肌肉软瘫

posterior root 后根 ): 节段性全部感觉消失

( 交叉性痛温觉消失 : 同侧面部 , 对侧躯体 )

( 偏身 , 多伴有自发性痛疼 )( 对侧三偏 : 硬瘫 , 痛、温、

本体、精细触觉消失 , 视觉消失 )

( 对侧相应区感觉消失 )

posterior horn ( 后角 ): 同侧节段低 1-2 节痛温觉消失 ,Ant. commissure ( 白质前连合 ): 对称节段性痛温觉消失

Tract ( 传导束 ): 分离性感觉消失 )

Summary of Sensory Disturbance( 感觉障碍小结 )


RECEPTORSfree n. endings

( 毛囊周围神经末梢tactile corpuscles

( 触觉小体 )

I

II

III丘脑中央辐射 ( 丘脑皮质束 )

内囊后肢

CEREBRAL CENTERS cortex of the sup. and middle parts of postcentral gyrus.

Posterior part of paracentral lobule ( 中央后回上中部皮质 , 中央旁小叶后部 )

spinal nn.( 脊 N)

( 脊髓白质前连合 )

( 脊髓后角固有束核 )

( 脊神经节 )

( 丘脑腹后外侧核 )

( 脊髓丘系 ) ( 脊髓丘脑前束 )

3) Tactile Pathway of Trunk and Limbs ( 躯干四肢触觉 )


RECEPTORSfree n. endings

( 毛囊周围神经末梢tactile corpuscles

( 触觉小体 )

I

II

trigem. lemniscus( 三叉丘系 )III丘脑中央辐射 ( 丘脑皮质束 )

CEREBRAL CENTERS cortex of the inferior part of postcentral gyrus.

( 中央后回下部皮质 )

trigeminal n.( 三叉 N)

( 脑桥内交叉 )

( 三叉神经脑桥核 )

(V 神经节 )

( 丘脑腹后内侧核 )

内囊后肢

4) Tactile Pathway of Head and Face ( 头面部触觉 )


RECEPTORSrod cells

( 视杆细胞 )cone cells

( 视锥细胞 )

II鼻侧

optic tract ( 视束 )III视辐射 ( 膝距束 )

CEREBRAL CENTERS banks of the calcarine sulcus

( lingual gyrus & cuneus) ( 距状沟两侧皮质 ) ( 舌回和楔叶 )

bipolar c. ( 双极细胞 )

( 视交叉 )

( 节细胞 )( 双极细胞 )

( 外侧膝状体 ) 颞侧

Ioptic n. ( 视 N)

内囊后肢

后部

3. Visual & pupillary reflexes 1) The visual pathway

( 视觉传导通路 )


3. Visual & pupillary reflexes 1) The visual pathway


RECEPTORSrod cells

( 视杆细胞cone cells

( 视锥细胞

IIganglion cell

( 节细胞 )鼻侧

bipolar c. ( 双极细胞 )

Optic chiasma ( 视交叉 )

颞侧

IOptic n. ( 视 n)

EW 核

(III 副核 )

ciliary ganglion睫状 N 节

Short ciliary nn( 睫短神经 )

Effectors sphincter pupillae

ciliary muscle ( 瞳孔括约肌 ,

睫状肌 )

oculomotor n.( 动眼 N)

lat. br.

侧支

optic tract ( 视束 )

pretectal area

( 顶盖前区 )

2) Pathway of the Pupillary Reflexes ( 瞳孔对光反射传导通路 )


RECEPTORS

spiralorgans

( 螺旋器 )

IIcochlear nuclei( 蜗 n 前 , 后核 )

lat. lemniscus ( 外侧丘系 )IIIacoustic radia.( 听辐射 )内囊后肢

CEREBRAL CENTERS transverse temporal gyri ( 颞横回 )下部

螺旋 N 节 ( 蜗神经 )

( 斜方体交叉 )( 内侧膝状体 )

斜方体

I

trapezoid body ( 斜方体 )

4. The acoustic pathway ( 听觉传导通路 )


Receptorscristae

ampullares ( 壶腹嵴 )

maculae of utricle &

saccule( 球椭圆囊斑 )

II前庭 N 核

med.longit.fasciculus( 内侧纵束 )

vestibulospinal tract ( 前庭脊髓束 ) Effectors ( 效应器 )

inf. cerebellar peduncle( 小脑下脚 )Cerebellar cortex

( 小脑皮质 )

sup. temporal gyrus cortex

( 颞上回皮质 )

I

相应神经

Effectors( 效应器 )

vestibular ganglion ( 前庭 N 节 )

III ventral nucleus of thalamus

( 丘脑腹侧核 )

III,IV,VI,XI核

5. The equilibratory pathway ( 平衡觉传导通路 )


B. The Motor (Descending) Pathways ( 运动传导通路 )

1. The pyramidal system ( 锥体系 ): 1) corticospinal tract ( 皮质脊髓束 )

2) corticonuclear tract ( 皮质核束 )

2. The extrapyramidal system ( 锥体外系 )


( 内囊后肢 ) post.limb of int. Capsule

大脑脚中 3/5

pyramidal decussation

( 锥体交叉 )

spinal nn.( 脊 N)

Effectors limbs mm.( 四肢肌 )

spinal nn.( 脊 N)

Effectors trunk mm.( 躯干肌 )

脊髓白质前连合

前角内侧核

前角外侧核

85%

皮质脊髓

侧束

15%

皮质脊髓

前束

LOWER MOTOR

UPPER MOTOR中央前回↑ 2/3

旁中央小叶pyramidal cells ( 锥体细胞 )

1. The pyramidal system ( 锥体系统 ) 1) Corticospinal Tract ( 皮质脊髓束 )


1) Corticospinal Tract ( 皮质脊髓束 )


2) Corticonuclear Tract ( 皮质核束 )

( 内囊膝部 ) genu of internal capsule大脑脚中 3/5 内侧

脑干内交叉

Effectors全部

头面肌咽喉肌

Effectors除舌肌 ,下面肌外全部肌

XII 核VII 核1/3 外

全部脑干内

运动 N 核除 XII 和VII 下 1/3

皮质核束

双侧支配

皮质核束

单侧支配

LOWER MOTOR NEURONS

相应脑 N相应脑 N

UPPER MOTOR NEURONS中央前回 1/3pyramidal cells

( 锥体细胞 )


Summary of Paralysis of Pyramidal System ( 锥体系瘫痪小结 )

Centres ( 中枢 )

Internal capsule( 内囊 )

( 对侧单肌群硬瘫 )

( 对侧三偏 : 硬瘫 , 痛、温、本体、精细触觉消失 , 视觉消失 )

( 损伤部位 ) ( 瘫痪类别 )

Brain stem( 脑干 )

Spinal cord( 脊髓 )

Peripheral nn.( 周围神经 )

( 交叉性瘫痪 : 同侧面肌软瘫 ,对侧四肢硬瘫 )

Lat. funiculus( 侧索 ): 同侧伤面以下硬瘫 ,Ant. Horn ( 前角 ): 同侧伤平面软瘫 )

( 单肌软瘫 , 感觉消失 )


2. The Extrapyramidal System ( 锥体外系 )

1) Definition: All the somatic motor tracts to skeletal

muscles except pyramidal system ( 除锥体系以外的全部躯体运动束 ).

2) Functions: a. to regulate the tonicity of the muscles

( 调节肌张力 )


The Extrapyramidal System ( 锥体外系 )

b. coordinate the muscular activities

( 协调肌肉活动 )

c. maintain the normal body posture

( 维持体态姿势 )

d. produce habitual and rhythmic move

ments ( 产生习惯性动作 )


3) The corpus striatum-substantia-corpus striatum circuit (system)

( 纹状体 - 黑质 - 纹状体环路 )

Cerebral Cortex frontal lobe ( 额叶 ) parietal lobe ( 顶叶 )

Neo-striatum( 新皮质 )

纹状体苍白球纤维

globus pallidus

( 苍白球 )

Int.Caps.

内囊

ventral anterior nuc. ventral lateral nucleus( 腹前核 , 腹外侧核 )

苍白球丘脑纤维

caudate nucleus + putamen

( 尾状核 , 壳 )

皮质纹状体纤维

Function: feedback regulation ( 反馈调节 )

Brodmann 4, 6 areas

黑质


4) The cortico-ponto-cerebellar circuit (system) ( 皮质 - 脑桥 - 小脑环

路 )CEREBRAL CORTEX

( 额叶 , 顶叶 , 颞叶 )

(Brodmann 4,6)

pontine nuc.( 脑桥核 )

cerebellar cortex

( 小脑皮质 )

dentate nuc.( 齿状核 )

丘脑腹前核丘脑腹外侧核

red nuc.( 红核 )

前角运动核

EFFECTORSskeletal mm.

( 屈侧骨骼肌 )

皮质脑桥纤维小脑中脚

脊神经

小脑上脚

内囊

红核脊髓束

脑桥臂交叉

结合臂交叉

被盖前交叉


Section 4 MENINGES & BLOOD VESSELS OF THE BRAIN & SPINAL CORD; & THE

CEREBROSPINAL FLUID (CSF)

A. The Meninges of the Brain and Spinal Cord ( 脑和脊髓的被膜 )

B. The Blood Vessels of the Brain and Spinal Cord ( 脑和脊髓的血管 )

C. The Circulation of the Cerebrospinal Fluid (CSF) ( 脑脊液循环 )

D. The Brain Barriers ( 脑屏障 )


A. The Meninges of the Brain and Spinal Cord

1. Meninges of the spinal cord ( 脊髓的被膜 )

1) spinal dura mater (spinal dura) ( 硬脊膜 )

a. epidural space ( 硬膜外隙 )

b. subdural space ( 硬膜下隙 )

[peridural anesthesia

硬膜外麻醉 ]

[extradural tumor

硬膜外肿瘤 ]



2) spinal arachnoid mater: ( 脊髓蛛网膜 )

a. subarachnoid space ( 蛛网膜下隙 )

b. terminal cistern ( 终池 )

[lumbar puncture 腰椎穿刺 ]

3) spinal pia mater

( 软脊膜 )

denticular ligament

( 齿状韧带 )





2. Meninges of the brain ( 脑的被膜 ) 1) cerebral dura mater ( 硬脑膜 ) a. cerebral falx ( 大脑镰 )


B. The Blood Vessels of the Brain




[hernia of tentorial

incisure 小脑幕切迹疝 ]


b. cerebellar tentorium: ( 小脑幕 ) tentorial incisure ( 小脑幕切迹 ) c. cerebellar falx ( 小脑镰 )d. diaphragma sellae ( 鞍隔 )


e. sinuses of dura mater ( 硬脑膜窦 )

sup. sagittal s.( 上矢状窦 )

inf. sagittal s.( 下矢状窦 )

straight sin.( 直窦 )

confluence of sinus( 窦汇 )

transverse sin.( 横窦 )

sig-moidsin.( 乙

状窦 )

int. jugular v. ( 颈内静脉 )

Cavernoussinus

( 海绵窦 )

sup. petrosal sin. (岩上窦 )

inf. petrosal sin. (岩下窦 )

[cavernous sinus thrombosis 海绵窦血栓形成 ]






2) cerebral arachnoid mater ( 脑蛛网膜 ) a. subarachnoid space ( 蛛网膜下隙 )



b. subarachnoid cisterns ( 蛛网膜下池 ) i. cerebellomedullary cistern ( 小脑延髓池 ) [cisternal puncture 小脑延髓池穿刺 ] ii. interpeduncular cistern ( 脚间池 ) iii. chiasmatic cistern ( 交叉池 )



iv. pontine cistern ( 桥池 )

v. circular cistern ( 环池 )

c. arachnoid granulations ( 蛛网膜粒 )



3) cerebral pia mater ( 软脑膜 )

choroid plexus ( 脉络丛 )

[meningitis 脑膜炎 ]


B. The Blood Vessels of the Brain1. Arteries of the brain ( 脑的动脉 ): Volume of blood flow ( 血流量 ): 心脑 :15%. 成人 : 50-60ml/100g/min 儿童 : 96-126 ml/100g/min.

O2 consumption (耗氧量 ): 20%.


B. The Blood Vessels of the Braincortical branches ( 皮质支 ) 1) internal carotid a. ( 颈内动脉 ) a. posterior communicating a. ( 后交通动脉 ) b. anterior choroidal a. ( 脉络膜前动脉 )


B. The Blood Vessels of the Brainc. anterior cerebral a. ( 大脑前动脉 ) anterior communicating a. ( 前交通动脉 ) central branches ( 中央支 )


B. The Blood Vessels of the Braind. middle cerebral a. ( 大脑中动脉 ) central branches ( 中央支 ) aa. of lentiform nucleus and corpus striatum (豆状核纹状体动脉 ) (“bleeding a. 出血动脉” ) [cerebrovascular spasm 脑血管痉挛 ] [cerebrovascular accident 脑血管意外 ] [cerebral hemorrhage 脑出血 ] [cerebral embolism 脑血管栓塞 ]


B. The Blood Vessels of the Brain

2) vertebral a. ( 椎动脉 ) a. anterior spinal a. ( 脊髓前动脉 ) b. posterior spinal a. ( 脊髓后动脉 )


B. The Blood Vessels of the Brain c. posterior inferior cerebellar a. ( 小脑下后动脉 ) d. basilar a. (基底动脉 ) i. anterior inferior cerebellar a. ( 小脑下前动脉 )

ii. labyrinthine a. (迷路动脉 ) iii. pontine aa. ( 脑桥动脉 ) iv. superior cerebellar a. ( 小脑上动脉 )


B. The Blood Vessels of the Brain v. posterior cerebral a. ( 大脑后动脉 )

3) cerebral arterial circle

(Willis’ circle) ( 大脑动脉环 )


B. The Blood Vessels of the Brain2. Veins of the brain ( 脑的静脉 ) 1) superficial veins (浅静脉 ) a. superior cerebral vv. ( 大脑上静脉 ) → superior sagittal sinus ( 上

矢状窦 ) b. middle cerebral vv. ( 大脑中静脉 ) → cavernous sinus ( 海绵窦 )


B. The Blood Vessels of the Brain c. inferior cerebral vv. ( 大脑下静脉 ) → transverse si

nus ( 横窦 )

2) deep vein (深静脉 ) great cerebral v.( 大脑大静脉 )→ straight sinus ( 直窦 )


C. Blood Vessels of the Spinal Cord ( 脊髓的血管 )

1. Arteries a. anterior spinal a. ( 脊髓前动脉 ) ← vertebral a. ( 椎动脉 ) b. posterior spinal a. ( 脊髓后动脉 ) ← vertebral a. ( 椎动脉 ) c. posterior intercostal aa. (肋间后动脉 ) d. lumbar aa. ( 腰动脉 )


2. Veins a. anterior spinal v. ( 脊髓前静脉 ) → internal

vertebral venous plexus ( 椎内静脉丛 ) b. posterior spinal v. ( 脊髓后静脉 ) → interna

l vertebral venous plexus ( 椎内静脉丛 )

C. Blood vessels of the spinal cord


choroid plexus (CP) of lateral ventricle ( 侧脑室脉络丛 )

CP of 3rd ventricle (第三脑室脉络丛 )

CP of 4th ventricle(第四脑室脉络丛 )

lat.ventricle ( 侧脑室 )

4th ventricle (第四脑室 )

interventricular foramen (室间孔 )

mesencephalicaqueduct ( 中脑水管 )

arachnoid space ( 蛛网膜下隙 )

(

正中孔)

(

外侧孔)

subarachnoidgranulations ( 蛛网膜粒 )

superiorsagittal sinus( 上矢状窦 )

central canal of spinal cord ( 脊髓中央管 )

3rd ventricle (第三脑室 )

D. The Circulation of the Cerebrospinal Fluid (CSF)

(

外侧孔)





CSF: 400-500ml/d, pH 7.4, 70-170 mm H2O

specific gravity = 1.003-1.008Function: nourish(营养 ), metabolism(代谢 ), pro

tection(保护 ), buoyancy (浮力 ),damper(减震 )[concussion of brain 脑震荡 ][hydrocephalus 脑积水 ]CSF-contacting neuronal system (接触脑脊液的神经元系统 ): 神经元胞体位于脑室内、室管膜内或脑实质内，直接与脑脊液接触。


1. Blood-brain barrier (BBB) ( 血 - 脑屏障 ) (1)The continuous endothelium ( 内皮细胞 ) of the capillary

wall; (2) a thick basal lamina(基底膜 ); (3) the bulbous “feet” of the astrocytes(星状细胞脚 ).

2. Blood-CSF barrier ( 血 - 脑脊液屏障 ) 3. CSF-brain barrier ( 脑脊液 - 脑屏障 )Immuno-neuro-endocrine network (免疫 - 神经 - 内分泌网络 )

E. The Brain Barriers ( 脑屏障 )

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Section 3 THE NERVOUS PATHWAYS ( 神经传导路 )