NC082-113O Chapt.02心妤

Chapter 3 Internal Anatomy of the Central Nervous System

Learning Objectives

ANATOMIC ORIENTATION LANDMARKS

Shaps of Corticospinal Fibers

Figure 3-1

Shape of the Ventricular Cavity

SPINAL CORD IN CROSS-SECTIONS

Sacral Section

Table 3-1

Lumbar Section

Figure 3-2

Figure 3-3

Thoracic Section

Figure 3-4

Figure 3-5

Cervical Section

BRAINSTEM IN TRANSVERSE SECTIONS

Figure 3-6

Medulla Oblongata

Caudal Medulla

Table 3-2

Figure 3-7

Caudal(Lower) Third of the Medulla

Figure 3-8

Middle Third of the Medulla

Figure 3-9

Rostral Third of the Medulla

Pons

Lower Pons

Figure 3-10

Figure 3-11

Figure 3-11 NC092F3-11

Table 3-3 NC092T3-03

Figure 3-12 NC093F3-12

Middle Pons

Figure 3-13 NC094F3-13

Pons-Midbrain Junction

Figure 3-14 NC095F3-14

Midbrain

Caudal Midbrain

Table 3-4 NC096T3-04

Rostral Midbrain

Figure 3-15 NC097F3-15

Figure 3-16 NC098F3-16

High Rostral Midbrain

Box 3-1 NC099B3-01

Figure 3-17 NC099F3-17

Figure 3-18 NC100F3-18

Midbrain-Diencephalon Junction

FOREBRAIN IN CORONAL SECTIONS

Table 3-5 NC101T3-05

Figure 3-19 NC102F3-19

Figure 3-20

Coronal Section Through the Posterior Thalamus

Coronal Section Through the Midthalamus

Cornal Section Through the Anterior Thalamus

Figure 3-21

Coronal Section Through the Anterior Commissure

Figure 3-22

Figure 3-23

Coronal Section Through the Anterior Limb of the Internal Capsule and Caudate Head

Figure 3-24

Coronal Section Through the Anterior Horn

Figure 3-25

FOREBRAIN IN HORIZONTAL SECTIONS

Figure 3-26

Figure 3-27

Figure 3-28

Figure 3-29

Figure 3-30

Summary

Quiz Questions

Technical Terms

NC131-151O Chapt.05

NC131-151O Chapt.05

Chapter 5 Basic Physiology of Nerve cells

LEARNING OBJECTIVES

NEURON

Nerve Cell Structure

Cell Body

Figure5-1NC132F5-01

Dendritic and Axonal Processes

Myelin Sheath

Synapse

Nerve Cell Types

Neuronal Circuits

Figure5-2NC134F5-02

Neuroglial Cells

CENTRAL AND PERIPHEARAL NERVOUS SYSTEMS

Figure5-3

NEURONAL PRUNING AND SYNAPSE ESTABLISHMENT IN THE BRAIN

Table5-1NC136T5-01

Figure5-4NC136F5-04

Figure5-5NC137F5-05

NERVE IMPULSE

BOX5-1NC137B5-01

Figure5-6NC138F5-6

Nerve Excitability

Impulse Conduction

NEURONAL RESPONSES TO BRAIN INJURIES

Figure5-7NC140F5-07

Axonal Reaction

Table5-2NC141T5-02

Wallerian Degeneration

Neuroglial Responses

Axonal Regeneration in Peripheral Nervous Systems

BOX5-2NC142B5-02

Axonal Regeneration in Central Nervous Systems

Table5-3NC142T5-03

NEUROTRANSMITTERS

Acetylcholine

BOX5-3

Figure5-8NC144F5-08

Table5-4NC145T5-04

Monoamines

Dopamine

Norepinephrine

Serotonin

GABA

Glutamate

Peptides

Drug Treatment Principles

CLINICAL CONSIDERATIONS

Brain Tumors

Multiple Sclerosis

Figure5-9NC148F5-9

Myasthenia Gravis

CLINICAL CONSIDERATIONS

Patient One

Patient Two

Patient ThreeNC150P03

SUMMARY

QUIZ QUESTIONS

TECHNICAL TERMS

NC027-081 Chapt.02-2

Chapter 2 Gross Anatomy of the Centeal Nervous System

LEARNING OBJECTIVES

STRUCTURES OF CENTRAL AND PERIPHERAL NERVOUS SYSTEMS

PRIMARY DIVISIONS OF THE BRAIN

GROSS STRUCTURES OF THE BRAIN

Telencephalon

Cerebral Hemispheres

Cortical surfaces

Dorsolateral Surface

Frontal Lobe

Parietal Lobe

Occipital Lobe

Temporal Lobe

Ventral Surface

Midsagittal Surface

Frontal Lobe

Parietal Lobe

Occipital Lobe

Temporal Lobe

Additional Structures

Insular Lobe

Limbic Lobe

Basal Ganglia

Figure 2-15

Figure 2-16

Figure 2-17

Caudate Nucleus

Putamen

Table 2-3

Globus Pallidus

Claustrum

Amygdloid Nucleus

Diencephalon

Thalamus

Figure 2-18

Figure 2-19

Figure 2-20

Hupothalamus

Brainstem

Midbrain

Pons

Medulla Oblongata

Cerebellum

Cerebellar Peduncles

Input to the Cerebellum

Output from the Cerebellum

Spinal Cord

Anatomic Structure

Networking of Spinal Nerves

Spinal Regulation of Muscles for Respiration

VENTRICLES

Lateral Ventricles

Third Ventricle

Fourth Ventricle

MEDULLARY CENTERS IN THE BRAIN

Projection Fibers

Association Fibers

Commissural Fibers

MENINGES OF THE BRAIN

Dura Mater

Falx Cerebri

Tentorium Cerebri

Falx Cerebelli

Arachnoid Membrane

Pia Mater

MENINGES OF THE SPINAL CORD

Spinal Dura Mater

Spinal Arachnoid Membrane

Spinal Pia Mater

CRANIAL NERVES

Nomenclature

Functions

AUTONOMIC NERVOUS SYSTEM

LESION LOCALIZATION

Rule 1: Cortical Lesion

Presenting Symptoms

Rationale

Additional Information

Rule 2: Subcortical Lesion

Presenting Symptoms

Rationale

Additional Information

CLINICAL CONSIDERATIONS

PATIENT ONE

PATIENT TWO

PATIENT THREE

PATIENT FOUR

PATIENT FIVE

PATIENT SIX

PATIENT SEVEN

SUMMARY

The human nervous system, which consists of the CNS (brain and spinal cord)and PNS (spinal and cranial nerves), is the generator of the electrical and chemical energy that controls body parts and their functions. The brain is responsible for initiating, controlling, and regulating all sensorimotor and cognitive (mental) functions. The spinal cord mediates sensory and motor commands, both somatic and visceral, to and from body parts that interact with the environment. The bony shell of the skull; the vertebral column; and the dural, arachnoid, and pial layers of the meninges protect the CNS. CSF in the subarachnoid space also helps protect the brain and spinal cord by serving as a mechanical buffer. Embryologically, the brain is derived from three vesicles; prosencephalon, mesencephalon, and rhombencephalon. The cerebral hemispheres, basal ganglia, limbic lobe, thalamus, hypothalamus, and lateral and third ventricles are derived from the prosencephalon. The mesencephalon decelops into the midbrain and cerebral aqueduct, whereas the rhombencephalon gives rise to the pons, cerebellum, medulla oblongata, and fourth ventricle . Each of these structures serves a specific sensorimotor or regulating function. The PNS, which includes spinal and cranial nerves, extends to organs, muscles, joints, blood vessels, and skin surfaces, forming an extensive network of cables and fine wires through the body. The PNS consists of the somatic and autonomic nervous systems. The somatic motor and sensory nerves innervate skeletal muscles, whereas the autonomic sensory and motor nerves innervate the visceral organs and glands. Cranial nerves regulate the sensory and motor functions of the face and head.

人類的神經系統是由中樞神經系統(大腦和脊柱)和周邊神經系統(脊髓和大腦神經)，是電位和化學能量的產生器，能控制身體的很多部位和他們的功能。大腦是負責開始、控制和管理所有知覺和認知的功能。脊柱是調解感覺和運動的控制，包括身軀和內臟與環境的接收和傳輸交互作用。頭骨的骨頭；脊椎圓柱；硬膜的蛛網膜；腦膜保護中樞神經。腦脊液在蛛網膜下的空腔也幫助保護大腦和脊柱藉由扮演一個物理的緩衝器。胚胎學者認為大腦是起源於三個小囊泡；前腦、中腦和菱形腦。大腦半球、基底神經節、邊緣體、丘腦、下丘腦，和側向及第三心室皆來自於前腦。中腦發展成腦部中間和大腦導水管，然而後腦發生腦橋、小腦、 延髓，和第四心室。這些結構每個都可作一個特殊的感覺運動來用或做調控的作用。周邊神經系統包括脊髓神經和腦神經，延伸到器官、肌肉、關節、血管，和皮膚表面，形成像是電纜和細金屬絲穿越身體般的廣泛網路。周邊神經系統包括軀體神經系統和自主神經系統。體運動神經和體感覺神經分布在骨骼肌引起刺激, 然而自主感覺神經和自主運動神經分布在內臟器官和腺體。腦神經調控臉部和頭部的感覺和運動功能。

QUIZ QUESTIONS

TECHNICAL TERMS

NC300-352O Chapt.15

Chapter 15 Synopsis of Cranial Nerves

LEARNING OBJECTIVES

Box 15-01

FUNCTIONAL CLASSIFICATION OF CRANIAL NERVES

Efferent

General Somatic Efferent

General Visceral Efferent

Special Visceral Efferent or Branchial Efferent

Afferent

General Somatic Afferent

General Visceral Afferent

Special Somatic Afferent

Special Visceral Afferent

BRANCHIAL ORIGIN OF SPEECH-RELATED MUSCLES

Table 15-1

Table 15-2

Table 15-3

Box 15-2

Box 15-3

CRANIAL NERVES AND THE AUTONOMIC NERVOUS SYSTEM

Table 15-4

Figure 15-2

Midbrain

Pons

Medulla

Figure 15-3

PATHWAYS

Motor or Efferent Pathways

Figure 15-4

Sensory or Afferent Pathways

INNERVATION PATTERN

Figure 15-5

CRANIAL NERVES AND THE SENSORIMOTOR FUNCTIONS

Olfactory Nerve

Figure 15-6

Special Visceral Afferent

Clinical concerns

Optic Nerve

Figure 15-7

Special Somatic Afferent

Figure 15-8

Clinical concerns

Table 15-5

Oculomotor Nerve

Box 15-04

General Somatic Efferent

General Visceral Efferent

Figure 15-9

Table 15-6

Table 15-7

Table 15-8

Figure 15-10

Clinical Concerns

Figure 15-11

Figure 15-12

Table 15-9

Trochlear Nerve

General Somatic Efferent

Clinical Concerns

Abducens Nerve

General Somatic Efferent

Clinical Concerns

Figure 15-13

Trigeminal Nerve

General Somatic Afferent

Figure 15-14

Table 15-10

Table 15-11

Table 15-12

Figure 15-15

Figure 15-16

Table 15-13

Figure 15-17

Special Visceral Efferent/ Branchial Efferent

Figure 15-18

Clinical Concerns

Table 15-14

Box 15-5

Fracial Nerve

Table 15-15

General Visceral Afferent

Special Visceral Afferent

Special Visceral Efferent/ Branchial Efferent

Clinical Information

Figure 15-19

Table 15-16

Figure 15-20

Box 15-06

Table 15-17

Vestibulocochlear Nerve

Special Somatic Afferent

Clinical Concerns

Glossopharyngeal Nerve

General Visceral Afferent

Table 15-18

Figure 15-21

Figure 15-22

General Visceral Afferent

Special Visceral Efferent

Special Visceral Afferent

Special Visceral Efferent/ Branchial Efferent

Table 15-16

Figure 15-20

Box 15-6

Table 15-17

Clinical Concerns

Vagus Nerve

General Visceral Afferent

Special Visceral Efferent/ Branchial Efferent

Table 15-19

Figure 15-23

Figure 15-24

Clinical Concerns

Figure 15-25

Spinal Accessory Nerve

Special Visceral Efferent/ Branchial Efferent

Clinical Concerns

Figure 15-26

Table 15-20

Hypoglossal Nerve

Figure 15-27

General Somatic Efferent

Clinical Concerns

Table 15-21

Figure 15-28

Figure 15-29

Table 15-22

Figure 15-30

Table 15-23

Figure 15-31

FUNCTION-BASED CRANIAL NERVE COMBINATIONS

Motor Control of Eye Muscles

Figure 15-32

Sensory Nerve Supply to Tongue

Figure 15-33

Motor Nerve Supply to the Soft Palate and Pharynx

Sensory Innervation of the Soft Palate and Pharynx

CLINICAL CONCERNS

Upper and Lower Motor Neuron Syndroms

Table 5-24

Figure 15-34 NC015F15-34

COMMON CRANIAL NERVE SYNDROMES

Table 15-25

Weber Syndrome (Midbrain Lesion)

Figure 15-35

Millard-Gubler Syndrome (Pons)

Locked-in Syndromes (Basal pons)

Figure 15-36

Wallerberg Syndrome (Lateral Medulla)

Medial Medullary Syndrome

Figure 15-37

CLINICAL CONSIDERATIONS

Patient 1 NC347P01 NC348P01

Patient 2 NC348P02

Patient 3 NC349P03

Patient 4 NC350P04

Patient 5 NC350P05

Patient 6 NC350P06

Patient 7 NC351P07

Patient 8 NC351P08

SUMMARY

QUIZ QUESTIONS

Question 15-01

Question 15-02

Match each of the following numbered classifications with its associated lettered statement.

1. GSA　　　a. pain and temperature

2. GSE b. vision and audition

3. SSA c. eye movements

4. SVA d. speech, phonation, and swallowing

5. SVE/BE e. taste and smell

6. GVA f. organ content.

7. GVE g. autonomic activities

Ans: 1a, 2c, 3b, 4e, 5g, 6d, 7f

Question 15-03

3. Match each of the numbered branchial arches with its lettered motor cranial nerve.

(1) first a. glossopharyngeal nerve

(2) second b. vagus nerve

(3) third c. facial nerve

(4) fouth and sixth d. trigeminal nerve

1.d 2.c 3.a 4.b

相關資料在NC p.306 Table 15-4.

Question 15-04

Question 15-05

Question 15-06

TECHNICAL TERMS

NC185-207O Chapt.08-1

Chapter 8 VISUAL SYSTEM

LEARNING OBJECTIVES

NC185L01

Outline the anatomy of the eyeball and describe the function of these structures

概述眼球內部解剖構造以及描述這些結構的功能

P185~188、Fig.8-2A、Fig.8-2B

NC185L02

Describe the structures of the retina and their functions.

描述視網膜的結構和他的功能。

這個學習目標是要我們在上完這一章後可以描述視網膜的結構和他的功能，188頁到192頁是有關視網膜的一些介紹。

視網膜在眼睛後方，含有可以回應光線的細胞。這些具特殊功能的細胞稱作光受體。在視網膜中有兩種光受體：桿細胞與視錐細胞。

NC185L03

Explain structural and functional differences between cones and rods

解釋圓錐體和桿狀體的構造和功能上的不同

P188~190 Figure8-3 Table8-1

NC185L04

Provide an account of photochemistry of retinal photoreceptors.

解釋視網膜上的感光體之光化學反應

可參考NC189F8-3之詳述

NC185L05

Discuss the mechanism of color vision and its disorders.

談論顏色視覺的機制和它的障礙。

課本內容：191~192頁

NC185L06

Explain the neural mechanism of dark adaptation

說明對暗適應的神經系統的機制

黑暗環境的適應稱為暗適應

在光亮的地方進入暗處後，會有一小段時間眼睛是看不見的，而眼睛需要7至30分中作調整才能適應，這些時間是視網膜紫質去作修復。

剛開始在比較亮的環境，所以由cones負責；進入到比較暗的環境後，就慢慢交由rods接手。而這個生理特性過程也造成轉換現象，也就是亮適應時一樣亮的紅花與藍花，暗適應後看起來藍花比紅花亮，主要由於cones與rods對不同波長的光敏感度不同，所以產生這個現象。

在眼睛的暗適應期，加紅色光可刺激錐狀細胞作用，縮短適應時間。

桿體(rods)

含有外端具感光性的光化學物質：視紫素，能夠在低亮度的環境反應明暗的訊號，提供類似單色的「黑白」視覺，解析力遠比錐體低劣。（負責黑白環境）

錐體(cones)

含有三種對於紅、綠、藍感光的不同色素，分別對不同波長的光最敏感（負責色彩環境）

課本p192

NC185L07

Describe optical properties of normal vision.

→描述正常視覺的光學特徵

§ 課本185~194頁及Figure8-1、Figure8-2、Figure8-3、Figure8-4、Figure8-5、Figure8-6、Figure8-7、Table8-1

NC185L08

Define common errors of refraction and their optical remediations

定義視覺折射錯誤及更正錯誤的輔具

P.200-202

NC185L09

Discuss the central visual pathway.

討論中樞視覺路徑

P.195~197 Figure8-8、Table8-2、Table8-3

NC185L10

Relate visual field defects with lesion sites.

連結視覺區缺陷與機能障礙(器官損害)部位。

→NC203T8-04、NC203F8-14

NC185L10

NC185L11

Describe the neural mechanism of visual reflexes

形容視覺反射的神經機制

P.192 Optical Mechanism開始提到許多的視覺神經機制。P.196的Visual Reflexes的大標題之下有Pupillary Light Reflex和Accommodation Reflex等反射反應。

ANATOMY OF THE EYE

Eyeball

Figure 8-1

Figure 8-2

Retina

Figure 8-3

Table 8-1

Distribution of Photosensors

Figure 8-4

Functions of Photosensors

VASCULAR SUPPLY OF THE RETINA

Figure 8-5

PHOTOCHEMISTRY OF RETINA

Spectral Sensitivity

Color Vision

Figure 8-6

Dark Adaptation

OPTICAL MECHANISM

Refraction

Figure 8-7

Lens Types

Figure 8-7

Optics of the Eye

Figure 8-7

Refraction by the Lens

Pupillary Aperture

Convergence

Retinal Image Formation

Figure 8-7

CENTRAL VISUAL PATHWAYS

Figure 8-8

Retinal Representation of Visual Fields

Table 8-2

Table 8-3

Retinal Representation to Optic Chiasm

Retinal Representation to the Lateral Geniculate Body

Retinal Representation to the Visual Cortex

Primary Visual Cortex

VISUAL CORTEX DEVELOPMENT

VISUAL REFLEXES

Pupillary Light Reflex

Figure 8-9

Figure 8-10

Accommodation Reflex

CLINICAL CONCERNS

Errors of Refraction

Hypermetropia

Myopia

Astigmatism

Disorders of Color Vision

Visual Acuity Assessment

Visual Field Defects

Table 8-4

Monocular Blindness

Bitemporal, or Heteronymous Hemianopia

Nasal Hemianopia

Homonymous Hemianopia

Homonymous Left Superior Quadrantanopsia

Homonymous Left Inferior Quadrantanopsia

Primary and Association Visual Cortices

LESION LOCALIZATION-RULE 4: VISUAL PATHWAY LESION

Presenting Symptoms and Rationale

CLINICAL CONSIDERATIONS

PATIENT ONE

PATIENT TWO

PATIENT THREE

PATIENT FOUR

PATIENT FIVE

PATIENT SIX

SUMMARY

The visual system is concerned with image perception, which involves four events: (1) the lens and cornea of the eye refract light rays (2) retinal photoreceptor cells then convert the electromagnetic energy of the light rays into changes in the membrane potential; (3) through integrating processing by other retinal neurons, the retinal ganglion transmits generated action potentials to the thalamus with relay to the visual cortex. (4) Finally, visual images are perceived in the primary visual cortex and interpreted in the associational visual cortex. Optical disturbances affect image formation, whereas lesions interrupting visual fibers result in different visual field losses.

視覺系統有關於圖像知覺，包含4個項目：(1)眼睛的晶狀體和角膜折射光射線(2) 視網膜上的視覺接受細胞把光射線的電磁能量轉變成膜電位的電位差；(3) 經由視網膜神經元的合成過程，視網膜神經節的傳導產生動作電位到視丘再傳達到視覺皮層。(4) 最後，視覺影像在首要視覺皮層裡被察覺並且在聯想的視覺皮層裡解釋。視覺的騷動影響成像，而打斷視覺纖維的損害導致不同的視野損失。

QUIZ QUESTIONS

TECHNICAL TERMS