NSC 218

COURSE
GUIDE
NSC 218
HUMAN ANATOMY IV
COURSE UNITS: 2 Credit units (18 hours of instruction online; 12

hours of Discussion forum online/tutorial; 24 hours of laboratory
practical)
Course Team (Course Writers) Dr. Adewole O.S. MBBS, PhD,

(Associate Professor).
Dr. Abiodun A. O. MBBS, FWCS, M.Sc. (Senior
Lecturer)
Dr. Ayannuga A. A. MBBS, Ph.D (Senior Lecturer)
Dr. Adeyemi D.A. PhD (Senior Lecturer)
Dr. Ojo S. K. MBChB, MSc (Lecturer II); Dr.
Arayombo B. E. MBChB, MSc (Lecturer II)
Department of Anatomy and Cell Biology, College
of Health Sciences,
Obafemi Awolowo University, Ile-Ife, Nigeria
Course Facilitators:
Dr O.O. Irinoye and Dr E.O Oladogba (Course
Editors)
Professor Mba Okoronkwo OON (Programme
Leader)
Dr S S Bello MBBS, PhD (Course Reviewer)
Department of Anatomy, FBMS, College of Health
Sciences, Usmanu Danfodiyo University, Sokoto,
Nigeria
NATIONAL OPEN UNIVERSITY OF NIGERIA

NSC 218 COURSE GUIDE
© 2021 by NOUN Press

National Open University of Nigeria
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All rights reserved. No part of this book may be reproduced, in any form
or by any means, without exclusive permission in writing from the
publisher.
Published by:
Printed by NOUN Press np@noun.edu.ng
ISBN:
ii
CONTENTS PAGE
General Introduction ……………………………..……….. iv
Course Aims …………………………………………..…….iv
Course Objectives…………………………………………....iv
Working through the Course ………………………………..v
Course Materials…………………………………………....vi
Study Units ………………………………………………..vi
Reference Textbooks……………………………………….vi
Equipment and Software Needed to Access Course ……….vii
Number and Places of Meeting…………………………….vii
Discussion Forum………………………………………….vii
Course Evaluation………………………………………...vii
Grading Criteria……………………………………………vii
Grading Scale ……………………………………………..vii
Schedule of Assignments with Dates………………………viii
Course Overview………………………………………….viii
How to get the most from this Course……………………viii
iii
INTRODUCTION
Welcome to the second semester course in Human Anatomy, NSC 218 –

Human Anatomy IV. This is a second semester course and a
continuation of Human Anatomy I (NSC 215) and Human Anatomy II
(NSC 217) where you have increased/improved your knowledge about
some, body structures and their organisations. You also covered the
protective covering of all the body organs as well as the supporting
systems. This second part will cover other internal organs that are
important to maintenance of life. As indicated in NSC 215, caring
always require sound understanding of the normal structure of the body
organs as to know what could be wrong and how such manifest. Basic
assessments done before planning general and nursing care usually
consider the various organs that function within systems and as
interelated systems. You will be required to be able to describe the
integumentary system that maintain, integrate and control body
functions. The anatomy of other sense organs such as eye, ear, tongue
and olfactory organ shall be covered. The gross anatomy of the brain
and spinal cord shall be covered. Peripheral and autonomic nervous
system, and discuss the clinical correlates of the body parts. You will
enjoy drawing and labelling, as well as seeing some of these organs in
real life. You will also see the variations in normal and diseased organs
as you are encouraged to participate in all laboratory assignments.
COURSE OVERVIEW
Human Anatomy (IV)
Human Anatomy (IV) is the fourth of the courses that covers the major
organs that are responsible for life. In this course, we are going to study
the integumentary system, the special senses, and the nervous system.
These are the regulatory systems. The structures and locations of the
various organs that make each of the systems will be studied.
COURSE OBJECTIVE
At the completion of this course, you should be able to:
• Discuss the anatomy and functions of the skin and special senses
• Describe the various disorders of the special senses
• Discuss the formation of the brain and the spinal cord from the
most primitive neural tube.
• Discuss the anatomy of the central nervous system.
• Differentiate between structural and functional divisions of the
nervous system.
• Discuss the peripheral and autonomic nervous systems
iv
COURSE IMPLEMENTATION
DOING THE COURSE
The course will be delivered adopting the blended learning mode, 70%
of online but interactive sessions and 30% of face-to-face during
laboratory sessions. You are expected to register for this course online
before you can have access to all the materials and have access to the
class sessions online. You will have hard and soft copies of course
materials, you will also have online interactive sessions, face-to-face
sessions with instructors during practical sessions in the laboratory. The
interactive online activities will be available to you on the course link on
the Website of NOUN. There are activities and assignments online for
every unit every week. It is important that you visit the course sites
weekly and do all assignments to meet deadlines and to contribute to the
topical issues that would be raised for everyone’s contribution.
You will be expected to read every module along with all assigned
readings to prepare you to have meaningful contributions to all sessions
and to complete all activities. It is important that you attempt all the
Self-Assessment Questions (SAQ) at the end of every unit to help your
understanding of the contents and to help you prepare for the in-course
tests and the final examination. You will also be expected to keep a
portfolio where you keep all your completed assignments.
COURSE REQUIREMENTS AND EXPECTATIONS OF YOU
Attendance of 95% of all interactive sessions, submission of all

assignments to meet deadlines; participation in all CMA, attendance of
all laboratory sessions with evidence as provided in the log book,
submission of reports from all laboratory practical sessions and
attendance of the final course examination. You are also expected to:
1. Be versatile in basic computer skills

2. Participate in all laboratory practical up to 90% of the time
3. Submit personal reports from laboratory practical sessions on
schedule
4. Log in to the class online discussion board at least once a week
and contribute to ongoing discussions.
5. Contribute actively to group seminar presentations.
v
EQUIPMENT AND SOFTWARE NEEDED TO ACCESS

COURSE
You will be expected to have the following tools:
1. A computer (laptop or desktop or a tablet)

2. Internet access, preferably broadband rather than dial-up access
3. MS Office software – Word PROCESSOR, Powerpoint,
Spreadsheet
4. Browser – Preferably Internet Explorer, Moxilla Firefox
5. Adobe Acrobat Reader
NUMBER AND PLACES OF MEETING (ONLINE, FACE-

TOFACE, LABORATORYPRACTICALS
The details of these will be provided to you at the time of

commencement of this course
DISCUSSION FORUM
There will be an online discussion forum and topics for discussion will
be available for your contributions. It is mandatory that you participate
in every discussion every week. Your participation link you, your face,
your ideas and views to that of every member of the class and earns you
some mark.
COURSE EVALUATION
There are two forms of evaluation of the progress you are making in this
course. The first are the series of activities, assignments and end of unit,
computer or tutor marked assignments, and laboratory practical sessions
and report that constitute the continuous assessment that all carry 30%
of the total mark. The second is a written examination with multiple
choice, short answers and essay questions that take 70% of the total
mark that you will do on completion of the course.
Students evaluation: The students will be assessed and evaluated based

on the following criteria
• IN-COURSE EXAMINATION:
In line with the university’s regulation, in-course examination will come

up in the middle of the semester. These would come in form of
vi
Computer Marked Assignment. This will be in addition to 1compulsory

Tutor Marked Assignment (TMA’s) and three Computer marked
Assignment that comes after every module
• LABORATORY PRACTICAL:
Attendance, record of participation and other assignments will be graded

and added to the other scores form other forms of examinations.
• FINAL EXAMINATION:
The final written examination will come up at the end of the semester
comprising essay and objective questions covering all the contents
covered in the course. The final examination will amount to 60% of the
total grade for the course.
LEARNER-FACILITATOR EVALUATION OF THE

COURSE
This will be done through group review, written assessment of learning

(theory and laboratory practical) by you and the facilitators.
GRADING CRITERIA
Grades will be based on the following Percentages

Tutor Marked Individual Assignments 10%
Computer marked Assignment 10%
Group assignment 5% 30%
Discussion Topic participation 5%
Laboratory practical 10%
End of Course examination 70%
GRADING SCALE
A = 70-100
B = 60 - 69
C= 50 - 59
F = < 49
SCHEDULE OF ASSIGNMENTS WITH DATES
To be provided for each module by the facilitator in addition to the ones

already spelt out in the course materials.
SPECIFIC READING ASSIGNMENTS

vii
To be provided by each module
REFERENCE/FURTHER READING
Hutchinson, M., Mallat, J., Marieb, E.N., Wilhelm P.B. (2007). A Brief
Atlas of the Human Body. Sna Franscisco: Pearson Education
Inc.
Katherine M. A. Rogers and William N. Scott (2011) Nurses! Test

Yourself in Anatomy and Physiology
Kathryn A. Booth, Terri. D. Wyman (2008) Anatomy, Physiology, and

Pathophysiology for Allied Health
Keith L Moore, Persuade T.V.N (2018), The Developing Human

Clinically Oriented Embryology 11th Edition Lippincott
Williams & Wilkins
Kent M. Van De Graff, R.Ward Rhees, Sidney Palmer (2010) Schaum‘s

Outline of human Anatomy and Physiology 3rd edition.
Philip Tate (2012) Seeley‘s Principles of Anatomy & Physiology 2nd

ed.
Sadler T.W (2012), Langman‘s Medical Embryology 12th edition.
Seeley‘s Principles of Anatomy & Physiology, Second edition Published

by McGraw-Hill, a business unit of The McGraw-Hill
Companies, Inc., 1221 Avenue of the Americas, New York, NY
10020. Copyright c 2012- Chapter 17&18
viii
MAIN
COURSE
CONTENTS PAGE
Module 1 The Special Senses………………………. 1
Unit 1 Integumentary System…………………….. 1

Unit 2 The Tongue and the Sense of Taste.............. 12
Unit 3 The Nose and the Sense of Smell.................. 20
Unit 4 The Ear and the Sense of Hearing................. 25
Unit 5 The Eyes and the Sense of Vision................ 39
Module 2 The Nervous System…………………… 58
Unit 1 Embryology of the central

nervous system………………………….. 58
Unit 2 Spinal cord……………………………… 75
Unit 3 Brain stem………………………………. 83
Unit 4 Dienecephalon and Basal ganglia…….… 91
Unit 5 Cerebral hemisphere……………………. 98
Unit 6 Ventricles and cerebrospinal fluid……… 108
Unit 7 Blood supply of central nervous system... 116
MODULE 3 The Peripheral and Autonomic

Nervous System………………………….. 125
Unit 1 Cranial nerves…………………………….. 125

Unit 2 Spinal nerves……………………………… 133
Unit 3 Autonomic nervous system……………….. 145
NSC 218 MODULE 1
MODULE 1 THE SPECIAL SENSES
UNIT 1 INTEGUMENTARY SYSTEM
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Functions of the integumentary system
3.2 Skin
3.3 Nails
3.4 Hair
3.5 Clinical correlates
4.0 Conclusion
5.0 Summary
6.0 Tutor Marked Assignments
7.0 References and other resources
1.0 INTRODUCTION
The integumentary system is familiar to most people because it covers

the outside the appearance of the system It is composed of a complex set
of organs that includes the skin and its derivatives (sweat and oil glands,
hairs, and nails).
Skin without blemishes is considered attractive, whereas acne is a source

of embarrassment for many people. The development of wrinkles and
the graying or loss of hair are signs of aging that some people find
unattractive. Because of these feelings, much time, effort, and money
are spent on changing the appearance of the integumentary system. For
example, people apply lotion to their skin, color their hair, and trim their
nails. They also try to prevent sweating with antiperspirants and body
odor with washing, deodorants, and perfumes.
2.0 OBJECTIVES
At the end of this unit, you should be able to:
• Describe the components and functions of the integumentary

system.
• Explain the role of skin in regulating body temperature.
• Describe the layers of skin and the characteristics of each layer.
• Explain the factors that affect skin colour.
• Outline the disorders associated with the integumentary system.
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NSC 218 HUMAN ANATOMY IV
3.0 MAIN CONTENT
3.1 Functions of integumentary System
The appearance of the integumentary system can indicate physiological

imbalances in the body. Some disorders, such as acne or warts, affect
just the integumentary system. Disorders of other parts of the body can
be reflected there, and thus the integumentary system is useful for
diagnosis. For example, reduced blood flow through the skin during a
heart attack can cause a pale appearance, whereas increased blood flow
as a result of fever can cause a flushed appearance. Also, the rashes of
some diseases are very characteristic, such as the rashes of measles,
Major functions:
1. Protection: The skin protects against abrasion and ultraviolet

light. It also prevents the entry of microorganisms and prevents
dehydration by reducing water loss from the body.
2. Sensation: The integumentary system has sensory receptors that

can detect heat, cold, touch, pressure, and pain.
3. Temperature regulation: Body temperature is regulated through

the control of blood flow through the skin and the activity of
sweat glands.
4. Vitamin D production: When exposed to ultraviolet light, the skin

produces a molecule that can be transformed into vitamin D.
5. Excretion: Small amounts of waste products are lost through the

skin and in gland secretions.
3.2 Skin
The skin is made up of two major tissue layers. The epidermis is the
most superficial layer of the skin; it consists of epithelial tissue. The
epidermis resists abrasion on the skin’s surface and reduces water loss
through the skin. The epidermis rests on the dermis, which is a layer of
connective tissue. The dermis is responsible for most of the structural
strength of the skin. The strength of the dermis is seen in leather, which
is produced from the hide (skin) of an animal. The epidermis is
removed, and the dermis is preserved by tanning.
The skin rests on the hypodermis which is a layer of loose connective
tissue. The hypodermis is not part of the skin or the integumentary
system, but it does connect the skin to underlying muscle or bone.
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NSC 218 MODULE 1
THE SKIN
3
COMPARISON OF THE SKIN (EPIDERMIS &DERMIS) AND

HYPODERMIS
Dermis
It is composed of strong and flexible connective tissue. Its cells are

typical of those found in any connective tissue proper:
i. Fibroblasts: cells that form the fibers of connective tissue

ii. Macrophages: protective cell capable of phagocytosis
iii. Mast cells: immune cell that initiates inflammation
iv. White blood cells: protection
Its semifluid matrix is heavily embedded with:
Collagen: strong, fibrous (threadlike) insoluble protein

Elastin: extracellular connective tissue protein
Reticular fibers: supporting framework tissue
The dermis binds the entire body together like a body stocking. It is your
hide and corresponds exactly to animal hides used to make leather
products. It is richly supplied with nerve fibers, blood vessels, and
lymphatic vessels. Major portions of hair follicles, as well as oil and
sweat glands, are derived from epidermal tissue but reside in the dermis
The layers of dermis
1. The thin, superficial papillary layer: highly vascularized

areolar connective tissue containing a woven mat of collagen and
elastin fibers. Its superior surface is thrown into peglike
projections called dermal papillae (papill=nipple) that indent the
overlaying epidermis. Many contain: Capillary loops, meissner’s
corpuscles: touch receptors and pain receptors.
On the palms of the hands and soles of the feet, these papillae lie atop
larger mounds called dermal ridges, which in turn cause the overlying
epidermis to form epidermal ridges that increase friction and enhance
the gripping ability of the fingers and feet. Epidermal ridge patterns are
genetically determined and unique to each of us. Because sweat pores
open along their crest, our fingerprints leave identifying films of sweat
called fingerprints on almost anything they touch. There are three types
of skin markings: Finger prints, Cleavage lines, Flexure lines
2. The reticular layer: It is deeper and account for 80% of the

thickness of the dermis. Extracellular matrix contains thick
bundles of interlacing fibers that run in various planes, most run
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NSC 218 MODULE 1
parallel to the skin surface, less dense regions, between these bundles
form cleavage, or tension lines. Collagen fibers give skin strength and
resiliency, binds water, helping keep the skin hydrated while elastin
fibers provide the stretch-recoil properties of skin.
Skin Colour: This is determined by three pigments: Melanin,

Hemoglobin and carotene
Melanin- Only pigment made in the skin, it is a polymer of tyrosine

which is an amino acid, ranges in color from yellow to reddish-brown to
black. Synthesis depends on an enzyme in melanocytes called
tyrosinase. It passes from melanocytes to the basal keratinocytes.
Melanocytes are stimulated by sunlight which causes substantial

melanin buildup, which helps protect the DNA of viable skin cells from
UV radiation by absorbing the light and dissipating the energy as heat.
Carotene: Yellow to orange pigment found in certain plant products

such as carrots. It tends to accumulate in the stratum corneum and in the
tissue of the hypodermis, it is the color most obvious in the palms and
soles, where the stratum corneum is thickest (example: the skin of the
heel).
Epidermis
Derivatives of the epidermis include the Sweat glands, Sebaceous

glands, Nails, Hair, Hair Follicles
Sweat (Sudoriferous) glands: Distributed over the entire skin surface

except the nipples and parts of the external genitalia. Two types of sweat
glands:
1 Eccrine
2 Apocrine
Eccrine: sweat glands, or merocrine sweat glands, produce true sweat,

they are the most numerous of the sweat glands, and are particularly
abundant on the palms of the hands, soles of the feet, and forehead.
Secretory part lies coiled in the dermis: The duct extends to open in a
funnel-shaped pore at the skin surface. Secretion commonly called sweat
is a hypotonic filtrate (lower osmotic pressure than a reference) of the
blood that passes through the secretory cells of the sweat glands and is
released by exocytosis. It contains 99% water, with some salts (mostly
sodium chloride), Vitamin C, Antibodies, Dermicidin (microbe-killing
peptide and traces of metabolic waste (urea, uric acid, ammonia)
5
Apocrine: It is largely confined to the axillary and anogenital areas,

Larger than eccrine glands. Ducts empty into hair follicles. Secretion
contains the same basic components as true sweat, plus fatty substances
and proteins. Odorless BUT, when its organic molecules are
decomposed by bacteria on the skin, it takes on a musky and generally
unpleasant odor (BODY ODOR).
3.3 Nails
The distal ends of primate digits have nails, whereas most other
mammals have claws or hooves. Nails protect the ends of the digits, aid
in manipulation and grasping of small objects, and are used for
scratching. A nail consists of the proximal nail root and the distal nail
body. The nail root is covered by skin, and the nail body is the visible
portion of the nail. The lateral and proximal edges of the nail are
covered by skin called the nail fold, and the edges are held in place by
the nail groove.
The stratum corneum of the nail fold grows onto the nail body as the
eponychium, or cuticle. Beneath the free edge of the nail body is the
hyponychium, a thickened region of the stratum corneum. The nail root
extends distally from the nail matrix. The nail also attaches to the
underlying nail bed, which is located between the nail matrix and the
hyponychium. The nail matrix and bed are epithelial tissue, with a
stratum basale that gives rise to the cells that form the nail. The nail
matrix is thicker than the nail bed and produces nearly all of the nail.
The nail bed is visible through the clear nail and appears pink because of
blood vessels in the dermis.
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NSC 218 MODULE 1
A small part of the nail matrix, the lunula, is seen through the nail body
as a whitish, crescent-shaped area at the base of the nail. The lunula,
seen best on the thumb, appears white because the blood vessels cannot
be seen through the thicker nail matrix. The nail contains a hard keratin,
which makes the nail hard. As the nail is formed in the nail matrix and
bed, it slides over the nail bed toward the distal end of the digit. Nails
grow at an average rate of 0.5–1.2 mm per day, and fingernails grow
more rapidly than toenails. Unlike hair, they grow continuously
throughout life and do not have a resting phase.
3.4 Hair
The presence of hair is one of the characteristics common to all

mammals; if the hair is dense and covers most of the body surface, it is
called fur. In humans, hair is found everywhere on the skin except the
palms, the soles, the lips, the nipples, parts of the external genitalia, and
the distal segments of the fingers and toes.
By the fifth or sixth month of fetal development, delicate, unpigmented

hair called lanugo has developed and covered the fetus. Near the time of
birth, terminal hairs, which are long, coarse, and pigmented, replace the
lanugo of the scalp, eyelids, and eyebrows. Vellus hairs, which are short,
fine, and usually unpigmented, replace the lanugo on the rest of the
body.
7
The hair follicle
At puberty, terminal hair, especially in the pubic and axillary regions,

replaces much of the vellus hair. The hair of the chest, legs, and arms is
approximately 90% terminal hair in males, compared with
approximately 35% in females. In males, terminal hairs replace the
vellus hairs of the face to form the beard. The beard, pubic, and axillary
hair are signs of sexual maturity. In addition, pubic and axillary hair
may function as wicks for dispersing odors produced by secretions from
specialized glands in the pubic and axillary regions. It also has been
suggested that pubic hair protects against abrasion during intercourse
and axillary hair reduces friction when the arms move.
i. Cleavage lines in the reticular layer of the dermis are important to

a surgeon because incision made parallel to these lines, the skin
gapes less and heals more readily than when the incision is made
across cleavage lines.
ii. Folliculitis, which is a disorder specific to hair, is an

inflammation of hair follicles. This disorder usually results from
shaving or excess rubbing of skin areas. It may also be caused by
bacteria and fungi. Follicles become red and itchy and often look
like pimples. Treatments include regular cleansing of skin,
topical antibiotics, and use of electric razors instead of razor
blades.
iii. Acne is an active inflammation of the sebaceous glands

accompanied by “pimples” (pustules or cysts) on the skin.
Usually caused by bacterial infection, particularly by
staphylococcus.
iv. Seborrhea: cradle cap in infants, caused by overactive sebaceous

glands.Raised lesions that gradually become yellow to brown and
begin to slough off oily scales
v. A burn is injury to a tissue caused by heat, cold, friction,

chemicals, electricity, or radiation. Burns are classified according
to the extent of surface area involved and the depth of the burn.
For an adult, the surface area that is burned can be conveniently
estimated by “the rule of nines,” in which the body is divided into
areas that are approximately 9%.
vi. Scabies is a very contagious skin condition. Scabies is caused by

mites that burrow beneath skin. Sometimes the burrows of the
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NSC 218 MODULE 1
mites, which look like red pencil marks, can be seen. Redness and
severe itching are usually the only symptoms of scabies. Most cases are
easily treated with prescription medications. Because scabies is
contagious, it is wise to treat an entire family if one member is infected.
Self-Assessment Exercises
At the histology laboratory, examine slides of the hair, skin and nail and
identify the parts of each of these components. Record your findings in
the logbook.
• Describe the components and functions of the integumentary

system.
• Explain the role of skin in regulating body temperature.
• Describe the layers of skin and the characteristics of each layer.
4.0 CONCLUSION
The integumentary system is familiar to most people because it covers

the outside the appearance of the system It is composed of a complex set
of organs that includes the skin and its derivatives (sweat and oil glands,
hairs, and nails).
5.0 SUMMARY
In this unit, you have learnt that:
i. The components of the integumentary system includes the skin,

the nails, glands and hairs.
ii. The integumentary system protects us from the external
environment. Other functions include sensation, temperature
regulation, vitamin D production, and excretion of small amounts
of waste products.
iii. The epidermis is stratified squamous epithelium divided into five
strata.
iv. Melanocytes produce melanin inside melanosomes and then
transfer the melanin to keratinocytes. The size and distribution of
melanosomes determine skin color. Melanin production is
determined genetically but can be influenced by ultraviolet light
(tanning) and hormones.
v. The nail is stratum corneum containing hard keratin and the nail
root is covered by skin, and the nail body is the visible part of the
nail. Nearly all of the nail is formed by the nail matrix, but the
nail bed contributes.
9
vi. Integumentary system is easily observed and often reflects events

occurring in other parts of the body (e.g., cyanosis, jaundice,
rashes).
6.0 TUTOR MARKED ASSIGNMENTS
1. The integumentary system
a. helps regulate body temperature.

b. is a site of fat storage.
c. is a site of vitamin E production.
d. eliminates large amounts of waste products from the body.
e. all of the above
2. A layer of skin (where mitosis occurs) that replaces cells lost

from the outer layer of the epidermis is the
a. stratum corneum.
b. stratum basale.
c. stratum lucidum.
d. reticular layer.
e. subcutaneous tissue.
For questions 3–7, match the layer of the epidermis with the
correct description or function:
a. stratum basale
b. stratum corneum
c. stratum granulosum
d. stratum lucidum
e. stratum spinosum
3. Production of keratin fibers; formation of lamellar bodies

4. Desquamation occurs; 25 or more layers of dead squamous cells
5. Production of cells; melanocytes produce and contribute melanin;
hemidesmosomes present
6. Production of keratohyalin granules; lamellar bodies release
lipids; cells die
7. Dispersion of keratohyalin around keratin fibers; layer appears
transparent; cells dead
8. In which of these areas of the body is thick skin found?
a. back of the hand d. bridge of the nose

b. abdomen e. sole of the foot
c. over the shin
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NSC 218 MODULE 1
7.0 REFERENCE AND OTHER RESOURCES
Inc.



Williams & Wilkins


ed.

11
UNIT 2 THE TONGUE AND THE SENSE OF TASTE
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Functions of Taste
3.2 Location of Taste Buds
3.3 Histology of Taste Buds
3.4 Taste Preference and Control of Diet
3.5 Clinical Correlates
4.0 Conclusion
5.0 Summary
6.0 Tutor-Marked Assignment
7.0 References/Further Reading
1.0 INTRODUCTION
Taste is mainly a function of the taste buds in the mouth, but it is

common experience that one’s sense of smell also contributes strongly
to taste perception. In addition, the texture of food, as detected by tactual
senses of the mouth, and the presence of substances in the food that
stimulate pain endings, such as pepper, greatly alter the taste experience.
The importance of taste lies in the fact that it allows a person to select
food in accord with desires and often in accord with the body tissues’
metabolic need for specific substances.
2.0 OBJECTIVES
• discuss the anatomy of the tongue and the function of each part.
• describe how taste sensations are created and interpreted
• discuss the five primary taste sensations
• describe the histology and function of a typical taste bud
• explain the neuronal pathways for the sense of taste
3.0 MAIN CONTENT
3.1 Functions of Taste
Substances called tastants dissolve in saliva, enter the taste pores, and
by various mechanisms cause the taste cells to depolarize. For example,
the diffusion of the positively charged ions Na+ and H+ into the taste
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NSC 218 MODULE 1
cells causes depolarization. The binding of tastants to receptors on the

taste hairs activates G proteins, which results in depolarization by
causing Ca2+ channels to open or K+ channels to close. When the taste
cells depolarize, they release neurotransmitters that diffuse to sensory
neurons associated with the taste cells. The neurotransmitters stimulate
action potentials in the sensory neurons, which are conducted to the
brain, where the sense of taste is perceived.
Five primary tastes have been identified in humans: salty, sour, sweet,
bitter, and umami (a Japanese term loosely translated as savoury). The
salty taste is stimulated by Na+; sour by acids; sweet by sugars, some
other carbohydrates, and some proteins; bitter by alkaloids (bases); and
umami by the amino acid glutamate and related compounds. The umami
taste sensation is most intense when coupled with the salty taste, hence
the popularity of adding salt to tomatoes, ketchup, soy sauce, and the
additive monosodium glutamate (MSG). Even though only five primary
tastes have been identified, humans can perceive a fairly large number
of different tastes, presumably by combining the five basic taste
sensations.
Thresholds for the five primary taste stimuli vary. Sensitivity for bitter
substances is the highest. Many alkaloids are poisonous, and the high
sensitivity for bitter tastes may be protective because of the avoidance of
bitter foods. On the other hand, humans tend to crave sweet, salty, and
umami tastes, perhaps in response to the body’s need for sugars,
carbohydrates, proteins, and minerals.
Many of the sensations thought of as being tastes are strongly influenced

by olfactory sensations.
This phenomenon can be demonstrated by pinching one’s nose to close

the nasal passages while trying to taste something. With olfaction
blocked, it is difficult to distinguish between the taste of a piece of apple
and the taste of potato. Much of the “taste” is lost by this action. This is
one reason that a person with a cold has a reduced sensation of taste.
The tongue can detect other stimuli besides taste, such as temperature
and texture, and these stimuli can influence the sensation of taste. Food
served at the wrong temperature is perceived as distasteful. Stimulation
of hot receptors by capsaicin or black pepper is interpreted as hot or
spicy, and stimulation of cold receptors is perceived as fresh or minty.
13
3.2 Location of Taste Buds
The taste buds are found on three types of papillae of the tongue, as
follows:
A large number of taste buds are on the walls of the troughs that
surround the circumvallate papillae, which form a V line on the
surface of the posterior tongue.
Moderate numbers of taste buds are on the fungiform papillae

over the flat anterior surface of the tongue.
Moderate numbers are on the foliate papillae located in the folds

along the lateral surfaces of the tongue. Additional taste buds are
located on the palate, and a few are found on the tonsillar pillars,
on the epiglottis, and even in the proximal oesophagus. Adults
have 3000 to 10,000 taste buds, and children have a few more.
Beyond the age of 45 years, many taste buds degenerate,
causing taste sensitivity to decrease in old age.
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Fig 2.1 Tongue, Papillae and Buds a) Surface of the tongue b) A papilla
c) A taste bud
15
3.3 Histology of Taste Buds
Each of the 10,000 taste buds on a person’s tongue consists of three

major types of specialised epithelial cells. The sensory cells of each taste
bud consist of about 50 taste cells. Each taste cell has several microvilli,
called taste hairs, extending from its apex into a tiny opening in the
epithelium called the taste pore. The remaining two non-sensory cell
types are basal cells and supporting cells. Like olfactory cells, the cells
of the taste buds are replaced continuously, each having a normal life
span of about 10 days.
Fig.2.2: Taste Bud
3.4 Taste Preference and Control of Diet
Taste preference simply means that an animal will choose certain types
of food in preference to others, and the animal automatically uses this to
help control the diet it eats. Furthermore, its taste preferences often
change in accord with the body’s need for certain specific substances.
The following experiments demonstrate this ability of animals to choose

food in accord with the needs of their bodies. First, adrenalectomies,
salt-depleted animals automatically select drinking water with a high
concentration of sodium chloride in preference to pure water, and this is
often sufficient to supply the needs of the body and prevent salt
depletion death. Second, an animal given injections of excessive
amounts of insulin develops a depleted blood sugar, and the animal
automatically chooses the sweetest food from among many samples.
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Third, calcium-depleted parathyroidectomies animals automatically

choose drinking water with a high concentration of calcium chloride.
Also, human beings reject any food that has an unpleasant affective
sensation, which in many instances protects our bodies from undesirable
substances. The phenomenon of taste preference almost certainly results
from some mechanism located in the central nervous system and not
from a mechanism in the taste receptors themselves, although the
receptors often become sensitised in favour of a needed nutrient. An
important reason for believing that taste preference is mainly a central
nervous system phenomenon is that previous experience with unpleasant
or pleasant tastes plays a major role in determining one’s taste
preferences. For instance, if a person becomes sick soon after eating a
particular type of food, the person generally develops a negative taste
preference, or taste aversion, for that particular food thereafter; the same
effect can be demonstrated in lower animals.
Much of what is perceived as a taste defect is truly a primary defect in

olfaction resulting in an alteration in taste.
Self-Assessment Exercise (1)
• discuss the five primary taste sensations

• describe the histology and function of a typical taste bud
• explain the neuronal pathways for the sense of taste
Self-Assessment Exercise (2)
At the histology laboratory, examine the histological structure of the

papillae with taste buds on the taste bud slide.
4.0 CONCLUSION
In this unit you learnt main function of the taste buds in the mouth, and
the common experience that one’s sense of smell also contributes
strongly to taste perception.
5.0 SUMMARY
• Taste is mainly a function of the taste buds in the mouth, but it is

common experience that one’s sense of smell also contributes
strongly to taste perception.
• Receptors on the hairs detect tastants (dissolved substances). Five

basic types of taste exist: sour, salty, bitter, sweet, and umami.
17
• Taste buds usually are associated with papillae –

circumvallate,fungiform and foliate papillae.
• Taste buds consist of taste cells, basilar cells, and supporting

cells. The taste cells have taste hairs that extend into taste pores.
• Taste preference simply means that an animal will choose certain

types of food in preference to others, and the animal
automatically uses this to help control the diet it eats.
Furthermore, its taste preferences often change in accord with the
body’s need for certain specific substances.
6.0 TUTOR MARKED ASSIGNMENT
1. Taste cells
a. are found only on the tongue.

b. extend through tiny openings called taste buds.
c. have no axons but release neurotransmitters when stimulated.
d. have axons that extend directly to the taste area of the cerebral
cortex.
2. Which of these is not one of the basic tastes?

a. spicy
b. salty
c. bitter
d. umami
e. sour
3. What are the three kinds of lingual papillae, and where are they
located?
4. Do taste receptors undergo adaptation?
5. Describe taste preference in relation to diet control.
7.0 REFERENCES/FURTHER READING
Atlas of the Human Body. Sna Franscisco: Pearson Education Inc.
Katherine, M. A., Rogers & William, N. S. (2011). Nurses! Test

Kathryn, A. B. & Terri, D. W. (2008). Anatomy, Physiology, and

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Williams & Wilkins
Kent, M., Van De Graff, R.,Ward Rhees & Sidney, Palmer (2010).
Schaum’s Outline of Human Anatomy and Physiology (3rd ed.).
Philip, Tate (2012). Seeley’s Principles of Anatomy & Physiology. (2nd

ed.).
19
UNIT 3 THE NOSE AND THE SENSE OF SMELL
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Olfactory epithelium and bulb
3.2 Threshold for detection of odors
3.3 Neuronal pathways for olfaction
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
Smell is the least understood of our senses. This results partly from the
fact that the sense of smell is a subjective phenomenon that cannot be
studied with ease in lower animals. Another complicating problem is
that the sense of smell is poorly developed in human beings in
comparison with the sense of smell in many lower animals.
2.0 OBJECTIVES
• describe the histological structure and function of the olfactory

epithelium and the olfactory bulb
• explain how the perception of many different odours is possible
• Describe the neuronal pathways for the sense of smell.
3.0 MAIN CONTENT
3.1 Olfactory Epithelium and Bulb
A small superior part of the nasal cavity is lined with olfactory

epithelium. Ten million olfactory neurons are present within the
olfactory epithelium. Olfactory neurons are bipolar neurons with
dendrites extending to the epithelial surface of the nasal cavity. The ends
of the dendrites are modified into bulbous enlargements with long,
specialised cilia, called olfactory hairs, which lie in a thin mucous film
on the epithelial surface. The mucus keeps the nasal epithelium moist,
traps and dissolves molecules, and facilitates the removal of molecules
and particles from the olfactory epithelium. Airborne odorants become
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dissolved in the mucus on the surface of the epithelium and bind to

molecules on the membranes of the olfactory hairs called olfactory
receptors. The odorants must first be dissolved in fluid in order to reach
the olfactory receptors. When an odorant binds to its receptor, a G
protein associated with the receptor is activated. As a result of activation
of the G protein, Na+ and Ca2+ channels in the membrane open. The
influx of ions into the olfactory hairs results in depolarization and the
production of action potentials in the olfactory Neurons. Once an
odorant binds to its receptor, however, the receptor accommodates and
does not respond to another odorant for some time.
Fig 2.3 Olfactory Region, Epithelium and Bulb
3.2 Threshold for detection of odors
The threshold for the detection of odours is very low, so very few
odorants bound to an olfactory neuron can initiate an action potential.
Methylmercaptan, which has a nauseating odour similar to that of rotten
cabbage, is added to natural gas at a concentration of about one part per
21
million. A person can detect the odour of about 1/25 billionth of a

milligram of the substance and therefore is aware of the presence of the
more dangerous but odourless natural gas. There are approximately
1000 different odorant receptors, which can react to odorants of different
sizes, shapes, and functional groups. The average person can distinguish
among approximately 4000 different smells. It has been proposed that
the wide varieties of detectable odors are actually combinations of a
smaller number of primary odours. The seven primary odours are
camphoraceous (e.g., moth balls), musky, floral, peppermint, ethereal
(e.g., fresh pears), pungent, and putrid. It is very unlikely, however, that
this list is an accurate representation of all primary odours, and some
studies point to the possibility of as many as 50 primary odours.
3.3 Neuronal Pathways for Olfaction
Axons from olfactory neurons form the olfactory nerves (I), which pass
through the olfactory foramina of the cribriform plate and enter the
olfactory bulb. There they synapse with interneurons that relay action
potentials to the brain through the olfactory tracts. Each olfactory tract
terminates in the olfactory cortex and the amygdala in the temporal
lobe. It is here that the sensation of smell is perceived. The olfactory
cortex is part of the limbic system, projecting to the hypothalamus,
amygdala, and hippocampus of the cerebrum. Odours can produce
strong emotional reactions, memories, and other responses. For
example, the perfume or cologne of a loved one can evoke good
feelings, and memories and food odours can cause salivation and
hunger. Within the olfactory bulb and olfactory cortex, feedback loops
occur that tend to inhibit transmission of action potentials resulting from
prolonged exposure to a given odorant. This feedback, plus the
temporary decreased in sensitivity at the level of the receptors, results in
adaptation to a given odour. For example, if you enter a room that has an
odour, you are aware of the odour, but you adapt to the odour and
cannot smell it as well after the first few minutes. If you leave the room
for some time and then re - enter the room, the odour again seems more
intense.
• Anosmia - a complete loss of smell

• Hyposmia – partial loss of smell or decreased sensation of smell
• Hyperosmia – enhanced smell sensitivity
• Dysosmia – distortion in odour perception(includes parosmia and
phantosmia)
• Parosmia – distortion of perception of an external stimulus
• Phantosmia – smell perception with no external stimulus.
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Common causes of smell disorders include:
Aging, sinus and other respiratory infections, smoking, growths in nasal

cavities, head injury, hormonal disturbances, dental problems, exposure
to certain chemicals, such as insecticides and solvents, radiation for
treatment of head and neck cancers.
1. At the histology laboratory, examine the olfactory cells slides

under the microscope.
2. At the gross anatomy laboratory, identify the location of the
olfactory epithelium and its relationship to the olfactory bubs and
the cribriform plate on the sagittal head model.
4.0 CONCLUSION
The ability to smell comes from specialized sensory cells, called

olfactory sensory neurons, which are found in a small patch of tissue
high inside the nose.
5.0 SUMMARY
• In this unit you have learnt that the sense of smell is a subjective
phenomenon that cannot be studied with ease in lower animals
• Olfaction is the sense of smell.
• Olfactory neurons in the olfactory epithelium are bipolar neurons.
Their distal ends have olfactory hairs. The olfactory hairs have
receptors that respond to dissolved substances. There are
approximately 1000 different odorant receptors.
• The receptors activate G proteins, which results in ion channels
opening and depolarization.
• At least seven (perhaps 50) primary odours exist. The olfactory
neurons have a very low threshold and accommodate rapidly.
• Axons from the olfactory neurons extend as olfactory nerves to

the olfactory bulb, where they synapse with interneurons. Axons
from these cells form the olfactory tracts, which connect to the
olfactory cortex. The olfactory bulbs and cortex accommodate to
odours.
23
1. Olfactory neurons
a. have projections called cilia.

b. have axons that combine to form the olfactory nerves.
c. connect to the olfactory bulb.
d. have receptors that react with odorants dissolved in fluid.
e. all of the above.
2. What are the characteristics of an odorant—a chemical molecule

that stimulates a smell receptor?
3. Does adaptation of smell receptors occur?
4. Do all of the volatile chemicals in the nose stimulate smell
receptors?
4 Which of the cranial nerves innervate the olfactory mucosa?
Inc.



Williams & Wilkins


ed.

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UNIT 4 THE EAR AND SENSE OF HEARING AND

BALANCE
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Auditory Structures
3.2 Auditory Functions
3.3 Neuronal Pathways for Hearing and Balance
3.4 Balance
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
The organs of hearing and balance are divided into three parts: the
external, middle, and inner ear. The external ear is the part extending
from the outside of the head to the tympanic membrane, or eardrum.
The middle ear is an air-filled chamber medial to the tympanic
membrane. The inner ear is a set of fluid-filled chambers medial to the
middle ear. The external and middle ears are involved in hearing only,
whereas the inner ear functions in both hearing and balance.
2.0 OBJECTIVES
• describe the anatomy of the ear and the function of each part
• explain how sounds travel through the ear and are interpreted in
the brain
• explain the role of the ear in maintaining equilibrium
• describe various disorders of the ear.
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3.0 MAIN CONTENT
3.1 Auditory Structures
External Ear/ Auricle
The auricle is the fleshy part of the external ear on the outside of the
head. The auricle opens into the external acoustic meatus, a passageway
that leads to the tympanic membrane. The auricle collects sound waves
and directs them toward the external acoustic meatus, which transmits
them to the tympanic membrane. The external acoustic meatus is lined
with hairs and ceruminous glands, which produce cerumen, a modified
sebum commonly called earwax. The hairs and cerumen help prevent
foreign objects from reaching the delicate tympanic membrane.
The tympanic membrane is a thin membrane separating the external ear

from the middle ear. It consists of a thin layer of connective tissue
sandwiched between two epithelial layers. Sound waves reaching the
tympanic membrane cause it to vibrate.
Middle Ear
Medial to the tympanic membrane is the air-filled cavity of the middle

ear. Two covered openings, the oval window and the round window on
the medial side of the middle ear, connect the middle ear with the inner
ear. The middle ear contains three auditory ossicles: the malleus, incus,
and stapes. These bones transmit vibrations from the tympanic
membrane to the oval window. The malleus is attached to the medial
surface of the tympanic membrane. The incus connects the malleus to
the stapes. The base of the stapes is seated in the oval window and is
surrounded by a flexible ligament. Two small muscles in the middle ear
help dampen vibrations of the auditory ossicles caused by loud noises.
The tensor tympani muscle is attached to the malleus and is innervated
by the trigeminal nerve (V). The stapedius muscle is attached to the
stapes and is innervated by the facial nerve (VII).
Two openings provide air passages from the middle ear. One passage
opens into the mastoid air cells in the mastoid process of the temporal
bone. The other passageway is the auditory tube, also called the
pharyngotympanic tube or the eustachian tube. The auditory tube
opens into the pharynx and enables air pressure to be equalised between
the outside air and the middle ear cavity.
When a person changes altitude, air pressure outside the tympanic

membrane changes relative to the air pressure in the middle ear. With an
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increase in altitude, the pressure outside the tympanic membrane

becomes less than the air pressure inside the middle ear and the
tympanic membrane is pushed outward. With a decrease in altitude, the
air pressure outside the ear becomes greater than in the middle ear and
the tympanic membrane is pushed inward. Distortion of the tympanic
membrane can make sounds seem muffled and stimulate pain. These
symptoms can be relieved by opening the auditory tube to allow air to
pass through the auditory tube to equalise air pressure. Swallowing,
yawning, chewing, and holding the nose and mouth shut while gently
trying to force air out of the lungs are methods used to open the auditory
tube.
Fig.3.1 Major Parts of the Ear
Inner Ear
The inner ear contains the sensory organs for hearing and balance. It
consists of interconnecting, fluid-filled tunnels and chambers within the
temporal bone called the bony labyrinth. The bony labyrinth is lined
with endosteum. When the inner ear is drawn, it is the endosteum that is
depicted. The bony labyrinth is divided into three regions: cochlea,
vestibule, and semicircular canals. The vestibule and semicircular canals
are involved primarily in balance, and the cochlea is involved in hearing.
Inside the bony labyrinth is a similarly shaped but smaller set of
membranous tunnels and chambers called the membranous labyrinth.
The membranous labyrinth is filled with a clear fluid called endolymph,
and the space between the membranous and bony labyrinths is filled
with a fluid called perilymph. Perilymph is very similar to cerebrospinal
27
fluid, but endolymph has a high concentration of potassium and a

lownconcentration of sodium, which is opposite from perilymph
andcerebrospinal fluid. The membranous labyrinth of the cochlea
separates the bony labyrinth into two parts. The cochlea is shaped like a
snail shell—that is, a coiled tube.
The base of the cochlea connects to the vestibule and the apex of the
cochlea is the end of the coiled tube. The bony core of the cochlea,
around which the tube coils, is shaped like a screw with threads called
the spiral lamina. A Y-shaped, membranous complex divides the
cochlea into three portions. The base of the Y is the spiral lamina. One
branch of the Y is the vestibular membrane, and the other branch is the
basilar membrane. The space between these membranes is called the
cochlear duct.
3.2 Auditory Functions
Properties of Sound
Vibration of matter, such as air, water, or a solid material, creates sound.

No sound occurs in a vacuum. For example, when a tuning fork vibrates,
it causes the surrounding air to vibrate. The air vibrations consist of
bands of compressed air followed by bands of less compressed air.
When these pressure changes are graphed through time, they have a
wave form; hence, they are called sound waves. These sound waves are
propagated through the air, somewhat as ripples are propagated over the
surface of water. The volume, or loudness, of sound is a function of
wave amplitude, or height, measured in decibels. The greater the
amplitude is, the louder the sound. The pitch of sound is a function of
the wave frequency. It is measured in hertz (Hz), which is the number of
waves or cycles per second. The higher the frequency is, the higher the
pitch. The normal range of human hearing is 20–20,000 Hz and 0 or
more decibels (db). Sounds louder than 125 db are painful to the ear.
Timbre is the resonance quality or overtones of a sound. A smooth
sigmoid curve is the image of a “pure” sound wave, but such a wave
almost never exists in nature. The sounds made by musical instruments
and the human voice are not smooth sigmoid curves but, rather, are
rough, jagged curves formed by numerous, superimposed curves of
various amplitudes and frequencies.
External Ear
The auricle collects sound waves and directs them into the external
acoustic meatus. Sound waves travel relatively slowly in air, 332 m/s,
and a small time interval may elapse between the time a sound wave
reaches one ear and the time it reaches the other. The brain can interpret
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this interval to determine the direction from which a sound is coming.

Sound waves are conducted through the external acoustic meatus and
strike the tympanic membrane, causing it to vibrate.
Middle Ear
Vibration of the tympanic membrane causes vibration of the three

auditory ossicles of the middle ear, and by this mechanical linkage
vibration is transferred to the oval window. The oval window is
approximately 20 times smaller than the tympanic membrane. The
mechanical force of vibration is amplified about 20-fold as it passes
from the tympanic membrane through the auditory ossicles to the oval
window because of this size difference. This amplification is necessary
because more force is required to cause vibration in a liquid, such as the
perilymph of the inner ear, than is required in air.
Fig.3.2: Middle Ear
Middle Ear
The tensor tympani and stapedius muscles are attached to auditory

ossicles. Excessively loud sounds cause these muscles to reflexively
contract and dampen the movement of the auditory ossicles. This sound
attenuation reflex protects the delicate inner ear structures from
damage by loud noises. The sound attenuation reflex responds most
effectively to low-frequency sounds and can reduce by a factor of 100
the energy reaching the oval window. The reflex is too slow to prevent
damage from a sudden noise, such as a gunshot, and it cannot function
effectively for longer than about 10 minutes, in response to prolonged
noise.
29
Inner Ear
As the stapes vibrates, it produces sound waves in the perilymph of the

scala vestibuli. Vibrations of the perilymph are transmitted through the
vestibular membrane and cause simultaneous vibrations of the
endolymph. The mechanical effect is as though the perilymph and
endolymph were a single fluid because the vestibular membrane is very
thin. Vibration of the endolymph causes distortion of the basilar
membrane, which is most important to hearing. As the basilar membrane
moves, the hair cells resting on it move relative to the tectorial
membrane, which remains stationary. The inner hair cell stereocilia are
bent as they move against the tectorial membrane, resulting in the
release of neurotransmitter and the production of action potentials in
sensory neurons.
The basilar membrane is not uniform throughout its length. The

membrane is narrower and denser near the oval window and wider and
less dense near the apex of the cochlea. The various regions of the
membrane can be compared to the strings in a piano, which has strings
of varying length and thickness. As a result of this organisation, sounds
with higher pitches cause the basilar membrane nearer the oval window
to distort maximally, whereas sounds with lower pitches cause the
basilar membrane nearer the apex of the cochlea to distort maximally.
Depending on which hair cells are stimulated along the length of the
basilar membrane, the brain interprets the pitch and timbre of sounds.
Sound volume, or loudness, is a function of sound wave amplitude.
As the volume of sound increases, the vibration of the basilar membrane

increases, the stimulation of hair cells increases, and the production of
action potentials increases. The brain interprets the higher frequency of
action potentials as a louder sound. The outer hair cells are involved in
regulating the tension of the basilar membrane, thereby increasing the
sensitivity of the inner ear to sounds. Stimulation of the inner hair cells
by the nervous system stimulates the contraction of actin filaments
within the hair cells, causing them to shorten. This adjustment in the
height of the outer hair cells, attached to both the basilar membrane and
the tectorial membrane, fine-tunes the tension of the basilar membrane
and the distance between the basilar membrane and tectorial membrane.
Sound waves in the perilymph of the scala vestibuli are also transmitted
the length of the scala vestibuli and through the helicotrema into the
perilymph of the scala tympani. This transmission of sound waves is
probably of little consequence because the helicotrema is very small.
Vibration of the basilar membrane produces most of the sound waves in
the perilymph of the scala tympani. Sound waves in the scala tympani
perilymph cause vibration of the membrane of the round window.
Vibration of the round window membrane is important to hearing
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because it acts as a mechanical release for sounds waves within the scala
tympani. If this window were solid, it would reflect the sound waves,
which would interfere with and dampen later sound waves. The round
window also allows the relief of pressure in the perilymph because fluid
is not compressible, thereby preventing compression damage to the
spiral organ.
3.3 Neuronal Pathway for Hearing and Balance
The axons of the sensory neurons supplying hair cells form the cochlear
nerve. These sensory neurons are bipolar neurons, and their cell bodies
are in the cochlear, or spiral, ganglion, located in the bony core of the
cochlea. The cochlear nerve joins the vestibular nerve to become the
vestibulocochlear nerve (VIII), which traverses the internal acoustic
meatus and enters the cranial cavity. The special senses of hearing and
balance are both transmitted by the vestibulocochlear (VIII) nerve.
The term vestibular refers to the vestibule of the inner ear, which is
involved in balance. The term cochlear refers to the cochlea of the inner
ear, which is involved in hearing. The vestibulocochlear nerve functions
as two separate nerves carrying information from two separate but
closely related structures. The auditory pathways within the CNS are
very complex, with both crossed and uncrossed tracts. Unilateral CNS
damage therefore usually has little effect on hearing. The neurons from
the cochlear ganglion synapse with CNS neurons in the cochlear nucleus
in the medulla oblongata. These neurons in turn either synapse in or pass
through the superior olivary nucleus in the medulla oblongata. Neurons
terminating in the superior olivary nucleus may synapse with efferent
neurons returning to the cochlea to modulate pitch perception. Nerve
fibers from the superior olivary nucleus also project to the trigeminal
(V) nucleus, which controls the tensor tympani, and the facial (VII)
nucleus, which controls the stapedius muscle. This is part of the sound
attenuation reflex pathway.
Ascending neurons from the superior olivary nucleus synapse in the

inferior colliculi, and neurons from there project to the thalamus, where
they synapse with neurons that project to the cortex. These neurons
terminate in the auditory cortex. Neurons from the inferior colliculi also
project to the superior colliculi, where reflexes that turn the head and
eyes in response to loud sounds are initiated.
Neuronal Pathways for Balance
The axons of the sensory neurons supplying hair cells of the maculae
and crista ampullaris form the vestibular nerve. These sensory neurons
are bipolar neurons, and their cell bodies are in the vestibular ganglion, a
31
swelling of the vestibulocochlear nerve located in the internal acoustic

meatus. The sensory neurons terminate in the vestibular nucleus within
the medulla oblongata. Axons run from this nucleus to numerous areas
of the CNS, such as the spinal cord, the cerebellum, the cerebral cortex,
and the nuclei controlling the extrinsic eye muscles.
Balance is a complex process not simply confined to one type of input.

In addition to vestibular sensory input, the vestibular nucleus receives
input from proprioceptive neurons throughout the body, as well as from
the visual system. People are asked to close their eyes while balance is
evaluated in a sobriety test because alcohol affects the proprioceptive
and vestibular components of balance (cerebellar function) to a greater
extent than it does the visual portion.
Reflex pathways exist between the dynamic balance part of the

vestibular system and the nuclei controlling the extrinsic eye muscles
(oculomotor, trochlear, and abducent). A reflex pathway allows the
maintenance of visual fixation on an object while the head is in motion.
This function can be demonstrated by spinning a person around about 10
times in 20 seconds, stopping him or her, and observing eye movements.
A slight oscillatory movement of the eyes, called nystagmus, occurs.
The eyes track in the direction of motion and return with a rapid
recovery movement before repeating the tracking motion.
3.4 Balance
The sense of balance, or equilibrium, has two components:

staticnbalance and dynamic balance. Static balance is associated with
the vestibule and is involved in evaluating the position of the head
relative to gravity. Dynamic balance is associated with the semicircular
canals and is involved in evaluating changes in the direction and rate of
head movements.
Static balance
Static balance is associated with the utricle and the saccule of the
vestibule. It is primarily involved in evaluating the position of the head
relative to gravity, although the system also responds to linear
acceleration or deceleration, such as when a person is in a car that is
increasing or decreasing speed. Most of the utricular and saccular walls
consist of simple cuboidal epithelium. The utricle and saccule, however,
each contain a specialised patch of epithelium about two to three mm in
diameter called the macula. The macula of the utricle is oriented parallel
to the base of the skull, and the macula of the saccule is perpendicular to
the base of the skull. The maculae resemble the spiral organ and consist
of hair cells, sensory neurons, and supporting cells. The “hairs” of the
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hair cells consist of numerous microvilli, called stereocilia, and one

cilium, called a kinocilium.
The stereocilia and kinocilium are embedded in the otolithic

membrane, which is a gelatinous mass weighted with crystals of
calcium carbonate and protein called otoliths. The otolithic membrane
moves in response to gravity, bending the hair cells and initiating action
potentials in their associated sensory neurons. The stereocilia function
much as do the stereocilia of cochlear hair cells, with tip links connected
to gated K+ channels. Deflection of the hairs toward the kinocilium
results in depolarization of the hair cell. The hair cells are constantly
being stimulated at a low level by the presence of the otolith-weighted
covering of the macula. When the otolithic membrane moves in
response to gravity, the pattern and intensity of hair cell stimulation
change. The change in action potentials produced is translated by the
brain into specific information about head position or linear
acceleration/deceleration. Much of this information is not perceived
consciously but is dealt with subconsciously. The body responds by
making subtle tone adjustments in the muscles of the back and neck,
which are intended to restore the head to its proper neutral, balanced
position.
Dynamic Balance
Dynamic balance is associated with the semicircular canals and is

involved in evaluating movements of the head. There are three
semicircular canals placed at nearly right angles to one another. One
semicircular canal lies nearly in the transverse plane, one in the frontal
plane, and one in the sagittal plane. The arrangement of the semicircular
canals enables a person to detect movement in all directions. The base of
each semicircular canal is expanded into an ampulla. Within each
ampulla, the epithelium is specialised to form a crista ampullaris. This
specialised sensory epithelium is structurally and functionally very
similar to the sensory epithelium of the maculae.
Each crista consists of a ridge or crest of epithelium with a curved,

gelatinous mass, the cupula, suspended over the crest. The hair like
processes of the crista hair cells, which are stereocilia similar to those in
the maculae and cochlear hair cells, are embedded in the cupula. The
cupula contains no otoliths and therefore does not respond to
gravitational pull. Instead, the cupula is a float that is displaced by
endolymph movements within the semicircular canals. As the head
begins to move, the endolymph does not move at the same rate as the
semicircular canals, which are part of the temporal one. This difference
causes displacement of the cupula in a direction opposite to that of the
movement of the head. To appreciate this effect, imagine holding a
33
feather (the cupula) in your hand (the crista ampullaris). If you rapidly
move your hand, the feather bends over in the direction opposite the
movement as it drags through the air (endolymph). The bending of the
stereocilia results in the stimulation of sensory neurons. The brain
interprets the direction of head movement based on which hair cells in
which crista ampullaris are stimulated. The semicircular canals detect
changes in the rate of movement rather than movement alone because
displacement of the cupula is most intense when the rate of head
movement changes rapidly. As with the static balance, the information
the brain obtains regarding dynamic balance is largely subconscious.
If a person continually spins in one direction, the endolymph of the

semicircular canals begins to move and catches up with the cupula, and
stimulation is stopped. If spinning suddenly stops, the endolymph
continues to move because of its momentum, causing displacement of
the cupula in the same direction as the head had been moving. The brain
interprets this movement of the cupula to mean the head is moving in the
opposite direction of the spin, even though the head is no longer
moving. This is why a person has a feeling of moving even after he or
she has stopped spinning.
• Tympanic Membrane Rupture

Rupture of the tympanic membrane may result in hearing impairment.
Foreign objects thrust into the ear, pressure, and infections of the middle
ear can rupture the tympanic membrane. Sufficient differential pressure
between the middle ear and the outside air can also rupture the tympanic
membrane. This can occur in flyers, divers, or individuals who are hit on
the side of the head by an open hand.
• Chorda Tympani
The chorda tympani is a branch of the facial nerve carrying taste

impulses from the anterior two-thirds of the tongue. It crosses through
the middle ear between the malleus and incus. The chorda tympani have
nothing to do with hearing but is just passing through. This nerve can be
damaged, however, during ear surgery or by a middle ear infection,
resulting in loss of taste sensation from the anterior two-thirds of the
tongue on the side innervated by that nerve.
• Human Speech and Hearing Impairment
The range of normal human speech is 250–8000 Hz. This is the range
that is tested for the possibility of hearing impairment because it is the
most important for communication.
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• Loud Noises and Hearing Loss
Prolonged or frequent exposure to excessively loud noises can cause

degeneration of the spiral organ at the base of the cochlea, resulting in
high-frequency deafness. The actual amount of damage can vary greatly
from person to person. High-frequency loss can cause a person to miss
hearing consonants in a noisy setting. Loud music, amplified to 120 db,
can impair hearing. The defects may not be detectable on routine
diagnosis, but they include decreased sensitivity to sound in specific
narrow frequency ranges and a decreased ability to discriminate between
two pitches. Loud music, however, is not as harmful as is the sound of a
nearby gunshot, which is a sudden sound occurring at 140 db. The sound
is too sudden for the attenuation reflex to protect the inner ear structures,
and the intensity is great enough to cause auditory damage. In fact,
gunshot noise is the most common recreational cause of serious hearing
loss.
• Meniere Disease
Meniere disease is the most common disease involving dizziness from

the inner ear. Its cause is unknown but it appears to involve a fluid
abnormality in one (usually) or both ears. Symptoms include vertigo,
hearing loss, tinnitus, and a feeling of “fullness” in the affected ear.
Treatment includes a low-salt diet and diuretics (water pills). Symptoms
may also be treated with medications for motion sickness.
• describe the anatomy of the ear and the function of each part
• explain how sounds travel through the ear and are interpreted in
the brain
• explain the role of the ear in maintaining equilibrium
• describe various disorders of the ear.
4.0 CONCLUSION
The organs of hearing and balance are divided into three parts: the
external, middle, and inner ear
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5.0 SUMMARY
In this unit you learnt
• The osseous labyrinth is a canal system within the temporal bone

that contains perilymph contains perilymph and the membranous
labyrinth. Endolymph is inside the membranous labyrinth.
• The external ear consists of the auricle and external acoustic
meatus. The middle ear connects the external and inner ears. The
tympanic membrane is stretched across the external acoustic
meatus.
• The malleus, incus, and stapes connect the tympanic membrane
to the oval window of the inner ear.
• The auditory tube connects the middle ear to the pharynx and
equalises pressure. The middle ear is connected to the mastoid air
cells. The inner ear has three parts: the semicircular canals; the
vestibule, which contains the utricle and the saccule; and the
cochlea.
• The cochlea is a spiral-shaped canal within the temporal bone.
The cochlea is divided into three compartments by the vestibular
and basilar membranes. The scala vestibuli and scala tympani
contain perilymph. The cochlear duct contains endolymph and
the spiral organ.
• The spiral organ consists of inner hair cells and outer hair cells,
which attach to the tectorial membrane.
• Pitch is determined by the frequency of sound waves and volume
by the amplitude of sound waves. Timbre is the resonance quality
(overtones) of sound.
• Axons from the vestibulocochlear nerve synapse in the medulla.
Neurons from the medulla project axons to the inferior colliculi,
where they synapse. Neurons from this point project to the
thalamus and synapse. Thalamic neurons extend to the auditory
cortex.
1. Name the three parts of the ear, and state their functions.
2. Describe the structural components of the middle ear and their
functions.
3. Which of these structures is found within or is a part of the
external ear?
a. oval window
b. auditory tube
c. ossicles
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d. external acoustic meatus

e. cochlear duct
4. Given these auditory ossicles:

1 incus
2 malleus
3 stapes
Choose the arrangement that lists the auditory ossicles in order from the
tympanic membrane to the inner ear.
a. 1,2,3
b. 1,3,2
c. 2,1,3
d. 2,3,1
e. 3,2,1
5. The spiral organ is found within the
a. cochlear duct.
b. scala vestibuli.
c. scala tympani.
d. vestibule.
e. semicircular canals.
6. An increase in the loudness of sound occurs as a result of an

increase in the sound wave.
a. frequency
b. amplitude
c. resonance
d. both a and b
7. Interpretation of different sounds is possible because of the

ability of it to vibrate at different frequencies and stimulate the:
a. vestibular membrane, vestibular nerve

b. vestibular membrane, spiral organ
c. basilar membrane, vestibular nerve
d. basilar membrane, spiral organ
Inc.
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Williams & Wilkins


ed.

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NSC 218 MODULE 1
UNIT 5 THE EYES AND THE SENSE OF VISION
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Anatomy of the Eye
3.2 Functions of the Eye
3.3 Visual Pathway
4.0 Conclusion
5.0 Summary
6.0 Tutor-Marked Assingment
1.0 INTRODUCTION
The visual system includes the eyes, the accessory structures, and the
sensory neurons that project to the cerebral cortex where action
potentials conveying visual information are interpreted. The eye consists
of the eyeball, or globe of the eye, and the optic nerve. Much of the
information we obtain about the world around us is detected by the
visual system. Our education is largely based on visual input and
depends on our ability to read words and numbers. Visual input includes
information about light and dark, movement, colour and hue.
2.0 OBJECTIVES
• list the accessory structures of the eye, and explain their functions
• describe the anatomy of the eye
• describe the focusing system of the eye and how it adjusts to see
distant and near objects
• explain the structure of the retina, and how light entering the eye
results in action potentials in the optic nerve
• outline the neuronal pathways for vision.
39
3.1 Anatomy of the Eye
Fig. 4.1: Sagittal Section of the Eye
The eyeball is composed of three layers. From superficial to deep they

are the fibrous layer, vascular layer, and retina. The fibrous layer
consists of the sclera and cornea; the vascular layer consists of the
choroid, ciliary body, and iris.
Fibrous Layer
The sclera is the firm, opaque, white, outer layer of the posterior five-
sixths of the eyeball. It consists of dense collagenous connective tissue
with elastic fibers. The sclera helps maintain the shape of the eyeball,
protects its internal structures, and provides an attachment point for the
extrinsic eye muscles. A small portion of the sclera can be seen as the
“white of the eye”.
The sclera is continuous with the cornea, the anterior sixth of the
eyeball. The cornea is avascular and transparent, permitting light to
enter the eye. The focusing system of the eye refracts, or bends, light
and focuses it on the nervous layer (retina). The cornea is responsible for
most of the refraction of light entering the eye.
The cornea consists of a connective tissue matrix containing collagen,

elastic fibers, and proteoglycans, with a layer of stratified squamous
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epithelium covering the outer surface and a layer of simple squamous

epithelium on the inner surface. The outer epithelium is continuous with
the conjunctiva over the sclera. The transparency of the cornea results
from its low water content. In the presence of water, proteoglycans trap
water and expand, which scatters light. In the absence of water, the
proteoglycans decrease in size and do not interfere with the passage of
light through the matrix.
Vascular Layer
The vascular layer of the eye is so named because it contains most of the
blood vessels of the eye. The posterior portion of the vascular layer,
associated with the sclera, is the choroid. This is a very thin structure
consisting of a vascular network and many melanin-containing pigment
cells so that it appears black in colour. The black colour absorbs light so
that it is not reflected inside the eye. If light were reflected inside the
eye, the reflection would interfere with vision. The interiors of cameras
are black for the same reason.
The choroid is continuous anteriorly with the ciliary body, which

consists of an outer ciliary ring and an inner group of ciliary processes.
The ciliary ring and the base of the ciliary processes contain smooth
muscle called ciliary muscles. Suspensory ligaments attach the ciliary
ring and processes to the lens of the eye, and contraction of the ciliary
muscles can change the shape of the lens. The ciliary process also
produces aqueous humour. The ciliary body is continuous anteriorly
with the iris of the eye, which is the “coloured part” of the eye. The iris
is a contractile structure, consisting mainly of smooth muscle,
surrounding an opening called the pupil. Light enters the eye through the
pupil, and the iris regulates the amount of light by controlling the size of
the pupil. The iris contains two groups of smooth muscles: a circular
group called the sphincter pupillae and a radial group called the dilator
pupillae. The sphincter papillae are innervated by parasympathetic fibers
from the oculomotor nerve (III). When they contract, the pupil constricts
and less light enters the eye. The dilator pupillae are innervated by
sympathetic fibers. When they contract, the pupil dilates and more light
enters the eye. The ciliary muscles, sphincter pupillae, and dilator
pupillae are sometimes referred to as the intrinsic eye muscles.
The colour of the eye differs from person to person. A large amount of
melanin in the iris causes it to appear brown or even black. Less melanin
results in light brown, green, or gray irises. Even less melanin causes the
eyes to appear blue. If there is no pigment in the iris, as in albinism, the
iris is pink because blood vessels in the eye reflect light back to the iris.
The genetics of eye colour is quite complex.
41
Retina
The retina is the inner layer of the eye, covering the inner surface of the
eye posterior to the ciliary body. The retina has over 126 million
photoreceptor cells, which respond to light. As a result, action potentials
are generated and conducted by the optic nerve (II) out of the eye to the
cerebral cortex, where the sense of vision takes place. When the
posterior region of the retina is examined with an ophthalmoscope,
several important features can be observed. Near the center of the
posterior retina is a small, yellow spot approximately four (4) mm in
diameter, the macula.
In the center of the macula is a small pit, the fovea centralise. The fovea,
followed by the macula, has the highest concentration of photoreceptor
cells in the retina. Thus, they are the part of the retina most sensitive to
light. Just medial to the macula is a white spot, the optic disc, through
which the central retinal artery enters and the central retinal vein exits
the eyeball. Branches from these vessels spread over the surface of the
retina. The optic disc is also the place where axons from the neurons of
the retina converge to form the optic nerve, which exits the posterior
eye.
The optic disc contains only axons and no photoreceptor cells.

Therefore, it does not respond to light and is called the blind spot of the
eye.
Chambers of the Eye
The interior of the eye is divided into three chambers: anterior

chamber, posterior chamber, and vitreous chamber. The anterior and
posterior chambers are located between the cornea and the lens. The iris
separates the anterior chamber from the posterior chamber, which are
continuous with each other through the pupil. The much larger vitreous
chamber is posterior to the lens. A fluid called aqueous humour fills
the anterior and posterior chambers. Aqueous humour helps maintain
intraocular pressure, which keeps the eyeball inflated and is largely
responsible for maintaining the shape of the eyeball. The aqueous
humour also refracts light and provides nutrition for the structures of the
anterior chamber, such as the cornea, which has no blood vessels.
Aqueous humour is produced by the ciliary processes as a blood filtrate
and is returned to the circulation through a venous ring called the scleral
venous sinus (canal of Schlemm) (shlem), which is located at the
junction of the sclera and cornea. The production and removal of
aqueous humour result in the “circulation” of aqueous humour and
maintenance of a constant intraocular pressure.
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Glaucoma is an abnormal increase in intraocular pressure that results

when the rate of production of aqueous humour exceeds its rate of
removal. A transparent, jellylike substance called vitreous humour fills
the vitreous chamber. The vitreous humour helps maintain intraocular
pressure and therefore the shape of the eyeball, and it holds the lens and
retina in place. It also functions in the refraction of light in the eye.
Vitreous humour is not produced as rapidly as is the aqueous humour,
and its turnover is extremely slow.
Lens
The lens is an avascular, transparent, biconvex disk located behind the

pupil. Biconvex means that each side of the lens bulges outward. The
lens is part of the focusing system of the eye, and light passing through
the lens is focused on the retina. The lens is a flexible structure, and
changing the shape of the lens is involved with adjusting the focus of
light. The lens consists of a layer of cuboidal epithelial cells on its
anterior surface and a posterior region of very long, columnar epithelial
cells called lens fibers. Cells from the anterior epithelium proliferate
and give rise to the lens fibers. The lens fibers lose their nuclei and other
cellular organelles and accumulate a set of proteins called crystalline. A
highly elastic, transparent lens capsule surrounds the lens. The
suspensory ligaments connect the lens capsule to the ciliary body.
Through the lens capsule and the suspensory ligaments, the ciliary body
can change the shape of the lens.
Accessory Structures
Accessory structures protect, lubricate, and move the eye. They include
the eyebrows, eyelids, conjunctiva, lacrimal apparatus, and extrinsic eye
muscles.
Eyebrows
The eyebrows are curved lines of hair over the orbit. They protect the
eyes by preventing perspiration, which can irritate the eyes, from
running down the forehead and into them, and they help shade the eyes
from direct sunlight.
Eyelids
The eyelids are moveable folds covering the anterior surface of the eye
when closed. The upper and lower eyelids meet at the medial and
lateral angles of the eye. The medial angle contains a small,
reddishpink mound called the caruncle. The caruncle contains some
43
modified sebaceous and sweat glands. The eyelids consist of five layers
of tissue. From the outer to the inner surface, they are (1) a thin layer of
skin on the external surface; (2) a thin layer of loose connective tissue;
(3) a layer of skeletal muscle consisting of the orbicularis oculi and
levator palpebrae superioris muscles; (4) a crescent-shaped layer of
dense connective tissue called the tarsal plate, which helps maintain the
shape of the eyelid; and (5) the conjunctiva.
The eyelids, with their associated lashes, protect the eyes from foreign
objects. If an object suddenly approaches the eye, the eyelids protect the
eye by rapidly closing and then opening, a response called the blink
reflex. Blinking, which normally occurs about 25 times per minute, also
helps keep the eye lubricated by spreading tears over the surface.
Movements of the eyelids are a function of skeletal muscles. The
orbicularis oculi muscle closes the lids, and the levator palpebrae
superioris elevates the upper lid. The eyelids also help regulate the
amount of light entering the eye. Eyelashes are attached as a double or
triple row of hairs to the free edges of the eyelids. Ciliary glands are
modified sweat glands that open into the hair follicles of the eyelashes to
keep them lubricated. When one of these glands becomes inflamed, it is
called a sty. Tarsal glands, or meibomian glands, are sebaceous glands
near the inner margins of the eyelids. They produce sebum, an oily,
semifluid substance that lubricates the lids and restrains tears from
flowing over the margin of the eyelids. An infection or a blockage of a
tarsal gland is called a chalazion, or meibomian cyst.
Fig. 4.2: The Left Eye and Accessory Structures.
Conjunctiva
The conjunctiva is a thin, transparent mucous membrane. It covers the

inner surface of the eyelids and the anterior white surface of the eye.
The conjunctiva reduces friction as the eyelids move over the surface of
the eye. It also is a barrier to the entry of microorganisms.
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NSC 218 MODULE 1
Lacrimal Apparatus
The lacrimal apparatus consists of a lacrimal gland, lacrimal

canaliculi, and a nasolacrimal duct. The lacrimal apparatus produces
tears, releases the tears onto the surface of the eye, and removes excess
tears from the surface. The lacrimal gland is in the superolateral corner
of the orbit and is innervated by parasympathetic fibers from the facial
nerve (VII). The lacrimal gland produces tears, which leave the gland
through several lacrimal ducts and pass over the anterior surface of the
eyeball. The lacrimal gland produces tears constantly at the rate of about
one (1) mL/day to moisten the surface of the eye, lubricate the eyelids,
and wash away foreign objects. Tears are mostly water, with some salts,
mucus, and lysozyme, an enzyme that kills certain bacteria. Most of the
fluid produced by the lacrimal glands evaporates from the surface of the
eye, but excess tears are collected in the medial corner of the eye by
small tubes called the lacrimal canaliculi. One lacrimal canaliculus
opens on the inner, medial surface of the upper eyelid, and the other
lacrimal canaliculus opens on the inner, medial surface of the lower
eyelid. The lacrimal canaliculi connect to the nasolacrimal duct, which
opens into the inferior meatus of the nasal cavity beneath the inferior
nasal concha.
Extrinsic Eye Muscles
The extrinsic eye muscles attach to the outside of the eyeball and cause
it to move. There are four rectus muscles, the superior, inferior,
medial, and lateral rectus muscles.
45
Fig. 4.3: The Extrinsic Muscles of the Right Eye
Rectus means straight, and the fibers of these muscles are nearly
straight with the anterior-posterior axis of the eyeball. There are two
oblique muscles, the superior and inferior oblique muscles, so named
because they are at an angle to the axis of the eyeball. The movements
of the eye can be described graphically by a figure resembling the letter
H. The clinical test for normal eye movement is therefore called the H
test. A person’s inability to move the eye toward one part of the H may
indicate dysfunction of an extrinsic eye muscle or the cranial nerve to
the muscle. The superior oblique muscle is innervated by the trochlear
nerve (IV). The nerve is so named because the superior oblique muscle
goes around a little pulley, or trochlea, in the superomedial corner of the
orbit. The lateral rectus muscle is innervated by the abducent nerve (VI),
so named because the lateral rectus muscle abducts the eye. The other
four extrinsic eye muscles are innervated by the oculomotor nerve (III).
3.2 Functions of the Eye
The eye receives light and produces action potentials. When the brain
interprets the action potentials, it results in vision.
Properties of Light
The electromagnetic spectrum is the entire range of wavelengths, or

frequencies, of electromagnetic radiation. Gamma waves have
the,shortest wavelength and radio waves the longest wavelength. Visible
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NSC 218 MODULE 1
light, the portion of the electromagnetic spectrum that can be detected

by the human eye, is a small part of the electromagnetic spectrum.
Within the visible spectrum, each colour has a different wavelength. An
important characteristic of light is that it can be refracted, or bent. As
light passes from air to a denser substance, such as glass or water, its
speed is reduced. If the surface of that substance is at an angle other than
90 degrees to the direction the light rays are traveling, the rays are bent
as a result of variation in the speed of light as it encounters the new
medium. This bending of light is called refraction. The greater the
curvature of the surface, the greater is the refraction of light. If the
surface of a lens is concave, with the lens thinnest in the center, the light
rays diverge as a result of refraction. If the surface is convex, with the
lens thickest in the center, the light rays converge. As light rays
converge, they finally reach a point at which they cross. This point is
called the focal point (FP), and causing light to converge is called
focusing.
If light rays strike an object that is not transparent, they bounce off the
surface. This phenomenon is called reflection. The images we see result
from light reflected from objects.
The Eye as a Camera
The eye is optically equivalent to the usual photographic camera. It has a

lens system, a variable aperture system (the pupil), and a retina that
corresponds to the film. The lens system of the eye is composed of four
refractive interfaces: (1) the interface between air and the anterior
surface of the cornea, (2) the interface between the posterior surface of
the cornea and the aqueous humour, (3) the interface between the
aqueous humour and the anterior surface of the lens of the eye, and (4)
the interface between the posterior surface of the lens and the vitreous
humour. The internal index of air is 1; the cornea, 1.38; the aqueous
humour, 1.33; the crystalline (on average), 1.40; and the vitreous
humour, 1.34.
Focusing System of the Eye
The light entering the eye passes through the focusing system of the eye
to strike the retina. The focusing system of the eye, which refracts light,
is the cornea, aqueous humour, lens, and vitreous humour. Light passing
through the focusing system is refracted, producing a focal point. No
image is produced at the focal point. Past the focal point is a place where
the image passing through the focusing system can be clearly seen. In a
normal eye, the focused image falls on the retina. The image is inverted
and reversed right to left because the light rays cross at the focal point.
47
The cornea and lens are the most important elements of the focusing
system of the eye. The cornea is responsible for most of the refraction of
light because the greatest contrast in media density is between the air
and the cornea. The shape of the cornea and its distance from the retina
are fixed, however, so that no adjustment in the location of the focused
image can be made by the cornea. Fine adjustments to the location of the
focused image are accomplished by changing the shape of the lens.
Increasing the curvature of the lens increases the refraction of light,
moving the focused image closer to the lens. Decreasing the curvature of
the lens decreases the refraction of light, moving the focused image
farther from the lens. In cameras, microscopes, and telescopes, focusing
is not accomplished by changing lens shape. Instead, focusing is
accomplished by moving the lens closer to or farther from the point at
which the image will be focused.
Distant and Near Vision
Distant vision occurs when looking at objects 20 feet or more from the
eye, whereas near vision occurs when looking at objects that are less
than 20 feet from the eye. In distant vision, the ciliary muscles in the
ciliary body are relaxed. The suspensory ligaments, however, maintain
elastic pressure on the lens, thereby keeping it relatively flat. The
condition in which the lens is flattened so that nearly parallel rays from a
distant object are focused on the retina is referred to as emmetropia and
is the normal resting condition of the lens. The point at which the lens
does not have to thicken for focusing to occur is called the far point of
vision and normally is 20 feet or more from the eye. When an object is
brought closer than 20 feet to the eye, the image falling on the retina is
no longer in focus. Three events occur to bring the image into focus on
the retina: accommodation by the lens, constriction of the pupil, and
convergence of the eyes.
1. Accommodation. When the eye focuses on a nearby object, the

ciliary muscles contract as a result of parasympathetic stimulation
from the oculomotor nerve (III). This sphincter like contraction
pulls the choroid toward the lens to reduce the tension on the
suspensory ligaments. This allows the lens to assume a more
spherical form because of its own elastic nature. The more
spherical lens has a more convex surface, causing greater
refraction of light, which brings the image back into focus on the
retina. This process is called accommodation.
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As an object is brought closer and closer to the eye, accommodation

becomes more and more difficult because the lens cannot become any
more convex. At some point, the eye no longer can focus the object, and
it is seen as a blur. The point at which this blurring occurs is called the
near point of vision, which is usually about two to three inches from
the eye for children, four to six inches for a young adult, 20 inches for a
45-yearold adult, and 60 inches for an 80-year-old adult. This increase in
the near point of vision is called presbyopia. It occurs because the lens
becomes more rigid with increasing age, which is why some older
people say they could read with no problem if they only had longer
arms.
2. Pupil constriction. When we look at a close-up object, the pupil

diameter decreases, which increases the depth of focus. The
depth of focus is the greatest distances through which an object
can be moved and still remain in focus on the retina. The main
factor affecting depth of focus is the size of the pupil. If the
pupillary diameter is small, the depth of focus is greater than if
the pupillary diameter is large. With a smaller papillary opening,
an object may therefore be moved slightly nearer or farther from
the eye without disturbing its focus. This is particularly important
when viewing an object at close range because the interest in
detail is much greater, and therefore the acceptable margin for
error is smaller. When the pupil is constricted, the light entering
the eye tends to pass more nearly through the center of the lens
and is more accurately focused than light passing through the
edges of the lens. Pupillary diameter also regulates the amount of
light entering the eye. The smaller the pupil diameter, the less
light entering the eye. As the pupil constricts during close vision,
therefore, more light is required on the object being observed.
3. Convergence. Because the light rays entering the eyes from a

distant object are nearly parallel, both pupils can pick up the light
rays when the eyes are directed more or less straight ahead. As an
object moves closer, however, the eyes must be rotated medially
so that the object is kept focused on corresponding areas of each
retina. Otherwise, the object appears blurry. This medial rotation
of the eyes is accomplished by a reflex that stimulates the medial
rectus muscle of each eye. This movement of the eyes is called
convergence.
49
Structure and Function of the Retina
The retina consists of an inner, neural layer and an outer, pigmented

layer. The neural layer contains three layers of neurons: photoreceptor,
bipolar, and ganglionic. The photoreceptor layer contains rods and
cones, which are the photoreceptor cells that respond to light. The rods
and cones synapse with bipolar cells, which in turn synapse with
ganglion cells. Axons from the ganglion cells pass over the inner
surface of the retina, converge at the optic disc (blind spot), and exit the
eye as the optic nerve (CN II). The neural layers are separated by the
plexiform (like a braid) layers. The outer plexiform layer is where the
photoreceptor cells synapse with the bipolar cells and the inner
plexiform layer is where the bipolar cells synapse with the ganglion
cells.
The pigmented layer consists of retinal pigment epithelium (RPE), a

single layer of cuboidal epithelial cells filled with melanin. It rests on
the Bruch membrane, which is the inner layer of the choroid consisting
of collagen and elastic fibers. Cells of the RPE phagocytize the spent
tips of rods and cones and produce retinal from vitamin A. Along with
the choroid, the pigmented layer provides a black-brown matrix that
enhances visual acuity by isolating individual photoreceptors and
reducing light scattering.
Fig. 4.4: Retina
Rods
Rods are responsible for non - colour vision and vision under conditions
of reduced light. Even though rods are very sensitive to light, they
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cannot detect colour, and sensory input reaching the brain from rods is
interpreted by the brain as shades of gray. Rods are bipolar neurons with
modified, light-sensitive dendrites, which are cylindrical in shape.
Cones
Cones are responsible for colour vision and visual acuity. Colour is a
function of the wavelength of light, and each colour results from a
certain wavelength of visible light. Cones require relatively bright light
to function. As the light decreases, so does the colour of objects that can
be seen until, under conditions of very low illumination, the objects
appear gray. This occurs because, as the light decreases, the number of
cones responding to the light decreases but the number of rods increases.
Cones are bipolar photoreceptor cells with a conical, light- sensitive part
that tapers slightly from base to apex.
Distribution of Rods and Cones in the Retina
Each eye has approximately 120 million rods and six to seven million
cones. The cones are most concentrated in the fovea centralis and the
macula. The fovea centralis has approximately 35,000 cones and no
rods. The rest of the macula has more cones than rods. Cones are
involved in visual acuity, in addition to their role in colour vision. When
one is looking at an object directly in front of the eye, the focusing
system of the eye places the image on the macula and fovea centralis.
The high concentration of cones makes it possible to see fine details.
The rods are 10–20 times more plentiful than cones over most of the
retina away from the macula. The high number of rods enables them to
“collect” light, and they are more important in low-light conditions.
Inner Layers of the Retina
Within the inner layers of the retina, interneurons modify the signals
from the photoreceptor cells before the signal leaves the retina.
Horizontal cells in the outer plexiform layer synapse with photoreceptor

cells and bipolar cells. Amacrine cells in the inner plexiform layer
synapse with bipolar and ganglion cells. Interplexiform cells connect
cells in the outer and inner plexiform layers, forming feedback loops.
The interneurons are either excitatory or inhibitory on the cells with
which they synapse. By increasing the signal from some photoreceptors
and decreasing the signal from others, these interneurons increase the
differences between boundaries, such as the edge of a dark object
against a light background.
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3.3 Visual Pathway
The optic nerve (II) leaves the eye and exits the orbit through the optic
foramen to enter the cranial cavity. Just anterior to the pituitary gland,
the optic nerves are connected to each other at the optic chiasm.
Ganglion cell axons from the nasal (medial) retina cross through the
optic chiasm and project to the opposite side of the brain. Ganglion cell
axons from the temporal (lateral) retina pass through the optic chiasm
and project to the brain on the same side of the body without crossing.
Beyond the optic chiasm, the axons form the optic tracts. Most of the
optic tract axons terminate in the thalamus. Some axons do not terminate
in the thalamus but separate from the optic tracts to terminate in the
superior colliculi, the center for visual reflexes. Neurons from the
thalamus form the fibers of the optic radiations, which project to the
visual cortex in the occipital lobe. Neurons of the visual cortex integrate
the messages coming from the retina into a single message, translate that
message into a mental image, and then transfer the image to other parts
of the brain, where it is evaluated and either ignored or acted on.
The image seen by each eye is the visual field of that eye. The visual
field of each eye can be divided into temporal (lateral) and nasal
(medial) parts. The temporal part of a visual field projects onto the nasal
retina, which projects to the visual cortex on the opposite side of the
brain. The nasal part of a visual field projects onto the temporal retina,
which projects to the same side of the brain. The nerve pathways are
arranged in such a way that images entering the eye from the right part
of each visual field (right temporal and left nasal) project to the left side
of the brain. Conversely, the left part of each visual field (left temporal
and right nasal) projects to the right side of the brain.
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The visual pathway
Fig.4.5: The Visual Pathway
1. Myopia or short - sightedness, is the ability to see close objects

clearly while distant objects appear blurry. Myopia is a defect of
the eye in which the focusing system, the cornea and lens, is
optically too powerful, or the eyeball is too long. As a result,
images are focused in front of the retina. Myopia is corrected by a
concave lens that spreads out the light rays coming to the eye so
that, when the light is focused by the eye, it is focused on the
retina. Such lenses are called “minus” lenses.
2. Hypermetropia or long – sightedness is the ability to see distant

objects clearly while close objects appear blurry. Hypermetropia
is a disorder in which the cornea and lens system is optically too
weak or the eyeball is too short. As a result, the focused image is
“behind” the retina when looking at a close object. In
hypermetropia, the lens must accommodate to bring somewhat
distant objects into focus, which would not be necessary for a
normal eye. Closer objects cannot be brought into focus because
the lens cannot change shape enough to focus the image on the
retina. Hypermetropia is corrected by a convex lens that causes
53
light rays to converge as they approach the eye and to focus on the
retina. Such lenses are called “plus” lenses.
3. Presbyopia is the normal, presently unavoidable degeneration of

the accommodation power of the eye that occurs as a
consequence of aging. It occurs because the lens becomes hard
and less flexible. The average age for onset of presbyopia is the
mid-forties. Avid readers and people engaged in fine, close work
may develop the symptoms earlier. Presbyopia can be corrected
by the use of “reading glasses” which are worn only for close
work and are removed when the person wants to see at a distance.
Alternatively, the problem may be corrected by the use of
bifocals, which have a different lens in the top and the bottom, or
by progressive lenses, in which the lens is graded.
4. Astigmatism This is a defect in which the cornea or lens is not

uniformly curved and the image is not sharply focused. Glasses
may be made to adjust for the abnormal curvature as long as the
curvature is not too irregular. If the curvature of the cornea or
lens is too irregular, the condition is difficult to correct.
5. Night Blindness Everyone sees less clearly in the dark than in

the light. A person with night blindness, or nyctalopia, however,
may not see well enough in a dimly lit environment to function
adequately. Night blindness results from loss of rod function. It
can result from general retinal degeneration, such as occurs in
retinitis pigmentosis or detached retinas. Temporary night
blindness can result from a vitamin A deficiency because vitamin
A is necessary to produce retinal. Patients with night blindness
can be helped with electronic optical devices, including
monocular pocket scopes and binocular goggles that
electronically amplify light.
6. Glaucoma Glaucoma is a condition involving excessive pressure

buildup in the aqueous humour. Glaucoma results from an
interference with normal reentry of aqueous humour into the
blood or from an overproduction of aqueous humour. The
increased pressure within the eye can close off the blood vessels
entering the eye and may destroy the retina or optic nerve,
resulting in blindness. Everyone older than 40 years should be
checked every two to three years for glaucoma; those older than
40 who have relatives with glaucoma should have an annual
check-up. Glaucoma is usually treated with eye drops, which do
not cure the problem but keep it from advancing. In some cases,
laser or conventional surgery may be used.
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• describe the anatomy of the eye

• describe the focusing system of the eye and how it adjusts to see
distant and near objects
• explain the structure of the retina, and how light entering the eye
• results in action potentials in the optic nerve
4.0 CONCLUSION
You learnt that the visual system includes the eyes, the accessory
structures, and the sensory neurons that project to the cerebral cortex
where action potentials conveying visual information are interpreted.
5.0 SUMMARY
The fibrous layer is the outer layer of the eyeball. It consists of

the sclera and cornea. The sclera is the posterior four-fifths of the
eyeball. It is white connective tissue that maintains the shape of
the eyeball and provides a site for muscle attachment. The cornea
is the anterior one-fifth of the eye. It is transparent and refracts
light that enters the eye.
The vascular layer is the middle layer of the eyeball. The black
choroid prevents the reflection of light inside the eye. The iris is
smooth muscle regulated by the autonomic nervous system. It
controls the amount of light entering the pupil. The ciliary
muscles control the shape of the lens. The ciliary process
produces aqueous humour.
The retina is the inner layer of the eyeball and contains neurons
sensitive to light. The macula (fovea centralis) is the area of
greatest sensitivity to light. The optic disc is the location through
which nerves exit and blood vessels enter the eye. It has no
photosensory cells and is therefore the blind spot of the eye.
The eyeball has three chambers: anterior, posterior, and vitreous.

The anterior and posterior chambers are filled with aqueous
humour, which circulates and leaves by way of the scleral venous
sinus. The vitreous chamber is filled with vitreous humour.
Accessory structures of the eye are the eyebrows, the eyelids, the
conjunctiva and lacrimal glands.
Visual pathway comprises ganglion cell axons form the optic

nerve, optic chiasm, and optic tracts. They extend to the
55
thalamus, where they synapse. From there, neurons form the optic
radiations that project to the visual cortex.
1. Tears
a. are released onto the surface of the eye near the medial corner of
the eye.
b. in excess are removed by the scleral venous sinus.
c. in excess can cause a sty.
d. can pass through the nasolacrimal duct into the oral cavity.
e. contain water, salts, mucus, and lysozyme.
2. The fibrous layer of the eye includes the
a. conjunctiva.
b. sclera.
c. choroid.
d. iris.
e. retina.
3. Concerning axons in the optic nerve from the right eye,
a. they all go to the right occipital lobe.

b. they all go to the left occipital lobe.
c. they all go to the thalamus.
d. they all go to the superior colliculus.
e. some go to the right occipital lobe and some go to the left
occipital lobe.
4. Contraction of the smooth muscle in the ciliary body causes the
a. lens to flatten.
b. lens to become more spherical.
c. pupil to constrict.
d. pupil to dilate.
5. Given these events:
1. medial rectus contracts

2. lateral rectus contracts
3. pupils dilate
4. pupils constrict
5. lens of the eye flattens
6. lens of the eye becomes more spherical
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Assume you are looking at an object 30 feet away. If you suddenly look
at an object that is one (1) foot away, which events occur?
a. 1,3,6
b. 1,4,5
c. 1,4,6
d. 2,3,6
e. 2,4,5
6. Why do you get a “runny nose” when you cry?
7. What are the layers of the retina?
8. Which are more numerous, rods or cones?
Inc.



Williams & Wilkins


ed.

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NSC 218 MODULE 2
MODULE 2 CENTRAL NERVOUS SYSTEM
CONTENTS
Unit 1 Embryology of the central nervous system

Unit 2 Spinal cord
Unit 3 Brain stem
Unit 4 Dienecephalon and Basal ganglia
Unit 5 Cerebral hemisphere
Unit 6 Ventricles and cerebrospinal fluid
Unit 7 Blood supply of central nervous system
1.0 INTRODUCTION
During a picnic on a sunny spring day, it is easy to concentrate on the

delicious food and the pleasant surroundings. The maintenance of
homeostasis requires no conscious thought. The autonomic nervous
system (ANS) helps keep body temperature at a constant level
bycontrolling the activity of sweat glands and the amount of blood
flowing through the skin. The central nervous system (CNS) consists of
the brain and spinal cord, the peripheral nervous system (PNS) consists
of sensory receptors and nerves outside the CNS. The PNS includes 12
pairs of cranial nerves and 31 pairs of spinal nerves. The CNS receives
sensory information, integrates and evaluates that information, stores
some information, and initiates reactions.
2.0 OBJECTIVES
At the end of this module, you should be able to:
• discuss the formation of the brain and the spinal cord from the
most primitive neural tube
• discuss the anatomy of the central nervous system.
UNIT 1 EMBRYOLOGY OF THE CENTRAL NERVOUS

SYSTEM
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Anomalies of closure
3.2 Spinal cord
4.0 Conclusion
5.0 Summary
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1.0 INTRODUCTION
Brain development occurs at several stages during childhood. The

critical period for brain growth appears to be during the first sixteen
weeks of life. At birth, a baby’s brain weighs approximately 25 per cent
of its future adult weight. By the time the child is two years old the brain
has increased to 75 per cent, and by six years, 90 per cent of its eventual
weight. This, then, indicates phenomenal growth of the central nervous
system during the early years. Peripheral nerves continue to become
myelinated (grow fatty sheaths to increase nerve transmission rate) and
fine physical control appears as the child moves towards adult status.
With the unique environment impinging on every waking and sleeping
hour, this plastic nervous system constantly matures and changes as
demands are put upon it.
2.0 OBJECTIVES
At the end of this unit, you will be able to:
• describe the transformation of the neural tube into the different

parts of the definitive brain.
• differentiate between the events that lead to the formation of the
brain and the spinal cord.
• discuss the cellular formation, differentiation and migration, and
the role of such processes in the formation of the brain and spinal
cord.
3.1 Anomalies of closure
The CNS is an ectodermal derivative that begins to differentiate in the

3rd intrauterine week in humans.
The brain starts its development soon after conception; it is vulnerable to

damage through pregnancy. The first indication of the nervous system is
within the neural plate, a thickened area of the ectoderm that forms after
the ovum has been fertilised in the third week of gestation, Slippers
shaped neural plate thickens rostral to the primitive node and midline
depression in the neural plate forms the neural groove. Edges of the
neural groove rise on both sides of the midline, fusing to convert the
groove to a tube. This neural tube is the beginning of the brain and
spinal cord. As the neural tube separates from the surface ectoderm
cells, the neural folds form the neural crest. Ganglia of the spine, cranial
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and autonomic nervous system develop from the neural crest. Fusion of
the neural groove edges begin in the cervical region and proceed in
cephalocaudal directions.
Formation of the neural tube.
A more cranial site of closure is noted in the forebrain to close the

cranial neuropore in conjunction with the cervical closure site on the
25th intrauterine day. Caudal neuropore closes in similar fashion 2 days
after the cranial counterpart. The neural tube give rise to the brain and
spinal cord, the canal of the tube differentiates into the ventricles and the
central canal of the spinal cord.
The embryo at twenty-three days shows the hindbrain and midbrain to

be formed, and the neural tube closes. In the fourth week the head folds
begin to develop as the forebrain grows rapidly. In the fifth week the eye
starts to grow, and cerebral hemispheres also develop from this area.
The nerves of the branchial arches become the cranial nerves. Peak head
breadth growth velocity occurs at thirteen post-menstrual weeks,
although a relatively high velocity continues to about thirty weeks. Peak
head circumference velocity occurs two to three weeks later, because the
cerebellum situated at the back of the skull grows later than the
cerebrum. Head volume, representing brain size, has its peak velocity at
thirty weeks and growth rapidly slows after this.
60
Anomalies of the closure of the neural tube results in several clinical

conditions such as anencephaly and spinal bifida. Various degrees of
these anomalies noted in many regions of the world. The introduction of
folic acid supplementation in ante-natal care had drastically reduced the
occurrence of such anomalies.
Anencephaly Spina bifida
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3.1.3 Brain Vesicle Formation
The 4th week witnesses the differentiation of the cranial part of the
neural tube into the 3 brain vesicles. Boundary demarcation follows
differential growth rate leading to the formation of the prosencephalon,
mesencephalon and rhombencephalon cranio-caudally. Same
mechanism results in the formation of 2 flexures, cervical and cephalic
flexures. Cephalic flexure opens to the ventral surface while the cervical
opens to the dorsal surface.
By the 5th week of development, the Prosencephalon is divided into the

Telencephalon and Diencephalon by differential growth rate. The
Rhombencephalon also divides into the cranial Metencephalon and
caudal Myelencephalon roughly by the cephalic (Pontine) flexure. The
canal of the neural tube follows the differentiation leading to formation
of Lateral, 3rd, 4th ventricles and the Aqueduct of Sylvius.
Telencephalon
The prosencephalon undergoes massive growth in the 5th week. Growth

is more in the cranio-lateral portion as against the midline portion. The
differential growth rate results in the ballooning of the lateral portion
forming the telencephalon while the more quiescent midline portion
forms the diencephalon. Ballooning is more in the dorsal part of the
telencephalon, the ventral part consist largely of the corpus striatum.
The roof plate ependymal layers in addition to surrounding vascular
mesenchyme form the choroid plexus.
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The choroid plexus bearing portion get “invaginated” due to the lateral
expansion of the ballooning lateral wall.
Just beyond the choroid plexus bearing region, there is proliferation of

neuroblast resulting in the slightly thickened portion that forms the
Hippocampus. The hippocampal portion get “buried” within the
enlarging cortex alongside the roof portion. It bulges into the cavity of
the lateral ventricle. The enlarging dorsal portion of the telencephalon
forms the cerebral cortex. Expansion is in the anterior, posterior and
lateral directions forming the frontal, occipital and temporal lobes
respectively. The ballooned cerebral cortex envelopes the diencephalon,
mesencephalon and upper part of metencephalon.
Axons from the cortical neurons coalesce and pass through the corpus
striatum dividing it into the medial caudate nucleus and the lateral
lentiform nucleus. The dividing axonal bundle forms the internal
capsule.
In the latter quarter of gestation, expansion of the cerebral cortex

exceeds the capacity of the cranial vault resulting in convolutions.
The degree of convolutions is directly related to the degree of

behavioural and neuronal complexity.
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Diencephalon
The portion of the prosencephalon just caudal and medial to the

telencephalon. It consists of roof plate and 2 alar plate, basal plate and
floor plate are absent. The roof plate consists of ependymal lining which
forms the choroid plexus with the surrounding vascular mesenchyme.
There is a caudal neuroepithelial thickening on the dorsal surface which
evaginates around the 7th week to form the pineal body sitting on the
mesencephalon.
The alar plate witness aggregation of cells which is divided into a dorsal
thalamus and a ventral hypothalamus by a hypothalamic sulcus. Cells of
the thalamus proliferate very rapidly resulting in an inward bulge of the
Thalamus obliterating the cavity and forming an adhesion. A ventral
thickening of the neuro-epithelium results in the formation of the
mammillary body which is functionally related to the hypothalamus. An
extension of the ventral wall forms the infundibulum. The infundibulum
alongside the Rathke’s pouch (from the oral cavity) form the pituitary
gland sitting in the Sella Turcica. The cephalic flexure topographically
makes the connection possible.
Mesencephalon
It has the typical basal and alar portions, the basal (ventral) part mediate
motor functions while the alar (dorsal) part mediates sensory function.
The sulcus limitans forms the boundary between the 2 sides. The basal
plate contains 2 groups of motor cells that aggregate into nuclei viz;
Somatic efferent; medially placed CN3 and CN4 motor supply to the
extraocular muscles.
General visceral efferent; laterally placed nucleus of Edinger-Westphal

(sphincter pupillary muscle).
Fibers that connect the spinal cord through the pons from the cerebral
cortex pass through the marginal layer over the basal layer. Marginal
layer over the basal layer enlarges to accommodate fibers forming the
crus cerebri. No particular nucleus is formed in the alar plate of the
mesencephalon. The overlying marginal layer of the alar plate had
neuroblast wave in it resulting in its enlargement. Initially 2 longitudinal
elevation is noticed in the marginal layer of the alar plate, with further
development, a transverse furrow separates them. 4 colliculi are thus
formed namely the inferior and superior colliculi on both sides of the
median sulcus. Serve as synaptic relay centre for auditory and visual
impulses respectively.
64
Metencephalon
It is the cranial portion of the Rhombencephalon. It has well defined

basal and alar plate in which neuroblasts form cellular aggregates that
form nuclei. The roof plate consists largely of ependymal layer, opened
alar plate. It is also the point of formation of the pons and cerebellum.
The fibres from the cerebral cortex to the spinal cord pass through the
marginal layer that overlies the basal plate. Passage of the fibres result in
the enlargement of the marginal layer forming the Pons. In addition to
the fibres, pontine nuclei that are formed from the alar region of the
rhombencephalon migrate in the marginal layer into the Pons. The basal
plate neuroblast differentiate into neurons that are arranged into 3 motor
nuclei mediolaterally;
Somatic efferent; CN6 for extraocular mm,
Special visceral efferent; CN5, CN7 for the 1st and 2nd pharyngeal
arches.
General visceral efferent; CN9 secretomotor supply submandibular

and sublingual glands
The alar plate of the metencephalon contains 3 groups of nuclei that

subserve sensory modalities;
Somatic afferent; CN5, CN8 complex
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The dorsolateral part of the marginal layer over the alar plate
differentiates into the Rhombic lip.
The rhombic lip is wide apart caudally but closes cranially. Pontine
flexure ensures the folding of the metencephalon on itself while the
rhombic lip differentiates into the cerebellar plates. At 12 weeks, a
central vermis and 2 lateral dilated cerebellar hemisphere are identified.
A transverse fissure separates the cerebellar plate into an upper and
lower parts. The fissure separate the vermis from the Nodule while the
hemisphere is separated from the Flocculus. The developing cerebellum
consist of 3 layers viz; neuroepithelial, mantle and marginal. The
external granular layer differentiates from the neuroepithelial layer. The
EGL give rise to granule, purkinje, golgi II neuron cells by the 6th
month, while the other cells (basket and stellate) are derived from the
marginal layer
Myelencephalon
This is the caudal portion of the rhombencephalon. The dorso-lateral

wall is opened up, basal and alar plate are still identifiable separated by
the sulcus limitan. 3 set of motor nuclei are identified in the basal plate;
Somatic efferent; forms a motor column continuous cranio-caudally,

CN12, (tongue) CN6, CN4, CN3 (eye) at different levels.
66
Special visceral efferent; continues cranially as a motor column CN11,

CN10, CN9 supplying the striated muscles of the soft palate and larynx,
pharynx, heart and gut.
General visceral efferent; supply the involuntary muscle of the gut,

heart and respiratory system.
The alar plate have similar arrangement;
Somatic afferent; CN8, CN5 for the ear and head surface.
Special visceral afferent; CN9 for the tongue taste bud. The ependymal
lining of the roof plate alongside the vascular mesenchyme form the
choroid plexus that produces CSF.
NEUROEPITHELIAL CELLS
The neuroepithelial cells lining the neural tube are of simple columnar
type.
Increase cellular proliferation after closure of tube, giving rise to

neuroblast (large deeply stained nucleus and pale cytoplasm). The
neuroblast gives rise to the 2nd layer, mantle layer which differentiate
into the gray matter. The axons of the mantle layer neurons coalesce in
the 3rd layer (outermost) forming the marginal layer.
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The mantle layer differentiates into a basal and alar plate.
The roof and floor plate are usually devoid of neuroblast, have only the
ependymal layer.
The ependymal layer is the final derivative of the neuroepithelial layer.

The dorsal Alar plate houses neurons that subserve sensory modalities,
while the ventral basal plate houses neurons that subserve motor
modalities.
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NEUROHISTOLOGY
Neuroblast; derived from neuroepithelial cell, differentiate through uni,

bi to multipolar neurons. Neurons may take different shapes and size
depending on function.
Glial cell; produced by the neuroepithelial cells following the production

of neurons. Differentiate into astrocyte in the mantle layer and
oligodendrocyte in the marginal layer.
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Astrocytes are star shaped, mainly protoplasmic in the mantle layer and
fibrous in the marginal layer. It is important for the formation of the
blood brain barrier.
Oligodendrocytes have small round deeply stained nucleus usually with

a halo in routine stain, appear in pair or string like formation. It is
responsible for myelination in the central nervous system. Myelination
of the white matter begins in the 2nd trimester and continues postnatally.
Microglia are of mesenchymal origin, invade the CNS in the latter half
of gestation. Usually cigar shaped with fine processes. They are
phagocytic cells
Ependymal cells are the final derivative of neuroepithelial cells. They

line the ventricle and central canal. They are cuboidal and low columnar
in shape.
3.2 Spinal Cord
The mantle layer gives rise to the gray matter of the spinal cord, while
the marginal layer forms the white matter of the spinal cord. Ventral
basal plate subserves motor function while dorsal alar plate subserves
sensory functions. Neuroblast aggregation in between the basal and alar
plate for the intermediate horn in some part of the developing spinal
cord. Intermediate horn neuroblast differentiates into the neurons of the
sympathetic portion of the autonomic nervous system. Intermediate horn
is limited to the region of T1 to T12 and L2-L3.
The axons of the basal plate neuron coalesce exiting through the
marginal layer to form the ventral motor root of the corresponding spinal
nerve about the 4th week. Dorsal root ganglia are derivatives of the
neural crest cells, its neuroblast differentiate into bipolar neurons.
The medial process enters the marginal layer of the alar plate of the SC
ending in the dorsal horn or ascending to higher centers. The other
70
process that grows peripherally coalesces with the ventral motor root to
form the spinal nerve trunk. Myelination is a function of the Schwann
cells in the axons outside the SC while the portion within the SC is
myelinated by oligodendrocyte.
The rate of elongation of the spinal cord and the vertebral column is not
the same. The vertebral column outpaces the spinal cord resulting in an
apparent ascent of the developing spinal cord. At about 3rd month of
life, spinal cord extends the entire length of the vertebral column, at
birth spinal cord ends at the lower border of L3 while at adult hood it
ends at
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L2/L3 boundary. Implication is the obliquity of spinal nerve forming

cauda equine and the formation of filum terminale.
NEURONAL MIGRATION
The neuroblast of the cerebral cortex proliferates rapidly around the

ventricle, forming neurons and supporting (glia) cells. The glial cells
differentiate into the oligodendrocyte and astrocyte.
The neurons that are formed from the neuroblast are largely of 2 types;
viz granular (sensory cortex) and pyramidal (motor). Different sizes and
composition of neurons at each point confer a stratified arrangement on
the cerebral cortex. Each layer consists of neurons of specified
composition and subserves similar functions. Movement of forming
neurons from the point of neuroblast proliferation to their definitive
position is mediated by internal and external cues.
Mechanism of migration is either radial or tangential means. While

radial migration means is mainly employed by the granular and
pyramidal neurons, the tangential mean is employed by interneurons.
Settling of the neuron in their definitive position is in an inside-out
fashion. Migration results in 6-layered cortical arrangement.
• Molecular; few oligodendrocyte almost no neuron.

• External granular; more of round granular neurons.
• External pyramidal; contains small pyramidal neurons.
• Internal granular; contain granular cells that are closely packed.
72
• Internal pyramidal; contain medium to large pyramidal cells,

home to Betz cells.
• Multiform layer; contains different cell type.
Clinical correlates
Anencephaly - this is the absence of a major portion of the brain, skull

and scalp that occurs during embryonic r. It is a cephalic disorder that
results from a neural tube defect that occurs when the rostral (head) end
of the neural tube fails to close, usually between the 23rd and 26th day
of conception. With very few exceptions, infants with this disorder do
not survive longer than a few hours or possibly days after birth.
Spina bifida - this is a developmental congenital disorder caused by the

incomplete closing of the embryonic neural tube. Some vertebrae
overlying the spinal cord are not fully formed and remain unfused and
open. If the opening is large enough, this allows a portion of the spinal
cord to protrude through the opening in the bones. There may or may
not be a fluid – filled sac surrounding the spinal cord. Spinal bifida
malformations fall into three categories: spina bifida occulta, spina
bifida cystic with meningocele, and spina bifida cystic with
myelomeningocele. The most common location of the malformations is
the lumbar and sacral areas. Spina bifida can be surgically closed after
birth, but this does not restore normal function to the affected part of the
spinal cord.
Self – Assessment Exercises
1. describe the transformation of the neural tube into the different

parts of the definitive brain.
2. differentiate between the events that lead to the formation of the
brain and the spinal cord.
3. discuss the cellular formation, differentiation and migration, and
the role of such processes in the formation of the brain and spinal
cord.
4.0 CONCLUSION
The CNS is an ectodermal derivative that begins to differentiate in the

3rd intrauterine week in humans.
5.0 SUMMARY
• The first indication of the nervous system is within the neural

plate, a thickened area of the ectoderm that forms after the ovum
has been fertilised in the third week of gestation.
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• The neural plate thickens rostral to the primitive node and

midline depression in the neural plate forms the neural groove.
Edges of the neural groove rise on both sides of the midline,
fusing to convert the groove to a tube. The neural tube is the
beginning of the brain and spinal cord. As the neural tube
separates from the surface ectoderm cells, the neural folds form
the neural crest. Ganglia of the spine, cranial and autonomic
nervous system develop from the neural crest.
• Anomalies of the closure of the neural tube results in several

clinical conditions such as anencephaly and spinal bifida.
• The 4th week witnesses the differentiation of the cranial part of

the neural tube into the 3 brain vesicles which leads to the
formation of the prosencephalon, mesencephalon and
rhombencephalon cranio-caudally. Same mechanism results in
the formation of 2 flexures, cervical and cephalic flexures.
Cephalic flexure opens to the ventral surface while the cervical
opens to the dorsal surface.
• By the 5th week of development, the Prosencephalon is divided

into the Telencephalon and Diencephalon by differential growth
rate. The Rhombencephalon also divides into the cranial
Metencephalon and caudal Myelencephalon roughly by the
cephalic (Pontine) flexure.
• The neuroblast of the cerebral cortex proliferates rapidly around

the ventricle, forming neurons and supporting (glia) cells. The
glial cells differentiate into the oligodendrocyte and astrocyte.
6.0 TUTOR MARK ASSIGNMENTS
1. What is the neural plate?

2. What are the differences between the right and left hemispheres
of the brain?
3. What are the primitive general functional areas of the brain?
4. When do the fontanelles of the skull close?
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UNIT 2 THE SPINAL CORD
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 General structure of the spinal cord
3.2 Meninges of the spinal cord
3.3 Internal structure of the spinal cord
3.4 Clinical correlate
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
The spinal cord is extremely important to the overall function of the

nervous system. It is the major communication link between the brain
and the PNS (spinal nerves) inferior to the head. The spinal cord
participates in the integration of incoming information and produces
responses through reflex mechanisms.
2.0 OBJECTIVES
• discuss the parts of the spinal cord

• describe the three meningeal layers surrounding the spinal cord
and brain
• describe the spinal cord in cross section and the origin of spinal
nerves
• describe the blood supply of the spinal cord
3.0 MAIN CONTENT
3.1 General structure of the spinal cord
The spinal cord connects to the brain at the level of the foramen
magnum and extends inferiorly in the vertebral canal to level L1–L2 of
the vertebral column. It is considerably shorter than the vertebral column
because it does not grow as rapidly as the vertebral column during
development. The spinal cord gives rise to 31 pairs of spinal nerves,
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which exit the vertebral column through intervertebral and sacral

foramina.
Develops from the caudal portion of the neural tube, it is a region of less
differentiation. It consists of 31 segments conferred by the emergence of
the spinal nerves; cervical -8, thoracic- 12, lumbar-5, sacral-5,
coccygeal- 1. Measuring about 42-45cm in adult.
The spinal cord is not uniform in diameter throughout its length. The
cervical enlargement in the inferior cervical region is where spinal
nerves supplying the upper limbs originate. The lumbosacral
enlargement in the inferior thoracic, lumbar, and superior sacral regions
is the site where spinal nerves supplying the lower limbs originate.
Immediately inferior to the lumbosacral enlargement, the spinal cord

tapers to form a conelike region called the conus medullaris. Nerves
arising from the inferior lumbosacral enlargement and the conus
medullaris extend inferiorly through the vertebral canal before exiting
the vertebral column. The numerous roots (origins) of these nerves
resemble the hairs in a horse’s tail and are therefore called the cauda
equine
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The spinal cord and segments
3.2 Meninges of the spinal cord
The spinal cord is a long cylindrical structure with flattened

anterioposterior surfaces. The spinal cord and brain are surrounded by
connective tissue membranes called meninges. The most superficial and
thickest membrane is the dura mater. The dura mater forms a sac, often
called the thecal sac, which surrounds the spinal cord. The thecal sac
attaches to the rim of the foramen magnum and ends at the level of the
second sacral vertebra. The spinal dura mater is continuous with the
dura mater surrounding the brain and the connective tissue surrounding
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the spinal nerves. The dura mater around the spinal cord is separated
from the periosteum of the vertebral canal by the epidural space, which
contains spinal nerves.
3.3 Internal structure of the spinal cord
The internal structure of the spinal cord consists of the white and gray
matter.
White matter is a collection of myelinated fibres, while cellular

aggregates are in the gray matter.
H-shaped gray matter located within the cylindrical white matter, bridge
of the h incorporating the central canal. Dorsal limbs of the h form the
posterior horn which extends close to surface.
The anterior horns are farther away from the surface. The medial
anterior horn cell innervate trunk muscles, lateral part supplies the
limbs. Ventral part of lateral horn supplies the proximal muscles while
dorsal part supplies distal muscles of limbs. The white matter is bounded
by the limbs of the H-shaped gray matter are grouped as the anterior,
posterior and lateral white column.
A narrow white commissure separates the anterior median fissure from

the grey commissure.
78
Spinal segments
Segmental differences exist with respect to the size of the grey horn and
the white column.
Cervical segment; large oval shaped structure, relatively larger white

matter. Posterior horn is smaller than the anterior. Posterior intermediate
septum divides the posterior column into graciles and cuneatus. The
posterior horn is enlarged from the C5 level downwards. Reticular
process is at the base of the posterior horn.
Thoracic segments; the gray matter is relatively smaller than the white
matter. Gracilis and cuneatus extend as far as mid thoracic segments,
while gracilis continues caudally. T1 is more of a cervical in outline and
gray and white matter proportion. Lateral horn at the base of the anterior
horn, give rise to the preganglionic sympathetic efferent. Dorsal nucleus
of Clarke located on the medial side of the base of the posterior horn,
most obvious in T10-T12.
Lumbar segment; almost circular in transverse section. White matter

proportionally less than gray matter. Gracilis has thinned out. Blunt
lateral process on the lateral side of the base of stout anterior horn.
Dorsal nucleus of Clarke in L1-L2.
Sacral segment; small cylindrical structure. Gray matter relatively more

than the white matter.
Thickened gray commissure, posterior and anterior horn. Small lateral
horn for the preganglionic parasympathetic cells.
Introduction of Needles into the Subarachnoid Space
Several clinical procedures involve the insertion of a needle into the

subarachnoid space inferior to the level of the second lumbar vertebra.
The needle is introduced into either the L3/L4 or the L4/L5
intervertebral space. The needle does not contact the spinal cord because
the spinal cord extends only approximately to the second lumbar
vertebra of the vertebral column. The needle enters the
subarachnoidspace, which extends to level S2 of the vertebral column.
The needle does not damage the nerve roots of the cauda equine located
in the subarachnoid space because the needle quite easily pushes them
aside. In spinal anesthesia, or spinal block, drugs that block action
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potential transmission are introduced into the subarachnoid space to

prevent pain sensations in the lower half of the body.
A spinal tap is the removal of CSF from the subarachnoid space. A

spinal tap may be performed to examine the CSF for infectious agents
(meningitis), for the presence of blood (hemorrhage), or for the
measurement of CSF pressure. A radiopaque substance may also be
injected into this area, and a myelogram (radiograph of the spinal cord)
may be taken to visualize spinal cord defects or damage.
Damage to the spinal cord can disrupt ascending tracts from the spinal
cord to the brain, resulting in the loss of sensation, and/or descending
tracts from the brain to motor neurons in the spinal cord, resulting in the
loss of motor functions. Automobile and motorcycle accidents are
leading causes, followed by gunshot wounds, falls, and swimming
accidents. Spinal cord injury is classified according to the vertebral level
at which the injury occurred, whether the entire cord is damaged at that
level or only a portion of the cord, and the mechanism of injury. Most
spinal cord injuries occur in the cervical region or at the thoracolumbar
junction and are incomplete.
Self – Assessment Exercise
• discuss the parts of the spinal cord

• describe the three meningeal layers surrounding the spinal cord
and brain
• describe the spinal cord in cross section and the origin of spinal
nerves
• describe the blood supply of the spinal cord
4.0 CONCLUSION
The spinal cord connects to the brain at the level of the foramen
magnum and extends inferiorly in the vertebral canal to level L1–L2 of
the vertebral column. It is considerably shorter than the vertebral column
because it does not grow as rapidly as the vertebral column during
development.
5.0 SUMMARY
The spinal cord gives rise to 31 pairs of spinal nerves. The spinal
cord has cervical and lumbosacral enlargements from which
spinal nerves of the limbs originate.
The spinal cord is shorter than the vertebral column. Nerves from
the end of the spinal cord form the cauda equina.
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Three meningeal layers surround the spinal cord. From

superficial to deep they are the dura mater, arachnoid mater, and
pia mater.
The epidural space is between the periosteum of the vertebral
canal and the dura mater, the subdural space is between the dura
mater and the arachnoid mater, and the subarachnoid space is
between the arachnoid mater and the pia mater.
Gray matter is divided into horns. The dorsal horns contain
sensory axons that synapse with interneurons. The ventral horns
contain the neuron cell bodies of somatic motor neurons, and the
lateral horns contain the neuron cell bodies of autonomic motor
neurons.
The dorsal root contains sensory axons, the ventral root has
motor axons, and spinal nerves have sensory and motor axons.
I. In the anatomy museum, identify the major features on the

models and slide of a cross – section of the spinal cord; also note
the three layers of the meninges on the cross- section models.
1. The spinal cord extends from the
a. medulla oblongata to the coccyx.

b. level of the third cervical vertebra to the coccyx.
c. level of the axis to the lowest lumbar vertebra.
d. level of the foramen magnum to level L1–L2 of the vertebral
column.
e. axis to the sacral hiatus.
2. Axons of sensory neurons synapse with the cell bodies of

interneurons in the of spinal cord gray matter.
a. anterior horn
b. lateral horn
c. posterior horn
d. gray commissure
e. lateral funiculi
3. Cell bodies for spinal sensory neurons are located in the

a. anterior horn of spinal cord gray matter.
b. lateral horn of spinal cord gray matter.
c. posterior horn of spinal cord gray matter.
d. dorsal root ganglia.
e. posterior columns.
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4. Contrast the epidural and the subarachnoid spaces.

5. Describe the appearance of the spinal cord in cross section.
6. Discuss the anatomy of the terminal portion of the spinal cord.
7.0 REFERENCES AND OTHER RESOURCES
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UNIT 3 BRAIN STEM
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Cranial nerve nuclei
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
The Brain Stem is a structural connection between the diencephalon and

the spinal cord. The brainstem consists of the medulla oblongata, pons,
and midbrain. It connects the spinal cord and cerebellum to the
remainder of the brain, and 10 of the 12 pairs of cranial nerves arise
from it. In general, the posterior part of the brainstem contains ascending
tracts from the spinal cord, cerebellum, and cranial nerves, whereas the
anterior part of the brainstem contains descending tracts involved with
motor control. The brainstem contains several nuclei involved in vital
body functions, such as the control of heart rate, blood pressure, and
breathing.
The caudal portion of the brain stem transit into the spinal cord at the
level of the foramen magnum. It contains ascending and descending
fibers interspersed with cellular aggregate known as the nuclei. The
corticospinal (motor), posterior column (fine touch, vibration sense and
proprioception) and spinothalamic (crude touch, temperature and pain).
2.0 OBJECTIVES
• to describe the anatomy of the different parts of the brain stem.

• to identify the characteristic features of the midbrain, pons and
medulla oblongata.
3.0 MAIN CONTENT
3.1 Cranial nerve nuclei
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The cranial nerve nuclei 3-12 are located in the brain stem in addition to
other anatomically distinct nuclei.
The midbrain contains CN 3, 4
The Pons contains CN 5, 6, 7
The Medulla contains CN 9, 10, 11, 12
The CN 8 is located in the pontomedullary junction. Diffuse cellular

arrangements are also located in the brain stem forming the Reticular
system. The reticular formation is related to several vital centers. The
sensory part of the CN 5 spans the whole of the brain stem as far as the
upper spinal cord. All cranial nerves emerge from the ventral surface of
the brain stem except the Trochlear.
Mid-brain
It is the shortest part of the brainstem measuring about 2cm. Ventrally it

is characterized by a V shaped crura that converge on the superior
surface of the pons. Dorsally, the superior and inferior colliculi form 2
pairs of round elevation. The superior cerebellar peduncle connects the
cerebellum to the dorsal surface of the midbrain caudal to the inferior
colliculus.
The medial geniculate body and lateral geniculate body are lateral to the
superior colliculus, while the pineal gland and pulvinar are superiorly
related.
The CN 3 emerges from the ventral surface on the medial side of the
cerebral peduncle, while the CN 4 courses ventrally from its point of
emergence on the dorsal surface inferior to the inferior colliculus.
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The 2 CN run between the superior cerebellar and posterior cerebral

arteries which provide blood supply for the midbrain.
It is ventro-dorsally divisible into the base, tegmentum and tectum.
Histologically the superior and inferior colliculi provide a logical

reference point.
Superior colliculus level; the oculomotor nucleus is close to midline

with the Edinger-Westphal nucleus cranial to it. The red nucleus is
lateral and ventral to CN 3, the axons of the CN pass through it. It
receives input from the contralateral cerebellar hemisphere (dentate
nucleus) via the superior cerebellar peduncle.
Inferior colliculus level; the nucleus of CN 4 lie ventral to the aqueduct,

its fibers run dorsally decussating dorsal to the aqueduct.
The Substantia Nigra forms the boundary between the crus and the
tegmentum. Its cells contain melatonin giving rise to nigrostriatal fibers.
Fibers project to the other basal ganglia nuclei. Loss of dopamine

producing cells explains Parkinsonism. Mesencephalic nucleus of CN 5
lies in the central gray matter, while spinal and medial lemnisci lie in the
lateral region of tegmentum.
The reticular formation is located between the medial lemniscus and the
central gray matter.
The crura contain corticospinal and corticonuclear fibers in the middle

2/3rd portion while frontopontine and temporopontine fibers occupy the
medial and lateral 1/6th.
The tectum is occupied by the superior and inferior colliculi with inputs
from the retina and cochlea respectively.
Efferent fibers travel in the tectospinal and tectobulbar tracts for general
light and sound reflexes
The pretectal nucleus is located at the junction between the midbrain and
the diencephalon subserving the pupillary light reflexes.
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3.3.4 Pons
The parts of the brainstem
The pons forms a bridge between the midbrain, medulla and the
cerebellum. It contains the respiratory center. It’s transversely running
fibers coalesce to form the middle cerebellar peduncle. The motor and
sensory part of the CN 5 emerges from its ventral surface just lateral to
the midline.
A midline groove houses the basilar artery, while the superior cerebellar
artery curves around its boundary with the midbrain. At the
pontomedullary junction CN 6 emerges at the midline while CN 7 and 8
emerge more laterally. The cerebellum covers the dorsal surface of the
pons with the pontine part of the 4th ventricle in between them. The
central aqueduct opens directly into the 4th ventricle. The superior
medullary velum (anchored on SCP) intervenes as the roof between the
ventricle and the cerebellum. The upper part and lower part of the pons
are distinguishable by the presence or absence of opened 4th ventricle.
The ventral part of the pons has pontine nuclei with corticopontine fibers
passing through them.
Upper pons; the motor nucleus of CN 5 is located on the lateral part of

the floor of 4th ventricle, while the main sensory nucleus (touch) is
lateral to it. The sensory nucleus is continuous with the mesencephalic
nucleus (proprioception) in the midbrain.
Lower pons; the nucleus of CN 6 lie on the floor of the 4th ventricle
near midline while that of CN 7 lies ventral and lateral to it. Fibers of
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CN 7 course dorsal to the nucleus of CN 6 raising a facial colliculus on

the floor of the 4th ventricle. The nucleus of CN 8 lie on the floor of the
4th ventricle lateral to the CN 7 extending to the medulla, the vestibular
portion is more medial.
Vestibular part receives fibers from the internal acoustic meatus, while
the cochlea part receives fibers from the spiral ganglia of cochlea. Both
travel in the inferior cerebellar peduncle.
Blood supply is from the basilar artery superior cerebellar and anterior
inferior cerebellar arteries.
Medulla oblongata
This is the portion of the brain stem that connects the pons to the spinal
cord. It is continuous with the spinal cord at the level of foramen
magnum. Dorsally the upper part is covered by the cerebellum with the
caudal part of the 4th ventricle intervening. This portion of the 4th
ventricle is roofed by a layer of ependyma and pia matter.
The caudal part of the dorsal surface presents 2 elevations namely the
gracile and cuneate tubercle secondary to underlying nuclei
mediolaterally. Ventrally, the upper part is grooved in the midline, the
pyramid and olive are elevations lateral to the midline. The pyramid is
secondary to the corticospinal fibers while the olive is secondary to the
inferior olivary nucleus. The most lateral elevation forms the lateral
boundary, the inferior cerebellar peduncle.
The CN 6, 7 and 8 emerge from the pontomedullary junction

mediolaterally. The CN 9, 10 and 11 emerge as rootlets lateral to olive
and CN 12 between pyramid and olive. 3 levels of medulla are
identifiable, the open part, the upper closed part and the lower closed
part.
Open part; the floor of the 4th ventricle is the site of most cranial nerve
nuclei. The hypoglossal nucleus is located adjacent to the midline
beneath the hypoglossal trigone. The nucleus of the vagus is located
lateral to the hypoglossal beneath the vagal trigone. It controls the
cardiac and visceral muscle and glandular secretions. The nucleus of
tractus solitarus lie lateral to that of vagal, its cranial part receives fibers
from chorda tympani, glossopharyngeal and internal laryngeal branch of
vagus.
The nucleus ambiguus lies lateral containing motor cell bodies for
larynx, soft palate, pharynx and upper oesophagus skeletal muscles. The
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inferior olivary nucleus is a crenated C-shaped strip of gray matter with

its open end facing the opposite cerebellar peduncle.
Upper closed part; it shows the central decussation of the fibers that
form the medial lemniscus (fibers of gracile and cuneate nuclei).
Lower closed part; it is characterized by the pyramidal decussation.

Centre for the control of reflex activities such as coughing, swallowing
and vomiting. Centers for the control of respiratory, cardiac and motor
function are also located in the medulla.
Blood supply of the medulla: anterior spinal branch of vertebral artery

(medial medullary syndrome).Posterior inferior cerebellar artery (lateral
medullary syndrome).
Parkinsonism: this is a neurological syndrome characterized by tremor,

hypokinesia, rigidity and postural instability. The neurodegenerative
condition Parkinson’s disease is the most common cause of
Parkinsonism. The motor symptoms of this disease result from the death
of dopamine – generating cells in the substantia nigra. Modern
treatments are effective at managing the early motor symptoms of the
disease, these include levodopa and dopamine agonists.
Brainstem stroke syndromes: there are a large number of well-defined

brainstem stroke syndromes, most of which involve ischemia in the
distribution of the basilar or vertebral arteries. Magnetic resonance
imaging (MRI) is frequently needed to make a specific diagnosis.
SELF – ASSESSMENT EXERCISE
• to describe the anatomy of the different parts of the brain stem.

• to identify the characteristic features of the midbrain, pons and
medulla oblongata.
4.0 CONCLUSION
The Brain Stem is a structural connection between the diencephalon and

the spinal cord. The brainstem consists of the medulla oblongata, pons,
and midbrain
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5.0 SUMMARY
• The midbrain is superior to the pons. The corpora quadrigemina

consists of four colliculi. The two inferior colliculi are involved
in hearing and the two superior colliculi in visual reflexes.
• The substantia nigra and red nucleus help regulate body
movements. The cerebral peduncles are the major descending
motor pathway
• The pons is superior to the medulla. Ascending and descending
tracts pass through the pons. The pons connects the cerebrum and
the cerebellum. Pontine nuclei regulate breathing, swallowing,
balance, chewing, and salivation.
• The medulla oblongata is continuous with the spinal cord and
contains ascending and descending tracts. Medullary nuclei
regulate the heart, blood vessels, breathing, swallowing,
vomiting, coughing, sneezing, hiccuping, balance, and
coordination. The pyramids are tracts controlling voluntary
muscle movement.
1. Important centers for heart rate, blood pressure, breathing,

swallowing, coughing, and vomiting are located in the
a. cerebrum.
b. medulla oblongata.
c. midbrain.
d. pons.
e. cerebellum.
2. In which of these parts of the brain does decussation of

descending tracts involved in the conscious control of skeletal
muscles occur?
a. cerebrum
b. diencephalon
c. midbrain
d. pons
e. medulla oblongata
3. Important respiratory centers are located in the

a. cerebrum.
b. cerebellum.
c. pons and medulla oblongata.
d. midbrain.
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e. limbic system
4. The cerebral peduncles are a major descending motor pathway
found in the
a. cerebrum.
b. cerebellum.
c. pons.
d. midbrain.
e. medulla oblongata.
5. The superior colliculi are involved in, whereas the inferior
colliculi are involved in
a. hearing, visual reflexes

b. visual reflexes, hearing
c. balance, motor pathways
d. motor pathways, balance
e. respiration, sleep
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UNIT 4 DIENCEPHALON AND BASAL GANGLIA
CONTENTS
1.0 Introduction
2.0 objectives
3.0 Main Content
3.1 Structure of the diencephalon
3.2 Thalamus
3.3 Basal ganglia
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
The forebrain consists largely of white matter with buried grey matter
aggregates.
Largest grey matter aggregate is the thalamus. Other grey matter

aggregate lies lateral to the thalamus known as the basal ganglia/nuclei.
The unexpanded portion of the forebrain that is in the midline is known
as the diencephalon. The grey matter aggregates are lateral relations of
the diencephalon, the thalamus more medial than the basal ganglia.
2.0 OBJECTIVES
• describe the diencephalon and basal ganglia

• discuss the anatomy of the thalamus and its surrounding
structures
• discuss the anatomical basis of Parkinson’s disease.
3.1 Structure of the diencephalon
The 3rd ventricle is the cavity of the diencephalon. It is a slit-like space

which lies in the sagittal plane roofed by the fornix and the corpus
callosum. The lateral wall of the 3rd ventricle is largely formed by the
thalamus. The thalamus is separated from the hypothalamus on the
lateral wall of the 3rd ventricle by the hypothalamic sulcus. The sulcus
runs from the interventricular foramen towards the aqueduct of the
midbrain. The lower part of the lateral wall and the floor of the 3rd
ventricle is formed by the hypothalamus. The optic chiasma forms the
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anterior end of the floor of the 3rd ventricle. The infundibulum is just
behind the optic chiasma and projects downward forming the pituitary
stalk. The pituitary stalk provides a path of communication between the
hypothalamus and the posterior lobe of pituitary gland. Other featureson
the external surface of the floor are mammillary bodies and posterior
perforated substance.
The median eminence is the portion of the floor just behind the
infundibulum. It contains cells that control the anterior pituitary gland.
The anterior wall of the 3rd ventricle is the lamina terminalis extending
from the anterior commissure to the optic chiasma. The body of the
fornix separates the anterior commissure from the interventricular
foramen. Between the rostrum, genu and body of the corpus callosum
and the body of the fornix is a 2 ply thin partition known as the septum
pellucidum. The roof is formed by pia matter which covers the superior
surface of the thalamus. The roof is invaginated by the pair of choroid
plexus.
The posterior wall tapers towards the midbrain. The pineal gland
projects posteriorly from the posterior wall, above the superior
colliculus. This small conical body secretes melatonin, its stalk is
attached to the posterior commissure. Calcification of the pineal gland is
common after 40 years and is thus useful for radiologist as an indicator
of brain symmetry.
3.2 Thalamus
It is the largest of the cellular aggregate of the forebrain. It forms the

lateral wall of the diencephalon. The medial surfaces of the thalamus lie
parallel to each other slightly bulging into the 3rd ventricle. An
interthalamic adhesion joins the 2 thalami in about 60-80% of cases,
there is however no exchange of substance via this connection. The
pulvinar is the posterior end of the medial surface of the thalamus. The
opening of the interventricular foramen forms the anterior limit of the
thalamus, while the posterior commissure is the posterior limit. It
extends from the 3rd ventricle to the medial side of the posterior limb of
the internal capsule.
The superior surface of the thalamus tapers anteriorly from the pulvinar
to the small anterior pole. The pia matter covering of the superior
surface extends to the pulvinar as far backward as the pineal gland. The
lateral edge of the superior surface is covered by ependyma and forms
part of the floor of the lateral ventricle. The substance of the thalamus is
divided into lateral, medial and anterior portions by the sheet of white
matter known as the internal medullary lamina.
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The lateral surface is closely related to the internal capsule. Lateral

boundary corresponds with the position of the stria terminalis and the
terminal vein. The inferior surface is medially continuous with the
hypothalamus separated by the hypothalamic sulcus.
The thalamic nuclei are grouped, following structural delineation by the

internal medullary lamina and function.
Anterior nuclei group; the anterior end of the thalamus separated from
the other part by the limbs of the internal medullary lamina. Connected
to the mammillary body and projects to the cingulate gyrus.
Medial nuclei group; the gray substance medial to the internal

medullary lamina, it projects to the frontal cortex.
Lateral nuclei group; mass of cells anterior to the pulvinar on the

lateral side of the thalamus, project to different parts of the brain
including motor cortex, postcentral gyrus and parietal lobe.
It receives fibres from the medial lemniscus, spinothalamic and
trigeminal tracts.
Posterior nuclei group; this consists of the pulvinar and the medial and
lateral geniculate bodies. The pulvinar is the large posterior nuclei that
projects to the temporal and parietal lobes.
The medial geniculate body is ventral to the pulvinar and lateral to the
midbrain, receives fibres from the lateral lemniscus and inferior
colliculus, projects into the temporal lobe.
The lateral geniculate body is an oval elevation on the posterior end of

the pulvinar, receives fibres from the optic tract and projects to the
visual cortex.
3.3 Basal ganglia
This consist of the caudate nucleus, lentiform nucleus, amygdaloid body

and claustrum. The lentiform nucleus consists of an outer putamen and
an inner globus pallidus. The caudate and putamen form the striatum. It
is the larger part of the basal ganglia and its afferent part.
Caudate nucleus: It is a comma shaped structure with a demonstrable

bulbous head, body and tail attached to the amygdaloid body.
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The basal ganglia
The convexity of the caudate nucleus projects into the ventricle. The
internal capsule fibres run in the concavity of the nucleus. The lentiform
nucleus; consist of the putamen and globus pallidus. It is biconvex in
shape with the putamen lateral and smaller medial globus pallidus.
The caudate nucleus and the putamen are joined by many
interconnecting fibre running through the anterior part of the internal
capsule (corpus striatum).
Amygdaloid body: a group of grey matter at the tip of the tail of the
caudate nucleus. It lies on the roof of the inferior horn of the lateral
ventricle. It has numerous neurons that connect it to the frontal, temporal
and olfactory lobes. Its efferent bundle (stria terminalis) runs parallel to
the concavity of the caudate nucleus. The claustrum is a saucer shaped
thin lamina of grey matter, lateral to the putamen.
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Functional anatomy
The corpus striatum is the afferent centre of the basal ganglia

receiving fibres from the cortex, thalamus and substantia nigra.
The globus pallidus is the efferent pathway of the basal ganglia

sending fibres to the thalamus, subthalamic nucleus, substantia
nigra etc
The basal ganglia offer supraspinal control over skeletal muscle

movement, modulating the rate, range and coordination.
Several neurotransmitter are involved in the different pathways

such as the acetylcholine, dopamine, glutamate, serotonin etc
Parkinsonism is the most common anomaly of the basal nuclei. It

involves a decrease in dopamine in the nigrostriatal pathway
following destruction of dopaminergic cells of the substantia
nigra. Huntington's disease is as a result of destruction of the
neurons in the striatum.
Huntington's disease - this is a neurodegenerative genetic disorder that

affects muscle coordination and leads to cognitive decline and
behavioural symptoms. The disease can affect both male and female and
presents mostly in mid – adult life although physical symptoms can
begin at any age. It is much more common in Western European people.
Parkinsonism - as discussed in the earlier unit.
Self – Assessment Exercises
• describe the diencephalon and basal ganglia

• discuss the anatomy of the thalamus and its surrounding
structures
• discuss the anatomical basis of Parkinson’s disease
4.0 CONCLUSION
The basal ganglia are a group of structures found deep within the
cerebral hemispheres. The structures generally included in the basal
ganglia are the caudate, putamen, and globus pallidus in the cerebrum,
the substantia nigra in the midbrain, and the subthalamic nucleus in the
diencephalon
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5.0 SUMMARY
• The diencephalon is located between the brainstem and the

cerebrum. It consists of the thalamus, subthalamus, epithalamus,
and hypothalamus.
• The thalamus consists of two lobes connected by the
interthalamic adhesion. The thalamus functions as an integration
center. All sensory input that reaches the cerebrum, except for the
sense of smell, synapses in the thalamus. Pain is registered in the
thalamus.
• The thalamus interacts with other parts of the brain to control
motor activity. The thalamus is involved with emotions and pain
perception. The subthalamus is inferior to the thalamus and is
involved in motor function.
• The epithalamus is superior and posterior to the thalamus and
contains the habenula, which influence emotions through the
sense of smell. The pineal gland may play a role in the onset of
puberty and the sleep–wake cycle.
• The hypothalamus is inferior to the thalamus. The hypothalamus
is a major integrating center for the ANS, helping control heart
rate, blood vessel diameter, urine release from the urinary
bladder, and the movement of food through the digestive tract.
The hypothalamus regulates body temperature, hunger, satiety,
thirst, and swallowing and interacts with the reticular activating
system.
• The hypothalamus is involved with sensations (sexual pleasure,
good feelings, rage, and fear). The mammillary bodies are reflex
centers for olfaction.
1. The major relay station for sensory input that projects to the
cerebral cortex is the
a. hypothalamus.
b. thalamus.
c. pons.
d. cerebellum.
e. midbrain.
2. Which part of the brain is involved with olfactory reflexes and

emotional responses to odours?
a. inferior colliculi
b. superior colliculi
c. mammillary bodies
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d. pineal gland
e. pituitary gland
3. Which of the following is a function of the hypothalamus?
a. regulates autonomic nervous system functions

b. regulates the release of hormones from the posterior
pituitary
c. regulates body temperature
d. regulates food intake (hunger) and water intake (thirst)
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UNIT 5 CEREBRAL HEMISPHERE
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Superolateral surface
3.2 Cortical area and structure 3.3 Nails
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
The cerebrum is the part of the brain that most people think of when the
term brain is mentioned. The cerebrum accounts for the largest portion
of total brain weight, which is about 1200 g in females and 1400 g in
males. Brain size is related to body size; larger brains are associated
with larger bodies, not with greater intelligence.
The cerebrum is divided into left and right hemispheres by a

longitudinal fissure. The most conspicuous features on the surface of
each hemisphere are numerous folds called gyri, which greatly increase
the surface area of the cortex. The grooves between the gyri are called
sulci. The central sulcus, which extends across the lateral surface of the
cerebrum from superior to inferior, is located about midway along the
length of the brain. The general pattern of the gyri is similar in all
normal human brains, but some variation exists between individuals and
even between the two hemispheres of the same cerebrum.
Each cerebral hemisphere is divided into lobes, which are named for the
skull bones overlying each one.
2.0 OBJECTIVES
• Describe the different regions of the cerebral hemisphere.

• Identify the boundaries of the different regions of the cerebral
hemisphere.
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• Identify the different gyri and sulci as well as the functional areas
of the cerebrum.
3.0 MAIN CONTENT
3.1 Superolateral surface
Each lobe consists of gyri and sulci that have specific name. 3 main
sulci delineate the boundary of the lobes, viz; central, lateral and parieto-
occipital. Lateral sulcus (fissure of Sylvius) is the sulcus that separates
the frontal from the temporal lobe. The anterior end of the sulcus
penetrates (anterior and ascending rami) the inferior frontal gyrus
dividing it into the Orbital, Triangularis and Operculum parts. Central
sulcus; (fissure of Rolando) runs on the superolateral surface of the
cerebrum just caudal to the anterio-posterior midpoint. It runs downward
and forward stopping short of the lateral sulcus. It separates the frontal
from the parietal lobe. The precentral gyrus is just anterior to it, while
the postcentral gyrus is just behind it.
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Medial surface
On the medial surface of the cerebral hemisphere, the corpus callosum

stands out as a collection of white matter that connects the 2 hemisphere.
The cingulate gyrus lies above the corpus callosum while the medial and
superior frontal gyri lie above it separated by the cingulate sulcus.
The paracentral lobule caps the medial end of the central sulcus. The
calcarine and parieto-occipital sulci form a Y shaped furrow lying on its
side facing posteriorly. The precuneus gyrus lies above the upper arm
and limb of the ‘Y’. The cuneus gyrus lies in between the 2 arms of the
‘Y’ The lingual gyrus lies below the ‘Y’ at the inferio-medial border of
the cerebrum. The inferior surface revealed the rectus gyrus, olfactory
tract/bulb and orbital gyrus and sulcus from medial to lateral.
Parrahippocampal gyrus lies medially on the inferior surface of temporal

lobe terminate in the uncus
The brain stem is the other major structure on the inferior surface of an
intact brain.
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3.2 Cortical area and structure
The primary motor sensory area corresponds with the precentral gyrus
and frontal lobe (Area 4 and 6). Afferent fibers exit via the
corticonuclear and pyramidal bundles, modulated by the Thalamus and
Cerebellum. The supplementary motor area corresponds with part of the
medial surface of the frontal lobe (Area 6 and 8). The primary
sensorimotor area corresponds with the postcentral gyrus and the
adjoining medial surface of the parietal lobe (Area 3, 2 and 1). Subserve
touch, kinaesthetic and vibration senses.
The inferior portion of postcentral gyrus corresponds with the

supplementary sensory area (Area 40 and 43), subserve pain and
temperature modalities. Anterior Motor speech area (Broca) corresponds
to the inferior orbital gyrus of the dominant hemisphere and the pars
triangularis (Area 44 and 45). Posterior speech area (Wernicke) is the
posterior end of the superior and middle temporal gyri and the lower
part of the parietal lobe.
Frontal eye field (Area 6, 8 and 9) is the centre of the middle frontal
gyrus, it subserves the voluntary eye movement and accommodation
functions.
Olfactory area corresponds with the Uncus and adjoining area. Visual
area (Area 17) is the medial surface of occipital lobe, posterior lip of
calcarine sulcus as far as the occipital pole. The striate cortex is the
association visual area (Area 18 and 19). Auditory area (Area 41 and 42)
is the floor of the lateral sulcus and the superior temporal gyrus, the
surrounding Area 22 is the association area. Gustatory area is the
inferior lip of the postcentral gyrus.
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CORTICAL STRUCTURE
The cerebral cortex consists of aggregates of cells in definite pattern.

The assembly of cells is along morphological and functional lines. Over
90% of the cortex has a 6 layered arrangement.
Layer I; plexiform or molecular layer, few cells mostly glia.

Layer II; external granular layer, cells predominantly small
granular type
Layer III; external pyramidal, predominantly pyramidal cells.
Layer IV; internal granular, consist of medium to large size
granular cells.
Layer V; internal pyramidal, pyramidal cells are medium to large
size, giant pyramidal cells (Betz) characterise this layer
Layer VI; multiform layer, different cell types are found in the
layer. The ratio of granular to pyramidal cells in any layer is
dependent on the modality it subserves
Cerebral white matter
The white matter of the cerebrum is made up of fibres that can be

grouped into 3 viz;
Commissural fibres; these fibres connect the 2 cerebral

hemispheres in a symmetrical fashion. They coalesce to form the
corpus callosum, anterior and posterior commissures.
Association fibres; they connect different parts of the same

cerebral hemisphere.
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Projection fibres; they connect the grey matter of the cerebral

hemisphere to subcortical nuclei in the brain stem, spinal cord
etc.
Commissural fibre
The corpus callosum is the most prominent commissural fibres

collection.
It provides asymmetrical connection between the hemispheres. From its

commencement at the anterior commissure it thickens posteriorly. It has
4 parts viz, Rostrum, Genu, Body, Splenium.
Forceps minor is formed by the laterally extending fibers of the genu,

while that of the splenium form the Forceps major. Forceps minor
connects the frontal cortex while Forceps major connects the occipital
cortex. The laterally extending fibers of the remaining parts of the
corpus callosum form a sheet of white matter that form the roof and
lateral walls of the different parts of the lateral ventricles
Projection fibres
The Internal capsule is the most prominent projection fibre. Consist of

afferent fibres from thalamic nuclei and efferent fibres that travel
through the cerebral peduncle of midbrain.
It is separated from the cavity of the lateral ventricle by the caudate

nucleus. The globus pallidus of the lentiform nucleus indents its lateral
edge conferring a lateral concavity on it. It has an anterior limb, a
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posterior limb connected by the genu. Retrolentiform and sublentiform

parts are posteriorly located.
The Anterior Limb lies between the head of caudate (medially) and the
lentiform (laterally) nuclei. Contain frontopontine fibres that travel from
cell bodies in the frontal part of the cortex to the pontine nuclei on
which they arborize. Passing through the thalamus they occupy the
medial part of the base of the cerebral peduncle. Fibres from the frontal
eye field to the oculomotor nucleus are suspected to pass through it.
Genu is the bent portion of the internal capsule. Contain corticonuclear
fibres from the cerebral cortex to the motor nuclei of cranial nerves in
the brain stem.
Posterior limb is located between the Thalamus (medially) and the

lentiform nucleus (laterally).
The anterior 2/3rd contains corticospinal fibers that travel from the
cortical cell bodies to the anterior horn cells of the spinal cord. The
fibers pass through the brainstem to the lower part of the medulla where
most of them decussate to form the lateral corticospinal tract.
Haemorrhage or thrombosis of the striate artery around the posterior
fiber results in paralysis of the opposite skeletal muscles. Fibers of the
Broca’s speech are affected on the left side. Posterior 1/3rd of the
posterior limb contain Thalamocortical fibers from thalamus to sensory
cortex.
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Retrolentiform part; located in the posterior end of lentiform nucleus,

contains the corticopontine fibres which occupy the lateral part of the
cerebral peduncle as well as optic radiations.
Sublentiform part is located below the posterior end of lentiform

nucleus, contains auditory radiations from MGB to the auditory area of
cortex.
Head injuries are classified as open or closed. In an open injury

the cranial cavity contents are exposed to the outside, whereas in
a closed injury the cranial cavity remains intact. Closed injuries,
which are more common than open injuries, involve the head
striking a hard surface or an object striking the head. Such
injuries may result in brain trauma.
The most common type of traumatic brain injury (75%–90%) is a

concussion, which is an immediate, but transient, impairment of
neural function, such as a loss of consciousness or blurred vision.
In some cases, postconcussion syndrome occurs a short time after
the injury. The syndrome includes increased muscle tension
ormigraine headaches, reduced alcohol tolerance, difficulty in
learning new things, reduction in creativity, changes in
motivation, fatigue, and personality changes. The symptoms may
be gone in a month or may persist for as long as a year.
A hematoma is a localized mass of blood released from blood

vessels but confined within an organ or a space. An accumulated
mass of blood can apply pressure to the brain, causing damage to
brain tissue. Blood is toxic to brain tissue. Hematomas of the
brain are classified according to where the bleeding occurs.
Epidural hematomas result from an accumulation of blood in the
epidural space and occur in about 1%–2% of major head injuries.
Subdural hematomas result from an accumulation of blood in the
subdural space and occur in 10%–20% of major head injuries.
Self- Assessment Exercise
• Describe the different regions of the cerebral hemisphere.

• Identify the boundaries of the different regions of the cerebral
hemisphere.
• Identify the different gyri and sulci as well as the functional areas
of the cerebrum.
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4.0 CONCLUSION
The cerebrum is divided into left and right hemispheres by a

longitudinal fissure. The most conspicuous features on the surface of
each hemisphere are numerous folds called gyri, which greatly increase
the surface area of the cortex. The general pattern of the gyri is similar
in all normal human brains, but some variation exists between
individuals and even between the two hemispheres of the same
cerebrum. Each cerebral hemisphere is divided into lobes, which are
named for the skull bones overlying each one.
5.0 SUMMARY
• The cortex of the cerebrum is folded into ridges called gyri and
grooves called sulci, or fissures. The longitudinal fissure divides
the cerebrum into left and right hemispheres. Each hemisphere
has five lobes.
• The frontal lobes are involved in voluntary motor function,
motivation, aggression, the sense of smell, and mood. The
parietal lobes contain the major sensory areas receiving sensory
input, such as touch, pain, temperature, balance, and taste. The
occipital lobes contain the visual centers. The temporal lobes
evaluate smell and hearing input and are involved in memory,
abstract thought, and judgment.
• Gray matter forms the cortex and nuclei of the cerebrum. White
matter forms the cerebral medulla, which consists of three types
of tracts (Association, Commissural and Projection fibers)
connect cerebrum to other parts of the brain and the spinal cord.
1. Which of these cerebral lobes is important in voluntary motor

function, motivation, aggression, sense of smell, and mood?
a. frontal
b. insula
c. occipital
d. parietal
e. temporal
2. Fibers that connect areas of the cerebral cortex within the same
hemisphere are:
a. projection fibers.
b. commissural fibers.
c. association fibers.
d. all of the above.
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3. The basal nuclei are located in the
a. inferior cerebrum.
b. diencephalon.
c. midbrain.
4. Describe the two layers of the cerebrum. Why is the outer layer
convoluted?
5. Distinguish between a sulcus and a fissure.
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UNIT 6 THE VENTRICLES AND CEREBROSPINAL

FLUID
CONTENTS
1.0 Introduction
2.0 Objective
3.0 Main Content
3.1 Lateral ventricle
3.2 Cerebrospinal fluid (CSF)
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
The ventricles are cavities within the brain for the production and
drainage of Cerebrospinal fluid (CSF). It consists of the lateral
ventricles, the 3rd ventricle and the 4th ventricle. The ventricular system
of the brain is continuous with the central canal of the spinal cord. The
ventricles contain CSF that cushions the brain and spinal cord within its
bony container as well as provide nourishment. They are modified
derivative of the neural canal.
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2.0 OBJECTIVES
• Differentiate the parts of the ventricular system and relate them to

the different regions of the brain.
• Describe the walls of the different parts of the ventricular system.
• Discuss the production and flow of the cerebrospinal fluid.
3.0 MAIN CONTENT
3.1 Lateral ventricle
It is a C-shaped continuous cavity within the cerebral hemisphere. It

consist of the body, anterior, posterior and inferior horns. Its medial wall
is marked by the slit like opening on the medial surface of the
hemisphere. This marks the point of invagination of the pia matter and
ependyma for the formation of the choroid plexus which produces the
CSF.
The choroid plexus of the lateral ventricle is continuous with that of the
3rd ventricle. The lateral ventricle produces most of the CSF.
Anterior Horn; it is triangular in outline with the apex pointing

laterally. The forceps minor forms the roof, while the floor is indented
by the head of the caudate nucleus.
Laterally the roof and the floor converge while they are kept apart by the
septum pellucidum on the medial side. The lateral ventricle
communicates with the 3rd ventricle via the interventricular foramen of
Monro located just behind the anterior column of fornix. It is also the
point of continuation of the Choroid plexus of the body and 3rd ventricle.
Body; the interventricular foramen of Monro is the boundary between

the anterior horn and body. The Thalamus and the body of the caudate
nucleus bulge into its floor. Thalamostriate vessels run between them.
The roof is formed by the corpus callosum and the body of fornix.
Invagination of the choroid plexus is via the medial wall (septum
pellucidum). Posterior Horn; the existence is variable. The collateral
eminence bulges on its floor. 2 bulges are on the medial wall, upper bulb
of posterior horn and lower calcar avis. The 2 can obliterate the horn.
The tapetum forms the roof and lateral wall. The optic radiation is
related to the lateral wall.
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Inferior Horn; it is the largest part of the ventricles. The Hippocampus

(medial) and the collateral eminence (lateral) form the floor of the horn.
The tail of the caudate nucleus forms the roof ending in a convexities
formed by the amygdaloid body and pes hippocampi. Lateral wall
formed by the tapetum.
Third ventricle
It is a slit-like space beneath the fornix and corpus callosum. Bounded

anteriorly by the anterior column of fornix and the interventricular
foramen of Monro. The lateral wall is largely occupied by the thalamic
bulge. The hypothalamic sulcus on the lateral wall connects the IVFM to
the aqueduct of the midbrain.
Fourth ventricle
It communicates with the 3rd ventricle via the aqueduct of the midbrain.
The pons and the upper medulla are ventral relations while the
cerebellum is largely a supero-dorsal relation. The floor is diamond
shaped with a tent like roof. It is triangular in sagittal section. Caudally
the lateral boundary of the floor is formed by the gracile and cuneate
tubercles with the inferior cerebellar peduncle superimposed on them.
The lateral boundary of the floor cranially is formed by the superior
cerebellar peduncle.
A thin stretch of white matter (superior medullary velum) connects the 2

superior cerebellar peduncle forming the cranial part of the roof. The
caudal part of the roof is formed by a combination of pia and ependyma.
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The foramen of Magendie is a central opening of it. The

cerebellomedullary cistern communicates via the foramen.
The narrow lateral recess has the foramen of Luschka that

communicates with the pontine cistern. The T-shaped choroid plexus
indents the cranial part of the roof. The floor (Rhomboid fossa) has a
midline groove (median sulcus) which connects the aqueduct of Sylvius
to the central canal of the spinal cord.
The cranial part of the floor is divided into the medial pontine part and
lateral vestibular part. The pontine part of the floor has a bulge (facial
colliculus) adjacent to the medial sulcus. Laterally extending white
matter (medullary striae) is found at the widest part of the floor. The
vestibular area overlies the vestibular nuclei. The floor of the medullary
part is divided into 2 by a faint groove that extends laterally from
median sulcus towards the lateral recess. The medial small triangle
(hypoglossal trigone) overlying the hypoglossal nucleus, while the
lateral (vagal trigone) overlies the dorsal nucleus of vagus.
3.2 Cerebrospinal fluid (CSF)
It is produced by a modified ependymal cells and choroid plexus which

is found in most part of the ventricular system. 70% of the CSF is
produced from the ventricles while the remaining 30% is produced from
brain capillaries. Total CSF volume is about 130ml, about 30ml is found
in the ventricles while the subarachnoid space contains about 100ml.
The body of the lateral ventricle and the 3rd ventricle are major site of
production. The fluid drains through the IVFM to the 3rd ventricle,
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through the Aqueduct of Sylvius to the 4th ventricle. It exits via the
Foramina of Magendie and Luschka into the subarachnoid space or flow
straight into the central canal of spinal cord. The fluid flows around the
superior sagittal sinus and is reabsorbed via the arachnoid granulation
into the venous system.
Flow of CSF
I. Lumbar puncture is a sterile procedure done to withdraw C.S.F.

from the spinal subarachnoid space and must be performed well
clear of the termination of the cord. A line joining the iliac crests
passes through the 4th lumbar vertebra and therefore the
intervertebral spaces immediately above or below this landmark
can be used with safety. The spine must be fully flexed (with the
patient either on his side or seated) so that the vertebral
interspinous spaces are opened to their maximum extent. The
needle is passed inwards and somewhat cranially exactly in the
midline and at right angles to the spine; the supraspinous and
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interspinous ligaments are traversed and then the dura is

penetrated, the latter with a distinct ‘give’. Occasionally root pain
is experienced if a root of the cauda equina is impinged upon, but
usually these float clear of the needle. At spinal puncture C.S.F.
can be obtained for examination; antibiotics, radio-opaque
contrast medium or anaesthetics may be injected into the
subarachnoid space, and the C.S.F. pressure can be estimated
(normal, when lying on the side, 80–180mm C.S.F.).
II. Hydrocephalus
CSF is produced at a rate of approximately 0.4 mL/min. If CSF returns

to the blood at the same rate, the volume of CSF in the ventricles and
subarachnoid space is constant. If the apertures of the fourth ventricle or
the cerebral aqueduct are blocked, CSF can accumulate within the
ventricles. This condition is called internal hydrocephalus, or
noncommunicating hydrocephalus, and it results in increased CSF
pressure. The production of CSF continues, even when the passages that
normally allow it to exit the brain are blocked. Consequently, fluid
builds inside the brain, causing pressure, which compresses the nervous
tissue and dilates the ventricles. Compression of the nervous tissue
usually results in irreversible brain damage. If the skull bones are not
completely ossified when the hydrocephalus occurs, the pressure may
also severely enlarge the head. The cerebral aqueduct may be blocked at
the time of birth or may become blocked later in life because of a tumor
growing in the brainstem. Internal hydrocephalus can be successfully
treated by placing a drainage tube (shunt) between the brain ventricles
and abdominal cavity to eliminate the high internal pressures. There is
some risk of infection being introduced into the brain through these
shunts, however, and the shunts must be replaced as the person grows. A
subarachnoid hemorrhage may block the return of CSF to the
circulation. If CSF accumulates in the subarachnoid space, the condition
is called external hydrocephalus, or communicating hydrocephalus.
In this condition, pressure is applied to the brain externally compressing
neural tissues and causing brain damage.
• Differentiate the parts of the ventricular system and relate them to

the different regions of the brain.
• Describe the walls of the different parts of the ventricular system.
• Discuss the production and flow of the cerebrospinal fluid.
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Activity
Locate and identify the ventricles, canals and capillary beds associated
with the circulation of cerebrospinal fluid on the brain models provided
or preserved animal brains in the anatomy laboratory/Museum.
4.0 CONCLUSION
The ventricles are cavities within the brain for the production and
drainage of Cerebrospinal fluid (CSF). It consists of the lateral
ventricles, the 3rd ventricle and the 4th ventricle. The ventricular system
of the brain is continuous with the central canal of the spinal cord. The
ventricles contain CSF that cushions the brain and spinal cord within its
bony container as well as provide nourishment.
5.0 SUMMARY
• The lateral ventricles in the cerebrum are connected to the third

ventricle in the diencephalon by the interventricular foramina.
• The third ventricle is connected to the fourth ventricle in the pons
by the cerebral aqueduct. The central canal of the spinal cord is
connected to the fourth ventricle.
• The fourth ventricle is connected to the subarachnoid space by
the median and lateral apertures.
• CSF is produced from the blood in the choroid plexus of each
ventricle by ependymal cells. CSF moves from the lateral to the
third and then to the fourth ventricle. From the fourth ventricle,
CSF enters the subarachnoid space through three apertures.
• CSF leaves the subarachnoid space through arachnoid
granulations and returns to the blood in the dural venous sinuses.
1. Cerebrospinal fluid is produced by the _______________,

circulates through the ventricles, and enters the subarachnoid
space. The cerebrospinal fluid leaves the subarachnoid space
through the
a. choroid plexuses, arachnoid granulations

b. arachnoid granulations, choroid plexuses
c. dural venous sinuses, dura mater
d. dura mater, dural venous sinuses
2. Describe the ventricles of the brain.
3. What are the physical characteristics of CSF?
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UNIT 7 BLOOD SUPPLY OF THE CENTRAL

NERVOUS SYSTEM
CONTENTS
1.0 Introduction
2.0 Objective
3.0 Main Content
3.1 Internal carotid system
3.2 Vertebral system
3.3 Basilar system
3.4 The Circle of Willis
3.5 Venous drainage
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
The brain requires a tremendous amount of blood to maintain its normal

functions. The brain has a very high metabolic rate, and brain cells are
not capable of storing high-energy molecules for any length of time. In
addition, brain cells depend almost entirely on glucose as their energy
source. Thus, the brain requires a constant blood supply to meet the
demands of brain cells for both glucose and oxygen. Even though the
brain accounts for only about 2% of the total weight of the body, it
receives approximately 15%–20% of the blood pumped by the heart.
Interruption of the brain’s blood supply for only seconds can cause
unconsciousness, and interruption of the blood supply for minutes can
cause irreversible brain damage.
2.0 OBJECTIVE
• describe the arterial supply of the brain and the spinal cord.
• describe the venous drainage of the brain and the spinal cord.
• define the blood-brain barrier and its effect on the movement of
materials into and out of the brain.
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3.0 MAIN CONTENT
3.1 Internal carotid system
The main blood supply to the central nervous system include the
internal carotid, vertebral and basilar systems of arteries.
The internal carotid system consists of the anterior and middle cerebral
arteries, anterior choroidal and posterior communicating arteries. The
internal carotid artery proceeds superiorly alongside the optic chiasma,
bifurcates into the middle cerebral artery and anterior cerebral artery.
It contributes to the formation of the choroid plexus of the lateral

ventricle (especially inferior horn). It gives 2 smaller branches before
bifurcating viz; anteriorchoroidal artery and posterior communicating
artery.
Anterior Choroidal Artery; It runs posterior to the optic tract,

clinically significant, long and thin artery. It is frequently involved in
CVA. It supplies:
Optic tract, Lateral geniculate body, Optic radiation, Uncus, Amygdala,

Hippocampus, Internal capsule, Lentiform nucleus (globus pallidus and
putamen) and Thalamus
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Posterior Communicating Artery; It runs posterior inferiorly to the

optic tract joining the posterior cerebral artery. It participates in the
formation of the circle of Willis.
Anterior Cerebral Artery; It runs superiorly and medially to the optic

nerve to enter the longitudinal fissure.
The two are interconnected by the anterior communicating artery just

before entering the longitudinal fissure. It runs posteriorly following the
corpus callosum supplying the medial surfaces of frontal and parietal
lobes rostral to the parieto-occipital sulcus.
It divides into 2 prominent branches:
Peri-callosal artery; adjacent to the corpus callosum.
Calloso-marginal artery; which follows the cingulate sulcus.

It supplies the paracentral lobule (medial aspects of the precentral and
postcentral gyri), and then its occlusion will cause restricted
contralateral motor and somatosensory deficits.
Middle Cerebral Artery; runs laterally into the lateral sulcus, supply
the insula and temporal pole. Numerous branches spread out from the
sulcus to supply the lateral surface of the cerebrum. Its occlusion causes
major motor and somatosensory deficits. Also, if the left hemisphere is
involved, language deficits are almost invariably found. Deep structures
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of diencephalon and telencephalon are supplied by its numerous small

branches (lenticulostriate arteries).
3.2 Vertebral system
Vertebral Arteries; they run alongside the medulla, fuse at the

pontomedullary junction to form the basilar artery. Before the union it
gives 3 branches;
The posterior spinal artery; runs along the dorsolateral aspect of SC

supplying the dorsal 1/3rd.
The anterior spinal artery; join together to form a single anterior

spinal artery, run on the antero-medial surface of SC to supply ventral
2/3rd.
Posterior Inferior Cerebellar Artery (PICA); approaches

thecerebellum to supply its inferior surface. As it curves around the
brainstem, the artery supplies the choroid plexus of the 4th ventricle and
much of the lateral medulla.
3.3 Basilar system
The basilar artery runs in the pontine groove, bifurcates at midbrain

level into 2 posterior cerebral arteries. Also give rise to the following;
Anterior inferior cerebellar artery; formed rostral to formation of
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basilar artery, supplies the anterior part of the inferior cerebellar surface
and the lower part of pons.
Superior cerebellar artery; it is formed just before the bifurcation of

basilar artery, supplies the upper part of pons, superior surface of
cerebellum and caudal part of midbrain.
The internal auditory artery; It supplies the middle ear, occlusion

causes vertigo and deafness. Often comes from AICA. Numerous
unnamed branches; e.g pontine arteries.
Posterior Cerebral Artery; it runs around the midbrain passing through

the superior cistern.
It supplies the medial surfaces of the occipital and temporal lobes. Also
send branches to the upper part of midbrain and lower part of
diencephalon. It also gives rise to several posterior choroidal arteries.
Since the primary visual cortex is located in the occipital lobe, occlusion
of the posterior cerebral artery could lead to visual loss among other
symptoms
Posterior Choroidal Arteries; form the choroid plexus of 3rd and that
of body of 4th ventricles.
3.4 The Circle of Willis
The posterior cerebral artery is connected to the internal carotid artery

by the posterior communicating artery. This completes an arterial
polygon called the circle of Willis which allows for anastomotic blood
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flow in case of occlusion. Several small arteries arise from the circle
which are grouped thus;
The antero-medial; supplies the head of caudate, anterior limb of

internal capsule and anterior part of hypothalamus.
The circle of willis
The anterolateral; also known as lenticulostriate, supplies the internal

capsule, globus pallidus, putamen, head of caudate, claustrum and
external capsule.
The posteromedial; supplies medial part of midbrain, anteriomedial

part of thalamus, subthalamic region, middle and posterior part of
hypothalamus.
The posterolateral; also known as thalamogeniculate artery, supply the

posterior part of thalamus and lateral part of midbrain.
3.5 Venous drainage
The principal route of venous drainage of the brain is through a system

of cerebral veins. These empty into the dura venous sinuses and
ultimately into the internal jugular vein. There is also a collection of
emissary veins.
These connect the extracranial veins with the dural sinuses. There is a
basilar venous plexus around the base of the brain that communicates
with the epidural venous plexus of the spinal cord. Cerebral veins are
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divided into superficial and deep groups. Generally, the superficial veins
lie on the surface of the cerebral hemispheres and empty into the
superior sagittal sinus. The deep veins drain internal structures and
eventually drain into the straight sinus. Cerebral veins are valve-less.
They are also interconnected by numerous functional anastomoses both
within a group and between the superficial and deep groups.
Blood Brain Barrier
• Branches of the arteries supplying the brain are located in the

subarachnoid space. Smaller branches from the arteries in the
subarachnoid space extend into the brain and quickly divide into
capillaries. The epithelial cells of these capillaries are surrounded
by the foot processes of astrocytes. The astrocytes promote the
formation of tight junctions between the epithelial cells. The
epithelial cells with their tight junctions form the blood–brain
barrier, which regulates the movement of materials from the
blood into the brain.
Materials that would enter many tissues by passing between the

epithelial cells of capillaries cannot pass through the blood–brain barrier
because of the tight junctions. Most materials that enter the brain pass
through the epithelial cells. Lipid-soluble substances, such as nicotine,
ethanol, and heroin, can diff use through the plasma membranes of the
epithelial cells and enter the brain. Water-soluble molecules, such as
amino acids and glucose, move across the plasma membranes of the
epithelial cells by mediated transport.
ii. The permeability characteristics of the blood–brain barrier must

be considered when developing drugs designed to affect the CNS.
For example, Parkinson disease is caused by a lack of the
neurotransmitter dopamine, which normally is produced by
certain neurons of the brain. A lack of dopamine results in
decreased muscle control and shaking movements. Administering
dopamine is not helpful because dopamine cannot cross the
blood–brain barrier. Levodopa (L-dopa), a precursor to
dopamine, is administered instead because it can cross the blood–
brain barrier. CNS neurons then convert levodopa to dopamine,
which helps reduce the symptoms of Parkinson disease.
• describe the arterial supply of the brain and the spinal cord.
• describe the venous drainage of the brain and the spinal cord.
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• define the blood-brain barrier and its effect on the movement of

materials into and out of the brain.
Activity
In the anatomy museum, identify the arterial supplies and venous

drainage of the central nervous system.
4.0 CONCLUSION
The brain requires a tremendous amount of blood to maintain its normal

functions. The brain has a very high metabolic rate, and brain cells are
not capable of storing high-energy molecules for any length of time. In
addition, brain cells depend almost entirely on glucose as their energy
source. Thus, the brain requires a constant blood supply to meet the
demands of brain cells for both glucose and oxygen.
5.0 SUMMARY
• The blood–brain barrier is formed by the endothelial cells of the

capillaries in the brain. It limits what substances enter brain
tissue.
• The principal route of venous drainage of the brain is through a
system of cerebral veins
• The main blood supply to the central nervous system includes the
internal carotid, vertebral and basilar systems of arteries.
• The internal carotid system consists of the anterior and middle
cerebral arteries, anterior choroidal and posterior communicating
arteries
• Vertebral arteries run alongside the medulla, fuse at the
pontomedullary junction to form the basilar artery. It has three
divisions: anterior spinal, posterior spinal and posterior inferior
cerebellar artery.
• The basilar system with several branches.
6.0 TUTOR MARKED EXERCISES
1. Which of the following statements is true?
a. The brain requires constant delivery of glucose and

oxygen to function.
b. The foot processes of astrocytes surround capillaries in
the brain.
c. Tight junctions between capillary epithelial cells form the
blood – brain - barrier.
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d. Glucose passes through capillary epithelial cells by

mediated transport.
2. Discuss the importance of the blood–brain barrier in maintaining

homeostasis within the brain.
3. True or false: Alcohol passes readily through the BBB because it
is a lipid-soluble compound.
4. Discuss the circle of willis.
5. Discuss the venous drainage of the central nervous system.
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MODULE 3 THE PERIPHERAL AND AUTONOMIC

NERVOUS SYSTEM
INTRODUCTION
Anatomically, the nervous system is divided into the central nervous

system (CNS) and the peripheral nervous system (PNS). The CNS
includes the brain and the spinal cord (see previous module). The PNS
(described in this module) includes the cranial nerves, arising from the
inferior aspect of the brain, and the spinal nerves, arising from the spinal
cord.
The autonomic nervous system (ANS) is a functional division of the

nervous system. It consists of components within the CNS and specific
nerves. The ANS is subdivided into sympathetic and parasympathetic
divisions that provide innervation to smooth and cardiac muscles, as
well as glands. The ANS functions autonomically to maintain
homeostasis and carry out many involuntary functions in the body. The
peripheral nervous system consists of nerves that branch off the CNS.
These nerves are called peripheral nerves and are classified in two types,
cranial nerves and spinal nerves.
2.0 OBJECTIVE
At the end of this module, you should be able to:
• Differentiate between structural and functional divisions of the

nervous system.
• Discuss the peripheral and autonomic nervous systems
CONTENT
Unit 1 Cranial nerves

Unit 2 Spinal nerves
Unit 3 Autonomic nervous system
UNIT 1 CRANIAL NERVES
CONTENT
1.0 Introduction
2.0 Objectives
3.0 Main content
3.1 Names and function
3.2 Trigeminal nerve and dental anesthesia
3.3 Brain stem reflexes
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4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
Cranial nerves are peripheral nerves that originate from the brain.
Roman numerals and names designate the twelve different cranial
nerves. The cranial nerves also have names in numeric order, this
mnemonic can help you remember their names:
On Occasion Our Trusty Truck Acts Funny; Very Good Vehicle Any
How. The mnemonic corresponds to the Olfactory (I), Optic (II),
Oculomotor (III), Trochlear (IV), Trigeminal (V), Abducent (VI),
Facial (VII), Vestibulocochlear (VIII), Glossopharyngeal (IX), Vagus
(X), Accessory (XI), and Hypoglossal (XII) nerves
2.0 OBJECTIVES
• Discuss the distribution and function of each of the cranial nerves

• Discuss the brain stem reflexes
3.0 MAIN CONTENT
3.1 Names and function
• Olfactory nerves carry smell information to the brain for

interpretation.
• Optic nerves carry visual information to the brain for

interpretation.
• Oculomotor nerves are found within the muscles that move the
eyeball, eyelid, and iris.
• Trochlear nerves act in the muscles that move the eyeball.
• Trigeminal nerves carry sensory information from the surface of

the eye, the scalp, facial skin, the lining of the gums, and the
palate to the brain for interpretation. They also are found within
the muscles needed for chewing.
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• Abducens nerves act in the muscles that move the eyeball.
• Facial nerves are found in the muscles of facial expression as

well as in the salivary and tear glands. These nerves also carry
sensory information from the tongue.
• Vestibulocochlear nerves carry hearing and equilibrium

information from the inner ear to the brain for interpretation.
• Glossopharyngeal nerves carry sensory information from the

throat and tongue to the brain for interpretation. They also act in
the muscles of the throat.
• Vagus nerves carry sensory information from the thoracic and

abdominal organs to the brain for interpretation. These nerves are
also found within the muscles in the throat, stomach, intestines,
and heart.
• Accessory nerves are found within the muscles of the throat,

neck, back, and voice box.
• Hypoglossal nerves are found within the muscles of the tongue.
3.2 Trigeminal nerve and dental anesthesia
Trigeminal means three twins, and the sensory distribution of the

trigeminal nerve in the face is divided into three regions, each supplied
by a branch of the nerve. The three branches, ophthalmic, maxillary,
and mandibular—arise directly from the trigeminal ganglion, which
serves the same function as the dorsal root ganglia of the spinal nerves.
Only the mandibular branch contains motor axons, which bypass the
trigeminal ganglion, much as the ventral root of a spinal nerve bypasses
a dorsal root ganglion.
The maxillary and mandibular branches are important in dentistry. The

maxillary nerve supplies sensory innervation to the maxillary teeth,
palate, and gingiva. The mandibular branch supplies sensory innervation
to the mandibular teeth, tongue, and gingiva. The various nerves
innervating the teeth are referred to as alveolar nerves. The superior
alveolar nerves to the maxillary teeth are derived from the maxillary
branch of the trigeminal nerve, and the inferior alveolar nerves to the
mandibular teeth are derived from the mandibular branch of the
trigeminal nerve.
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Dentists inject anesthetic to block sensory transmission by the alveolar

nerves. The superior alveolar nerves are not usually anesthetized directly
because they are difficult to approach with a needle. For this reason, the
maxillary teeth are usually anesthetized locally by inserting the needle
beneath the oral mucosa surrounding the teeth. The inferior alveolar
nerve probably is anesthetized more often than any other nerve in the
body. To anesthetize this nerve, the dentist inserts the needle somewhat
posterior to the patient’s last molar and extends the needle near where
the mandibular branch of the trigeminal nerve enters the mandibular
foramen. Several nondental nerves are usually anesthetized during an
inferior alveolar block. The mental nerve, which supplies cutaneous
innervation to the anterior lip and chin, is a distal branch of the inferior
alveolar nerve. When the inferior alveolar nerve is blocked, the mental
nerve is blocked also, resulting in a numb lip and chin. Nerves lying
near the point where the inferior alveolar nerve enters the mandible
often are also anesthetized during inferior alveolar anesthesia. For
example, the lingual nerve can be anesthetized to produce a numb
tongue. The facial nerve lies some distance from the inferior alveolar
nerve, but in rare cases anesthetic can diffuse far enough posteriorly to
anesthetize that nerve. The result is a temporary facial palsy, with the
injected side of the face drooping because of flaccid muscles, which
disappears when the anesthesia wears off. If the facial nerve is cut by an
improperly inserted needle, permanent facial palsy may occur.
3.3 Brain stem reflexes
Many of the brainstem reflexes are associated with cranial nerve

function. The circuitry of most of these reflexes is too complex for our
discussions. In general, these reflexes involve sensory input from the
cranial nerves or spinal cord, as well as the motor output of the cranial
nerves. Turning of the eyes toward a flash of light, a sudden noise, and a
touch on the skin are examples of brainstem reflexes. Moving the eyes
to track a moving object is another complex brainstem reflex. Some of
the sensory neurons from cranial nerve VIII (vestibulocochlear) form a
reflex arc with neurons of cranial nerves V (trigeminal) and VII (facial),
which send axons to muscles of the middle ear and dampen the effects
of very loud, sustained noises on delicate inner ear structures. Reflexes
that occur during the process of chewing allow the jaws to react to foods
of various hardness and protect the teeth from breakage. Both the
sensory and motor components of the reflex arc are carried by cranial
nerve V (trigeminal). Reflexes involving input through cranial nerve V
(trigeminal) and output through cranial nerve XII (hypoglossal) move
the tongue about to position food between the teeth for chewing and
then move the tongue out of the way so that it is not bitten.
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Brainstem reflexes are used to determine if the brainstem is functioning.

Brainstem reflexes are mediated by cranial nerve sensory nuclei, cranial
nerve motor nuclei, and reticular formation nuclei. The presence of a
reflex indicates that sensory input reaches the brainstem and the nuclei
are functioning to produce a response. The absence of a reflex is taken
to indicate damage to the nuclei involved in the reflex.
Cranial Nerve Disorders
Trigeminal neuralgia, also called tic douloureux, involves the trigeminal

nerve and consists of sharp bursts of pain in the face. This disorder often
has a trigger point in or around the mouth, which, when touched, elicits
the pain response in some other part of the face. The cause of trigeminal
neuralgia is unknown. Facial palsy (called Bell palsy) is a unilateral
paralysis of the facial muscles. The affected side of the face droops
because of the absence of muscle tone. Although the cause of facial
palsy is often unknown, it can result from inflammation of the facial
nerve or a stroke or tumor in the cerebral cortex or brainstem. The facial
nerve passes from deep to superficial through the parotid gland,
andtemporary facial palsy can result from inflammation of the parotid
gland. Temporary facial palsy can even result from extreme cold in the
face, where the superficial branches of the facial nerve are located.
Disorders of the cranial nerves can be determined using the

following tests:
The olfactory nerves (I) are tested by asking a patient to smell

various substances.
Cranial nerves III, IV, and VI are tested by asking a patient to

track the movement of the physician’s finger. If a patient cannot
move her eyeballs properly, there may be damage to one of these
nerves. Recall that these nerves control the muscles that move the
eyeballs.
Cranial nerve V controls the muscles needed for chewing. To

assess this nerve, a patient is asked to clench his teeth. The
physician then feels the jaw muscles. If they feel limp or weak,
this nerve may be damaged.
If a person can no longer make facial expressions, then cranial

nerve VII may be damaged. This nerve controls the muscles
needed to make facial expressions.
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If a patient cannot extend his tongue and move it from side to

side, cranial nerve XII may be damaged. This nerve controls
tongue movement.
• Discuss the distribution and function of each of the cranial nerves

• Discuss the brain stem reflexes
4.0 CONCLUSION
Cranial nerves are designated by Roman numerals (I–XII) or specific

names.
5.0 SUMMARY
• The two types of general functions are sensory and motor.

Sensory includes special senses and general senses. Motor
includes somatic motor and parasympathetic.
• The trigeminal nerve (V) has three branches—ophthalmic,
maxillary, and mandibular. The superior alveolar nerve (branch
of the maxillary) and the inferior alveolar nerve (branch of the
mandibular) are used for dental anesthesia.
• Many reflexes are mediated through the brainstem. The brainstem
is considered to be non-functional when reflexes at all levels of
the brainstem are non-functional and there is no spontaneous
breathing, which is mediated through the medulla oblongata
1. The cranial nerve involved in chewing food is the
a. trochlear (IV).
b. trigeminal (V).
c. abducent (VI).
d. facial (VII).
e. vestibulocochlear (VIII).
2. The cranial nerve involved in moving the tongue is the
a. trigeminal (V).
b. facial (VII).
c. glossopharyngeal (IX).
d. accessory (XI).
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e. hypoglossal (XII).
3. The cranial nerve involved in feeling a toothache is the
a. trochlear (IV).
b. trigeminal (V).
c. abducent (VI).
d. facial (VII).
e. vestibulocochlear (VIII).
4. From this list of cranial nerves:
1. optic (II)
2. oculomotor (III)
3. trochlear (IV)
4. trigeminal (V)
5. abducent (VI)
Select the nerves that are involved in moving the eyes.

a. 1,2,3
b. 1,2,4
c. 2,3,4
d. 2,4,5
e. 2,3,5
1. trigeminal (V)
2. facial (VII)
3. glossopharyngeal (IX)
4. vagus (X)
5. hypoglossal (XII)
Select the nerves that innervate the salivary glands.

a. 1,2
b. 2,3
c. 3,4
d. 4,5
e. 3,5
1. oculomotor (III)
2. trigeminal (V)
3. facial (VII)
4. vestibulocochlear (VIII)
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5. glossopharyngeal (IX)
6. vagus (X)
7. Where do the cranial nerves attach to the brain?
8. Of all the cranial nerves, which is most important to a dentist?
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UNIT 2 SPINAL NERVES
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Structure of nerves
3.2 Distribution of nerves
3.3 Major nerve plexuses
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
Spinal nerves are peripheral nerves that originate from the spinal cord.
There are 31 pairs of spinal nerves: 8 pairs of cervical nerves (numbered
C1 through C8), 12 pairs of thoracic nerves (numbered T1 through T12),
5 pairs of lumbar nerves (numbered L1 through L5), 5 pairs of sacral
nerves (numbered S1 through S5), and one pair of coccygeal nerves
(Co).
2.0 OBJECTIVES
• Locate and describe the spinal nerves.

• Discuss the spinal reflex arc.
3.0 MAIN CONTENT
3.1 Structure of nerves
Nerves consist of collections of axons, Schwann cells, and connective

tissue in the PNS. Each axon, or nerve fiber, and its Schwann cell sheath
are surrounded by a delicate connective tissue layer, the endoneurium. A
heavier connective tissue layer, the perineurium, surrounds groups of
axons to form nerve fascicles. A third layer of dense connective tissue,
the epineurium, binds the nerve fascicles together to form a nerve. The
connective tissue of the epineurium is continuous with the dura mater
surrounding the CNS. An analogy of this relationship is a coat (the dura)
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and its sleeve (epineurium). The connective tissue layers of nerves make
them tougher than the nerve tracts in the CNS.
Structure of a nerve
3.2 Distribution of nerves
There are 31 pairs of spinal nerves, each identified by a letter and a

number. The letter indicates the region of the vertebral column from
which the nerve emerges: C, cervical; T, thoracic; L, lumbar; and S,
sacral. The single coccygeal nerve may be identified as Co, but typically
receives no designation. The number indicates the location in each
region where the nerve emerges from the vertebral column, with the
smallest number always representing the most superior origin. For
example, the most superior nerve exiting from the thoracic region of the
vertebral column is designated T1. The cervical nerves are designated
C1–C8, the thoracic nerves T1–T12, the lumbar nerves L1–L5, and the
sacral nerves S1–S5. Note that the number of each type of nerve
matches the number of each type of vertebrae, except for the cervical
nerves. Although there are only 7 cervical vertebrae, there are 8 pairs of
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cervical spinal nerves because 2 pairs of nerves are associated with the
first cervical vertebra. The first pair of cervical nerves exit the spinal
cord between the skull and the first cervical vertebra and the second pair
exit through the intervertebral foramina between the first and second
cervical vertebrae. The nerves arising from each region of the spinal
cord and vertebral column supply specific regions of the body. Not
surprisingly, the nerves supply skeletal muscles in a top to bottom
pattern: the cervical nerves supply muscles of the head, neck, shoulders,
and upper limbs; the thoracic nerves supply muscles of the upper limbs,
thorax, vertebral column, and hips; the lumbar nerves supply muscles of
the vertebral column, hips, and lower limbs; and the sacral nerves
supply muscles of the lower limbs.
Each of the spinal nerves except C1 has a specific cutaneous sensory

distribution. A dermatome is the area of skin supplied with sensory
innervation by a pair of spinal nerves. A dermatomal map shows the
distribution of all the dermatomes.
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136
Dermatomes of the skin
3.3 Major nerve plexuses
Spinal nerves arise from the spinal cord as rootlets. The rootlets
combine to form the ventral and dorsal roots, which combine to form the
spinal nerve. The spinal nerve divides to form branches called rami.
Each spinal nerve has a dorsal and a ventral ramus. Additional
communicating rami are associated with the sympathetic division of the
ANS. The dorsal rami innervate most of the deep muscles of the dorsal
trunk responsible for movement of the vertebral column. They also
innervate the connective tissue and skin near the midline of the back.
The ventral rami are distributed in two ways. In the thoracic region, the
ventral rami form intercostal (between ribs) nerves, which extend along
the inferior margin of each rib and innervate the intercostal muscles and
the skin over the thorax. The ventral rami of the cervical, lumbar, sacral,
and coccygeal spinal nerves form plexuses. The term plexus means braid
and describes the organization produced by the intermingling of the
nerves. The brachial plexus will be used to illustrate how the spinal
nerves intermingle within a plexus and then give rise to nerves that are
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distributed throughout the body. Th e brachial plexus is the most

complicated plexus, and other plexuses have similar, but simpler,
interconnections.
Brachial plexus
The brachial plexus originates from spinal nerves C5–T1. The ventral
rami of the spinal nerves are called the roots of the plexus. These roots
should not be confused with the dorsal and ventral roots from the spinal
cord, which are more medial. The five roots join to form three trunks,
which separate into six divisions and then join again to create three
cords (posterior, lateral, and medial) from which five major branches,
or nerves, emerge. The five major nerves are the axillary, radial,
musculocutaneous, ulnar, and median nerves. They supply the upper
limb.
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The brachial plexus
The distribution of the radial nerve to skeletal muscles of the upper limb
is shown below.
The radial nerve
In a similar fashion, nerves arising from plexuses are distributed to

skeletal muscles throughout the body. Nerves arising from plexuses also
supply the skin. Note that axons of spinal nerves C5–T1 can reach the
radial nerve through the interconnections of the brachial plexus. Thus,
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NSC 218 MODULE 3
axons in the radial nerve arise from levels C5–T1 of the spinal cord. The
cutaneous distribution of a nerve arising from a plexus is different from
the cutaneous distribution (dermatome) arising from a spinal nerve
because the plexus nerve consists of axons from more than one level of
the spinal cord.
Cervical Plexus
The cervical plexus is a relatively small plexus originating from spinal

nerves C1–C4. Branches derived from this plexus innervate superficial
neck structures, including several of the muscles attached to the hyoid
bone. The cervical plexus innervates the skin of the neck and posterior
portion of the head. The phrenic nerve, which originates from spinal
nerves C3–C5, is derived from both the cervical and brachial plexus.
The phrenic nerves descend along each side of the neck to enter the
thorax. They descend along the sides of the mediastinum to reach the
diaphragm, which they innervate. Contraction of the diaphragm is
largely responsible for the ability to breathe.
Lumbar and Sacral Plexuses
The lumbar plexus originates from the ventral rami of spinal nerves
L1–L4 and the sacral plexus from L4 to S4. Because of their close,
overlapping relationship and their similar distribution, however, the two
plexuses often are considered together as a single lumbosacral plexus
(L1–S4). Four major nerves exit the lumbosacral plexus and enter the
lower limb: the obturator, femoral, tibial, and common fi bular
(peroneal) nerves. Other lumbosacral nerves supply muscles of the
lower back, hip, and lower abdomen and the skin of the hip and thigh.
The tibial and common fi bular nerves originate from spinal segments
L4–S3 and are bound together within a connective tissue sheath for the
length of the thigh. The two nerves bound together are referred to jointly
as the sciatic nerve. The sciatic nerve is by far the largest peripheral
nerve in the body. It passes through the greater sciatic notch in the coxal
bone and descends in the posterior thigh to the back of the knee, where
the tibial and common fibular nerves separate from each other. The
sciatic nerve supplies the posterior thigh muscles, the tibial nerve
supplies the posterior compartment of the leg, and the common fibular
supplies the anterior and lateral compartments. Branches of the two
nerves combine to form the sural nerve, which supplies the skin on the
posterior and lateral leg.
Coccygeal Plexus
The coccygeal plexus is a very small plexus formed from the ventral
rami of spinal nerve S5 and the coccygeal nerve (Co). This small plexus
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supplies the muscles of the pelvic floor and the skin over the coccyx.
The dorsal rami of the coccygeal nerves also innervate some skin over
the coccyx.
Radial Nerve Damage
The radial nerve lies near the humerus in the axilla. When crutches are
used improperly, the crutch is pushed tightly into the axilla. This can
damage the radial nerve by compressing it against the humerus,
resulting in crutch paralysis. In this disorder, muscles innervated by the
radial nerve lose their function. The major symptom of radial nerve
damage is wrist drop, an inability to extend the wrist when the pronated
forearm is held parallel to the ground. Consequently, the wrist drops into
a flexed position. The radial nerve can be permanently damaged by a
fracture of the humerus in the proximal part of the arm. A sharp edge of
the broken bone may cut the nerve, resulting in permanent paralysis
unless the nerve is surgically repaired. Because of potential damage to
the radial nerve, a broken humerus should be treated very carefully.
Ulnar Nerve Damage
The ulnar nerve is the most easily damaged of all the peripheral nerves,
but such damage is almost always temporary. Slight damage to the ulnar
nerve may occur where it passes posterior to the medial epicondyle of
the humerus. The nerve can be felt just below the skin at this point, and,
if this region of the elbow is banged against a hard object, temporary
ulnar nerve damage may occur. This damage results in painful tingling
sensations radiating down the ulnar side of the forearm and hand.
Because of this sensation, this area of the elbow is often called the
funny bone or crazy bone.
Median Nerve Damage
Damage to the median nerve occurs most commonly where it enters the
wrist through the carpal tunnel. This tunnel is created by the concave
organization of the carpal bones and the retinaculum on the anterior
surface of the wrist. None of the connective tissue components of the
carpal tunnel expand readily. The tendons passing through the carpal
tunnel may become inflamed and enlarged as a result of repetitive
movements. This inflammation can produce pressure within the carpal
tunnel, thereby compressing the median nerve and resulting in
numbness, tingling, and pain in the fingers. The thenar muscles,
innervated by the median nerve, have reduced function, resulting in
weakness in thumb flexion and opposition. This condition is referred to
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as carpal tunnel syndrome. Carpal tunnel syndrome is common among

people who perform repetitive movements of the wrists and fingers,
such as keyboard operators. Surgery is often required to relieve the
pressure.
• Describe the spinal nerves.

• Discuss the spinal reflex arc.
Activity
• In the histology laboratory, observe and recognize the

microscopic slides of a nerve and its connective tissue coverings.
• In the gross anatomy laboratory/ dissection room, identify the
major spinal nerve plexuses – cervical, brachial, lumbar and
sacral plexuses.
4.0 CONCLUSION
The five major plexuses are the cervical (C1–C4), brachial (C5– T1),
lumbar (L1–L4), sacral (L4–S4), and coccygeal (S5 and coccygeal
nerve). The lumbar and sacral plexuses are often considered together as
the lumbosacral plexus. A major nerve of the cervical plexus is the
phrenic nerve. The major nerves of the brachial plexus are the axillary,
radial, musculocutaneous, ulnar, and median nerves.
5.0 SUMMARY
• Individual axons are surrounded by the endoneurium. Groups of

axons, called fascicles, are bound together by the perineurium.
The fascicles form the nerve and are held together by the
epineurium.
• Eight cervical, 12 thoracic, 5 lumbar, 5 sacral pairs, and 1

coccygeal pair make up the spinal nerves. The distribution of
spinal nerves to skeletal muscles has a top-to bottom pattern in
which superior nerves supply superior muscles and inferior
nerves supply inferior muscles.
• Spinal nerves have specific cutaneous distributions called

dermatomes. Spinal nerves branch to form rami. The dorsal rami
supply the muscles and skin near the midline of the back.
142
1. Which of these is a correct count of the spinal nerves?
a. 9 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

b. 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal
c. 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal
d. 8 cervical, 11 thoracic, 4 lumbar, 6 sacral, 1 coccygeal
e. 7 cervical, 11 thoracic, 5 lumbar, 6 sacral, 1 coccygeal
2. Given these structures:

1. dorsal ramus
2. dorsal root
3. plexus
4. ventral ramus
5. ventral root
Choose the arrangement that lists the structures in the order that an
action potential passes through them, given that the action potential
originates in the spinal cord and propagates to a peripheral nerve.
a. 2,1,3
b. 2,3,1
c. 3,4,5
d. 5,3,4
e. 5,4,3
3. Damage to the dorsal ramus of a spinal nerve results in

a. loss of sensation.
b. loss of motor function.
c. both a and b.
4. A dermatome
a. is the area of skin supplied by a pair of spinal nerves.
b. exists for each spinal nerve except C1.
c. can be used to locate the site of spinal cord or nerve root
damage.
5. A collection of spinal nerves that join together after leaving the

spinal cord is called a
a. ganglion.
b. nucleus.
c. projection nerve.
d. plexus.
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6. Which of these nerves arises from the cervical plexus?
a. median
b. musculocutaneous
c. phrenic
d. obturator
e. ulnar sheath.
7. The sciatic nerve is actually two nerves combined within the

same. The two nerves are the
a. femoral and obturator.

b. femoral and gluteal.
c. common fibular (peroneal) and tibial.
d. common fibular (peroneal) and obturator.
e. tibial and gluteal.
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144
UNIT 3 AUTONOMIC NERVOUS SYSTEM
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Difference between PNS and ANS
3.2 Anatomy of the ANS
3.3 Sympathetic Division
3.4 Parasympathetic Division
3.5 Physiology of ANS
3.6 Receptors
3.7 Regulation of
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
During a picnic on a sunny spring day, it is easy to concentrate on the

delicious food and the pleasant surroundings. The maintenance of
homeostasis requires no conscious thought. The autonomic nervous
system (ANS) helps keep body temperature at a constant level by
controlling the activity of sweat glands and the amount of blood flowing
through the skin. The ANS helps regulate the complex activities
necessary for the digestion of food. The movement of absorbed nutrients
to tissues is possible because the ANS controls heart rate, which helps
maintain the blood pressure necessary to deliver blood to tissues.
Without the ANS, all of the activities necessary to maintain homeostasis
would be overwhelming.
A functional knowledge of the ANS enables you to predict general

responses to a variety of stimuli, explain responses to changes in
environmental conditions, comprehend symptoms that result from
abnormal autonomic functions, and understand how drugs affect the
ANS.
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NSC 218 MODULE 3
2.0 OBJECTIVES
• distinguish further between the ANS and the somatic system.

• predict the effects of sympathetic versus parasympathetic
stimulation on specific organs.
3.0 MAIN CONTENTS
3.1 Difference between PNS and ANS
The peripheral nervous system (PNS) is composed of sensory and motor

neurons. Sensory neurons carry action potentials from the periphery to
the central nervous system (CNS), and motor neurons carry action
potentials from the CNS to the periphery. Motor neurons are either
somatic motor neurons, which innervate skeletal muscle, or autonomic
motor neurons, which innervate smooth muscle, cardiac muscle, and
glands.
Although axons of autonomic, somatic, and sensory neurons are in the

same nerves, the proportion varies from nerve to nerve. For example,
nerves innervating smooth muscle, cardiac muscle, and glands, such as
the vagus nerves, consist primarily of axons of autonomic motor
neurons and sensory neurons. Nerves innervating skeletal muscles, such
as the sciatic nerves, consist primarily of axons of somatic motor
neurons and sensory neurons. Some cranial nerves, such as the
olfactory, optic, and vestibulocochlear nerves, are composed entirely of
axons of sensory neurons. The cell bodies of somatic motor neurons are
in the CNS, and their axons extend from the CNS to skeletal muscle.
The ANS, on the other hand, has two neurons in a series extending
between the CNS and the organs innervated.
The first neurons of the series are called preganglionic neurons. Their
cell bodies are located in the CNS within either the brainstem or the
lateral part of the spinal cord gray matter, and their axons extend to
autonomic ganglia located outside the CNS. The autonomic ganglia
contain the cell bodies of the second neurons of the series, which are
called postganglionic neurons. The preganglionic neurons synapse with
the postganglionic neurons in the autonomic ganglia. The axons of the
postganglionic neurons extend from autonomic ganglia to effector
organs, where they synapse with their target tissues.
146
3.2 Anatomy of the ANS
The ANS is subdivided into the sympathetic and the parasympathetic

divisions and the enteric nervous system (ENS). The sympathetic and
parasympathetic divisions differ structurally in (1) the location of their
preganglionic neuron cell bodies within the CNS and (2) the location of
their autonomic ganglia. The enteric nervous system is a complex
network of neuron cell bodies and axons within the wall of the digestive
tract. An important part of this network is sympathetic and
parasympathetic neurons. For this reason, the enteric nervous system is
considered to be part of the ANS.
3.3 Sympathetic Division
Cell bodies of sympathetic preganglionic neurons are in the lateral horns

of the spinal cord gray matter between the first thoracic (T1) and the
second lumbar (L2) segments. The sympathetic division is sometimes
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NSC 218 MODULE 3
called the thoracolumbar division because of the location of the

preganglionic cell bodies.
The axons of preganglionic neurons are small in diameter and

myelinated. The short connection between a spinal nerve and a
sympathetic chain ganglion through which the preganglionic axons pass
is called a white ramus communicans because of the whitish colour of
the myelinated axons. Sympathetic axons exit the sympathetic chain
ganglia by the following four routes:
1. Spinal nerves - Preganglionic axons synapse with postganglionic

neurons in sympathetic chain ganglia. They can synapse at the
same level that the preganglionic axons enter the sympathetic
chain, or they can pass superiorly or inferiorly through one or
more ganglia and synapse with postganglionic neurons in a
sympathetic chain ganglion at a different level.
Axons of the postganglionic neurons pass through a gray ramus

communicans and re - enter a spinal nerve. Postganglionic axons
are not myelinated, thereby giving the gray ramus communicans
its grayish colour. All spinal nerves receive postganglionic axons
from a gray ramus communicans. The postganglionic axons then
project through the spinal nerve to smooth muscle and glands
located in the skin and skeletal muscles.
2. Sympathetic nerves - Preganglionic axons enter the sympathetic

chain and synapse in a sympathetic chain ganglion at the same or
a different level with postganglionic neurons. The postganglionic
axons leaving the sympathetic chain ganglion form sympathetic
nerves, which supply organs in the thoracic cavity.
3. Splanchnic nerves- Some preganglionic axons enter sympathetic

chain ganglia and, without synapsing, exit at the same or a
different level to form splanchnic nerves. Those preganglionic
axons extend to collateral ganglia, where they synapse with
postganglionic neurons. Axons of the postganglionic neurons
leave the collateral ganglia through small nerves that extend to
effector organs in the abdominopelvic cavity.
4. Innervation to the adrenal gland – The splanchnic nerve

innervation to the adrenal glands is different from other ANS
nerves because it consists of only preganglionic neurons. Axons
of the preganglionic neurons do not synapse in sympathetic chain
ganglia or in collateral ganglia. Instead, the axons pass through
those ganglia and synapse with cells in the adrenal medulla. The
adrenal medulla is the inner portion of the adrenal gland;
148
itconsists of specialized cells derived during embryonic

development from neural crest cells, which are the same
population of cells that gives rise to the postganglionic cells of
the ANS. Adrenal medullary cells are round, have no axons or
dendrites, and are divided into two groups. About 80% of the
cells secrete epinephrine also called adrenaline and about 20%
secrete norepinephrine, also called noradrenaline. Stimulation of
these cells by preganglionic axons causes the release of
epinephrine and norepinephrine. These substances circulate in the
blood and affect all tissues having receptors to which they can
bind. The general response to epinephrine and norepinephrine
released from the adrenal medulla is to prepare the individual for
physical activity. Secretions of the adrenal medulla are
considered hormones because they are released into the general
circulation and travel some distance to the tissues in which they
have their effect.
3.4 Parasympathetic Division
The cell bodies of parasympathetic preganglionic neurons are either

within cranial nerve nuclei in the brainstem or within the lateral parts of
the gray matter in the sacral region of the spinal cord from S2 to S4. For
that reason, the parasympathetic division is sometimes called the
craniosacral division. Axons of the parasympathetic preganglionic
neurons from the brain are in cranial nerves III, VII, IX, and X and
from the spinal cord in pelvic splanchnic nerves. The preganglionic
axons course through these nerves to terminal ganglia, where they
synapse with postganglionic neurons. The axons of the postganglionic
neurons extend relatively short distances from the terminal ganglia to
the effector organs. The terminal ganglia are either near or embedded
within the walls of the organs innervated by the parasympathetic
neurons. Many of the parasympathetic ganglia are small but some, such
as those in the wall of the digestive tract, are large.
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NSC 218 MODULE 3
3.5 Physiology of ANS
Neurotransmitters
Sympathetic and parasympathetic nerve endings secrete one of two

neurotransmitters. If the neuron secretes acetylcholine, it is a
cholinergic neuron; if it secretes norepinephrine (or epinephrine), it is
an adrenergic neuron. Adrenergic neurons are so named because at one
time it was believed that they secreted adrenaline, which is another
name for epinephrine. All preganglionic neurons of the sympathetic and
parasympathetic divisions and all postganglionic neurons of the
parasympathetic division are cholinergic. Almost all postganglionic
neurons of the sympathetic division are adrenergic, but a few
postganglionic neurons that innervate thermoregulatory sweat glands are
cholinergic. In recent years, substances in addition to the regular
neurotransmitters have been extracted from ANS neurons. These
substances include nitric oxide; fatty acids, such as eicosanoids;
peptides, such as gastrin, somatostatin, cholecystokinin, vasoactive
intestinal peptide, enkephalins, and substance P; and monoamines, such
as dopamine, serotonin, and histamine. The specific role that many of
these compounds play in the regulation of the ANS is unclear, but they
appear to function as either neurotransmitters or neuromodulator
substances.
3.6 Receptors
Receptors for acetylcholine and norepinephrine are located in the

plasma membrane of certain cells. The combination of neurotransmitter
and receptor functions as a signal to cells, causing them to respond.
Depending on the type of cell, the response is excitatory or inhibitory.
150
Cholinergic Receptors
Cholinergic receptors are receptors to which acetylcholine binds. They

have two major, structurally different forms. Nicotinic receptors bind
to nicotine, an alkaloid substance found in tobacco, and muscarinic
receptors bind to muscarine, an alkaloid extracted from some poisonous
mushrooms. Although nicotine and muscarine are not naturally in the
human body, they demonstrate the differences between the two classes
of cholinergic receptors. Nicotine binds to nicotinic receptors but not to
muscarinic receptors, whereas muscarine binds to muscarinic receptors
but not to nicotinic receptors. On the other hand, nicotinic and
muscarinic receptors are very similar because acetylcholine binds to and
activates both types of receptors. The membranes of all postganglionic
neurons in autonomic ganglia and the membranes of skeletal muscle
cells have nicotinic receptors. The membranes of effector cells that
respond to acetylcholine released from postganglionic neurons have
muscarinic receptors.
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NSC 218 MODULE 3
ANS supply to organs of the body
3.7 Regulation of ANS
Much of the regulation of structures by the ANS occurs through

autonomic reflexes, but input from the cerebrum, the hypothalamus, and
other areas of the brain allows conscious thoughts and actions, emotions,
and other CNS activities to influence autonomic functions. Without the
regulatory activity of the ANS, an individual has limited ability to
maintain homeostasis. Autonomic refl exes, like other reflexes, involve
sensory receptors, sensory neurons, interneurons, motor neurons, and
effector cells. For example, baroreceptors (stretch receptors) in the
walls of large arteries near the heart detect changes in blood pressure,
and sensory neurons transmit information from the baroreceptors
through the glossopharyngeal and vagus nerves to the medulla
oblongata. Interneurons in the medulla oblongata integrate the
information, and action potentials are produced in autonomic neurons
that extend to the heart. If baroreceptors detect a change in blood
152
pressure, autonomic reflexes change heart rate, which returns blood

pressure to normal.
A sudden increase in blood pressure initiates a parasympathetic reflex,

which inhibits cardiac muscle cells and reduces heart rate, thus bringing
blood pressure down toward its normal value. Conversely, a sudden
decrease in blood pressure initiates a sympathetic reflex, which
stimulates the heart to increase its rate and force of contraction, thus
increasing blood pressure. Other autonomic reflexes participate in the
regulation of blood pressure. For example, numerous sympathetic
neurons transmit a low but relatively constant frequency of action
potentials that stimulate blood vessels throughout the body, keeping
them partially constricted. If the vessels constrict further, blood pressure
increases; if they dilate, blood pressure decreases. Thus, altering the
frequency of action potentials delivered to blood vessels along
sympathetic neurons can either raise or lower blood pressure.
The brainstem and the spinal cord contain important autonomic reflex
centers responsible for maintaining homeostasis. The hypothalamus,
however, is in overall control of the ANS. Almost any type of
autonomic response can be evoked by stimulating a part of the
hypothalamus, which in turn stimulates ANS centers in the brainstem or
spinal cord. Although there is overlap, stimulation of the posterior
hypothalamus produces sympathetic responses, whereas stimulation of
the anterior hypothalamus produces parasympathetic responses. In
addition, the hypothalamus monitors and controls body temperature. The
hypothalamus has connections with the cerebrum and is an important
part of the limbic system, which plays an important role in emotions.
The hypothalamus integrates thoughts and emotions to produce ANS
responses. Pleasant thoughts of a delicious banquet initiate increased
secretion by salivary glands and by glands within the stomach and
increased smooth muscle contractions within the digestive system.
These responses are controlled by parasympathetic neurons. Emotions
such as anger increase blood pressure by increasing heart rate and
constricting blood vessels through sympathetic stimulation. The enteric
nervous system is involved with autonomic and local reflexes that
regulate the activity of the digestive tract. For example, in an ANS
reflex, sensory neurons detecting stretch of the digestive tract wall send
action potentials to the CNS. In response, the CNS sends action
potentials out the ANS, causing smooth muscle in the digestive tract
wall to contract.
The neurons of the enteric nervous system also operate independently of

the CNS to produce local reflexes. A local reflex does not involve the
CNS, but it does produce an involuntary, unconscious, stereotypic
response to a stimulus. For example, sensory neurons not connected to
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NSC 218 MODULE 3
the CNS detect stretch of the digestive tract wall. These sensory neurons
send action potentials through the enteric plexuses to motor neurons,
causing smooth muscle contraction or relaxation.
Clinical correlates
Effects of Spinal Cord Injury on ANS Functions
Spinal cord injury can damage nerve tracts, resulting in the loss of
sensation and motor control below the level of the injury. Spinal cord
injury also interrupts the control of autonomic neurons by ANS centers
in the brain. For the parasympathetic division, effector organs
innervated through the sacral region of the spinal cord are affected, but
most effector organs still have normal parasympathetic function because
they are innervated by the vagus nerve. For the sympathetic division,
brain control of sympathetic neurons is lost below the site of the injury.
The higher the level of injury, the greater the number of body parts
affected.
Immediately after spinal cord injury, spinal cord reflexes below the level
of the injury are lost, including ANS reflexes. With time, the reflex
centers in the spinal cord become functional again. This recovery is
particularly important for reflexes involving urination and defecation.
Autonomic reflexes mediated through the vagus nerves or the enteric
nervous system are not affected by spinal cord injury.
Dopamine and the Treatment of Shock
Norepinephrine is produced from a precursor molecule called dopamine.

Certain sympathetic neurons release dopamine, which binds to
dopamine receptors. Dopamine is structurally similar to norepinephrine
and it binds to beta receptors. Dopamine hydrochloride has been used
successfully to treat circulatory shock because it can bind to dopamine
receptors in kidney blood vessels. The resulting vasodilation increases
blood flow to the kidneys and prevents kidney damage. At the same
time, dopamine can bind to beta receptors in the heart, causing stronger
contractions.
Self-Assessment Exercise
Describe the effects of sympathetic versus parasympathetic stimulation

on specific organs.
Activity
154
In the anatomy museum, locate and examine any parts of the autonomic
nervous system on models available.
4.0 CONCLUSION
The cell bodies of somatic motor neurons are located in the CNS, and
their axons extend to skeletal muscles, where they have an excitatory
effect that usually is controlled consciously.
5.0 SUMMARY
• The cell bodies of the preganglionic neurons of the ANS are

located in the CNS and extend to ganglia, where they synapse
with postganglionic neurons. The postganglionic axons extend to
smooth muscle, cardiac muscle, or glands and have an excitatory
or inhibitory effect, which usually is controlled unconsciously.
• Preganglionic cell bodies are in the lateral horns of the spinal
cord gray matter from T1 to L2. Preganglionic axons pass
through the ventral roots to the white rami communicantes to the
sympathetic chain ganglia.
• Preganglionic cell bodies are in nuclei in the brainstem or the
lateral parts of the spinal cord gray matter from S2 to S4.
Preganglionic axons from the brain pass to ganglia through
cranial nerves. Preganglionic axons from the sacral region pass
through the pelvic splanchnic nerves to the ganglia.
Preganglionic axons pass to terminal ganglia within the wall of or
near the organ that is innervated.
• Sympathetic, parasympathetic, and sensory neurons intermingle
in autonomic nerve plexuses. Sympathetic axons reach organs
through spinal, sympathetic, and splanchnic nerves.
• Parasympathetic axons reach organs through cranial and pelvic
splanchnic nerves. Sensory neurons run alongside sympathetic
and parasympathetic neurons within nerves and nerve plexuses.
• Acetylcholine is released by cholinergic neurons (all
preganglionic neurons, all parasympathetic postganglionic
neurons, and some sympathetic postganglionic neurons).
• Norepinephrine is released by adrenergic neurons (most
sympathetic postganglionic neurons). Acetylcholine binds to
nicotinic receptors (found in all postganglionic neurons) and
muscarinic receptors (found in all parasympathetic and some
sympathetic effector organs). Norepinephrine and epinephrine
bind to alpha and beta receptors (found in most sympathetic
effector organs).
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NSC 218 MODULE 3
• Activation of nicotinic receptors is excitatory, whereas activation

of muscarinic, alpha, and beta receptors is either excitatory or
inhibitory.
1. Given these phrases:
1. Neuron cell bodies in the nuclei of cranial nerves

2. Neuron cell bodies in the lateral gray matter of the spinal
cord (S2–S4)
3. Two synapses between the CNS and eff ector organs
4. Regulates smooth muscle
Which of the phrases are true for the autonomic nervous system?
a. 1,3
b. 2,4
c. 1,2,3
d. 2,3,4
e. 1,2,3,4
1. gray ramus communicans

2. white ramus communicans
3. sympathetic chain ganglion
Choose the arrangement that lists the structures in the order an action
potential passes through them from a spinal nerve to an eff ector organ.
a. 1,2,3
b. 1,3,2
c. 2,1,3
d. 2,3,1
e. 3,2,1
1. collateral ganglion
2. sympathetic chain ganglion
3. white ramus communicans
4. splanchnic nerve
Choose the arrangement that lists the structures in the order an action
potential travels through them on the way from a spinal nerve to an
effector organ.
156
a. 1,3,2,4
b. 1,4,2,3
c. 3,1,4,2
d. 3,2,4,1
e. 4,3,1,2
4. The white ramus communicans contains
a. preganglionic sympathetic fibers.

b. postganglionic sympathetic fibers.
c. preganglionic parasympathetic fibers.
d. postganglionic parasympathetic fibers.
5. The cell bodies of the postganglionic neurons of the sympathetic

division are located in the
a. sympathetic chain ganglia

b. collateral ganglia.
c. terminal ganglia.
d. dorsal root ganglia.
e. both a and b.
6. Splanchnic nerves
a. are part of the parasympathetic division.

b. have preganglionic neurons that synapse in the collateral
ganglia.
c. exit from the cervical region of the spinal cord.
d. travel from the spinal cord to the sympathetic chain
ganglia.
7. Which of the following statements regarding the adrenal
gland is true?
a. The parasympathetic division stimulates the adrenal gland
to release acetylcholine.
b. The parasympathetic division stimulates the adrenal gland
to release epinephrine.
c. The sympathetic division stimulates the adrenal gland to
release acetylcholine.
d. The sympathetic division stimulates the adrenal gland to
release epinephrine.
8. The parasympathetic division
a. is also called the craniosacral division.

b. has preganglionic axons in cranial nerves.
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NSC 218 MODULE 3
c. has preganglionic axons in pelvic splanchnic nerves.

d. has ganglia near or in the wall of eff ector organs.
9. Which of these is not a part of the enteric nervous system?
a. ANS motor neurons

b. neurons located only in the digestive tract
c. sensory neurons
d. somatic motor neurons
10. Concerning the distribution of autonomic axons,
a. autonomic nerve plexuses contain sympathetic and

parasympathetic axons.
b. sympathetic axons reach the skin and skeletal muscles of
most of the body through spinal nerves.
c. sympathetic axons reach thoracic organs and parts of the
head and neck through sympathetic nerves.
d. sympathetic axons reach abdominopelvic organs through
splanchnic nerves.
Inc.



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COURSE

COURSE UNITS: 2 Credit units (18 hours of instruction online; 12

Course Team (Course Writers) Dr. Adewole O.S. MBBS, PhD,

NATIONAL OPEN UNIVERSITY OF NIGERIA

© 2021 by NOUN Press

Printed by NOUN Press np@noun.edu.ng

Course Aims …………………………………………..…….iv

Working through the Course ………………………………..v

Study Units ………………………………………………..vi

Equipment and Software Needed to Access Course ……….vii

Number and Places of Meeting…………………………….vii

Grading Scale ……………………………………………..vii

Schedule of Assignments with Dates………………………viii

How to get the most from this Course……………………viii

Welcome to the second semester course in Human Anatomy, NSC 218 –

Human Anatomy (IV)

At the completion of this course, you should be able to:

DOING THE COURSE

COURSE REQUIREMENTS AND EXPECTATIONS OF YOU

Attendance of 95% of all interactive sessions, submission of all

1. Be versatile in basic computer skills

EQUIPMENT AND SOFTWARE NEEDED TO ACCESS

You will be expected to have the following tools:

1. A computer (laptop or desktop or a tablet)

NUMBER AND PLACES OF MEETING (ONLINE, FACE-

The details of these will be provided to you at the time of

Students evaluation: The students will be assessed and evaluated based

In line with the university’s regulation, in-course examination will come

Computer Marked Assignment. This will be in addition to 1compulsory

Attendance, record of participation and other assignments will be graded

LEARNER-FACILITATOR EVALUATION OF THE

This will be done through group review, written assessment of learning

Grades will be based on the following Percentages

SCHEDULE OF ASSIGNMENTS WITH DATES

To be provided for each module by the facilitator in addition to the ones

SPECIFIC READING ASSIGNMENTS

To be provided by each module

Katherine M. A. Rogers and William N. Scott (2011) Nurses! Test

Kathryn A. Booth, Terri. D. Wyman (2008) Anatomy, Physiology, and

Keith L Moore, Persuade T.V.N (2018), The Developing Human

Kent M. Van De Graff, R.Ward Rhees, Sidney Palmer (2010) Schaum‘s

Philip Tate (2012) Seeley‘s Principles of Anatomy & Physiology 2nd

Sadler T.W (2012), Langman‘s Medical Embryology 12th edition.

Seeley‘s Principles of Anatomy & Physiology, Second edition Published

Module 1 The Special Senses………………………. 1

Unit 1 Integumentary System…………………….. 1

Module 2 The Nervous System…………………… 58

Unit 1 Embryology of the central

MODULE 3 The Peripheral and Autonomic

Unit 1 Cranial nerves…………………………….. 125

MODULE 1 THE SPECIAL SENSES

UNIT 1 INTEGUMENTARY SYSTEM

The integumentary system is familiar to most people because it covers

Skin without blemishes is considered attractive, whereas acne is a source

At the end of this unit, you should be able to:

• Describe the components and functions of the integumentary

3.0 MAIN CONTENT

3.1 Functions of integumentary System

The appearance of the integumentary system can indicate physiological

1. Protection: The skin protects against abrasion and ultraviolet