LESSON #19 (6 HOURS)
Theme. Spinal cord, shape, topography. Membranes of the spinal cord.
Reflex arcs. Spinal cord (internal structure). Base of brain. Topography of 12 cranial nerves
Aіm: Study the structural and topographical peculіarіtіes of the spinal cord and its membranes. Peculiarities of white and gray substance, topography of cranial nerves on the base of the brain.
The professіonal orіentatіon. Study the structure, size, topography of the spinal cord is necessary for neurology, neurological therapy and neurosurgery. Knowledge about anatomy of spinal cord membranes, nuclei and fascicle of spinal cord and their structure is the base for understanding of physiological processes and clinic diagnosis and treatment.
Knowledge the main parts of brain and their development is the base for understanding of detail structure and of medulla oblongata, pons, cerebellum, rhomboid fossa, midbrain, diencephalon and forebrain. It gives fundament for neurological therapy, neurosurgery and traumatology.
Base level of knowledge and skіlls
1. Latіn termіnology.
2. Structure of backbone.
3. Skull.
I. Practical work – 9:00-12:00 am (4 hours)
1) Іllustratіve materіal
1. Preparation of the spinal cord.
2. Preparation of the brain.
3. Demonstrational preparations of the spinal cord and meninges in museum.
4. Skeleton of backbone.
2) Methods of practical work.
Task 1.Using a preparation, convince that spinal cord is situated in the spinal canal and has the extent from the big cervical opening to the upper brim of the second lumbar vertebra (in new-born — to the third vertebra, in man — to the first lumbar vertebra). Find on the preparation top and lower limits of the spinal cord. Pay attention that the spinal cord below ends in cerebral cone, from which to the bottom the terminal filament is going, which consists of the membranes of the spinal cord.
Task 2. On the prepararion of the membranes of the spinal cord you need to find the enlargement of the spinal cord (in the upper section — cervical, and in the lower — lumbar); the cerebral cone, in which the spinal marrow ends; terminal filament, which is descending to the first and the second coccyx vertebra.
Task 3. On the isolated preparation of the spinal cord find front and back fissurae, which is going longitudinally along the front surface and divides it into two symmetrical halves (left and right); weakly expressed lateral grooves — front and back, which divide each half of the spinal cord into three funiculi.
Task 4. On the museum preparations and the preparation of the spinal cord show the roots of the spinal nerves; spinal ganglia, which are situated at the place of joining of the front and back rootlets; spinal nerves, which are formed from the joining of the front and back rootlets.
Task 5. Draw the outer construction of the spinal cord, where you need to indicate all its anatomical formations.
Task 6. The preparation of the spinal cord. Show the position of the marrow, its cervical and lumbar enlargements on the micropreparation of the spinal cord. The secular and sexual peculiarities of the topography of the spinal cord. Show also fissures and clefts of the spinal cord, cauda equina and terminal filament.
Task 7. The preparation of the inner structure of the spinal cord. Dissect the lumbar segment of the marrow on which show its inner structure, pay attention to the gray liquid, its form, location and components, nucleus and relation to the white liquid. Make accent on the importance of knowledge of inner structure of the marrow in topical diagnostics of neurotic illnesses.
Task 8. The preparation of the spinal rootlets, cords, branches of spinal nerves. On the macropreparation of the spinal cord show the peculiarities of forming spinal rootlets, cords and branches of spinal nerves and the formation of the cauda equina. Show the structure of the reflex arch (its components). Give the main statements about neural segments, their number in cervical, thoracic, lumbar, sacral and rump sections.
· Practical skills and abilities of students, demonstrate on preparations:
Special attention should be paid to the following:
1. The base of the cerebrum: olfactory bulb, tracts, trigonum, substantia perforata anterior, n. opticus, hiasma opticum, and tractus opticus. Looking at the tuber cinereum and hypophysis. Corpora mammilares, substantia perforata posterior, pedunculi cerebri, sites of exit of nn. trigeminus, trachlearis, oculomotorius, pons, middle pedunculi cerebelli. The main fissurae and sulci of hemispheres, pallium and trunc of the cerebrum.
2. Medial surface of the cerebrum: fornix, corpus callosum thalamus, septum pellucidum, foramen inteventriculare, comissura posterior, corpus quadrigeminus, aqueductus cerebri, corpus pineale, cavity of ventriculi quarti (IV).
II. Seminar discussion 12:30 am – 14:00 pm (2 hours)
1. Why is the pain caused by inadequate oxygenation of the heart muscle felt not only in the midline of the thorax but often also in the arms and base of the neck?
Because sensory nerves to the heart run with the sympathetic fibres, and like them originate in the upper thoracic segments of the spinal cord. Since visceral pain is "referred" to the body wall area supplied by the same segments, pain occurs in the upper thoracic wall. T1 contributes to the brachial plexus so pain is also felt in the arms.
From which sources do the pelvic organs receive autonomic innervation?
(a) Sympathetic: from the lowest part of the sympathetic outflow (L1 and L2)
via the hypogastric plexus.
(b) Parasympathetic; from the pelvic outflow, leaving the spinal cord in the
pelvic nerves (S2 and S3), forming a pelvic plexus and synapsing in or close
to the target organs.
A collection of cell bodies located outside the CNS is called
A. A tract
B. A nerve
C. A nucleus
D. A ganglion
Which of following neuron types are pseudounipolar?
E. Sensory neurons
F. somatic motor neurons
G. neurons in the retina
H. autonomic motor neurons
The central nervous system consists of the brain and
A. The cranial nerves
B. The spinal nerves
C. The spinal cord
D. The ganglia
· Discussion of theoretical questions:
1. What is the morpho-functional element of nervous system?
2. What does the neuron consist of ?
3. Where the spinal cord is situated ?
4. Describe the external form of the spinal cord ?
5. Describe the skeletotopy of the spinal cord.
6. What is the length of the spinal cord ?
7. Which the upper and lower borders of the spinal cord in different age ?
8. Which surfaces and sulcus (fissurae) of spinal cord do you know?
9. Where are located intumescentiae (enlargement) of spinal cord?
10. What is “cauda equina”, and structural components that form it?
11. Which membranes does spinal cord have?
12. Which membrane spaces are around the spinal cord? Their contains.
13. Where does the cerebrospinal fluid circulate?
14. Where can they do spinal punction? Why?
15. What is the segment of the spinal cord?
16. Show structure parts of the segment and reflector arc.
17. How are white and gray substance represented in spinal cord?
18. Which fascicles are located in spinal cord?
19. Which parts of gray substance in different segments of spinal cord they distinguish?
20. Which nuclei are located in cornu anterior? What are they by their function?
21. Which nuclei are located in cornu lateral? What are they by their function?
22. Which nuclei are located in cornu posterior? What are they by their function?
23. Which tracts are located in anterior fascicles? Ascending or descending are they?
24. Which tracts are located in lateral fascicles? Ascending or descending are they?
25. Which tracts are located in posterior fascicles? Ascending or descending are they?
26. Name the parts of the brain.
27. Which primary and secondary brain vesicles do you know?
28. What does develop from the telencephalon?
29. What does develop from the mesencephalon.
30. What does develop from the rhombencephalon.
31. Describe the inferior surface of brain.
32. Show on the basis of the cerebrum the sites of exit of all cranial nerves.
ІІІ. Independent students work – 14:15pm – 15:00 pm
References:
а) basic
1. Atlas of Human Anatomy/ Frank H. Netter,- 5 edition, - 2011 by Saunders, an Imprint of Elsevior Inc.
2. Gray's Anatomy for Students: With STUDENT CONSULT Online Access, 2e, - 2010. 2092 p. Richard L. Drake Ph.D, A. Wayne Vogl, Adam W.M. Mitchell, – Printed in Canada.
3. Materials preparation for lectures
4. Materials preparation for practical classes
b) additional
1. Human anatomy & physiology /Elaine N. Marieb, Katja Hoehn., San Francisco : Benjamin Cummings, c2010., 8th ed.
2. F.H. Netter. Atlas of Human Anatomy. – Cіba Pharmaceutіcals Dіvіsіon, 1994. – 514 p.
3. Synelnіkov R.D. The atlas of anatomy of the man. Іn 4-th volumes. -: Medіcіna, 1991.
4. Reminetskyy B.Y., Fedonyuk Y.I. Human anatomy. Notes. 136 p.
5. Lectures.
Methodical instructions have been prepared by:
The instruction was discussed and confirmed at the department meeting
25.06.2012. Protocol number 11