ABOUT THE AUTHOR

Jennifer Tobin is currently a Ph.D. candidate in Anatomy and Neurobiology at Boston University School of Medicine. She has been a supporter of and a volunteer for the Accelerated Cure Project since 2003. After multiple sclerosis affected the lives of people close to her, Jennifer wanted to use her neuroscience training to help individuals with MS to better understand the disease. She realized that a diagnosis of MS can leave many people with questions about their bodies, the disease, new terminology, and treatment choices. Jennifer wrote this document with the hope that it would help individuals with MS and their loved ones to better understand the central nervous system and how it can be affected by MS. In turn, this knowledge may enable people to communicate better with their doctors and become more active participants in their treatment.


Table of Contents

INTRODUCTION

PART 1: MICROSCOPIC ANATOMY

PART 2: SIGNALING BY NEURONS

PART 3: GROSS ANATOMY OF THE CENTRAL NERVOUS SYSTEM

PART 4: MAGNETIC RESONANCE IMAGING

RESOURCES


Introduction to Neuroanatomy

FOR INDIVIDUALS WITH MS, THEIR FAMILY, AND THEIR FRIENDS

After being diagnosed with Multiple Sclerosis (MS), many people find themselves in a world of uncertainty and new terminology. You may feel like you don’t want to ask “stupid” questions about concepts that seem so simple and clear to medical professionals or maybe you don’t even know where to begin asking questions. The goal of this booklet is to provide a clear and complete introduction to neuroanatomy so that individuals with MS, along with their family and friends, may better understand their disease.

This document is divided into four parts. Part 1, Microscopic Anatomy, introduces the different cell types found in the nervous system. The cells are the building blocks for all of the more complex structures in the nervous system. Signaling by Neurons, Part 2, describes how nerve cells communicate with one another, which is the basis for all functions of the nervous system. Part 3, Gross Anatomy of the Central Nervous System, describes the structure and function of the spinal cord and brain. Finally, Part 4 provides a brief introduction to magnetic resonance imaging, which is commonly used to diagnose and track the progression of MS by producing images of the brain and spinal cord.


The nervous system is the control center of the body. It allows us to touch, see, smell, taste, and hear. It collects and integrates this sensory information, allowing us to have awareness of ourselves and of our surroundings. The nervous system initiates voluntary movements and regulates involuntary ones. It is also responsible for memory, consciousness, emotion, and regulation of the body’s internal clock.

The functional unit of the nervous system is the neuron (nerve cell or nerve fiber), a specialized cell that has the ability to carry electrical impulses. The supporting cells of the nervous system are collectively called glia, or neuroglia. The cells of the nervous system will be discussed in more detail in the following section.

There are three ways in which the nervous system is commonly divided. The first division is based on location: the central nervous system (CNS) is composed exclusively of the brain and spinal cord; the peripheral nervous system (PNS) includes all of the other nervous tissue in the body.

The second division is based on the type of signal that a given nerve fiber carries: the sensory nervous system carries information from a remote site to the brain, while the motor nervous system carries impulses from the brain to muscles of the body. Neurons that carry sensory information are often called ascending fibers because the signal travels “up” to the brain, and motor neurons are considered descending fibers because the signal originates in the brain and travels “downward”.

The final division is that of the somatic and autonomic nervous systems. Each of these systems has both sensory and motor components. The somatic motor system sends impulses to skeletal, or voluntary, muscles and the somatic sensory system transmits information from touch, pain, temperature and position receptors throughout the body. The autonomic motor system conducts motor impulses to the heart, smooth muscles of body organs, and glands, which are collectively called the viscera. The autonomic sensory system receives pain and other feedback from the viscera.


Neurons:

The neuron [Greek: neuron, nerve or string] is the primary functional unit of the nervous system. The cell body, commonly called the soma [Greek: soma, body], is the metabolic center of the neuron. The majority of the cell’s energy production and protein synthesis takes place here. The cell body is also home to the nucleus, a small organelle that contains the neuron’s DNA.

Neurons have two types of processes, tube-like extensions from the cell body, called axons and dendrites. Axons [Greek: axon, axis] are processes that transmit signals away from the soma to target cells, which include muscle cells and other neurons. As an axon approaches its target, it divides to form smaller branches, called axon collaterals. These collaterals allow the axon to form contacts with many different sites on a single target cell or with several nearby target cells. A single axon can range in length from about 100μm (1 μm = 1 micron = one 1,000,000th of a meter) to a few feet, depending on the location of its target structure.

Dendrites [Greek: dendrites, relating to a tree] receive signals from axons and relay them to the soma where they are integrated with other incoming signals. In addition to receiving signals, a second important function of dendrites is to increase the receptive surface area of the neuron. This is achieved through the extensive branching pattern of most dendrites and the small projections called spines that are found along the length of the dendrite.

Each neuron has exactly one axon and at least one dendrite. Neurons are often characterized by the number of processes originating from the cell body. For example, a pseudounipolar neuron has a single process that almost immediately branches into an axon and a dendrite. A bipolar neuron has two processes: one axon and one dendrite. Multipolar neurons have one axon and several dendrites.

The specialized regions of contact between neurons (most commonly between an axon and a dendritic spine) are called synapses [Greek: synapsis, point of contact]. Synapses permit the one-way transmission of neural signals from one cell to another. The mechanism of synaptic transmission will be discussed in Part 2.

Figure 1: Neuron Types

This is an illustration of three common types of neurons: mutipolar, pseudounipolar, and bipolar. They are oriented similarly for ease of comparison, but this side-by-side orientation does not occur in the body. Note that each neuron has one axon and at least one dendrite. (image credit: Patricia Smith)

Glia:

The supporting cells of the nervous system are collectively called glia [Greek: glia, glue]. Three types of glia are found in the central nervous system: astrocytes, microglia, and oligodendrocytes. Astrocytes [Greek: astron, star; kytos, hollow] are star-shaped cells that lie in the spaces between neurons. These cells provide a rigid support structure for neurons and make sure that the only points of contact between neurons are at synapses. Astrocytes also form “scars” after the loss of or damage to CNS tissue, which prevents the regeneration of lost synapses. The sclerosis [Greek: sklerosis, hardening], or scarring, that occurs in MS is a result of the astrocytic response to damaged CNS neurons. (Interestingly, embryonic astrocytes seem to assist in the formation of synapses and promote neuronal growth.)


Microglia [Greek: mikro-, small] are small cells that are not normally abundant in the central nervous system. Microglia remain quiescent (at rest) until they are stimulated by the presence of an antigen, a substance that the body recognizes as foreign or damaged. Once activated, the microglia bind to the antigen and “present” it to a subset of immune system cells produced in the thymus gland, called T cells. Together the T cells and microglia initiate an immune response against the antigen, in order to protect the CNS. Activated microglia can engulf and phagocytize [Greek: phagein, to eat], or digest, cellular debris, fragments, and even injured neurons.

The third type of glial cell found in the CNS is the oligodendrocyte [Greek: oligos, little, few], often called “oligo” for short. Oligos have many processes, or “arms,” extending from the cell body, which form segments of myelin along axons in the CNS, as described below. Since oligos do not exist outside of the CNS, myelin in the PNS is formed by another type of glial cell, the Schwann cell.

Myelin:

Myelin [Greek: myelos, marrow] is a lipid-rich substance that is composed of concentric layers of glial cell membrane, the “skin” that surrounds each cell. In the CNS, one process from an oligodendrocyte wraps around a single portion of an axon several times to form a segment of myelin. Each oligo may send out several extensions to form several segments of myelin on multiple axons. Small, unmyelinated regions, called nodes of Ranvier, separate myelin segments from each other. The term “myelin sheath” collectively refers to all the segments of myelin surrounding a given axon. The segmented nature of the myelin sheath is important for the conduction of neuronal signals down the axon, which will be discussed in Part 2.

Figure 2 – Oligodendrocytes and myelin

The processes of oligodendrocytes produce the myelin sheaths of the CNS. Processes are shown wrapping around an axon several times to form a segment of myelin (orange). The unmyelinated regions (purple) between segments of myelin are the nodes of Ranvier. One segment of myelin in the upper left of the figure has been shown in cross-section to demonstrate the layered structure of myelin. (image credit: Yuko Rodriguez)

MS lesions are sites of inflammation in the CNS where myelin is damaged and stripped away from the axons of neurons, resulting in demyelinated axons and damage to the nearby oligodendrocytes and/or axons. As further described in Part 3, the location of the lesion will determine what type of symptoms, if any, may result.

Meninges:

The central nervous system is enclosed by a series of three membranes: the dura mater, arachnoid mater, and pia mater. These membranes are collectively called the meninges [Greek: meninx, membrane]. The main functions of the meninges are to protect the brain and spinal cord, provide structural support to large blood vessels that supply the CNS, and physically anchor the brain to the skull.


Figure 3: Meninges

In this illustration of the human skull, part of the forehead has been “opened up” to show the underlying meninges and brain. Starting on the outside, the layers are: bone, dura mater, arachnoid mater, subarachnoid space, pia mater, gray matter of brain, white matter of brain. (image credit: Fiona Graeme-Cook)

The outermost membrane is the dura mater [Latin: dura mater, hard mother], which is a very tough two-layered sheet of tissue. In many places the two layers of dura are closely attached to one another, but in the skull the layers can separate to form venous sinuses, large blood vessel-like openings that drain deoxygenated blood from the brain. The outer layer of the dura is tightly adhered to the internal surface of the skull, while the inner layer is more closely associated with the underlying arachnoid mater. In certain areas of the skull, where more support is required, the inner layer of the dura folds over on itself to create a 4-layered structure, commonly called a fold or “reflection.” One such reflection is the tentorium cerebelli [Latin: tentorium, tent], which supports the occipital lobes of the cerebral cortex and prevents the weight of the cerebrum from pressing on the cerebellum. See Part 3 for a description of these brain regions. The dura mater contains a few blood vessels that generally supply the bones of the skull.

The intermediate membrane, the arachnoid mater [Greek: arachne, spider], is a thin sheet of tissue that loosely surrounds the brain and spinal cord. The arachnoid mater envelops nerves that arise directly from the brain or spinal cord, until they exit the skull or vertebral column. The arachnoid membrane also sends a network of delicate, web-like fibers towards the underlying pia mater.

The pia mater [Latin: pia mater, tender mother] is the most delicate of the meninges and lies directly on the surface of the spinal cord and brain. Unlike the dura and arachnoid, the pia mater follows the convoluted surface of the brain closely, dipping down in to the many folds of the cerebral cortex. The pia is also the most vascular

(i.e. contains the most blood vessels) of the meninges. The small blood vessels that lie in the pia mater supply the brain and spinal cord.

There are small spaces separated by the layers of meninges. The epidural space [Greek: epi-, upon] lies between the outer/endosteal layer of the dura mater and the skull or vertebrae. This space is extremely narrow and contains the middle meningeal artery, which supplies blood to most of the dura mater. A rupture in the middle meningeal artery will result in an epidural hematoma, a localized swelling filled with blood. Between the dura and arachnoid mater is the subdural space [Latin: sub-, beneath]. This space contains a minute amount of fluid as well as some cerebral veins. Damage to one of these veins will lead to a subdural hematoma. The subarachnoid space, which lies between the arachnoid and pial membranes, is filled with cerebrospinal fluid. This fluid provides some nutrients to the CNS, acts as a protective barrier against infection, and cushions the CNS from impact with its bony covering.


Cerebrospinal fluid:

Cerebrospinal fluid (CSF) is a clear, colorless fluid that circulates around the brain and spinal cord. CSF has a similar composition to blood serum, the fluid left behind when cells and clotting factors are removed from whole blood. CSF protects the brain from damage against the skull and provides a “bath” for the brain to float in, decreasing its effective weight. Approximately 400-500 milliliters (about a pint) of cerebrospinal fluid is produced each day by the choroid plexus [Greek: chorioeides, skinlike; Latin: plectere, to weave], a highly vascularized tissue that lines some of the ventricles, or cavities, within the brain. CSF flows through the four brain ventricles then continues into the subarachnoid space, where it is eventually reabsorbed into the venous sinuses by small structures known as arachnoid villi [Greek: arachne, spider; Latin: villus, hair]. The absorbed CSF then continues through the blood circulation.

The subarachnoid space is not uniform in size throughout the CNS. The space in the lumbar portion (lower back) of the vertebral column is so large that it is known as the lumbar cistern. A lumbar puncture takes advantage of this large reserve of CSF. In a lumbar puncture a needle is inserted between two lumbar vertebrae into the subarachnoid space in order to obtain a small sample of cerebrospinal fluid for testing. CSF analysis can aid in the diagnosis of MS by ruling out the presence of acute infections that may not show up on a blood test and by enabling the detection of oligoclonal bands. Oligoclonal bands are immunoglobulins (antibodies) found in the cerebrospinal fluid. Multiple oligoclonal bands in the CSF suggest inflammation in the central nervous system and support a diagnosis of MS. A headache may result after a lumbar puncture if the patient tries to get up too quickly or move too much because the loss of CSF causes the brain to become more “heavy” in the skull. This can cause the brain to pull on the dura mater and irritate the nerves and vessels associated with it.

Blood-brain barrier:

Endothelial cells [Greek: endon, within; thele, nipple] are the specialized cells that line the inside of all the blood vessels in the body. In most regions of the body, there are tiny openings between the endothelial cells allowing certain nutrients, enzymes, and bacteria in the bloodstream to enter the surrounding tissue. In the CNS, the seal between adjacent endothelial cells is especially tight, forming the blood-brain barrier (BBB). Additional structural support for the BBB is provided by astrocytes that lie along the outside of the blood vessels. The BBB is technically a blood-CNS barrier as it is present in the spinal cord as well as the brain.

The BBB is a physical barrier that prevents many substances in the blood from entering the CNS. Molecules that are lipid, or fat, soluble (such as oxygen, carbon dioxide, ethanol, and steroid hormones) can pass through the BBB by dissolving through the membrane of the endothelial cells. Also, certain essential cellular nutrients, such as amino acids, have specialized transport mechanisms by which they are able to leave the blood and enter the brain. Astrocytes, in addition to their structural role, are involved in maintaining a balance of ions (charged particles such as sodium, calcium, and potassium) between the blood and the CNS.

The BBB is advantageous because it prevents toxins and infectious agents from entering the central nervous system. However, this tight seal has made treating diseases of the CNS more difficult because it also prevents antibiotics and other medications normally delivered through the blood from entering the brain and spinal cord.


Every neuron is primed with an imbalance of ions between the surrounding extracellular fluid and the inside of the cell. This imbalance of charged particles, or polarity, is essential for the neuron’s ability to produce signals. Neurons also have the ability to synthesize neurotransmitters, chemical molecules that are released from the axon terminal of one neuron upon stimulation and bind to receptor sites on the surface of neighboring neurons. This causes small channels on the surface of the neighboring neuron to open, allowing specific ions to enter or exit the cell in order to equalize the imbalance in charge, or depolarize the cell.

A neurotransmitter molecule binding to its receptor produces a characteristic “stop” or “go” response in the neuron. Each neuron sums up all of the individual “stop” and “go” signals to determine if the overall input to the cell is greater than a critical level, called threshold. If threshold is met or exceeded, the neuron generates an output signal called an action potential. Action potentials are electrical signals that propagate down the entire length of an axon through the opening and subsequent closing of adjacent ion channels. Upon reaching the axon terminal, the action potential stimulates the release of neurotransmitters into the synapse, which will bind to receptors on nearby neurons. If threshold is not reached, no action potential will be generated.

In unmyelinated axons, ion channels are distributed evenly along the entire length of the axon, 100-200 per square micron. The act of opening and closing ion channels to conduct the action potential down an axon takes time. The longer the axon, the more time it will take for the action potential to reach the synapse. This process is called active transmission.

In myelinated axons, the ion channels are highly concentrated in the unmyelinated nodes of Ranvier, roughly 1000-2000 per square micron. Action potentials therefore “jump” down the axon from one node of Ranvier to the next, decreasing the actual distance that the signal must travel and thereby speeding up the rate of neuronal signaling. This is called saltatory conduction [Latin: saltatore, to jump, dance]. Additionally, myelin has a high lipid content which allows it to act as insulation for the axon, similar to the rubber coating that surrounds electrical wires keeping the electrical charge contained within the wire.

Figure 4: Saltatory conduction

This figure demonstrates saltatory conduction using a diagram of three myelinated axons. At Point A, ion channels open, ions rush into the axon, and an action potential is generated. The action potential then jumps to the next node of Ranvier, Point B (middle axon), followed by Point C (right axon). After the action potential moves to the next node the axon returns to its rest state as ions leave the axon. (image credit: Claudia Wolf)

Myelinated segments of axons do contain ion channels, but fewer than about 25 per square micron. When an axon is demyelinated as occurs in MS, the rate of conduction slows down because the action potential can no longer “jump” down the axon. Action potentials must then be propagated using active transmission, but with fewer ion channels than would be found in unmyelinated axons.

Both myelinated and unmyelinated axons are present in the CNS. Certain types of pain and temperature receptors send their information along unmyelinated axons. However, the majority of motor and other types of sensory signals are carried predominantly along myelinated axons.


The central nervous system is composed of the brain and the spinal cord. The CNS is covered by meninges and protected by bony structures, the skull and vertebrae. The tissue of the central nervous system can be subdivided into gray matter and white matter, a classification that is based on the appearance of the tissue to the naked eye. Gray matter is primarily composed of neuronal cell bodies and dendrites. White matter is characterized by an abundance of axons, whose fatty myelin sheath gives the tissue its white appearance.

An important distinction to make at this point is that between a neuron and a nerve. These terms are not interchangeable, however sometimes you will hear a neuron referred to as a nerve cell or fiber. A nerve is made up of many axons, originating from many different neurons, which are held together in a fibrous sheath called the epineurium [Greek: epi-, upon; neuron, nerve]. In this sense several neurons contribute to the formation of a single nerve.

Other terms used in the description of neuroanatomy indicate the positional relationship of one structure to another: Dorsal and posterior mean behind, or towards the back; ventral and anterior mean towards the front or in front of. Medial indicates that a structure is close or closer to the midline of the body, while lateral means that a structure is farther away from the midline, towards the right or left. Finally, superior means above and inferior means below.

Spinal Cord:

The spinal cord is a bundle of nervous tissue that extends down the back through the vertebral column. It is continuous with the brainstem at the base of the skull and terminates a few inches below the ribcage. The adult spinal cord is 42-45 centimeters long on average and only about 1 centimeter in diameter at its widest point. Don’t let the small size fool you; the spinal cord has several very important functions. It receives and begins to process sensory information from nerves throughout the body. All of the motor neurons that control voluntary movements are located in the spinal cord. The spinal cord is also responsible for most reflexes, including the knee-jerk reflex and the withdrawal reflex when one encounters a painful stimulus.

The central portion of the spinal cord is composed of gray matter surrounded by white matter. In a cross-section, the gray matter is easily identified by its characteristic butterfly, or “H” shape. The tips of the H (or the tips of the butterfly’s wings) are called horns. There are 2 dorsal horns and 2 ventral horns. Somatic motor neurons that supply skeletal muscles are located in the ventral horn. The motor neurons that are closest to the midline of the spinal cord innervate muscles of the trunk, while those that are more lateral innervate the extremities (arms, legs, fingers, toes). The cells in the dorsal horn are generally small “interneurons” that relay incoming sensory signals to both motor neurons and other sensory neurons.

Figure 5: Spinal cord cross-section

The somae of sensory neurons (blue) are found in the dorsal root ganglia. Sensory axons enter the spinal cord through the dorsal root and often synapse on interneurons (green) in the gray matter. Motor neuron cell bodies are located in the gray matter and the axons leave the spinal cord through the ventral root. Spinal nerves are formed when the dorsal and ventral roots join together. (image credit: Jennifer Tobin)


The functional organization of the spinal cord is based on the pairs of spinal nerves that emerge from the cord at regular intervals. Each spinal nerve is made from the union of a ventral motor root and a dorsal sensory root. The axons of motor neurons leave the spinal cord through the ventral motor root and then travel in the spinal nerve until reaching their target muscle. Sensory cell bodies are not located in the spinal cord, but in small aggregations along the dorsal root of the spinal nerve, called dorsal root ganglia [Greek: ganglion, nerve bundle]. The processes of sensory neurons travel through the spinal nerve to specialized sensory receptors located throughout the body.

The portion of the spinal cord associated with a given pair of spinal nerves is known as a segment. Spinal nerves exit the vertebral column through small openings called intervertebral foramen [Latin: foramen, opening]. Since each pair of spinal nerves leaves the vertebral column through a specific vertebra (one of the bones that make up the vertebral column), the spinal nerves are named after their associated vertebra.

The vertebral column is divided into 5 regions based on the physical characteristics of the individual vertebrae. The cervical [Latin: cervix, neck] vertebrae are located in the neck and are the smallest of the vertebrae. The thoracic [Latin: thorax, chest] vertebrae are associated with the ribs. Lumbar [Latin: lumbaris, loin] vertebrae are found in the lower back and are thick in order to support the body. The sacral [Latin: sacer, sacred] vertebrae are fused together to form a structure called the sacrum, which is located behind the pelvis. Finally, the coccygeal [Greek: kokkux, cuckoo, resembling a cuckoo’s beak] vertebrae are small, incompletely formed bones just inferior to the sacrum. The 31 pairs of spinal nerves and their corresponding spinal segments are as follows: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. You may hear the sacral and coccygeal segments of the spinal cord and vertebrae referred to as the sacrococcygeal region. The levels of the spinal cord are abbreviated by using the first letter of the name of the vertebral type associated with the nerves. For example, C-spine refers to the cervical segments of the spinal cord, while T-spine refers to the thoracic segments. Also, C5 refers to the 5th spinal nerve in the cervical region.

If you were to look at the entire length of the spinal cord, you would notice that there are two regions that are slightly larger in diameter than the rest of the cord. These are the cervical and lumbar enlargements that contain the motor neurons that supply the arms and legs, respectively.

Figure 6: Spinal cord

This is a profile of the spinal cord within the vertebral column. Each region of the spinal cord (cervical, thoracic, lumbar, sacrococcygeal) is a different color. The spinal nerves are seen exiting the vertebral column on the right. (image credit: James Steinberg)

As you can see in Figure 6, the spinal cord does not extend the full length of the vertebral column. The spinal cord normally terminates at around L1 to L2 (lumbar vertebrae 1 to 2). The roots of lumbar, sacral, and coccygeal spinal nerves must descend beyond the end of the spinal cord to reach their exit point. Collectively these nerve roots are known as the cauda equina (Latin: horse’s tail).


Each spinal nerve carries sensory information from a specific region of the body. The area of skin that is innervated, or supplied, by a single spinal nerve is called a dermatome. MS lesions in the spinal cord can produce sensory symptoms that feel like “bands” of altered sensation around the body. These bands correspond to the dermatomes (see Figure 7) supplied by spinal nerves. Sensory nerves above the level of the lesion are not affected, but those below the level of the lesion are affected. Since sensory information travels up the spinal cord to the brain, the lesion acts like a roadblock to these signals, preventing them from continuing onto the brain. Similarly, motor symptoms also occur below the level of the spinal lesion. In this case the “roadblock” prevents the signals from the brain from traveling down the spinal cord.

Figure 7: Dermatome map

Spinal nerves are listed next to the area of skin that they innervate. The colors used in this figure correspond to the regions of the spinal cord in Figure 6. (image credit: James Steinberg)

Brain:

The brain has three major subdivisions: the cerebrum, the cerebellum, and the brain stem.

Cerebrum

The cerebrum [Latin: cerebrum, brain] is derived from two embryologic structures: the telencephalon and the diencephalon. The telencephalon [Greek: telos, end; encephalon, in the head] gives rise to the cerebral cortex and a collection of structures known as the basal ganglia. The diencephalon [Greek: dia, through; encephalon, in the head] forms several structures including the thalamus, hypothalamus, and optic nerves.

Telencephalon – cerebral cortex

The surface of the cerebral cortex [Latin: cortex, bark or rind] is very convoluted, allowing for a greater area of cortex to fit inside the skull. The folds of tissue that project outwards are called gyri (singular: gyrus) [Greek: gyros, circle] and the grooves between the folds are called sulci (singular: sulcus) [Latin: sulcus, ditch]. The pattern of gyri and sulci in a brain is characteristically arranged and can be used as anatomical landmarks for certain functional areas of the brain.

The cerebral cortex is divided vertically into two hemispheres, which are generally physically symmetrical but have some important differences in function. The left hemisphere is responsible for logic, mathematics, language, reasoning, storage of language-based memories, and the right side of the body. The right hemisphere integrates input from all of the senses and is responsible for visual-spatial skills, art, music, storage of sensory-based memories, and the left side of the body. Both hemispheres are able to interpret sensory information, make decisions, and play a part in learning and memory functions. The primary means of communication between the right and left cerebral hemispheres is through a structure known as the corpus callosum [Latin: corpus, body; callosus, hard]. The corpus callosum is a large bundle of axons that transmits signals from one hemisphere to the other, so that the cerebral cortex is able to function as a single unit.


Figure 8: Corpus callosum

This is a top-down view of the cerebral cortex with the right hemisphere in gray and the left hemisphere in white. The right hemisphere is slightly “cut away” to reveal the corpus callosum, bands of nerve fibers extended between the two hemispheres. The green arrows represent the exchange of information between the hemispheres. (image credit: Joel Jacobs, Ph.D.)

Each cerebral hemisphere is divided into 5 lobes, or sections: frontal, parietal, temporal, occipital, and limbic. The lobes have distinct functional characteristics that are described briefly in Table 1.

Table 1: Lobes of the Cerebral Cortex Figure 9: Lobes of cerebral cortex

The lobes of the cerebral cortex, as well as the cerebellum and brain stem are shown in relation to the head and face. The limbic lobe can not be seen here because it is internal to the other lobes of the cortex. (image credit: Claudia Wolf)

While MS lesions in the cerebral cortex are quite common, they do not usually produce major symptoms. One reason for this is that adjacent cortical regions often have very similar or redundant functions, making it more difficult for a lesion to have a great effect on any particular function. Large cerebral lesions may cause general weakness or numbness, and in rare circumstances can result in aphasia [Greek: aphatos, speechless], memory difficulties, or other cognitive problems.

Cortical Lobe Location Primary Functions
Frontal lobe Roughly the anterior 13 of the cerebral cortex • initiation of voluntary movements • production of written and spoken language • personality and “executive” function
Parietal lobe Superior half of the middle 13 of the cortex • processing of tactile information, perception of movement and awareness of the body’s orientation in space (proprioception) • comprehension of language • spatial organization and perception
Temporal lobe Inferior half of the middle 13 of the cortex • processing of auditory information • comprehension of language • visual processing • learning and memory
Occipital lobe Posterior 13 of the cerebral cortex processing of visual information
Limbic lobe Internal aspect of the cortex • emotion • drive-related behavior • memory

Telencephalon – basal ganglia

The basal ganglia [Latin: basis, base] are a collection of bilateral nuclei (in the central nervous system, the term nuclei refers to a collection of neuronal cell bodies) that are located internal to the cerebral cortex. They are often referred to as “sub-cortical” nuclei. The nuclei that comprise the basal ganglia are the caudate nucleus, putamen, globus pallidus and the substantia nigra. Some texts will also include the subthalamic nucleus, amygdala, and the claustrum in their description of the basal ganglia.

The basal ganglia’s position within the brain is illustrated by the profile on the lower right The upper left image is an enlarged version of the basal ganglia. The dotted lines indicate that part of the caudate nucleus has been removed to make other structures, such as the putamen and globus pallidus, visible. (image credit: Joel Jacobs, Ph.D.)

The basal ganglia initiate and help control voluntary movements. They also have an important role in balance and postural reflexes. The neurodegenerative disorders Parkinson’s disease and Huntington disease are movement disorders that result from dysregulation, or abnormal function, of the basal ganglia.

Diencephalon

The structures that are located deep within the cerebral cortex, in the center of the brain, are collectively called the diencephalon. The largest of these structures is the thalamus [Greek: thalamos, chamber]. The thalamus is a bilateral collection of nuclei located in the center of the brain that functions as a processing and relay center for the cerebral cortex. It receives input from the other areas of the CNS, integrates them, and subsequently sends signals to various regions of the cerebral cortex.

The hypothalamus [Greek: hypo-, under] is a small bilateral structure just inferior to the thalamus. The hypothalamus contains the appetite and thirst centers of the brain and plays a role in emotional and drive-related behaviors. It controls many of the body’s autonomic functions and hormone levels through the pituitary gland. (This is why you will often hear the term hypothalamic-pituitary axis.) The pituitary gland has a wide variety of functions including control of growth, metabolism, blood pressure, sexual function, and thyroid function, as well as mediating the body’s response to stress.

The optic nerves [Greek: optikos, visible] carry visual information from each eye to the occipital lobe of the cortex where the majority of visual processing takes place. Inflammation of the optic nerve results in optic neuritis, a relatively common condition in MS. This can result in visual disturbances including blurred or double vision, loss of sight, pain, and/or headaches.

Cerebellum:

The cerebellum [Latin: cerebellum, little brain] is located beneath the cerebral hemispheres on the posterior surface of the brain. The cerebellum communicates with the cerebral cortices and brainstem through fiber bundles called the cerebellar peduncles [Latin: pedunculus, foot], which also anchor the cerebellum to the rest of the brain. The cerebellum is involved with the processing of somatosensory (sensations from the body) information, balance, control and coordination of voluntary movements. Damage to the cerebellum can result in problems with balance, control of posture, and coordination of movements.


Brain stem:

The brain stem is continuous with the cerebrum above and with the spinal cord below. The functions of the brainstem are diverse. The uppermost portion of the brainstem is the midbrain. The midbrain is involved with vision and hearing. The pons [Latin: pons, bridge], the middle portion of the brain stem, controls consciousness and arousal, and aids in the coordination of movement. The lower portion of the brainstem, the medulla oblongata, regulates vital

Table 2: Cranial Nerves

body functions such as respiration and heart rate. Nuclei in the brainstem communicate with the cerebral cortex, the cerebellum and the spinal cord. Most of the cranial nerves originate in the brain stem.

Cranial nerves supply motor and sensory innervation to the head, receive sensory information from the eyes, ears, nose and mouth, and provide autonomic innervation to the head and neck. These nerves are especially important because they control the “special senses” of vision, hearing, smell and taste.

Nerve Name Functions
I Olfactory Smell
II Optic Vision
III Oculomotor Movement of the eyes, elevation of the eyelids, constriction of pupil in response to light
IV Trochlear Inferior and lateral movement of the eyes
V Trigeminal Sensation from the face, control of the muscles involved in chewing
VI Abducent Lateral movement of the eye
VII Facial Control of the muscles involved in facial expression, taste, tear production, salivation
VIII Vestibulocochlear Hearing and balance
IX Glossopharyngeal Salivation, taste, sensation from external ear
X Vagus Control of the muscles involved in swallowing, taste, autonomic innervation of various organs including tongue, larynx (area of voice production), pharynx (throat), heart, bronchi of lungs, esophagus
XI Accessory Control of the muscles of the palate, pharynx, larynx
XII Hypoglossal Control of the muscles of the tongue

MRI:

Magnetic resonance imaging (MRI) takes advantage of the abundance of hydrogen atoms in all of the body’s fluids and tissues. The protons that spin around the nucleus of hydrogen atoms produce tiny magnetic fields. When the atoms enter a strong magnetic field, in this case because your body has entered the MRI scanner, the protons’ spins are forced into alignment with the magnetic field. Radio frequency pulses are sent into the magnetic field by the MRI scanner, which transmits energy waves to the protons, causing them to tilt out of alignment. As the protons fall out of alignment, they absorb some of the energy generated by the scanner. When the radio pulse is turned off, the protons relax and return to alignment with the magnetic field, transferring energy to their surrounding environment (tissue). Each tissue has a characteristic “relaxation time”, which is the time that it takes for a given tissue to absorb the energy released by its protons. For example, myelin, which is rich in lipids, absorbs energy faster than cerebrospinal fluid, which is mostly water. By measuring the amount of energy in the scanner after each radio pulse, a computer is able to construct an image of the insides of the body.

There are several techniques used by the scanner’s computer to construct these body images. T1-weighted images focus on the rate of relaxation as protons realign with the magnetic field. In this type of scan, white matter (myelin) appears lighter than gray matter, and bone, air, and fluids appear black. T2-weighted images are based on the rate at which protons lose their tilt. In these images, white matter is darker than gray matter, fluid is white, and bone is black. Tissue damage appears dark in T1-weighted images and white in T2-weighted images.

Another technique used with MRIs is the intravenous injection of a contrast agent called gadolinium (Gd or Gad). Gd is a chemical element with magnetic properties that shorten the relaxation time of nearby protons. On a T1-weighted image, areas rich in Gd appear brighter than the surrounding tissue. After its injection, Gd remains in the blood vessels unless the blood-brain barrier is ruptured, as it is in cases of the acute inflammation seen in “active” MS lesions. In this situation, Gd leaks out into the nervous tissue around the lesion resulting in a bright “spot” on the MRI. The Gd solution used with MRIs is known to be very safe and is excreted from the body in urine.

While bright (hyperintense) spots on a T1weighted MRI indicate active lesions that enhance with Gd, hyperintense areas on T2weighted images could be either acute lesions or sites of chronic damage. Areas that appear as hypointense (dark) spots for six or more months on T1 images are called “persistent black holes” and indicate sites where axons have been damaged and tissue has been lost.

For additional information on magnetic resonance imaging, please refer to the Accelerated Cure Project Newsletter, Fall 2004, Vol. 3 Issue

3. This can be downloaded by visiting: www.acceleratedcure.org/news/newsletter.php.

Summary

The nervous system is very complex and scientists are still trying to solve many of its mysteries. Hopefully this paper has given you a better understanding of basic neuroanatomy. Below is a list of websites that can give you some more information about the nervous system or MRI. Don’t be hesitant to ask your neurologist or health care provider any questions you have about MS and how it affects your body.


Helpful Websites:

A brief tour of the brain: This site is mostly text and offers a more historical account of what is known about the brain. It also has a good description of the communication between neurons. www.nldontheweb.org/catterall.htm

Medline Plus Medical Encyclopedia – MRI:

This site is maintained by the U.S. National Academy of Health and the National Institute of Health. It provides links to a series of articles and tutorials about MRI. www.nlm.nih.gov/medlineplus/mriscans.html

Society for Neuroscience: The society offers a variety of public resources on their website.The Brain Briefings and Brain Backgrounders are short online articles about a variety of topics. www.sfn.org

While you are waiting… a guide to brain anatomy:

This website describes the parts of the brain, their functions, and what symptoms may result from damage to specific brain areas. www.waiting.com/brainanatomy.html

Whole Brain Atlas – Harvard University: This is an interactive map (or atlas) of the human brain using MRI images. You can look at the normal brain or the brain with a variety of neurological conditions, including MS. www.med.Harvard.edu/AANLIB/home.html

Wikipedia: This online encyclopedia is a great resource if you are looking for some more in-depth information on a specific brain area. en.wikipedia.org

References:

Moore, Keith L. and Agur, Anne M. R. (1995) Essential Clinical Anatomy. Lippincott Williams & Wilkins, Baltimore, MD.

Kingsley, Robert E. (2000) Concise Text of Neuroscience, second edition. Lippincott Williams & Wilkins, Baltimore, MD.

Bashir, Khurram and Whitaker, John N. (2002) Handbook of Multiple Sclerosis. Lippincott Williams & Wilkins, Baltimore, MD.

Gray, Henry (2003) Gray’s Anatomy 16th edition. Merchant Book Company, Finland.

Accelerated Cure Project: This is a nonprofit organization dedicated to curing MS by determining its causes.

Credits

Author: Jennifer Tobin Artists: Patricia Smith, Yuko Rodriguez, Fiona

Graeme-Cook, Claudia Wolf, Jennifer Tobin, James Steinberg, Joel Jacobs, Ph.D. Editors: Accelerated Cure Project Staff Design: Clockwork Design Group, Inc


The Accelerated Cure Project for Multiple Sclerosis is a national nonprofit organization dedicated to curing MS by determining its causes. Focused primarily on accelerating the pace of MS breakthroughs, the Accelerated Cure Project seeks to remove obstacles to investigating the causes of MS and encourages collaboration between research organizations and clinicians. It is developing a “Cure Map,” a systematic plan of research into the causes of MS, and implementing a large-scale, multidisciplinary MS Sample Repository to accelerate the search for environmental and genetic factors in MS.

Accelerated Cure Project provides the following MS resources and materials at no charge:

  • MS News: One of the most popular, comprehensive, and continuously updated sources of MS-related news available today. It can be found at msnews.acceleratedcure.org.
  • MS Quickstart Guide: A booklet called, So you have MS...Whats Next? that tells you all youll need to know when you or a loved one is diagnosed with MS. Based on the experiences of people with MS, its a useful place to start your introduction to having MS.
  • Working with Multiple Sclerosis: A booklet to guide you through the various problems that can crop up when trying to manage a career and a chronic disease.
  • Multiple Sclerosis Primer: Provides an in-depth introduction to MS as a disease, how it is diagnosed, and treated, and whats involved.
  • Quarterly Print Newsletter: Updates relating to Accelerated Cure Projects recent efforts and research.
  • Email Announcements: Prompt notification of upcoming events, breaking MS news, and the availability of MS related resources.
  • Healthcare Market Overview: Provides useful information for someone just diagnosed with a chronic disease looking to understand how everything interoperates. .
  • Book Reviews: written by Accelerated Cure Project volunteers about MS-related books.
  • Interviews with MS researchers: explaining their specific fields of study.
  • Clinical Trials: links to online resources for understanding and participating in studies.

Click on the “Sign Up” button at the top of every web page to receive all these benefits and others at: www.acceleratedcure.org/offerings