1. Lab 5: White Matter and the Ventricles Christopher Ramnanan, Ph.D. cramnana@uottawa.ca Describe the anatomic correlates pertinent to the production, flow and reabsorption of cerebrospinal fluid. Identify the following structures of the limbic system: fornix, amygdala, mammillary bodies and hippocampus. Identify intercortical, commissural and projection fibers on sections of the brain. Identify the internal capsule and the associated fibers in the anterior limb, posterior limb and genu. Name the major cerebrospinal fluid (CSF) containing structures, including the lateral ventricles and the intracranial cisterns created in the subarachnoid space. Wed. February 25 th, 2015

2. The CSF containing ventricle system Lateral ventricles (LV): Associated with the caudate nucleus Anterior Horn: associated w/ Head caudate nucleus Body: associated w/ Body of caudate nucleus Inferior and Posterior Horns: associated w/ Tail of caudate nucleus 3 rd Ventricle: associated with thalamus 4 th Ventricle: Associated with pons, medulla, cerebellum Cerebral Aqueduct: associated w/ midbrain Anterior HornBody Inferior Horn Posterior (Occipital) Horn

3. Production and Flow of CSF Choroid Plexus, Lat. Ventr. Choroid Plexus; 3 rd Ventr. Choroid Plexus, 4 th Ventr. CSF is produced (~500 mL/day, adult) by the choroid plexus in all four ventricles. Typical description of flow: Lateral ventricles  IV Foramen of Munro  3 rd ventricle  Cerebral Aqueduct  4 th ventricle  exits Foramen of Magendie (Median Plane) and Foramen of Luschka (Bilateral)  Cisterna Magna to circulate around CNS CSF fluid is mainly reabsorbed in the venous sinus system system via arachnoid granulations (most easily seen in the superior sagittal sinus).

5. Prominent CSF cisterns Interpeduncular cistern (chiasmatic cistern): located anterior to the midbrain; contains optic chiasm Quadrigeminal (superior) cistern: posterior to midbrain Cisterna magna (cerebellomedullary cistern): largest pool; located b/w the cerebellum and the medulla; receives CSF from Luschka/Magendie Pontine (pre-pontine) cistern: located anterior to pons

6. MRI Ventricles and CSF cisterns – Sagittal view These cisterns can best be approximated (where the CSF pools would have been, in life) in sagittal brain specimens with dura intact. The cisterns are useful landmarks in sagittal clinical images, as are the ventricle structures.

7. The cortex has white matter connections with other parts of the CNS including: A)Association fibers: connections to other regions of cortex within the same hemisphere; B)Projection fibers: connections to subcortical structures (thalamus, basal ganglia, brainstem, spinal cord) and C)Commissural fibers: connections to cortex within contralateral hemisphere We won’t go into any detailed discussion of any particular association fibers, but we will discuss important commissural and projection fibers over the next few slides.

8. Prominent Commissural Structure: The Corpus Callosum Rostrum Splenium Genu Splenium Note: -Corpus callosum larger in females than males; may relate to females > males in terms of multitasking http://cercor.oxfordjournals.org/content/23/10/2514 http://cercor.oxfordjournals.org/content/23/10/2514 -Agenesis of corpus callosum is a common congenital malformation (may affect motor milestones, social behaviour and cognitive functions in children; often misdiagnosed) -Corpus callosum surgical resection sometimes used in epileptic patients to limit incidents of secondary seizures Genu

9. FYI links: The story of Kim Peek, who inspired the autistic character in the movie Rain Man: https://www.psychologytoday.com/blog/the-superhuman-mind/201303/the-brain-the-real- rain-man Patients with partial or complete lack of corpus callosum share their experiences: http://blogs.scientificamerican.com/observations/2012/12/20/patients-reflect-on-life-with- a-common-brain-malformation How corpus callosum disorders can be diagnosed: http://www.nodcc.org/how-a-dcc-is-diagnosed

10. Prominent Projection Structure: The Internal Capsule Includes most fibers (descending motor, ascending sensory) that travel between cortex and subcortical structures (thalamus, brainstem, spinal cord). We will identify structures passing through the anterior limb, the genu, and the posterior limb of the internal capsule. The optic radiations are associated with posterior aspect of the posterior limb.

11. Internal Capsule, Coronal View Corona radiata fibers will continue as the internal capsule. Some fibers of the internal capsule descending from the precentral gyrus (ie. motor tracts) will continue as cerebral peduncles in midbrain. Note: In this coronal plane, you can see that internal capsule is landmark that separates the thalamus and head of the caudate nucleus (medial) from the lentiform nucleus (not well observed in this particular cut). Corona radiata

12. Transverse View Through Internal Capsule: Major Components Anterior limb -frontopontine tracts -thalamic radiations to prefrontal cortex Genu Genu (the bend) -Corticobulbar motor tracts supplying face Posterior Limb 1) descending corticospinal motor tracts supplying limbs 2) thalamic somatosensory radiations to primary somatosensory cortex 3) auditory radiations (medial geniculate nucleus to primary auditory cortex in temporal lobe) 4) optic radiations (lateral geniculate nucleus to primary visual cortex in occipital lobe) Ant. Limb passes b/w caudate head and lentiform nucleus Post. Limb passes b/w thalamus and lentiform nucleus

13. The Internal Capsule includes: Sensory information (except olfaction) relayed from thalamus to cortex (thalamic or thalamocortical radiations ). Selected fibers include: Thalamus to Frontal Lobe: Prefrontal Cortex (Ant. Limb) Thalamus to Parietal Lobe: Primary Somatosensory Cortex (Post Limb) Thalamus to Temporal Lobe: Primary Auditory Cortex (Post Limb) Thalamus to Occipital Lobe: Primary Visual Cortex (Post Limb) Genu Post Limb Ant Limb

14. The Internal Capsule includes: Descending motor tracts from the primary motor cortex (precentral gyrus): Corticobulbar tracts (to brainstem) Corticospinal tracts (to spinal cord) H A L

15. The Internal Capsule includes: Ascending sensory information that will be relayed (via the thalamus) to the primary somatosensory cortex (postcentral gyrus): The dorsal column/medial leminscus tract (fine touch/proprioception) The spinothalamic tract (pain/temperature)

16. The Internal Capsule includes: The auditory radiations (from medial geniculate nucleus to primary auditory cortex of the temporal lobe; this is conceptual) Auditory radiations

17. Medial (nasal side) optic tract fibers cross Most fibers terminate in Thalamus (lateral geniculate bodies) Axons are relayed via optic radiations to visual cortex of occipital lobe The Internal Capsule includes: The optic radiations (lateral geniculate nucleus to primary visual cortex of the occipital lobe)

18. Today’s objectives include selected structures that were previously introduced to you, in some detail, in the Psychiatry Block: hippocampus,fornix, amygdala, mammillary bodies, and cingulate gyrus The limbic structures function in emotion, memory, motivation, and learning. The Limbic System

19. http://www.neuroanatomy.ca/flex_labs/Limbic_System/story.html Note: you are only responsible for identifying the cingulate gyrus. Note that this gyrus spans several lobes and is associated with corpus callosum.

20. http://www.neuroanatomy.ca/flex_labs/Limbic_System/story.html Note: Olfactory input projects to amygdala

21. http://www.neuroanatomy.ca/flex_labs/Limbic_System/story.html Inf. Horn, Lat. Vent. Hippocampus Note: you can use inferior horn, lat ventricle to ID tail of the caudate and the hippocampus (grey matter above and below ventricle, respectively).

22. http://www.neuroanatomy.ca/flex_labs/Limbic_System/story.html Note: you can use the uncus to approximate location of amygdala

23. The hippocampal grey matter will have a characteristic white swirl of white matter associated with it (contrast to amygdala, which will appear as a solid block of grey matter).

24. Thalami Corpus Callosum (cut) Hippocampus Fornix Mammillary Body Lat. Ventricle, Inf. Horn. Fornix fornix hippocampus mammillary bodies The fornix is a white matter structure leaving the hippocampus that projects mainly to the mammillary bodies (hypothalamus) which, in turn, mainly projects to the thalamus via mammillothalamic tracts. Hippocampus Fornix Thalamus Mammillary Body

26. * * * * Main AfferentsMain Efferents Cingulate cortexAssociation cortex, thalamus Hippocampus Cingulate cortex, Association cortex Mammillary bodies (via fornix), Amygdala Mammillary Bodies HippocampusThalamus AmygdalaHippocampusHypothalamus *

27. FYI: The legacy of H.M., Henry Molaison http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649674/ -In 1953, underwent bilateral medial temporal lobectomy to treat epilepsy -Epileptic seizures were effectively controlled but significant impact on aspects of memory, while other aspects of memory remained intact. -Maybe one of the most studied brains in history

28. Several clinical lectures have described limbic functions associated with the basal ganglia. While we studied the well-defined motor circuit of the basal ganglia, note that there is a limbic circuit as well.

29. Fornix Hippocampus Internal capsule Inf. Horn of Lat. Ventricle Ant. Horn, Lat Vent.

30. Fornix Hippocampus Internal capsule Inf. Horn of Lat. Ventricle Ant. Horn, Lat Vent. Post. Horn of Lat. Ventricle Lateral View, Lentiform N. Digital Anatomy Resource: ID -ventricles -limbic system structures -internal capsule components

31. Digital Anatomy Resource: ID -ventricles -grey matter (including basal ganglia from last week) -white matter (internal capsule components, and what fibers run through each part)

32. LAB 5 CHECKLIST – WHITE MATTER AND VENTRICLES BRAIN MATTER and LANDMARKS White Matter -Corona radiata -Internal capsule -Anterior limb -Frontopontine tracts -Thalamic radiations to frontal cortex -Genu -Corticobulbar motor tracts -Posterior limb -Corticospinal motor tracts -Thalamic radiations to 1 o somatosensory cortex (spinothalamic and dorsal column/medial leminiscus pathways) -Thalamic radiations to 1 o auditory cortex -Thalamic radiations to 1 o visual cortex -Optic radiations -Cerebral peduncles -Corpus callosum -Rostrum -Genu -Splenium VENTRICLES and CSF -Lateral ventricles -Anterior horn -Body -Inferior horn -Posterior horn -IV Foramen of Munro -3 rd ventricle -Cerebral aqueduct -4 th ventricle -Foramen of Magendie -Foramen of Luschka -Choroid plexus -Arachnoid granulations -Cisterns -Interpeduncular cistern -Pontine (pre-pontine) -Cisterna magna -Quadrigeminal cistern NB: Items italicized are conceptual, those denoted with a * are FYI Limbic System -Hippocampus -Amygdala -Mammillary bodies -Cingulate gyrus -Fornix