神經(jīng)系統(tǒng)傳導通路-中國醫(yī)科大學培訓講學

Chapter19theconductivepathwayofnervoussystemNervoussystemthesensoryconductivepathwaythemotorconductivepathwaythechemicalpathwayofnervoussystem1Thereflexpathwasreferredtotheconductivepathofprecedingordescendingwithoutviacerebralcortex.VisualconductivepathwayandpupillarylightreflexAuditoryconductivepathwayConductivepathwayofequilibratorysensationSensory（preceding）conductivepathwayconsciousnonconscioustrunk、fourlimbsHeadandfacialpartConductivepathwayofproprioceptivesenseTrunk,fourlimbsHeadandfacialpartTheconductivepathwayofsensationofpainandwarm,thicktouchsensationandressuresenseConductivepathwayofvisceralsenseGeneralvisceralsenceSpecialvisceralsensecorticalsubstance－neostriatum－dorsalthalamus

－circuitloopofcortex

neostriatum－circuitofblacksubstancepallidum－circuitloopofsubthalamuscortex－bridgeofvarolius－cerebellum－circuitofcortexcorticospinaltractcorticonucleartractpyramidaltractMotor（descending）conductivepathwayExtracorticospinaltract2Themiddleandsuperiorpartof

posteriorcentralgyrusTheposteriorpartofparacentrallobuleMuscle,tendon,joint,skinperipheralprocessspinalnervespinalgangliacentralprocessGoll'scolumnBurdach'sfibersgracilenucleusBurdach'snucleusbulbarlemniscusofoppositesideallpartsofbrainstemventralposterolateralnucleusofdorsalthalamus

posteriorlimbofinternalcapsule①③②conductivepathwayofproprioceptivesensetheconductivepathwayofconsciousproprioceptivesenseoftrunkandfourlimbsandfinetouchThesensoryconductivepathway3（二）TheconductivepathwayofunconsciousproprioceptivesenseintrunkandfourlimbsTheproprioceptorofmuscle,tendon,andjointspinalcordthemedialpartofradixposteriorC8～L2segmentofthoracicnucleusposteriorspinocerebellartractinferiorcerebellarpedunclecortexofpalaeocerebellumfuniculuslateralismedullaespinalisofhomonymythelateralpartofthe5thto7thoflumbosacralenlargementfiberofsecondclassanteriorspinocerebellartractofoppositesideandipsolateralsuperiorcerebellarpedunclecortexofpalaeocerebellum46①visualconerodbipolarneuronnodalcellopticnervechiasmopticumvisualtractexternalgeniculatebodyopticradiationposteriorlimbofinternalcapsulethetwo

sidesofcalcarinefissure②③Inthechiasmopticum,thefiberderivedfromretinaoftwoeyes’nasalsideintersect,whilethetemplesideonesdon’tintersect.visualpathwayandpupillarylightreflexpathwayvisualpathway7③Thelesionofdecussatingfiberofchiasmopticumcaninducethehalfblindnessintemplesideofbinocularvisualfield；④thelesionofnon-decussatingfiberofchiasmopticum’slateralpartcaninducethehalfblindnessinnasalsideofbinocularvisualfield;⑤thelesionofvisualtractinonesidecaninducehomonymoushemianopsiaofoppositeside.Thedamagingofconductivepathwayindifferentpositioncaninducedifferentvisualfileddefect:①Theinjuryofretinacaninducevisualfielddefect,whichisrelatedtothepositionandscopeofinjury;②Theopticnerveinjuryofonessidecaninduceabsoluteblindnessofthiseye；8Therouteofpupillarylightreflex：accessorynucleusofoculomotornerveoftwosidesciliaryganglionretina→opticnerve→chiasmopticum→thevisualtractoftwosides→brachiumofsuperiorcolliculus→pretectalarea→→oculomotornerve→→postganglionicfibre→pupilsphinctermuscle→thecontractionoftwopupils

directlightreflexindirectlightreflex

The

pupillarylightreflex

pathway9exist（+）exist（+）loss（—）loss（—）theinjuryofoculomotornerveloss（—）exist（+）exist（+）loss（—）theinjuryofopticnerveindirectlightreflexdirectlightreflexindirectlightreflexdirectlightreflexhealthyeyeilleyeThepupillarylightreflexrepresentationofinjuryindifferentposition10The

auditorypathwayorganofCorti→bipolarcell

(exchangeneuron）→cochlearnerve→ventralcochlearnucleusdorsalandcochlearnucleus

(exchangeneuron）

→trapezoidbodyofponsoverlapstotheoppositeside→laterallemniscus→thedorsi-lateralpartoftegmentumofmidbrain→inferiorcolliculus

(exchangeneuron）

→brachiumofinferiorcolliculus→medialgeniculatebody

(exchangeneuron）→acousticradiation→posteriorlimbofinternalcapsule→transversetemporalgyriofauditoryfieldincerebralcortex

Theauditoryimpulsionisconducingoftwosides.Ifonesidepathabovelaterallemniscusisdamaged,theobvioussymptomwouldn’thappen.Butifthecochlearnerve,internalearormiddleearisdamaged,auditoryhandicapwillbeinduced.11UppermotorneuronsLowermotorneuronsfinalcommonpathanteriorhornofspinalcordmotorneuronsomaticmotorareaofcerebralcortexpyramidalcellcorticonucleartractcorticospinaltractpyramidaltractcranialnervemotornucleus

pyramidalsystemMotorpathwayspyramidaltractThegiantpyramidalcellofparacentrallobule’santeriorpartandprecentralgyrusandthepyramidalcellsofothertypeaswellastheaxonofpyramidalcellwhichlieatthefrontallobeandapicallobeconstitutepyramidaltract.12trunkmuscle,limbsmusclethemiddleandsuperiorpartofanteriorcentralgyrustheanteriorpartofparacentrallobulepyramidalcellposterior

limbofinternalcapsulemidbrain,ponslateralcorticospinaltractanteriorcorticospinaltractanteriorhornmotorneuronspinalnerve①②

corticospinaltractmedullaoblongata13pyramidalcell（inferiorpartofanteriorcentralgyrus）corticonucleartractnucleusofoculomotornervenucleusoftrochlearnervenucleusofabducentnervemotornucleusoftrigeminalnervethesuperiorpartof

nucleusoffacialnervenucleusambiguusaccessorynucleusextraocularmusclesmassetermusclefacialmuscles（frontalmuscle、orbicularismuscle)laryngealmusclesternocleidomastoidtrapeziuskneeofinternalcapsule①②

corticonucleartract14theinferiorhalfoffacialnucleus→cheekmuscle、orbicularis

orisnucleusofhypoglossalnerve→lingualmuscleonlyreceptthe

corticonucleartractfiberofoppositesidesupranuclearparalysisoffacialnerveinfranuclearparalysisoffacialnervesupranuclearparalysisofhypoglossalnerveinfranuclearparalysisofhypoglossalnerve15Theprincipalinjuryrepresentationofuppermotorneuronsandlowermotorneurons16Itisr