Difference between revisions of "Neurohistology"

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This article covers basic (normal) '''neurohistology'''.  It is essential to have a good grasp on neurohistology... before doing [[neuropathology]].
This article covers basic (normal) '''neurohistology'''.  It is essential to have a good grasp on neurohistology and [[neuroanatomy]]... before doing [[neuropathology]].


==Normal cells==
''This article'' has some overlap with the ''[[neuroanatomy]]'' article, as there isn't a clear divider between microscopic and macroscopic.
*Neuron:
 
**Abundant cytoplasm - '''key feature'''.
=Normal cells=
**Often very large cells, with angled edges.
This section deals with normal cellular constituents of the CNS.
**Prominent nucleolus.
 
**Nissl substance (granular perinuclear material - rough ER).
==Overview==
*Glial cells.
===Central nervous system===
**Oligodendrocyte.
====Neuron====
***Small round nuclei (lymphocyte-like nucleus) - '''key feature'''.
*Abundant cytoplasm - '''key feature'''.
***May resemble a ''fried egg'' on H&E (clear cytoplasm, central nucleus).
*Often very large cells, with angled edges.
**Astrocyte.
*Prominent nucleolus.
***Irregular non-ovoid nucleus - '''key feature'''.
*Nissl substance (granular perinuclear material = rough endoplasmic reticulum).
***Nuclei less dense than in oligodendrocyte.
 
***Close to blood vessels.
====Glial cells====
***Form blood-brain barrier.
*Oligodendrocyte.
***Cytoplasm normally ''not'' visible.
**Small round nuclei (lymphocyte-like nucleus) - '''key feature'''.
***Image: [http://embryology.med.unsw.edu.au/histology/endocrine/pin42he.jpg astrocyte (med.unsw.edu.au)] (in [http://embryology.med.unsw.edu.au/notes/endocrine12.htm endocrine development]).
**May resemble a ''fried egg'' on H&E (clear cytoplasm, central nucleus).
**Microglia - macrophage of the brain (derived from monocyte).
**Image: [http://www.urmc.rochester.edu/libraries/courses/neuroslides/lab1a/images/1-11.png oligodendrocyte urmc.rochester.edu]
***May be large.
*Astrocyte.
***May have vesicles.
**Irregular non-ovoid nucleus - '''key feature'''.
***Rarely seen in normal tissue.
**Nuclei less dense than in oligodendrocyte.
**Close to blood vessels.
**Form blood-brain barrier.
**Cytoplasm normally ''not'' visible.
**Image: [http://embryology.med.unsw.edu.au/histology/endocrine/pin42he.jpg astrocyte (med.unsw.edu.au)] (in [http://embryology.med.unsw.edu.au/notes/endocrine12.htm endocrine development]).
*Microglia - macrophage of the brain (derived from monocyte).
**Typically large cells with abundant cytoplasm.
***Often have vesicles.
**Rarely seen in normal tissue.
**Three morphologic types:
***Ramified microglia.
***Hypertrophic microglia.
***Dystrophic microglia - often seen in neurodegnerative disease.
*Ependyma.
*Ependyma.
**Simple ciliated cuboidal epithelium.
**Simple ciliated cuboidal epithelium.
**Image: [http://www.stonybrookmedicalcenter.org/sbumcfiles/images/221-001.jpg Ependyma (stonybrookmedicalcenter.org)].
**Image: [http://www.stonybrookmedicalcenter.org/sbumcfiles/images/221-001.jpg Ependyma (stonybrookmedicalcenter.org)].
*Choroid plexus.
**Specialized ependymal cells
**Cuboidal epithelial cells surrounding a core of capillaries and loose connective tissue.
**Ventricular location.
=====Images=====
[[File:Blausen 0870 TypesofNeuroglia.png |500px| Types of neuroglia (WC/Blausen)]]
<gallery>
File:Astrocytes.jpg | Astrocytes highlighted by GFAP (WC/Jeffery J. Iliff)
Image:Oligodendrocyte_HE_stain_high_mag.jpg | Oligodendrocytes with fried-egg appearance (WC/jensflorian)
Image:Ependyma.png|Ependymal cells. (WC/marvin101)
File:Psammoma bodies in the choroid plexus, HE.JPG | Choroid plexus (WC/Patho)
File:Mikroglej 1.jpg | Microglial cells, Lectin stain (WC/Grzegorz Wicher)
</gallery>


===Normal cellular constituents in a table===
===Peripheral nervous system===
{| class="wikitable"
====Ganglion cell====
|  
*Nerve cell body.
|Key feature
*Found in ganglions - encapsulated body ~ 100-300 μm.
|Other features
*Large round nucleus with prominent nucleolus - '''key feature'''.
|Image
*Abundant eosinophilic granular cytoplasm.
====Schwann cell====
*Principal glia of the PNS.
*Myelinated or unmyelinated.
*Ovoid, wavy nuclei.
*Cells have a basal membrane.
*Found in peripheral nerves.
*Aka ''neurolemmocytes''.
=====Images=====
<gallery>
Image:Ganglion_very_high_mag.jpg | Ganglion - very high mag. (WC/Nephron)
Image:Peripheral nerve, cross section.jpg | Peripheral nerve - cross section. (WC/Reytan)
File:Nerve root - very high mag.jpg | Nerve root HPS stain (WC/Nephron)
</gallery>
 
WC:
*[http://commons.wikimedia.org/wiki/File:Ganglion_intermed_mag.jpg Ganglion - intermed. mag. (WC/Nephron)].
 
==Normal cellular constituents in a table==
{| class="wikitable sortable"
! Cell  
! Key feature
! Other features
! Image
|-
|-
|Neuron  
|Neuron  
Line 50: Line 98:
|Microglia
|Microglia
| rod-like shape,<br> may have "bent" nucleus
| rod-like shape,<br> may have "bent" nucleus
| rarely seen in normal tissue
| typically have a sharply<br> demarcated bubbly cytoplasm;<br> rarely seen in normal tissue
| [http://missinglink.ucsf.edu/lm/ids_104_cns_injury/Response%20_to_Injury/Microglia.htm (ucsf.edu)],[http://www.pathology.vcu.edu/WirSelfInst/neuro_medStudents/glialpath.html (vcu.edu)]
| [http://www.neuropathologyweb.org/chapter1/chapter1dMicroglia.html (neuropathologyweb.org)],<br> [http://missinglink.ucsf.edu/lm/ids_104_cns_injury/Response%20_to_Injury/Microglia.htm (ucsf.edu)],[http://www.pathology.vcu.edu/WirSelfInst/neuro_medStudents/glialpath.html (vcu.edu)]
|-
|-
|}
|}


===Neurons===
==Neurons==
There are many types of 'em.  Broadly, they can be classified as:
There are many types of 'em.  Broadly, they can be classified as:
#Pyramidal - have a pyramidal shape.
#Pyramidal - have a pyramidal shape.
Line 68: Line 116:
*Send dendrites in all directions.
*Send dendrites in all directions.


Image: [http://www.stonybrookmedicalcenter.org/sbumcfiles/images/238-002.jpg Motor neuron (stonybrookmedicalcenter.org)].
===Images===
www:
*[http://www.stonybrookmedicalcenter.org/sbumcfiles/images/238-002.jpg Motor neuron (stonybrookmedicalcenter.org)].
<gallery>
Image:Medulla_oblongata_-_posterior_-_cn_xii_-_very_high_mag.jpg | Motor neurons - nucleus of CN XII - very high mag. (WC)
</gallery>
 
=Structures=
This section deals with structures seen at several places in the CNS.
 
==Grey matter and white matter==
{| class="wikitable"
|
| '''Grey matter'''
| '''White matter'''
|-
| Definition
| neurons present
| neurons absent
|-
| Extracellular <br>space (neuropil)
| dense - darker pink (on [[H&E stain|H&E]]/[[HPS stain|HPS]])
| fine mesh - lighter pink (on H&E/HPS)
|-
| Image
| [[Image:Grey_matter_and_white_matter_-_very_high_mag.jpg|thumb|Right 2/3 of image. (WC/Nephron)]]
| [[Image:Grey_matter_and_white_matter_-_very_high_mag.jpg|thumb|Left 1/3 of image. (WC/Nephron)]]
|}
 
Additional images (white matter vs. grey matter):
<gallery>
Image:Grey_matter_and_white_matter_-_high_mag.jpg | Grey-white matter interface - high mag. (WC)
Image:Grey_matter_and_white_matter_-_intermed_mag.jpg | Grey and white matter - intermed. mag. (WC)
File:LFB_CNS_cortex_supratentorial.jpg | Normal cortex - LFB. (WC/jensflorian)
File:LFB_CNS_cortex_grey-white_matter_junction.jpg | White-grey matter junction - LFB. (WC/jensflorian)
</gallery>
 
==Vessels==
The small blood vessels in the CNS are separated from the surrounding tissue in histologic sections. This is normal.  The spaces are called ''Virchow-Robin spaces''.<ref>URL: [http://www.whonamedit.com/synd.cfm/43.html http://www.whonamedit.com/synd.cfm/43.html]. Accessed on: 2 August 2011.</ref>
 
=Histology by anatomical structure=
This section deals with specific anatomical structures.


==Histology by anatomical structure==
==Subependyma==
===Subependyma===
Features:<ref>Croul SE. 28 June 2010.</ref>
Features:<ref>Croul SE. 28 June 2010.</ref>
*Ependyma (simple ciliated cuboidal epithelium).
*Ependyma (simple ciliated cuboidal epithelium).
*Subependymal plate - connective tissue with blood vessels.
*Subependymal plate - connective tissue with blood vessels.


===Pons===
==Caudate==
Features:
*Looks like bacon.<ref>Croul SE. 28 June 2010.</ref>
*Image: [http://www.stonybrookmedicalcenter.org/sbumcfiles/images/243-scout.jpg Pons (stonybrookmedicalcenter.org)].
 
===Caudate===
Features:
Features:
*Neurons with adjacent ependymal lining.<ref>URL: [http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1 http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1]. Accessed on: 2 July 2010.</ref>
*Neurons with adjacent ependymal lining.<ref>URL: [http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1 http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1]. Accessed on: 2 July 2010.</ref>
Line 88: Line 171:
Notes:  
Notes:  
*Caudate, putamen and nucleus accumbens are collectively called ''neostriatum''.<ref name=Ref_PSNP23-24>{{Ref PSNP|23-34}}</ref>
*Caudate, putamen and nucleus accumbens are collectively called ''neostriatum''.<ref name=Ref_PSNP23-24>{{Ref PSNP|23-34}}</ref>
===Putamen===
==Putamen==
Features:
Features:
*Histologically identical to the ''caudate'' - but not adjacent to a ventricle, i.e. an ependymal lining.
*Striatopallidal fibers [[AKA]] ''pencils of Wilson'' (also ''pencil fibers of Wilson''<ref name=Ref_PSNP23-24>{{Ref PSNP|23-34}}</ref> and ''Wilson's pencils''<ref name=pmid8985875>{{cite journal |author=Kimura M, Kato M, Shimazaki H, Watanabe K, Matsumoto N |title=Neural information transferred from the putamen to the globus pallidus during learned movement in the monkey |journal=J. Neurophysiol. |volume=76 |issue=6 |pages=3771–86 |year=1996 |month=December |pmid=8985875 |doi= |url=http://jn.physiology.org/cgi/pmidlookup?view=long&pmid=8985875}}</ref>) - bundles of blue fibres (on H&E LFB).
*Striatopallidal fibers [[AKA]] ''pencils of Wilson'' (also ''pencil fibers of Wilson''<ref name=Ref_PSNP23-24>{{Ref PSNP|23-34}}</ref>) - bundles of blue fibres (on H&E LFB).
*Neurons:
**Internal capsule associated white matter.
*#Small - GABA.
***Image: [http://frontalcortex.com/?page=oll&topic=24&qid=760 Pencils of Wilson (frontalcortex.com)].
*#Large (very rare: ~1 in 100-200) - cholingeric.


===Globus pallidus===
Notes:
*Histologically identical to the ''caudate'' - but not adjacent to a ventricle.
**The caudate is adjacent to an ependymal lined space, putamen is not.<ref>URL: [http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1 http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1]. Accessed on: 22 December 2010.</ref>
*[[Necrotic]] putamen in methanol poisoning.<ref name=pmid19015300>{{Cite journal  | last1 = Bhatia | first1 = R. | last2 = Kumar | first2 = M. | last3 = Garg | first3 = A. | last4 = Nanda | first4 = A. | title = Putaminal necrosis due to methanol toxicity. | journal = Pract Neurol | volume = 8 | issue = 6 | pages = 386-7 | month = Dec | year = 2008 | doi = 10.1136/jnnp.2008.161976 | PMID = 19015300 }}</ref>
 
===Images===
<gallery>
Image:Globus_pallidus_and_putamen_-_very_low_mag.jpg | Globus pallidus & putamen - showing Wilson's pencils - very low mag. (WC)
Image:Putamen_-_intermed_mag.jpg | Putamen - intermed. mag. (WC)
</gallery>
www:
*[http://frontalcortex.com/?page=oll&topic=24&qid=760 Pencils of Wilson (frontalcortex.com)].
 
==Globus pallidus==
*[[AKA]] ''paleostriatum''.<ref name=Ref_PSNP23>{{Ref PSNP|23}}</ref>
*[[AKA]] ''paleostriatum''.<ref name=Ref_PSNP23>{{Ref PSNP|23}}</ref>
*Location:
**Superior of the ''substantia innominata''.
**Medial to the ''putamen''.


Features:
Features:
*Histologically distinct from caudate and putamen.
*Histologically distinct from caudate and putamen.


===Hippocampus===
===Image===  
====Structures====
<gallery>
Image:Nucleus_basalis_of_Meynert_-l-_very_low_mag.jpg | Globus pallidus, putamen and the nucleus basalis in the substantia innominata - very low mag. (WC)
</gallery>
 
==Hippocampus==
===Structures===
Hippocampal formation:<ref>URL: [http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1 http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1]. Accessed on: 2 July 2010.</ref>
Hippocampal formation:<ref>URL: [http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1 http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1]. Accessed on: 2 July 2010.</ref>
#Dentate gyrus.  
#Dentate gyrus.  
Line 118: Line 222:
#Subiculum ([[AKA]] subicular complex).
#Subiculum ([[AKA]] subicular complex).
#*Transitions to the six layers in the ''entorhinal cortex''.
#*Transitions to the six layers in the ''entorhinal cortex''.
#**No vacuolated looking stuff next to it.


Images:  
Important notes:
*[http://en.wikipedia.org/wiki/File:Brainmaps-macaque-hippocampus.jpg Hippocampus - frontal section (WP)].
*CA1 - weak link, dies in ischemia, affected by hypoglycemia, degenerative diseases and toxins.
*[http://commons.wikimedia.org/wiki/File:Hippocampus_%28brain%29.jpg Hippocampus - good schematic (WC)].
*CA2 - resistant to ischemia.
*CA4 - involved in [[epilepsy]],<ref name=pmid3518570>{{Cite journal  | last1 = Ingvar | first1 = M. | title = Cerebral blood flow and metabolic rate during seizures. Relationship to epileptic brain damage. | journal = Ann N Y Acad Sci | volume = 462 | issue =  | pages = 194-206 | month =  | year = 1986 | doi =  | PMID = 3518570 }}</ref> usu. normal in degenerative diseases.<ref>D. Munoz. 27 July 2011.</ref>
====Images====
<gallery>
Image:Brainmaps-macaque-hippocampus.jpg | Hippocampus - frontal section. (WC)
Image:Hippocampus_%28brain%29.jpg | Hippocampus - schematic. (WC)
</gallery>
www:
*[http://www.ajnr.org/cgi/content-nw/full/28/5/958/F1 Hippocampus (ajnr.org)].
*[http://www.ajnr.org/cgi/content-nw/full/28/5/958/F1 Hippocampus (ajnr.org)].
*[http://edoc.hu-berlin.de/dissertationen/schubert-stephan-nicolas-2003-09-26/HTML/schubert_html_21d219b1.png Hippocampus and subiculum (hu-berlin.de)].
*[http://edoc.hu-berlin.de/dissertationen/schubert-stephan-nicolas-2003-09-26/HTML/schubert_html_21d219b1.png Hippocampus and subiculum (hu-berlin.de)].
*[http://spinwarp.ucsd.edu/NeuroWeb/Text/br-800epi/br-800epi1.gif Hippocampus - crappy schematic (ucsd.edu)].
*[http://spinwarp.ucsd.edu/NeuroWeb/Text/br-800epi/br-800epi1.gif Hippocampus - crappy schematic (ucsd.edu)].


Important notes:
===Layers of CA<ref name=Ref_PSNP25>{{Ref PSNP|25}}</ref>===
*CA1 - weak link, dies in ischemia, affected by hypoglycemia, degenerative diseases and toxins.
*CA2 - resistant to ischemia.
 
====Layers of CA<ref name=Ref_PSNP25>{{Ref PSNP|25}}</ref>====
#Molecular layer - opposed to the dentate gyrus (of Hippocampal formation).
#Molecular layer - opposed to the dentate gyrus (of Hippocampal formation).
#Neurons (described above).
#Neurons (described above).
Line 136: Line 244:
#*Connects to the ''mammillary bodies'' via the ''fornix'' (circuit of Papez).
#*Connects to the ''mammillary bodies'' via the ''fornix'' (circuit of Papez).


===Cerebellum===
==Cerebellum==
Main components:
Main components:
*Cortex (superficial) - branches (Christmas tree-like).
*Cortex (superficial) - branches (Christmas tree-like).
Line 142: Line 250:
**Image: [http://www.stonybrookmedicalcenter.org/sbumcfiles/images/227-scout.jpg Cerebellum, cortex & dendate nucleus - low power (stonybrookmedicalcenter.org)].
**Image: [http://www.stonybrookmedicalcenter.org/sbumcfiles/images/227-scout.jpg Cerebellum, cortex & dendate nucleus - low power (stonybrookmedicalcenter.org)].


Dentate nucleus:<ref name=Ref_PSNP27>{{Ref PSNP|27}}</ref>
===Dentate nucleus===
*Ribbon of grey matter consisting of:
Features:<ref name=Ref_PSNP27>{{Ref PSNP|27}}</ref>
*Ribbon of grey matter.
**Large neurons.
**Large neurons.
**Small neurons.
**Small neurons.


Cerebellar cortex:
====Images====
<gallery>
Image:Dentate_nucleus_-_cerebellum_-_intermed_mag.jpg | Dentate nucleus of the cerebellum - intermed. mag. (WC)
Image:Dentate_nucleus_-_cerebellum_-_high_mag.jpg | Dentate nucleus of the cerebellum - high mag. (WC)
</gallery>
 
===Cerebellar cortex===
*Layers (superficial to deep) - mnemonic ''MPG'':<ref>URL: [http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1 http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1]. Accessed on: 2 July 2010.</ref>
*Layers (superficial to deep) - mnemonic ''MPG'':<ref>URL: [http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1 http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1]. Accessed on: 2 July 2010.</ref>
*#Molecular layer -- "very pink" on H&E.
*#Molecular layer -- "very pink" on H&E.
Line 156: Line 271:
*#***Large nucleolus (~1x RBC diameter =~ size of granule cell).
*#***Large nucleolus (~1x RBC diameter =~ size of granule cell).
*#Granule cell layer -- "very blue" on H&E.  
*#Granule cell layer -- "very blue" on H&E.  
*#*Granule cells (many), interneurons (Golgi cells --few in number). (???)
*#*Granule cells (neurons) - majority of cells, small (~10 micrometres), round.
*Images:
*#**May look like small cell carcinoma to the uninitiated.  
**[http://www.stonybrookmedicalcenter.org/sbumcfiles/images/227_001.jpg Cerebellar cortex - micrograph (stonybrookmedicalcenter.org)].
*#*Golgi cells (interneurons) - few in number, elongated/columnar, 3-5x size of granule cell.
**[http://upload.wikimedia.org/wikipedia/commons/7/7c/Gray706.png Cerebellar cortex - schematic (Gray's Anatomy - WC)].


Notes:
Notes:
*''Bergmann glia'' are found between the molecular layer & granular layer.  They are normally not seen.  They are increased & prominent in pathologic states (e.g. ischemia); "Bergmann gliosis".<ref name=Ref_PSNP18>{{Ref PSNP|18}}</ref>
*''Bergmann glia'' are found between the molecular layer & granular layer.  They are normally not seen.  They are increased & prominent in pathologic states (e.g. ischemia); "[[Bergmann gliosis]]".<ref name=Ref_PSNP18>{{Ref PSNP|18}}</ref>


===Cerebral cortex===
====Images====
www:
*[http://www.stonybrookmedicalcenter.org/sbumcfiles/images/227_001.jpg Cerebellar cortex - micrograph with labels (stonybrookmedicalcenter.org)].
<gallery>
Image:Gray706.png | Cerebellar cortex - schematic. (Gray's Anatomy/WC)
Image:Cerebellar_cortex_-_intermed_mag.jpg | Cerebellar cortex - intermed. mag. (WC)
Image:Cerebellum_-_biel_-_high_mag.jpg | Cerebellar cortex - high mag. [[Bielschowsky stain]]. (WC)
</gallery>
 
==Cerebral cortex==
Layers (superficial to deep):
Layers (superficial to deep):
#Molecular layer.
#Molecular layer.
Line 174: Line 297:
#*Not prominent in frontal cortex.
#*Not prominent in frontal cortex.
#*Where the thalamic axons end.
#*Where the thalamic axons end.
#*Divided in three (''a'', ''b'', ''c'') in the calcarine cortex due to two white matter bands (external band of Baillarger, internal band of Baillarger) than are grossly identified as the ''line of Gennari''.<ref name=Ref_PSNP24>{{Ref PSNP|24}}</ref>
#*Divided in three (''a'', ''b'', ''c'') in the calcarine cortex due to two white matter bands (external band of Baillarger, internal band of Baillarger) that are grossly identified as the ''line of Gennari''.<ref name=Ref_PSNP24>{{Ref PSNP|24}}</ref><ref>URL: [http://www.ncbi.nlm.nih.gov/books/NBK11524/ http://www.ncbi.nlm.nih.gov/books/NBK11524/]. Accessed on: 7 January 2011.</ref>
#**Image: [http://moon.ouhsc.edu/kfung/iacp-olp/APAQ-Images/N1-MS-01-01.gif Calcarine cortex (ouhsc.edu)].<ref>URL: [http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/N1-MS-01-01-Ans.htm http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/N1-MS-01-01-Ans.htm] and [http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/n1-ms-01.htm http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/n1-ms-01.htm]. Accessed on: 31 October 2010.</ref>
#Inner pyramidal layer.
#Inner pyramidal layer.
#*Location of ''Betz neurons'' - large motor neurons of cerebral cortex.
#*Location of ''Betz neurons'' - large motor neurons of cerebral cortex.
Line 181: Line 305:
Images:
Images:
*[http://commons.wikimedia.org/wiki/File:Cajal_cortex_drawings.png Cajal drawings - different areas (WC)].
*[http://commons.wikimedia.org/wiki/File:Cajal_cortex_drawings.png Cajal drawings - different areas (WC)].
*[http://commons.wikimedia.org/wiki/File:Visual_cortex_-_intermed_mag.jpg Visual cortex - intermed. mag. (WC)].
*[http://www.ncbi.nlm.nih.gov/books/NBK11524/figure/ch31visualcortex.F13/?report=objectonly Visual cortex - nissl stain (nlm.nih.gov)].<ref>URL: [http://www.ncbi.nlm.nih.gov/books/NBK11524/ http://www.ncbi.nlm.nih.gov/books/NBK11524/]. Accessed on: 7 January 2011.</ref>
*[http://www.ruf.rice.edu/~lngbrain/cglidden/Lab8_fig1.gif Different stains (rice.edu)].
*[http://www.ruf.rice.edu/~lngbrain/cglidden/Lab8_fig1.gif Different stains (rice.edu)].
*[http://williamcalvin.com/bk7/img/bk7p31.jpg Cerebral cortex (williamcalvin.com)].
*[http://williamcalvin.com/bk7/img/bk7p31.jpg Cerebral cortex (williamcalvin.com)].
*[http://www.benbest.com/science/anatmind/anatmd5.html Cerebral cortex (benbest.com)].
*[http://www.benbest.com/science/anatmind/anatmd5.html Cerebral cortex (benbest.com)].


===Pineal gland===
===Cingulate cortex===
*Spindle neurons, [[AKA]] ''von Economo neurons''.
**Thought to be important in cognition and problem solving.<ref name=pmid11411161>{{Cite journal  | last1 = Allman | first1 = JM. | last2 = Hakeem | first2 = A. | last3 = Erwin | first3 = JM. | last4 = Nimchinsky | first4 = E. | last5 = Hof | first5 = P. | title = The anterior cingulate cortex. The evolution of an interface between emotion and cognition. | journal = Ann N Y Acad Sci | volume = 935 | issue =  | pages = 107-17 | month = May | year = 2001 | doi =  | PMID = 11411161 }}</ref>
 
====Images====
<gallery>
Image:Spindle_neurons_-_high_mag.jpg | Spindle neurons - high mag. (WC)
Image:Spindle_neurons_-_very_high_mag_-_cropped.jpg | Spindle neurons - cropped - very high mag. (WC)
</gallery>
 
==Pineal gland==
{{Main|Pineal gland}}
Features:<ref name=Ref_PSNP25-26>{{Ref_PSNP|25-26}}</ref><ref name=Blue_Histology_-_Endocrines>URL: [http://www.lab.anhb.uwa.edu.au/mb140/corepages/endocrines/endocrin.htm http://www.lab.anhb.uwa.edu.au/mb140/corepages/endocrines/endocrin.htm]. Accessed on: 31 October 2010.</ref>
Features:<ref name=Ref_PSNP25-26>{{Ref_PSNP|25-26}}</ref><ref name=Blue_Histology_-_Endocrines>URL: [http://www.lab.anhb.uwa.edu.au/mb140/corepages/endocrines/endocrin.htm http://www.lab.anhb.uwa.edu.au/mb140/corepages/endocrines/endocrin.htm]. Accessed on: 31 October 2010.</ref>
*Cells in lobulated clusters or linear arrays (low power).
*Cells in lobulated clusters or linear arrays (low power).
Line 194: Line 331:
**Cylindrical hyperchromatic nucleus ~ 1/2 the size of pinealocyte.
**Cylindrical hyperchromatic nucleus ~ 1/2 the size of pinealocyte.


Images:
Notes:
*Highly cellular structure - may be confused with (metastatic) [[small cell carcinoma]].
*Often calcified.
===Images===
<gallery>
Image:Pineal_gland_-_very_high_mag.jpg | Pineal gland - very high mag. (WC/Nephron)
Image:Pineal_gland_-_intermed_mag.jpg | Pineal gland - intermed. mag. (WC/Nephron)
Image:Pineal.jpg | Pineal gland. (WC)
</gallery>
www:
*[http://www.lab.anhb.uwa.edu.au/mb140/corepages/endocrines/Images/pin42he.jpg Pineal gland (anhb.uwa.edu.au)].<ref name=Blue_Histology_-_Endocrines>URL: [http://www.lab.anhb.uwa.edu.au/mb140/corepages/endocrines/endocrin.htm http://www.lab.anhb.uwa.edu.au/mb140/corepages/endocrines/endocrin.htm]. Accessed on: 31 October 2010.</ref>
*[http://www.lab.anhb.uwa.edu.au/mb140/corepages/endocrines/Images/pin42he.jpg Pineal gland (anhb.uwa.edu.au)].<ref name=Blue_Histology_-_Endocrines>URL: [http://www.lab.anhb.uwa.edu.au/mb140/corepages/endocrines/endocrin.htm http://www.lab.anhb.uwa.edu.au/mb140/corepages/endocrines/endocrin.htm]. Accessed on: 31 October 2010.</ref>
*[http://commons.wikimedia.org/wiki/File:Pineal.jpg Pineal gland - crappy (WC)].
===IHC===
*Synaptophysin +ve.<ref name=Ref_PSNP25-26>{{Ref_PSNP|25-26}}</ref>
 
==Midbrain==
Structures:
*Substantia nigra ([[Parkinson's disease]]).
*Nuclei of CN IV (posterior).
*Nuclei of CN III (anterior).
*Cerebral penduncles (anterior).
*Red nuclei.
 
===Schematics===
<gallery>
Image:Cn3nucleus.png | Midbrain (WC)
Image:Gray696.png | Nuclei of the CNs (WC)
Image:Brain_stem_sagittal_section.svg | Nuclei of the CNs - sagittal section of brain stem (WC)
</gallery>
 
==Pons==
Features:
*Looks like bacon (at very low power).<ref>Croul SE. 28 June 2010.</ref>
*Images:
**[http://www.stonybrookmedicalcenter.org/sbumcfiles/images/243-scout.jpg Pons (stonybrookmedicalcenter.org)].
**[http://commons.wikimedia.org/wiki/File:Pons_-_intermed_mag.jpg Pons - intermed. mag. (WC)].
 
===Locus ceruleus===
*Literally means ''blue spot''.
*Location: adjacent to midline + anterior to 4th ventricle.
 
Microscopic features:
*Pigmented neurons.
**Produce norepinephrine.


Notes:
Notes:
*Highly cellular structure - may be confused with (metastatic) small cell carcinoma.
*Pale in [[Parkinson disease]] due to neuronal loss.<ref name=Ref_PCPBoD8_677>{{Ref PCPBoD8|677}}</ref>


IHC:
====Images====
*Synaptophysin +ve.<ref name=Ref_PSNP25-26>{{Ref_PSNP|25-26}}</ref>
<gallery>
Image:Locus_ceruleus_-_very_low_mag.jpg | Locus ceruleus (LC) - very low mag. (WC)
Image:Locus_ceruleus_-_low_mag.jpg | Locus ceruleus (LC) - low mag. (WC)
Image:Locus_ceruleus_-_intermed_mag.jpg | Locus ceruleus (LC) - intermed. mag. (WC)
Image:Locus_ceruleus_-_high_mag.jpg | Locus ceruleus (LC) - high mag. (WC)
</gallery>
www:
*[http://www.scholarpedia.org/article/File:Bouret_LC_anat2.jpg LC - labeled on MRI - (scholarpedia.org)].
 
==Medulla oblongata==
*[[AKA]] ''medulla''.
===Anatomy===
Schematic: [http://commons.wikimedia.org/wiki/File:Gray694.png Medulla oblongata - Gray's anatomy (WC)].
 
====Anterior====
*Pyramids: adjacent to midline, anterior.
*Olives: lateral and posterior to pyramids.
 
====Posterior - important nuclei (location)====
*CN XII: 4th ventricle + adjacent to midline; medial to nucleus of CN X.<ref name=Ref_Neuroanat13>{{Ref Neuroanat|13}}</ref>
*CN X: 4th ventricle + lateral to nucleus of CN XII.
**This is were [[Lewy body]] formation starts.<ref name=pmid19501577>{{cite journal |author=Miller VM, Kenny RA, Oakley AE, Hall R, Kalaria RN, Allan LM |title=Dorsal motor nucleus of vagus protein aggregates in Lewy body disease with autonomic dysfunction |journal=Brain Res. |volume=1286 |issue= |pages=165–73 |year=2009 |month=August |pmid=19501577 |doi=10.1016/j.brainres.2009.05.083 |url=}}</ref>
 
=====Image=====
<gallery>
Image:Medulla_oblongata_-_posterior_-_very_low_mag.jpg | Medulla oblongata - very low mag. (WC)
</gallery>
 
==Pituitary gland==
===Anatomy===
*Located in sella turcica below optic chiasm.
*Anterior lobe is epithelial.
*Posterior lobe is neuroepithelial.
*The infundibulum connects the pituitary to the brain
Schematic: [[File:Gray1181.png Pituitary gland - Gray's anatomy (WC)]].
 
 
====Images====
<gallery>
File:Anterior and posterior pituitary.jpg | Anterior & posterior pituitary. (WC)
File:Adenohypofýza HE.jpg | Adenohypophysis. (WC/Držiak)
</gallery>


==See also==
=See also=
*[[Neuropathology]].
*[[Neuropathology]].
*[[Muscle biopsy]].
*[[Muscle biopsy]].
*[[CNS tumours]].
*[[CNS tumours]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


==External links==
=External links=
*[http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1 Neuropathology micrographs - identifying the site (stonybrookmedicalcenter.org)].
*[http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1 Neuropathology micrographs - identifying the site (stonybrookmedicalcenter.org)].
*[http://education.vetmed.vt.edu/Curriculum/VM8054/Labs/Lab9/lab9.htm Neural tissues - veterinary histology (vetmed.vt.edu)].
*[http://education.vetmed.vt.edu/Curriculum/VM8054/Labs/Lab9/lab9.htm Neural tissues - veterinary histology (vetmed.vt.edu)].

Latest revision as of 12:34, 17 October 2022

This article covers basic (normal) neurohistology. It is essential to have a good grasp on neurohistology and neuroanatomy... before doing neuropathology.

This article has some overlap with the neuroanatomy article, as there isn't a clear divider between microscopic and macroscopic.

Normal cells

This section deals with normal cellular constituents of the CNS.

Overview

Central nervous system

Neuron

  • Abundant cytoplasm - key feature.
  • Often very large cells, with angled edges.
  • Prominent nucleolus.
  • Nissl substance (granular perinuclear material = rough endoplasmic reticulum).

Glial cells

  • Oligodendrocyte.
  • Astrocyte.
  • Microglia - macrophage of the brain (derived from monocyte).
    • Typically large cells with abundant cytoplasm.
      • Often have vesicles.
    • Rarely seen in normal tissue.
    • Three morphologic types:
      • Ramified microglia.
      • Hypertrophic microglia.
      • Dystrophic microglia - often seen in neurodegnerative disease.
  • Ependyma.
  • Choroid plexus.
    • Specialized ependymal cells
    • Cuboidal epithelial cells surrounding a core of capillaries and loose connective tissue.
    • Ventricular location.
Images

Types of neuroglia (WC/Blausen)

  • Astrocytes highlighted by GFAP (WC/Jeffery J. Iliff)

  • Oligodendrocytes with fried-egg appearance (WC/jensflorian)

  • Ependymal cells. (WC/marvin101)

  • Choroid plexus (WC/Patho)

  • Microglial cells, Lectin stain (WC/Grzegorz Wicher)

Peripheral nervous system

Ganglion cell

  • Nerve cell body.
  • Found in ganglions - encapsulated body ~ 100-300 μm.
  • Large round nucleus with prominent nucleolus - key feature.
  • Abundant eosinophilic granular cytoplasm.

Schwann cell

  • Principal glia of the PNS.
  • Myelinated or unmyelinated.
  • Ovoid, wavy nuclei.
  • Cells have a basal membrane.
  • Found in peripheral nerves.
  • Aka neurolemmocytes.
Images

  • Ganglion - very high mag. (WC/Nephron)

  • Peripheral nerve - cross section. (WC/Reytan)

  • Nerve root HPS stain (WC/Nephron)

WC:

Normal cellular constituents in a table

Cell Key feature Other features Image
Neuron cytoplasm Nissl substance (prominent
RER), "sharp" corners
in cell membrane, nucleolus
- usu. prominent[1] 		red neurons (WC)
Astrocyte non-ovoid nucleus no cytoplasm (unsw.edu)
Oligodendrocyte round small nucleus peri-nuclear clearing (vetmed.vt.edu)
Microglia rod-like shape,
may have "bent" nucleus 		typically have a sharply
demarcated bubbly cytoplasm;
rarely seen in normal tissue 		(neuropathologyweb.org),
(ucsf.edu),(vcu.edu)

Neurons

There are many types of 'em. Broadly, they can be classified as:

  1. Pyramidal - have a pyramidal shape.
    1. Dentrites go to molecular layer.
    2. Axons go to outside of cortex.
  2. Non-pyramidal.

Motor neurons:

  • Coarse Nissl substance - key feature.
    • Nissl described as having a tigroid appearance.[2]
  • Polygonal shape.
  • Send dendrites in all directions.

Images

www:

  • Motor neurons - nucleus of CN XII - very high mag. (WC)

Structures

This section deals with structures seen at several places in the CNS.

Grey matter and white matter

Grey matter White matter
Definition neurons present neurons absent
Extracellular
space (neuropil) 		dense - darker pink (on H&E/HPS) fine mesh - lighter pink (on H&E/HPS)
Image
Right 2/3 of image. (WC/Nephron)
Left 1/3 of image. (WC/Nephron)

Additional images (white matter vs. grey matter):

  • Grey-white matter interface - high mag. (WC)

  • Grey and white matter - intermed. mag. (WC)

  • Normal cortex - LFB. (WC/jensflorian)

  • White-grey matter junction - LFB. (WC/jensflorian)

Vessels

The small blood vessels in the CNS are separated from the surrounding tissue in histologic sections. This is normal. The spaces are called Virchow-Robin spaces.[3]

Histology by anatomical structure

This section deals with specific anatomical structures.

Subependyma

Features:[4]

  • Ependyma (simple ciliated cuboidal epithelium).
  • Subependymal plate - connective tissue with blood vessels.

Caudate

Features:

  • Neurons with adjacent ependymal lining.[5]
    • The caudate forms lateral wall of lateral ventricle.

Notes:

  • Caudate, putamen and nucleus accumbens are collectively called neostriatum.[6]

Putamen

Features:

  • Striatopallidal fibers AKA pencils of Wilson (also pencil fibers of Wilson[6] and Wilson's pencils[7]) - bundles of blue fibres (on H&E LFB).
  • Neurons:
    1. Small - GABA.
    2. Large (very rare: ~1 in 100-200) - cholingeric.

Notes:

  • Histologically identical to the caudate - but not adjacent to a ventricle.
    • The caudate is adjacent to an ependymal lined space, putamen is not.[8]
  • Necrotic putamen in methanol poisoning.[9]

Images

  • Globus pallidus & putamen - showing Wilson's pencils - very low mag. (WC)

  • Putamen - intermed. mag. (WC)

www:

Globus pallidus

  • AKA paleostriatum.[10]
  • Location:
    • Superior of the substantia innominata.
    • Medial to the putamen.

Features:

  • Histologically distinct from caudate and putamen.

Image

  • Globus pallidus, putamen and the nucleus basalis in the substantia innominata - very low mag. (WC)

Hippocampus

Structures

Hippocampal formation:[11]

  1. Dentate gyrus.
  2. Hippocampus proper (AKA Ammon's horn) - this is subdivided:
    • Cornu ammonis 3 (CA3) - location: superior.
      • Large pyramidal neurons.
    • CA1 (AKA Sommer's sector) - location: inferior (next to subiculum).
      • Small dispersed pyramidal neurons.
    • CA2 - location: in between CA3 and CA1, lateral.
      • Narrow band of neurons between CA3 and CA1.
    • CA4 - location: medial (closest to dentate gyrus; CA4 sits in "open" part of "U").
  3. Subiculum (AKA subicular complex).
    • Transitions to the six layers in the entorhinal cortex.
      • No vacuolated looking stuff next to it.

Important notes:

  • CA1 - weak link, dies in ischemia, affected by hypoglycemia, degenerative diseases and toxins.
  • CA2 - resistant to ischemia.
  • CA4 - involved in epilepsy,[12] usu. normal in degenerative diseases.[13]

Images

  • Hippocampus - frontal section. (WC)

  • Hippocampus - schematic. (WC)

www:

Layers of CA[14]

  1. Molecular layer - opposed to the dentate gyrus (of Hippocampal formation).
  2. Neurons (described above).
  3. Alveus - opposed to the lateral ventricle.
    • Connects to the mammillary bodies via the fornix (circuit of Papez).

Cerebellum

Main components:

Dentate nucleus

Features:[15]

  • Ribbon of grey matter.
    • Large neurons.
    • Small neurons.

Images

  • Dentate nucleus of the cerebellum - intermed. mag. (WC)

  • Dentate nucleus of the cerebellum - high mag. (WC)

Cerebellar cortex

  • Layers (superficial to deep) - mnemonic MPG:[16]
    1. Molecular layer -- "very pink" on H&E.
      • Inhibitory interneurons: stellate cells, basket cells.
    2. Purkinje cell layer.
      • One cell layer thick - hueuege cells (~50-80 micrometers[1]).
        • Very large nucleus (~4x RBC diameter =~ 4x the size of granule cell).
          • Large nucleolus (~1x RBC diameter =~ size of granule cell).
    3. Granule cell layer -- "very blue" on H&E.
      • Granule cells (neurons) - majority of cells, small (~10 micrometres), round.
        • May look like small cell carcinoma to the uninitiated.
      • Golgi cells (interneurons) - few in number, elongated/columnar, 3-5x size of granule cell.

Notes:

  • Bergmann glia are found between the molecular layer & granular layer. They are normally not seen. They are increased & prominent in pathologic states (e.g. ischemia); "Bergmann gliosis".[17]

Images

www:

  • Cerebellar cortex - schematic. (Gray's Anatomy/WC)

  • Cerebellar cortex - intermed. mag. (WC)

  • Cerebellar cortex - high mag. Bielschowsky stain. (WC)

Cerebral cortex

Layers (superficial to deep):

  1. Molecular layer.
    • Empty appearing.
  2. Outer granular layer.
    • Higher cell density & smaller cells than pyramidal layer.
  3. Outer pyramidal layer.
  4. Inner granular layer.
    • Not prominent in frontal cortex.
    • Where the thalamic axons end.
    • Divided in three (a, b, c) in the calcarine cortex due to two white matter bands (external band of Baillarger, internal band of Baillarger) that are grossly identified as the line of Gennari.[18][19]
  5. Inner pyramidal layer.
    • Location of Betz neurons - large motor neurons of cerebral cortex.
  6. Multiforme layer (Polymorphic layer).

Images:

Cingulate cortex

  • Spindle neurons, AKA von Economo neurons.
    • Thought to be important in cognition and problem solving.[22]

Images

  • Spindle neurons - high mag. (WC)

  • Spindle neurons - cropped - very high mag. (WC)

Pineal gland

Main article: Pineal gland

Features:[23][24]

  • Cells in lobulated clusters or linear arrays (low power).
  • Pinealocyte:
    • Light staining and round nuclei with neuroendocrine look (i.e. salt-and-pepper chromatin).
    • Broad rim of light cytoplasm.
  • Astrocytes:
    • Cylindrical hyperchromatic nucleus ~ 1/2 the size of pinealocyte.

Notes:

  • Highly cellular structure - may be confused with (metastatic) small cell carcinoma.
  • Often calcified.

Images

  • Pineal gland - very high mag. (WC/Nephron)

  • Pineal gland - intermed. mag. (WC/Nephron)

  • Pineal gland. (WC)

www:

IHC

  • Synaptophysin +ve.[23]

Midbrain

Structures:

  • Substantia nigra (Parkinson's disease).
  • Nuclei of CN IV (posterior).
  • Nuclei of CN III (anterior).
  • Cerebral penduncles (anterior).
  • Red nuclei.

Schematics

  • Midbrain (WC)

  • Nuclei of the CNs (WC)

  • Nuclei of the CNs - sagittal section of brain stem (WC)

Pons

Features:

Locus ceruleus

  • Literally means blue spot.
  • Location: adjacent to midline + anterior to 4th ventricle.

Microscopic features:

  • Pigmented neurons.
    • Produce norepinephrine.

Notes:

Images

  • Locus ceruleus (LC) - very low mag. (WC)

  • Locus ceruleus (LC) - low mag. (WC)

  • Locus ceruleus (LC) - intermed. mag. (WC)

  • Locus ceruleus (LC) - high mag. (WC)

www:

Medulla oblongata

Anatomy

Schematic: Medulla oblongata - Gray's anatomy (WC).

Anterior

  • Pyramids: adjacent to midline, anterior.
  • Olives: lateral and posterior to pyramids.

Posterior - important nuclei (location)

  • CN XII: 4th ventricle + adjacent to midline; medial to nucleus of CN X.[27]
  • CN X: 4th ventricle + lateral to nucleus of CN XII.
Image

  • Medulla oblongata - very low mag. (WC)

Pituitary gland

Anatomy

  • Located in sella turcica below optic chiasm.
  • Anterior lobe is epithelial.
  • Posterior lobe is neuroepithelial.
  • The infundibulum connects the pituitary to the brain

Schematic: File:Gray1181.png Pituitary gland - Gray's anatomy (WC).


Images

  • Anterior & posterior pituitary. (WC)

  • Adenohypophysis. (WC/Držiak)

See also

References

  1. ↑ 1.0 1.1 Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 16. ISBN 978-0443069826.
  2. ↑ URL: http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1. Accessed on: 5 July 2010.
  3. ↑ URL: http://www.whonamedit.com/synd.cfm/43.html. Accessed on: 2 August 2011.
  4. ↑ Croul SE. 28 June 2010.
  5. ↑ URL: http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1. Accessed on: 2 July 2010.
  6. ↑ 6.0 6.1 Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 23-34. ISBN 978-0443069826.
  7. ↑ Kimura M, Kato M, Shimazaki H, Watanabe K, Matsumoto N (December 1996). "Neural information transferred from the putamen to the globus pallidus during learned movement in the monkey". J. Neurophysiol. 76 (6): 3771–86. PMID 8985875. http://jn.physiology.org/cgi/pmidlookup?view=long&pmid=8985875.
  8. ↑ URL: http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1. Accessed on: 22 December 2010.
  9. ↑ Bhatia, R.; Kumar, M.; Garg, A.; Nanda, A. (Dec 2008). "Putaminal necrosis due to methanol toxicity.". Pract Neurol 8 (6): 386-7. doi:10.1136/jnnp.2008.161976. PMID 19015300.
  10. ↑ Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 23. ISBN 978-0443069826.
  11. ↑ URL: http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1. Accessed on: 2 July 2010.
  12. ↑ Ingvar, M. (1986). "Cerebral blood flow and metabolic rate during seizures. Relationship to epileptic brain damage.". Ann N Y Acad Sci 462: 194-206. PMID 3518570.
  13. ↑ D. Munoz. 27 July 2011.
  14. ↑ Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 25. ISBN 978-0443069826.
  15. ↑ Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 27. ISBN 978-0443069826.
  16. ↑ URL: http://www.stonybrookmedicalcenter.org/pathology/neuropathology/chapter1. Accessed on: 2 July 2010.
  17. ↑ Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 18. ISBN 978-0443069826.
  18. ↑ Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 24. ISBN 978-0443069826.
  19. ↑ URL: http://www.ncbi.nlm.nih.gov/books/NBK11524/. Accessed on: 7 January 2011.
  20. ↑ URL: http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/N1-MS-01-01-Ans.htm and http://moon.ouhsc.edu/kfung/iacp-olp/apaq-text/n1-ms-01.htm. Accessed on: 31 October 2010.
  21. ↑ URL: http://www.ncbi.nlm.nih.gov/books/NBK11524/. Accessed on: 7 January 2011.
  22. ↑ Allman, JM.; Hakeem, A.; Erwin, JM.; Nimchinsky, E.; Hof, P. (May 2001). "The anterior cingulate cortex. The evolution of an interface between emotion and cognition.". Ann N Y Acad Sci 935: 107-17. PMID 11411161.
  23. ↑ 23.0 23.1 Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 25-26. ISBN 978-0443069826.
  24. ↑ 24.0 24.1 URL: http://www.lab.anhb.uwa.edu.au/mb140/corepages/endocrines/endocrin.htm. Accessed on: 31 October 2010.
  25. ↑ Croul SE. 28 June 2010.
  26. ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 677. ISBN 978-1416054542.
  27. ↑ Crossman, Alan R.; Neary, David. (2010). Neuroanatomy: An Illustrated Colour Text (4th ed.). Churchill Livingstone. pp. 13. ISBN 978-0702030864.
  28. ↑ Miller VM, Kenny RA, Oakley AE, Hall R, Kalaria RN, Allan LM (August 2009). "Dorsal motor nucleus of vagus protein aggregates in Lewy body disease with autonomic dysfunction". Brain Res. 1286: 165–73. doi:10.1016/j.brainres.2009.05.083. PMID 19501577.

External links

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