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The middle layer of the meninges is the arachnoid (ah- ◗ The cerebellum (ser-eh-BEL-um) is located immedi- RAK-noyd) discount 5mg proscar with mastercard. This membrane is loosely attached to the deep- ately below the posterior part of the cerebral hemi- est of the meninges by weblike fibers buy 5mg proscar with visa, allowing a space for spheres and is connected with the cerebrum, brain stem, the movement of cerebrospinal fluid (CSF) between the two ANTERIOR POSTERIOR CEREBRUMCEREBRUMCEREBRUM Corpus callosum DIENCEPHALON: Thalamus Sagittal plane Hypothalamus Pituitary gland BRAIN STEM: Midbrain Pons Medulla oblongata Spinal cord CEREBELLUM Figure 10-1 Brain, sagittal section. THE NERVOUS SYSTEM: THE BRAIN AND CRANIAL NERVES 203 Table 10•1 Organization of the Brain DIVISION DESCRIPTION FUNCTIONS Cerebrum Largest and uppermost portion of the brain Cortex (outer layer) is site for conscious Divided into two hemispheres, each subdi- thought, memory, reasoning, and abstract vided into lobes mental functions, all localized within specific lobes Diencephalon Between the cerebrum and the brain stem Thalamus sorts and redirects sensory input; Contains the thalamus and hypothalamus hypothalamus maintains homeostasis, controls autonomic nervous system and pituitary gland Brain stem Anterior region below the cerebrum Connects cerebrum and diencephalon with spinal cord Midbrain Below the center of the cerebrum Has reflex centers concerned with vision and hearing; connects cerebrum with lower 10 portions of the brain Pons Anterior to the cerebellum Connects cerebellum with other portions of the brain; helps to regulate respiration Medulla oblongata Between the pons and the spinal cord Links the brain with the spinal cord; has centers for control of vital functions, such as respiration and the heartbeat Cerebellum Below the posterior portion of the cerebellum Coordinates voluntary muscles; maintains Divided into two hemispheres balance and muscle tone membranes. The innermost layer around the brain, the pia mater (PI-ah MA-ter), is attached to the nervous tissue of the brain and spinal cord and follows all the contours of these Checkpoint 10-2 The meninges are protective membranes around the brain and spinal cord. What are the names of the three structures (see Fig. It is made of a delicate connec- layers of the meninges from the outermost to the innermost? The pia mater 204 CHAPTER TEN Frontal lobe Parietal lobe Occipital lobe ANTERIOR Longitudinal fissure Left Right hemisphere hemisphere Central sulcus Gyri POSTERIOR Figure 10-2 External surface of the brain, superior view. The division into two hemispheres and into lobes is visible. Periosteum Skin Dural (venous) Skull sinus Dura mater Arachnoid villus Arachnoid Meninges Pia mater Gray matter Brain tissue White matter Figure 10-3 Frontal (coronal) section of the top of the head. ZOOMING IN What is located in the spaces where the dura mater divides into two layers? THE NERVOUS SYSTEM: THE BRAIN AND CRANIAL NERVES 205 Cerebrospinal Fluid line space, the third ventricle, by means of openings called foramina (fo-RAM-in-ah). The third ventricle is sur- Cerebrospinal (ser-e-bro-SPI-nal) fluid is a clear liquid rounded by the diencephalon. Continuing down from the that circulates in and around the brain and spinal cord third ventricle, a small canal, called the cerebral aqueduct, (Fig. The function of the CSF is to support nervous extends through the midbrain into the fourth ventricle, tissue and to cushion shocks that would otherwise injure which is located between the brain stem and the cerebel- these delicate structures. This ventricle is continuous with the central canal of to the cells and transports waste products from the cells.

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For ambulatory chil- dren in whom surgical reconstruction is planned proscar 5 mg sale, initial contact knee flexion of more than 20° or greater than 20° midstance knee flexion in the presence of a popliteal angle of greater than 45° indicates the need for hamstring 11 5mg proscar amex. As part of muscle-lengthening procedure for young children when the popliteal angle is greater than 50° under anesthesia 2. Progressive fixed knee flexion contracture greater than 5° to 10° 3. Difficulty seating, pulling forward out of the wheelchair because of spastic or contracted hamstrings 4. Severe whole spine kyphosis in sitting that resolves when the hamstrings are inactivated 5. Increased knee flexion at foot contact; normal should be less than 20° 6. Increased knee flexion in midstance (more than 20°) with popliteal angle greater than 50° Case 11. She had no knee flexion contrac- skin breakdown in the middle of her back from sitting in ture. It was recommended to her mother that she have a her wheelchair and her school chair (Figure C11. Her distal hamstring lengthening that would allow her to long- mother also worried that she was hunched over, which sit on the floor. After this surgery, she no longer had prob- was only apparent while she sat upright (Figure C11. Also, there will be almost constant hamstring activity through stance phase on the EMG with a contracted hamstring on physical exami- nation in a few children. This constant EMG activity, or EMG activity that has a significant premature activation in initial swing, also indicates the need for hamstring lengthening. Specific Treatments As already noted, nighttime splinting occasionally combined with Botox in- jections may provide improved muscle length in a few moderate hamstring contractures. Nighttime splinting will not be of any significant use in severe contractures.

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