DiencephalonDiencephalonDiencephalonDiencephalon

Won Taek Lee, Won Taek Lee, M.D., Ph.DM.D., Ph.D..

DiencephalonDiencephalonDiencephalonDiencephalon

• Thalamus Thalamus dorsal thalamus dorsal thalamus

• HypothalamusHypothalamuspituitary glandpituitary gland

• EpithalamusEpithalamushabenular nucleus and commissurehabenular nucleus and commissurepineal glandpineal gland

• Subthalamus Subthalamus ventral thalamus ventral thalamus subthalamic nucleus (STN)subthalamic nucleus (STN) field of Forel field of Forel

DiencephalonDiencephalon

dorsal surfacedorsal surface

DiencephalonDiencephalon

ventral surfaceventral surface

Diencephalon

Medial Surface

THALAMUSTHALAMUS

Classification of Thalamic NucleiClassification of Thalamic NucleiClassification of Thalamic NucleiClassification of Thalamic Nuclei

I. I. Lateral Nuclear GroupLateral Nuclear Group

II.II. Medial Nuclear GroupMedial Nuclear Group

III.III. Anterior Nuclear GroupAnterior Nuclear Group

IV.IV. Posterior Nuclear GroupPosterior Nuclear Group

V.V. Metathalamic Nuclear GroupMetathalamic Nuclear Group

VI.VI. Intralaminar Nuclear GroupIntralaminar Nuclear Group

VII.VII. Thalamic Reticular NucleusThalamic Reticular Nucleus

Classification of Thalamic NucleiClassification of Thalamic NucleiClassification of Thalamic NucleiClassification of Thalamic Nuclei

15 mm* 12 mm*

* Distance from anterior thalamic pole

4.02 mm* 2.02 mm*

* Distance from anterior thalamic pole

LATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUP

Ventral Nuclear GroupVentral Nuclear Group Ventral Posterior Nucleus (VP)Ventral Posterior Nucleus (VP)

ventral posterolateral nucleus ventral posterolateral nucleus (VPL, (VPL, V.c.a.e. & V.c.p.e.V.c.a.e. & V.c.p.e.)) - pars oralis (VPLo, VLp)- pars oralis (VPLo, VLp) - pars caudalis (VPLc, VPL)- pars caudalis (VPLc, VPL) ventral posteromedial nucleus (VPM)ventral posteromedial nucleus (VPM) - pars principalis (VPM, - pars principalis (VPM, V.c.a.i. & V.c.a.e.V.c.a.i. & V.c.a.e.)) - pars parvocellularis (VPMpc, - pars parvocellularis (VPMpc, V.c.pc.i.V.c.pc.i., VMb), VMb) ventral posteroinferior nucleus (VPI, ventral posteroinferior nucleus (VPI, V.c.pc.eV.c.pc.e))

LATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUP

Ventral Lateral Nucleus (VL)Ventral Lateral Nucleus (VL)

- pars oralis (VLo, - pars oralis (VLo, V.o.a.V.o.a. VLa) VLa)

- pars caudalis (VLc, - pars caudalis (VLc, V.o.p.V.o.p., VLp), VLp)

- pars medialis (VLm, - pars medialis (VLm, V.o.m. & V.o.i.,V.o.m. & V.o.i., VMp, VM) VMp, VM)

Ventral Anterior Nucleus (VA, Ventral Anterior Nucleus (VA, L.po.L.po.))

- pars parvicellularis (VApc)- pars parvicellularis (VApc)

- pars magnocellularis (VAmc)- pars magnocellularis (VAmc)

LATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUP

VentralVentralNuclear GroupNuclear Group

TTTTTT

ML, STTML, STTCbllCbllGPiGPiSNrSNr

Prefrontal Prefrontal SMA MI, PM SISMA MI, PM SI

LATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUP

Dorsal or Lateral Nuclear GroupDorsal or Lateral Nuclear Group

Lateral Dorsal Nucleus (LD, Lateral Dorsal Nucleus (LD, D.sf.D.sf.))

Lateral Posterior Nucleus (LP, Lateral Posterior Nucleus (LP, D.im. & Z.im.D.im. & Z.im.))

Pulvinar (P, Pulvinar (P, Pu.Pu.))

LATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUPLATERAL NUCLEAR GROUP

SC, PretectalSC, PretectalHFHF

VisualVisualAssociationAssociation

areaarea

SomestheticSomestheticAssociationAssociation

AreaArea

cingulate gyrus,cingulate gyrus,precuneusprecuneus

MEDIAL NUCLEAR GROUPMEDIAL NUCLEAR GROUPMEDIAL NUCLEAR GROUPMEDIAL NUCLEAR GROUP

Dorsomedial Nucleus (MD, Dorsomedial Nucleus (MD, M.M.)) - pars magnocellularis, MDmc)- pars magnocellularis, MDmc) - pars parvocellularis, MDpc)- pars parvocellularis, MDpc) - pars paralaminaris (MDpl;- pars paralaminaris (MDpl; pars multiformis, MDmf)pars multiformis, MDmf) - pars densocellularis, MDdc)- pars densocellularis, MDdc)

Midline Nuclear GroupMidline Nuclear Group Paratenial Nucleus (Pt, Paratenial Nucleus (Pt, Pt.Pt.)) Reunience Nucleus (Re, Reunience Nucleus (Re, Edy.Edy.)) Submedial Nucleus (Sm)Submedial Nucleus (Sm) Rhomboid Nucleus (Rh)Rhomboid Nucleus (Rh)

ANTERIOR NUCLEAR GROUPANTERIOR NUCLEAR GROUP

anteroventral nucleus (AV, anteroventral nucleus (AV, A.pr.A.pr.))

anterodorsal nucleus (AD, anterodorsal nucleus (AD, A.d.A.d.))

anteromedial nucleus (AM, anteromedial nucleus (AM, A.m.A.m.))

POSTERIOR NUCLEAR GROUPPOSTERIOR NUCLEAR GROUP

suprageniculate nucleus (SG, suprageniculate nucleus (SG, Li.Li.))

nucleus limitans (Lim, nucleus limitans (Lim, Li.Li.))

posterior nucleus (PO, posterior nucleus (PO, Li.por.Li.por.))

MEDIAL & ANTERIOR NUCLEAR GROUPMEDIAL & ANTERIOR NUCLEAR GROUPMEDIAL & ANTERIOR NUCLEAR GROUPMEDIAL & ANTERIOR NUCLEAR GROUP

MB, HFMB, HFPrefrontalPrefrontal

CortexCortexFrontalFrontal

Eye FieldEye Field MedialMedialFrontalFrontalGyrusGyrus

cingulatecingulategyrusgyrus Basal Basal

forebrainforebrain SNr, SC, RFSNr, SC, RF

METATHALAMIC NUCLEAR GROUPMETATHALAMIC NUCLEAR GROUPMETATHALAMIC NUCLEAR GROUPMETATHALAMIC NUCLEAR GROUP

Medial Geniculate Nucleus (MG)Medial Geniculate Nucleus (MG)

ventral or principal or ventral or principal or

parvocellular nucleus (MGv)parvocellular nucleus (MGv)

dorsal nucleus (MGd)dorsal nucleus (MGd)

medial nucleus (MGm)medial nucleus (MGm)

Lateral Geniculate Nucleus (LG)Lateral Geniculate Nucleus (LG)

dorsal nucleus (LGd)dorsal nucleus (LGd)

ventral nucleus (LGv)ventral nucleus (LGv)

INTRALAMINAR NUCLEAR GROUPINTRALAMINAR NUCLEAR GROUPINTRALAMINAR NUCLEAR GROUPINTRALAMINAR NUCLEAR GROUP

Rostral Intralaminar NucleiRostral Intralaminar Nuclei

central lateral nucleus, CL, central lateral nucleus, CL, i.La.i.La.))

central medial nucleus, CeM, central medial nucleus, CeM, Co.Co.))

paracentral nucleus, PC, paracentral nucleus, PC, i.La.i.La.))

Caudal Intralaminar NucleiCaudal Intralaminar Nuclei

(CM-PF nuclear complex)(CM-PF nuclear complex)

centre median nucleus, CM, centre median nucleus, CM, Ce.Ce.))

parafascicular nucleus, PF, parafascicular nucleus, PF, Pf.Pf.))

THALAMIC RETICULAR NUCLEUSTHALAMIC RETICULAR NUCLEUSTHALAMIC RETICULAR NUCLEUSTHALAMIC RETICULAR NUCLEUS

Cerebral CortexCerebral CortexCerebral CortexCerebral Cortex

Subcortical StructureSubcortical StructureSubcortical StructureSubcortical Structure

ThalamicThalamicReticularReticularNucleusNucleus

ThalamicThalamicReticularReticularNucleusNucleus

ThalamocorticalThalamocorticalNeuronNeuron

ThalamocorticalThalamocorticalNeuronNeuron

Summary of Thalamic ConnectivitySummary of Thalamic ConnectivitySummary of Thalamic ConnectivitySummary of Thalamic Connectivity

I.I. Sensory InputSensory Input general sensationgeneral sensation special sensationspecial sensation

taste, equilibrium, hearing, visiontaste, equilibrium, hearing, vision

II.II. Motor InputMotor Input

cerebellum, basal gangliacerebellum, basal ganglia

III. III. Reticular FormationReticular Formation

IV.IV. Limbic SystemLimbic System mammillary nucleusmammillary nucleus hippocampal formationhippocampal formation

Sensory InputSensory InputSensory InputSensory Input

(1) General Sensation(1) General Sensation

1. Medial lemniscus1. Medial lemniscus

VPLc ----------- VPLc ----------- S I, S IIS I, S II

2. Spinothalamic tract2. Spinothalamic tract VPLc -----------VPLc ----------- S I, S IIS I, S II POm -----------POm ----------- retroinsular cortexretroinsular cortex Sm ------------- Sm ------------- frontal lobe(?)frontal lobe(?) CL -------------CL ------------- diffuse cortical areasdiffuse cortical areas

3. Trigeminothalamic tract3. Trigeminothalamic tract

VPM -------------VPM ------------- S I, S IIS I, S II

Sensory InputSensory InputSensory InputSensory Input

(2) Taste sensation(2) Taste sensation

VPM pc -------VPM pc ------- gustatory area (Brodmann area 43)gustatory area (Brodmann area 43)

(3) Sense of equilibrium(3) Sense of equilibrium

VPLo ---------- VPLo ---------- S IS I

(4) Auditory sensation(4) Auditory sensation

MGv ----------- MGv ----------- A I (Brodmann area 41, 42)A I (Brodmann area 41, 42) MGd ----------- MGd ----------- A IIA II

(5) Vision(5) Vision

LGd ---------- LGd ---------- V I (Brodmann area 17)V I (Brodmann area 17) Pi, Pl ---------- Pi, Pl ---------- V I, V II (Brodmann area 17, 18, 19)V I, V II (Brodmann area 17, 18, 19)

Motor InputMotor InputMotor InputMotor Input

(1) Cerebellum(1) Cerebellum VLc, VPLo, Nucleus X (cell sparse zone)VLc, VPLo, Nucleus X (cell sparse zone) -------------------- M I (Brodmann area 4), Premotor areaM I (Brodmann area 4), Premotor area CL -----------CL ----------- diffuse cortical areasdiffuse cortical areas

(2) Basal ganglia(2) Basal ganglia 1. GPi (internal segment of globus pallidus)1. GPi (internal segment of globus pallidus) VLo --------VLo -------- SMA (supplementary motor area)SMA (supplementary motor area) VApc -------VApc ------- frontal cortexfrontal cortex CM ---------CM --------- diffuse cortical areas, striatum,diffuse cortical areas, striatum,

subthalamic nucleussubthalamic nucleus 2. SNr (pars reticularis of substantia nigra)2. SNr (pars reticularis of substantia nigra) VLm, VAmc - fronal cortexVLm, VAmc - fronal cortex MDpc --------- medial frontal cortexMDpc --------- medial frontal cortex MDpl ---------- frontal eye field (Brodmann area 8)MDpl ---------- frontal eye field (Brodmann area 8)

Reticular Formation & Limbic SystemReticular Formation & Limbic SystemReticular Formation & Limbic SystemReticular Formation & Limbic System

Reticular formationReticular formation rostral intralaminar nuclei (CL, Cem, PC), Rhrostral intralaminar nuclei (CL, Cem, PC), Rh ----- diffuse cortical areas----- diffuse cortical areas thalamic reticular nucleus (R), LGvthalamic reticular nucleus (R), LGv ----- adjacent thalamic nucleus----- adjacent thalamic nucleus

Limbic SystemLimbic System

Mammillary BodyMammillary Body AV, AD, AM ----- AV, AD, AM ----- cingulate gyrus cingulate gyrus

Hippocampal FormationHippocampal Formation AV, AD, AM ----- AV, AD, AM ----- cingulate gyruscingulate gyrus

LD ------------------LD ------------------ cingulate gyrus, precuneuscingulate gyrus, precuneus Re -------------------Re ------------------- medial cortex, entorhinal cortexmedial cortex, entorhinal cortex

Clinical Syndromes of the ThalamusClinical Syndromes of the ThalamusClinical Syndromes of the ThalamusClinical Syndromes of the Thalamus

Posterolateral thalamic syndromesPosterolateral thalamic syndromes sensory disorderssensory disorders

Thalamic (Dejerine-Roussy) syndromeThalamic (Dejerine-Roussy) syndrome ----- VP nucleus - pain----- VP nucleus - pain Medial thalamic syndromesMedial thalamic syndromes

disorders of consciousnessdisorders of consciousness thalamic neglect, thalamic amnesia, thalamic neglect, thalamic amnesia, akinetic mutismakinetic mutism

Anterolateral thalamic syndromesAnterolateral thalamic syndromes

motor disordersmotor disorders

paresis, ataxia, motor incoordination, dysphagiaparesis, ataxia, motor incoordination, dysphagia

Thalamic (Dejerine-Roussy) SyndromeThalamic (Dejerine-Roussy) SyndromeThalamic (Dejerine-Roussy) SyndromeThalamic (Dejerine-Roussy) Syndrome

Joseph Jules Dejerine Joseph Jules Dejerine (1849-1917)(1849-1917)

Gustave Roussy Gustave Roussy (1874-1948)(1874-1948)

Modality:Modality: Vision Vision

Receptor:Receptor: Photoreceptor Cell of RetinaPhotoreceptor Cell of Retina

Cranial Nerve: II (Optic nerve)Cranial Nerve: II (Optic nerve)

1st Neuron:1st Neuron: Bipolar CellBipolar Cell

2nd Neuron:2nd Neuron: Ganglion CellGanglion Cell optic nerveoptic nerve

optic chiasmoptic chiasm

optic tractoptic tract

3rd Neuron:3rd Neuron: Lateral Geniculate Nucleus Lateral Geniculate Nucleus optic radiationoptic radiation

Termination:Termination: Visual Areas (V I, V II)Visual Areas (V I, V II) Brodmann area 17 (V I), 18, 19 (V II)Brodmann area 17 (V I), 18, 19 (V II)

Modality:Modality: Vision Vision

Receptor:Receptor: Photoreceptor Cell of RetinaPhotoreceptor Cell of Retina

Cranial Nerve: II (Optic nerve)Cranial Nerve: II (Optic nerve)

1st Neuron:1st Neuron: Bipolar CellBipolar Cell

2nd Neuron:2nd Neuron: Ganglion CellGanglion Cell optic nerveoptic nerve

optic chiasmoptic chiasm

optic tractoptic tract

3rd Neuron:3rd Neuron: Lateral Geniculate Nucleus Lateral Geniculate Nucleus optic radiationoptic radiation

Termination:Termination: Visual Areas (V I, V II)Visual Areas (V I, V II) Brodmann area 17 (V I), 18, 19 (V II)Brodmann area 17 (V I), 18, 19 (V II)

Visual (Optic) PathwayVisual (Optic) Pathway Visual (Optic) PathwayVisual (Optic) Pathway

1. Pigment Epithelium1. Pigment Epithelium - retinal detachment- retinal detachment

2. Neuronal Layer2. Neuronal Layer

(1) Photosensitive Cell Layer(1) Photosensitive Cell Layer

Rod Cell, Cone CellRod Cell, Cone Cell

(2) Bipolar Cell Layer(2) Bipolar Cell Layer Bipolar CellBipolar Cell Horizontal CellHorizontal Cell Amacrine CellAmacrine Cell

(3) Ganglion Cell Layer(3) Ganglion Cell Layer Ganglion CellGanglion Cell Optic Nerve (II)Optic Nerve (II)

RETINA RETINA - Pars Nervosa- Pars Nervosa

Visual Visual PathwayPathway

1. Optic nerve1. Optic nerve

2. Optic chiasm2. Optic chiasm

3. Optic tract3. Optic tract

4. Lateral 4. Lateral geniculategeniculate bodybody

5. Optic radiation5. Optic radiation

6. Visual cortex6. Visual cortex

Visual (Optic) PathwayVisual (Optic) PathwayVisual (Optic) PathwayVisual (Optic) Pathway

Visual PathwayVisual Pathway Lateral Geniculate Nucleus (LGd)Lateral Geniculate Nucleus (LGd) Visual PathwayVisual Pathway Lateral Geniculate Nucleus (LGd)Lateral Geniculate Nucleus (LGd)

Dorsal Nucleus (LGd)Dorsal Nucleus (LGd)

Magnocellular PartMagnocellular Part 1, 21, 2 Parvocellular PartParvocellular Part 3, 4, 5, 63, 4, 5, 6

contralateral afferentscontralateral afferents 1, 4, 61, 4, 6 ipsilateral afferentsipsilateral afferents 2, 3, 52, 3, 5

Ventral Nucleus (LGv)Ventral Nucleus (LGv)

part of thalamicpart of thalamic reticular nucleusreticular nucleus

dorsolateral

ventromedial

Optic Radiation (Geniculocalcarine Tract)Optic Radiation (Geniculocalcarine Tract)Optic Radiation (Geniculocalcarine Tract)Optic Radiation (Geniculocalcarine Tract)

Meyer’s loopMeyer’s loop

Clinical Features of Visual Pathway LesionClinical Features of Visual Pathway Lesion Clinical Features of Visual Pathway LesionClinical Features of Visual Pathway Lesion

1. optic nerve1. optic nerve

2. optic chiasm2. optic chiasm

3. optic tract3. optic tract

4. 5. optic radiation4. 5. optic radiation

A. unilateral blindnessA. unilateral blindness

B. bitemporal hemianopsiaB. bitemporal hemianopsia

C. left homonymousC. left homonymous hemianopsiahemianopsia

D. left inferior homony-D. left inferior homony- mous quadranopsiamous quadranopsia

E. left superior homony-E. left superior homony- mous quadranopsiamous quadranopsia

Signs of Visual Pathway LesionSigns of Visual Pathway LesionSigns of Visual Pathway LesionSigns of Visual Pathway Lesion

Optic nerveOptic nerve - ipsilateral blindness- ipsilateral blindness

Optic chiasmOptic chiasm - bitemporal hemianopsia- bitemporal hemianopsia

Optic tractOptic tract - contralateral homonymous hemianopsia- contralateral homonymous hemianopsia

Optic radiationOptic radiation - contralateral homonymous quadranopsia- contralateral homonymous quadranopsia - intact light reflex- intact light reflex

Visual CortexVisual Cortex - contralateral homonymous quadranopsia- contralateral homonymous quadranopsia - macular sparing- macular sparing

Visual Field DefectVisual Field DefectVisual Field DefectVisual Field Defect

left inferior optic radiation lesionleft inferior optic radiation lesionright superior quadranopsiaright superior quadranopsia

HypothalamusHypothalamus Limbic SystemLimbic SystemHypothalamusHypothalamus Limbic SystemLimbic System

EpithalamusEpithalamus Limbic SystemLimbic SystemEpithalamusEpithalamus Limbic SystemLimbic System

Habenular NucleusHabenular Nucleus

Medial Habenular NucleusMedial Habenular Nucleus

Lateral Habenular NucleusLateral Habenular Nucleus

Habenular CommissureHabenular Commissure

Pineal GlandPineal Gland

SubthalamusSubthalamus Basal GangliaBasal GangliaSubthalamusSubthalamus Basal GangliaBasal Ganglia

Subthalamic nucleusSubthalamic nucleus

zona incertazona incerta

Field of ForelField of Forel

H H ansa lenticularisansa lenticularis

H1H1 thalamic fasciculusthalamic fasciculus

H2H2 lenticular fasciculuslenticular fasciculus