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Attribution: Department of Neurology, 2009

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Limbic System




   J.H. Martin. Neuroanatomy: Text and Atlas. McGraw-Hill, 2003. 3rd ed.




M1 CNS Head and Neck
   March 18, 2009
Lecture Outline
•    Brief Review of Cortical Function

•    Neuroanatomy of Limbic System
      –  Cortex
          •    Hippocampus
          •    Parahippocampal gyrus
          •    Amygdala
          •    Cingulate gyrus
          •    Olfactory cortex
      –  Diencephalon
          •  Thalamus – Anterior nucleus, Mediodorsal nucleus
          •  Hypothalamus - Medial Hypothalamus, Mammillary bodies

•    Connections
      –  Amygdala
      –  Hippocampus – Papez Circuit

•    Blood Supply
Important Terms
•    Brodman Areas 4, 3, 17,       •    Uncus
     41, 42                        •    Entorhinal Cortex
•    Primary Sensory Cortex        •    Olfactory Bulb
•    Primary Motor Cortex          •    Olfactory Tract
•    Unimodal Association          •    Forix
     Areas
                                   •    Mammillary body
•    Multimodal Association
     Areas                         •    Mammillothalamic Tract
•    Limbic Association Areas      •    Anterior Nucleus of the
                                        Thalamus
•    Limbic Cortex
                                   •    Mediodorsal Nucleus of
•    Cingulate Gyrus                    the Thalamus
•    Amygdala                      •    Papez Circuit
      –  Centromedial Division
                                   •    Neocortex
      –  Central Nucleus
      –  Basolateral Division
                                   •    Paleocortex
•    Hippocampal Formation         •    Archicortex
      –    Parahippocampal gyrus   •    Stria Termialis
      –    Dentate
      –    Subiculum
      –    CA1, CA2, CA3
Functional Areas of the Cerebral Cortex



The cerebral cortex is
divided into:
Primary motor & sensory areas
   (M1, S1, A1, V1)
Brodman areas 4, 3, 41,42, 17)

Unimodal association areas
  (MA, SA, AA, VA)

Multimodal association areas
  (Posterior and anterior)

Limbic association areas
  (Limbic lobe)

Limbic cortex
  (Hippocampus & Amygdala)




                                 Mesulam, Principles of Behavioral and Cognitive Neurology, 2000
LIMBIC LOBE (Cortical Areas)          Cortex Type
Cingulate gyrus & Isthmus                     Neocortex (six layers)
Subcallosal area
Parahippocampal Gyrus                         Paleocortex (3-5 layers)
Uncus
Hippocampus                                  Archicortex (3 layers)
(Deep within parahippocampal gyrus)




                   Rick Altschuler
Hippocampal Formation and Amygdala

                                                      fornix and mammillary body




 amygdala

    hippocampal
     formation
         J.H. Martin. Neuroanatomy: Text and Atlas.
         McGraw-Hill, 2003. 3rd ed.




The hippocampal formation and the
amygdala are often described as
being “inside” the telencephalon.
The hippocampal formation can be
viewed in the floor of the inferior horn
of the lateral ventricle.


                                                            Source Undetermined
However, the amygdala and hippocampal formation
A                            are cortical areas that are continuous with
                             surface cortical structures.

                                 fornix                 A B


                                                                                          fornix &
                                                                                          mammillary
                                                                                          body




B
                                amygdala

                                   hippocampal
                                    formation
                                             J.H. Martin. Neuroanatomy: Text and Atlas.
                                             McGraw-Hill, 2003. 3rd ed.


                                          fornix
                                          mammillary body
                                          hippocampal formation

    Source Undetermined
AMYGDALOID COMPLEX:
                        Located in temporal lobe, rostral (forward) of the
                        hippocampal formation, in the anterior end of the
                             temporal horn of the lateral ventricle.
                      Contains 3 groups of nuclei:
                          Basolateral Group – Connections to Cortical
                      Structures
                          Corticomedial Group (smaller) – Receives large
                      Olfactory Input
                         Central Nucleus – Connections to Reticular /
                      Autonomic Regions of the Brain Stem


                        Function – General Limbic emotions & behaviors,
                      fear, anger, satiety (eating), environmental context
                      (reactions to environment)



Source Undetermined
The Amygdala
                                      •  A matrix of many nuclei

                                      •  Creates a bulge on the
                                         parahippocampal gyrus called
                                         the uncus

                                      •  Nuclei can be subdivided into:

                                        Corticomedial division (CM)
                                       with connections to the olfactory
                                       system and the hypothalamus
                                       (social behavior modulation)

                                         Central nucleus (Ce)
                                       with connections to the
                                Ce
                              CM BL    brain stem and hypothalamus
                                       (regulation of the autonomic
                                        nervous system)
                      UNCUS
                                         Basolateral division (BL)
Source Undetermined
                                       with connections to the
                                       cerebral cortex
                                       (emotional memory, e.g., fear)
The Olfactory Bulb is the major input to the Corticomedial Amygdala
    neocortical olfactory
    association area
                                                             olfactory bulb

primary olfactory cortex
                                                                  olfactory tract




     entorhinal
       area


        uncus




corticomedial amygdala

                            Gray’s Anatomy
The Corticomedial Amygdala


Connections of the
Corticomedial Nuclei:
                                                                                               Stria Terminalis
•  the Olfactory Bulb
    through the Lateral
    Olfactory Tract

•  the Medial Hypothalamus
    through the
    Stria Terminalis

•  through these connections                                                              Medial Hypothalamus
    odors influence sexual
    and other social
    behaviors in mammals Olfactory
                           Bulb

                                 Lateral
                                 Olfactory
                                 Tract                 Corticomedial Amygdala
                                 Modified From J.H. Martin, Neuroanatomy: Text and Atlas, 3rd ed Fig. 16-7
The Central Nucleus of the Amygdala
The Central Nucleus

connects to the
hypothalamus and
brain stem through the                                                                       lateral and medial
                                                                                               hypothalamus
Ventral Amygdalofugal
 Pathway (VAFP)




                                                                                   VAFP




                         Central Nucleus                                Reticular Formation and
                                                                        Cranial Nerve Nuclei
                                                                        regulating the
                                                                        autonomic nervous system
                           Modified From J.H. Martin, Neuroanatomy: Text and Atlas, 3rd ed Fig. 16-7
The Basolateral Amygdala

                                    Nuclei of the Basolateral Amygdala
                                    are reciprocally connected to:

                                    •  frontal lobe multimodal association
                                         cortex (connections not shown)

                                       •  unimodal and multimodal
                                           sensory association cortex
                                           of the:
                                           temporal lobe
                                           occipital lobe



                          BL


                  UNCUS
                                 Sensory Association Cortex
                                  Temporal Lobe
Source Undetermined
Gray’s Anatomy
A “triangular” circuit links the
                         Amygdala to the Orbital & Pre-
                         Frontal Cortex, Basal Ganglia
                         and to the Mediodorsal Nucleus
                         of the Thalamus. This circuit is
                         involved with the experience
                         and expression of emotional
                         responses including anger, fear,
Source Undetermined
                         pleasure and depression.



                                         Imaging from
                                      subjects with clinical
                                           depression

   Source Undetermined
The Hippocampal Formation:
           1. Dentate Gyrus
           2. Hippocampus
           3. Subiculum

                       Hippocampus (CA1, CA2, CA3)   Fornix



                                                               Dentate Gyrus

                                                                     Subiculum




                                                                Entorhinal Cortex
                                                                  of the
                                                              Parahippocampal Gyrus



 Source Undetermined
The hippocampus and the
  dentate gyrus are both
 archicortex with 3 layers.


There are multiple inputs to entorhinal
cortex, including fibers from the cingulate
gyrus, basolateral amygdala, olfactory
cortex and cortical association areas.
The Perforant pathway goes from entorhinal
cortex to dentate gyrus.
Granule cells (middle layer) of dentate gyrus
project (mossy fibers) to the hippocampus.
Pyramidal cells (middle layer) of
hippocampus give rise to the fornix, the
output tract of the hippocampal complex.
The fornix projects to mammillary bodies of
hypothalamus and septal nuclei.




                                                Haines, Fundamental Neuroscience for Basic and Clinical
                                                Applications, 3rd edition, 2005, Fig. 31-4
Basic neural circuits through the Hippocampal Formation


                                                         Mammillary Bodies &
                                                       Anterior Nuc. of thalamus
Multimodal Sensory Association Cortex:
              Parietal
                and                                                     fornix
         Temporal Neocortex



        Entorhinal Cortex        Dentate Gyrus    CA3       CA1          Subiculum
                                                   Hippocampus
(an area of the
parahippocampal
gyrus)
                                 perforant path
                                                    The Papez Circuit

                                                    Cingulate Gyrus
       Department of Neurology
The Papez Circuit




Manter and Gatz's Essentials of Clinical Neuroanatomy and Neurophysiology, 8th ed
COMPONENTS OF HIPPOCAMPAL FORMATION:
            Subiculum,Hippocampus, Dentate Gyrus
Efferents (Output): FORNIX




          Haines, Fundamental Neuroscience for Basic and Clinical Applications, 3rd edition, 2005, Fig. 31-5
Cortical Network Subserving Memory


                                        primary sensory areas
                                                                (long term storage of
                                                                   explicit memories)
                                  unimodal sensory association areas


                     (active            multimodal receptive
                     working              association area:
                     memory)           Posterior Parietal Cortex
multimodal expressive
  association area:
    Dorsolateral
  Prefrontal Cortex


                                        limbic association areas


    (formation of     Hippocampal                              Basolateral
                        Formation                              Amygdala      (formation of
    explicit memory:                                                          emotional
    semantic, episodic)                                                       memory)
        Department of Neurology
Cerebral arteries supply the cortex and superficial white matter


                                middle cerebral artery


                                anterior cerebral artery


                                posterior cerebral artery

                                  border zones




                                Modified From Haines, Fundamental
                                Neuroscience for Basic and Clinical
                                Applications, 3rd edition, 2005, Figs. 8-7, 8-9
Anterior Cerebral Artery
  includes leg and foot                           Territories of the Anterior,
  areas of the somato-                               Middle, and Posterior
  sensory and motor                                   Cerebral Arteries
  cortices




Middle Cerebral Artery
  includes hand and face areas
  of the somatosensory and
  motor cortices                                  Posterior Cerebral Artery
                                 Gray’s Anatomy      includes visual cortex
Distribution of the Cerebral Arteries to Internal Structures
                               of the Cerebral Hemispheres




Modified From J.H. Martin, Neuroanatomy: Text and Atlas, 3rd ed Fig. 4-5
Additional Source Information
                                  for more information see: http://open.umich.edu/wiki/CitationPolicy

Slide 3: J.H. Martin. Neuroanatomy: Text and Atlas. McGraw-Hill, 2003. 3rd ed.
Slide 6: Mesulam, Principles of Behavioral and Cognitive Neurology, 2000
Slide 7: Rick Altschuler
Slide 8: Source Undetermined; J.H. Martin. Neuroanatomy: Text and Atlas. McGraw-Hill, 2003. 3rd ed.
Slide 9: Source Undetermined; J.H. Martin. Neuroanatomy: Text and Atlas. McGraw-Hill, 2003. 3rd ed.
Slide 10: Source Undetermined
Slide 11: Source Undetermined
Slide 12: Gray’s Anatomy
Slide 13: Modified From J.H. Martin, Neuroanatomy: Text and Atlas, 3rd ed Fig. 16-7
Slide 14: Modified From J.H. Martin, Neuroanatomy: Text and Atlas, 3rd ed Fig. 16-7
Slide 15: Source Undetermined
Slide 16: Gray’s Anatomy
Slide 17: Source Undetermined; Source Undetermined
Slide 18: Source Undetermined
Slide 19: Haines, Fundamental Neuroscience for Basic and Clinical Applications, 3rd edition, 2005, Fig. 31-4
Slide 20: Department of Neurology
Slide 21: Manter and Gatz's Essentials of Clinical Neuroanatomy and Neurophysiology, 8th ed
Slide 22: Haines, Fundamental Neuroscience for Basic and Clinical Applications, 3rd edition, 2005, Fig. 31-5
Slide 23: Department of Neurology
Slide 24: Modified From Haines, Fundamental Neuroscience for Basic and Clinical Applications, 3rd edition, 2005, Figs. 8-7, 8-9
Slide 25: Gray’s Anatomy
Slide 26: Source Undetermined

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03.19.09: Limbic System

  • 1. Attribution: Department of Neurology, 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution–Non-commercial–Share Alike 3.0 License: http://creativecommons.org/licenses/by-nc-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/education/about/terms-of-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
  • 2. Citation Key for more information see: http://open.umich.edu/wiki/CitationPolicy Use + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (USC 17 § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation License Make Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (USC 17 § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (USC 17 § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
  • 3. Limbic System J.H. Martin. Neuroanatomy: Text and Atlas. McGraw-Hill, 2003. 3rd ed. M1 CNS Head and Neck March 18, 2009
  • 4. Lecture Outline •  Brief Review of Cortical Function •  Neuroanatomy of Limbic System –  Cortex •  Hippocampus •  Parahippocampal gyrus •  Amygdala •  Cingulate gyrus •  Olfactory cortex –  Diencephalon •  Thalamus – Anterior nucleus, Mediodorsal nucleus •  Hypothalamus - Medial Hypothalamus, Mammillary bodies •  Connections –  Amygdala –  Hippocampus – Papez Circuit •  Blood Supply
  • 5. Important Terms •  Brodman Areas 4, 3, 17, •  Uncus 41, 42 •  Entorhinal Cortex •  Primary Sensory Cortex •  Olfactory Bulb •  Primary Motor Cortex •  Olfactory Tract •  Unimodal Association •  Forix Areas •  Mammillary body •  Multimodal Association Areas •  Mammillothalamic Tract •  Limbic Association Areas •  Anterior Nucleus of the Thalamus •  Limbic Cortex •  Mediodorsal Nucleus of •  Cingulate Gyrus the Thalamus •  Amygdala •  Papez Circuit –  Centromedial Division •  Neocortex –  Central Nucleus –  Basolateral Division •  Paleocortex •  Hippocampal Formation •  Archicortex –  Parahippocampal gyrus •  Stria Termialis –  Dentate –  Subiculum –  CA1, CA2, CA3
  • 6. Functional Areas of the Cerebral Cortex The cerebral cortex is divided into: Primary motor & sensory areas (M1, S1, A1, V1) Brodman areas 4, 3, 41,42, 17) Unimodal association areas (MA, SA, AA, VA) Multimodal association areas (Posterior and anterior) Limbic association areas (Limbic lobe) Limbic cortex (Hippocampus & Amygdala) Mesulam, Principles of Behavioral and Cognitive Neurology, 2000
  • 7. LIMBIC LOBE (Cortical Areas) Cortex Type Cingulate gyrus & Isthmus Neocortex (six layers) Subcallosal area Parahippocampal Gyrus Paleocortex (3-5 layers) Uncus Hippocampus Archicortex (3 layers) (Deep within parahippocampal gyrus) Rick Altschuler
  • 8. Hippocampal Formation and Amygdala fornix and mammillary body amygdala hippocampal formation J.H. Martin. Neuroanatomy: Text and Atlas. McGraw-Hill, 2003. 3rd ed. The hippocampal formation and the amygdala are often described as being “inside” the telencephalon. The hippocampal formation can be viewed in the floor of the inferior horn of the lateral ventricle. Source Undetermined
  • 9. However, the amygdala and hippocampal formation A are cortical areas that are continuous with surface cortical structures. fornix A B fornix & mammillary body B amygdala hippocampal formation J.H. Martin. Neuroanatomy: Text and Atlas. McGraw-Hill, 2003. 3rd ed. fornix mammillary body hippocampal formation Source Undetermined
  • 10. AMYGDALOID COMPLEX: Located in temporal lobe, rostral (forward) of the hippocampal formation, in the anterior end of the temporal horn of the lateral ventricle. Contains 3 groups of nuclei: Basolateral Group – Connections to Cortical Structures Corticomedial Group (smaller) – Receives large Olfactory Input Central Nucleus – Connections to Reticular / Autonomic Regions of the Brain Stem Function – General Limbic emotions & behaviors, fear, anger, satiety (eating), environmental context (reactions to environment) Source Undetermined
  • 11. The Amygdala •  A matrix of many nuclei •  Creates a bulge on the parahippocampal gyrus called the uncus •  Nuclei can be subdivided into: Corticomedial division (CM) with connections to the olfactory system and the hypothalamus (social behavior modulation) Central nucleus (Ce) with connections to the Ce CM BL brain stem and hypothalamus (regulation of the autonomic nervous system) UNCUS Basolateral division (BL) Source Undetermined with connections to the cerebral cortex (emotional memory, e.g., fear)
  • 12. The Olfactory Bulb is the major input to the Corticomedial Amygdala neocortical olfactory association area olfactory bulb primary olfactory cortex olfactory tract entorhinal area uncus corticomedial amygdala Gray’s Anatomy
  • 13. The Corticomedial Amygdala Connections of the Corticomedial Nuclei: Stria Terminalis •  the Olfactory Bulb through the Lateral Olfactory Tract •  the Medial Hypothalamus through the Stria Terminalis •  through these connections Medial Hypothalamus odors influence sexual and other social behaviors in mammals Olfactory Bulb Lateral Olfactory Tract Corticomedial Amygdala Modified From J.H. Martin, Neuroanatomy: Text and Atlas, 3rd ed Fig. 16-7
  • 14. The Central Nucleus of the Amygdala The Central Nucleus connects to the hypothalamus and brain stem through the lateral and medial hypothalamus Ventral Amygdalofugal Pathway (VAFP) VAFP Central Nucleus Reticular Formation and Cranial Nerve Nuclei regulating the autonomic nervous system Modified From J.H. Martin, Neuroanatomy: Text and Atlas, 3rd ed Fig. 16-7
  • 15. The Basolateral Amygdala Nuclei of the Basolateral Amygdala are reciprocally connected to: •  frontal lobe multimodal association cortex (connections not shown) •  unimodal and multimodal sensory association cortex of the: temporal lobe occipital lobe BL UNCUS Sensory Association Cortex Temporal Lobe Source Undetermined
  • 17. A “triangular” circuit links the Amygdala to the Orbital & Pre- Frontal Cortex, Basal Ganglia and to the Mediodorsal Nucleus of the Thalamus. This circuit is involved with the experience and expression of emotional responses including anger, fear, Source Undetermined pleasure and depression. Imaging from subjects with clinical depression Source Undetermined
  • 18. The Hippocampal Formation: 1. Dentate Gyrus 2. Hippocampus 3. Subiculum Hippocampus (CA1, CA2, CA3) Fornix Dentate Gyrus Subiculum Entorhinal Cortex of the Parahippocampal Gyrus Source Undetermined
  • 19. The hippocampus and the dentate gyrus are both archicortex with 3 layers. There are multiple inputs to entorhinal cortex, including fibers from the cingulate gyrus, basolateral amygdala, olfactory cortex and cortical association areas. The Perforant pathway goes from entorhinal cortex to dentate gyrus. Granule cells (middle layer) of dentate gyrus project (mossy fibers) to the hippocampus. Pyramidal cells (middle layer) of hippocampus give rise to the fornix, the output tract of the hippocampal complex. The fornix projects to mammillary bodies of hypothalamus and septal nuclei. Haines, Fundamental Neuroscience for Basic and Clinical Applications, 3rd edition, 2005, Fig. 31-4
  • 20. Basic neural circuits through the Hippocampal Formation Mammillary Bodies & Anterior Nuc. of thalamus Multimodal Sensory Association Cortex: Parietal and fornix Temporal Neocortex Entorhinal Cortex Dentate Gyrus CA3 CA1 Subiculum Hippocampus (an area of the parahippocampal gyrus) perforant path The Papez Circuit Cingulate Gyrus Department of Neurology
  • 21. The Papez Circuit Manter and Gatz's Essentials of Clinical Neuroanatomy and Neurophysiology, 8th ed
  • 22. COMPONENTS OF HIPPOCAMPAL FORMATION: Subiculum,Hippocampus, Dentate Gyrus Efferents (Output): FORNIX Haines, Fundamental Neuroscience for Basic and Clinical Applications, 3rd edition, 2005, Fig. 31-5
  • 23. Cortical Network Subserving Memory primary sensory areas (long term storage of explicit memories) unimodal sensory association areas (active multimodal receptive working association area: memory) Posterior Parietal Cortex multimodal expressive association area: Dorsolateral Prefrontal Cortex limbic association areas (formation of Hippocampal Basolateral Formation Amygdala (formation of explicit memory: emotional semantic, episodic) memory) Department of Neurology
  • 24. Cerebral arteries supply the cortex and superficial white matter middle cerebral artery anterior cerebral artery posterior cerebral artery border zones Modified From Haines, Fundamental Neuroscience for Basic and Clinical Applications, 3rd edition, 2005, Figs. 8-7, 8-9
  • 25. Anterior Cerebral Artery includes leg and foot Territories of the Anterior, areas of the somato- Middle, and Posterior sensory and motor Cerebral Arteries cortices Middle Cerebral Artery includes hand and face areas of the somatosensory and motor cortices Posterior Cerebral Artery Gray’s Anatomy includes visual cortex
  • 26. Distribution of the Cerebral Arteries to Internal Structures of the Cerebral Hemispheres Modified From J.H. Martin, Neuroanatomy: Text and Atlas, 3rd ed Fig. 4-5
  • 27. Additional Source Information for more information see: http://open.umich.edu/wiki/CitationPolicy Slide 3: J.H. Martin. Neuroanatomy: Text and Atlas. McGraw-Hill, 2003. 3rd ed. Slide 6: Mesulam, Principles of Behavioral and Cognitive Neurology, 2000 Slide 7: Rick Altschuler Slide 8: Source Undetermined; J.H. Martin. Neuroanatomy: Text and Atlas. McGraw-Hill, 2003. 3rd ed. Slide 9: Source Undetermined; J.H. Martin. Neuroanatomy: Text and Atlas. McGraw-Hill, 2003. 3rd ed. Slide 10: Source Undetermined Slide 11: Source Undetermined Slide 12: Gray’s Anatomy Slide 13: Modified From J.H. Martin, Neuroanatomy: Text and Atlas, 3rd ed Fig. 16-7 Slide 14: Modified From J.H. Martin, Neuroanatomy: Text and Atlas, 3rd ed Fig. 16-7 Slide 15: Source Undetermined Slide 16: Gray’s Anatomy Slide 17: Source Undetermined; Source Undetermined Slide 18: Source Undetermined Slide 19: Haines, Fundamental Neuroscience for Basic and Clinical Applications, 3rd edition, 2005, Fig. 31-4 Slide 20: Department of Neurology Slide 21: Manter and Gatz's Essentials of Clinical Neuroanatomy and Neurophysiology, 8th ed Slide 22: Haines, Fundamental Neuroscience for Basic and Clinical Applications, 3rd edition, 2005, Fig. 31-5 Slide 23: Department of Neurology Slide 24: Modified From Haines, Fundamental Neuroscience for Basic and Clinical Applications, 3rd edition, 2005, Figs. 8-7, 8-9 Slide 25: Gray’s Anatomy Slide 26: Source Undetermined