Provide me an image of brain sensitive structures in brain
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Here is the image from Guyton and Hall's Textbook of Medical Physiology, along with a full explanation of the pain-sensitive structures in the brain.
Pain-Sensitive Structures in the Brain
Figure 49.9 - Areas of headache resulting from different causes (Guyton and Hall Textbook of Medical Physiology)
The diagram shows three color-coded zones:
- Pink (front/face) - Nasal sinus and eye headaches
- Purple (upper/front skull) - Cerebral vault headaches
- Teal (posterior skull) - Brainstem and cerebellar vault headaches
Pain-Sensitive vs. Insensitive Structures
Pain-SENSITIVE structures (can cause headache when stimulated):
| Structure | Notes |
|---|---|
| Skin, subcutaneous tissue, scalp muscles | Richly innervated; extracranial |
| Extracranial arteries (e.g., superficial temporal) | Stretching/inflammation causes pain |
| Venous sinuses (dural sinuses) and their large tributaries | Tugging causes intense headache |
| Dura at the base of the brain | Especially sensitive; stimulated by mass lesions |
| Middle meningeal artery | Especially sensitive - surgeons anesthetize specifically |
| Proximal cerebral arteries (anterior, middle cerebral; internal carotid intracranially) | Pain referred to eye/orbitotemporal area |
| Cranial nerves V, IX, X and upper cervical nerves (C1-C3) | Transmit impulses through dura |
| Eye, ear, nasal cavities, paranasal sinuses | Delicate structures with rich pain receptors |
Pain-INSENSITIVE structures (do NOT cause pain when cut/stimulated):
- Brain parenchyma (cortex, white matter) - almost totally insensitive
- Pia-arachnoid (most of it)
- Ependyma and choroid plexuses
- Cerebellum and ventricular walls
Referred Pain Zones (from the diagram)
- Above the tentorium (supratentorial lesions): Pain via CN V (trigeminal) - referred to front half of head (forehead, temporal, orbital regions)
- Below the tentorium (posterior fossa lesions): Pain via CN IX, X, and C1-C3 - referred to occipital/posterior head region
Source: Guyton and Hall Textbook of Medical Physiology, Fig. 49.9; Adams and Victor's Principles of Neurology 12th Ed., "Pain-Sensitive Cranial Structures"
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