Physiology of the Neurologic SystemSpace Occupying LesionsInterruption of Cerebral circulationInflammatory ProblemsSpinal Cord InjuryNeuromuscular DisordersPeripheral Nerve DisordersThe neurologic or nervous system is composed of two primaryareas; the central nervous system which includes the brain and thespinal cord, and the peripheral nervous system which includes allthe network of nerves extending from the central system. In order to enhance the understanding of a very complex system, commondisorders and conditions are categorized according to thephysiological origin of the problem, as well as to similaritiesinvolved in nursing care. The concept of increased intracranialpressure is presented, followed by a discussion of commonconditions involved. Neuromuscular degenerative diseases,inflammatory conditions, spinal cord injuries and problems of cerebral circulation are broad categories under which specificconditions are addressed.
PHYSIOLOGY OF THE NEUROLOGIC SYSTEM
Organization of the Nervous System
. Central nervous system (CNS).1. Brain2. Spinal Cord
. Peripheral nervous system (PNS).1. Twelve pairs of cranial nerves2. Thirty-one pairs of spinal nerves3. Autonomic nervous systema. Sympathetic systemb. Parasympathetic system.CELLS OF THE NERVOUS SYSTEM
. Neuron-the functional cell of the nervous system.1. Common characteristics.a. Responds or reacts to stimulib. Conducts impulsesc. Influences other neurons.2. Structure.a. Cell body-contains the cell nucleus which controls cellular activity.b. Axon-conducts impulses away from the cell bodyc. Dendrites-receive incoming stimuli and transmit them to theaxon of another neuron.3. Function/classification.a. Afferent neurons (sensory) transmit information away from theCNS.b. Efferent neurons (motor) transmit information away from theCNS.c. Somatic system1). Afferent are sensory neurons that transmit impulses from theskeletal muscles and skin to the CNS.2). Efferent are motor neurons that transmit impulses that lead tocontraction and control of skeletal muscle.d. Visceral system.1). Afferent are sensory neurons that transmit impulses fromsmooth muscle and cardiac muscle to the CNS.2) Efferent are motor neurons that transmit impulses to the glands,cardiac muscle, and smooth muscle.e. Synapse or synaptic terminals are areas of chemicaltransmission of an impulse from the axon of one neuron to thedendrites of another neuron.
Supporting cells provide support, nourishment, and protection tothe neuron.1.Neurilemma – protective cells which surround the axonsin the PNS.a.Provide for effective regeneration of PNS nerve fibers.b.From the myelin sheath in the PNS.c.No neurilemma present in the CNS.2.Glial cells – protective cells in the CNS; responsible for the formation of the myelin.3.Myelin sheath.a.Dense membrane or insulator around the axon.b.Facilitates function of the neuron,c.Contributes to the blood-brain barrier to protect thecentral nervous system against harmful molecules.
Nerve regeneration – entire neuron is unable to undergocomplete regeneration.1. The axons of the PNS may regenerate via the connective tissueneurilemma, providing the cell body of the neuron remains viable.2. Neuron regeneration in the CNS is very limited, possibly due tothe lack of neurilemma.3. Scar tissue is a major deterrent to successful cellular regeneration.
. Impulse conduction.1. Reflex arc.a. Reflex are is the functional unit which provides pathways over which nerve impulses travel.b. Passage of impulses over a reflex arc is called a reflex act or areflex.c. Reflex arc – The afferent neuron carries the stimulus to thespine; integrates it into and through the spine (CNS) to the efferentneuron; crosses the synapse with the message from the CNS tothe organ or muscle which responds to the stimuli. This is thesequence of events when testing the deep tendon reflexes.2. Synaptic transmission.a. A chemical synapse maintains a one-way communication linkbetween neurons.b. Chemical neurotransmitters (neuro-mediators) facilitate thetransmission of the impulse across the synapse.1). Acetylcholine.2). Norepinephrine.3). Dopamine.4). Histamine.c. Impulses pass in only one direction.CENTRAL NERVOUS SYSTEMThe brain and the spinal cord within the vertebral columnmake up the
central nervous system
The brain and the spinal column are protectedby the rigid bony structure of the skull and thevertebral column.
Meninges –protective membranes that cover the brain and are continuous with those of thespinal cord.1.Pia mater-a delicate vascular connectivetissue layer that covers the surfaces of thebrain barrier.2.Arachnoid-a delicate nonvascular, waterproof membrane that encases the entire CNS; thesubarachnoid space contains the cerebralspinal fluid.3.Dura mater-a tough membrane immediatelyoutside the arachnoid; provides protection tothe brain and spinal cord.
Cerebral spinal fluid (CSF).1.Serves to cushion and protect the brain andspinal cord; brain literally floats in CSF.2.CSF is clear, colorless, watery fluid;approximately 100 to 200 cc total volume, witha normal fluid pressure of 70 to 150 mm of water 9average-125 cm water pressure).3.Formation and circulation of CSF.a.Fluid is secreted by the choroids plexuslocated in the ventricles of the brain.b.CSF flows through the lateral ventricles intothe third ventricle, flows through the Aqueductof Sylvius into the fourth ventricle where thecentral of the spinal column opens.c.From the fourth ventricle, there are openingsinto the cranial subarachnoid space; CSFflows around the spinal cord ad brain.