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Intr oduction
Organization of the nervous system
ANATOMICAL organization
(1 ) Central nervous system
a) Brain:
FUNCTIONAL organization
the nervous system is divided into 2 systems:
Synaptic Transmission
Synapse is the site of junction between two neurons.
With no protoplasmic continuity.
Types of synapses
1. Axo-dendritic: most numerous, least excitable.
2. Axo-somatic:
Functional anatomy
(A) Synaptic knobs: contain
1. mitochondria. (ATP synthesis).
2. Vesicles containing; neurotransmitters.
3. Large number of Ca channeles & release sites for neurotransmitters.
(b) Synaptic cleft: 30-50 nm width & contains extracellular fluid.
Postsynaptic Potentials
(a) Excitatory post synaptic potential (EPSP)
It is a state of partial depolarization
(2-5 msec).
Occurs due to release of excitatory
neurotransmitters as acetylcholine.
It is caused by opening of ligand
gated Na+ channels and closure of
the ligand gated K+ channels or CL
channeles.
To reach the threshold value,
EPSPs must be summated:
(1) Time (temporal) summation:
One presynaptic Knob is stimulated repetitively.
Each EPSP reach postsynaptic membrane before the ending of the previous one.
N.B . In temporal summation, the time between stimuli must be less than the
duration of the EPSP.
(2) Space (spatial) summation:
Several presynaptic knobs are stimulated simultaneously. When the excitation reaches
the firing level, action potential starts.
50 EPSPs are needed to reach the firing level.
Sensory 6
• The inhibitory interneurones, in turn, inhibit the anterior horn cell & its
surrounding cells.
It is the time needed for release of neurotransmitters and binding of the transmitter to
receptors. The more the number of synapses, the slower the conduction.
(3) Fatigue
►Def:
Decrease rate of discharge in post synaptic neuron due to rapid repetitive
stimulation.
Mainly due to decrease chemical transmitter in presynaptic terminal.
►Importance
It prevents over excitation in CNS.
(It is a gift from the god to the epileptic patients).
B) Habituation
►Def
It is the gradual loss of response to a benign stimulus, when it is repeated for several
times at intervals.
►Mechanism
Decrease Ca++ in presynaptic neuron caused by unknown gradual inactivation of Ca ++
channels → decrease release of chemical transmitter.
C) Sensitization
►Def
It is the prolonged augmented response due to application of a noxious stimulus
accompanying the benign stimulus.
►Mechanism
Presynaptic Facilitation
-The 3rd neuron is excitatory neuron; which secretes serotonin.
- Serotonin increase cAMP in the presynaptic terminals.
- cAMP Phosphorylates a protein in the K+ channels and close them.
- This prevents repolarization & prolongs depolarization.
- Depolarization Keeps Ca++ achannels opened → Increase release of the chemical
transmitter.
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Neuronal Pool
Def:
A collection of neurons having the same function.
(2) Divergence
One neuron activates many neurons.
Its functions are:
a. Amplification e.g One cortical cell
activates 1000 AHCs in spinal cord.
b. Distribution of signals.
@ Occlusion:
This means occurrence of a smaller response when 2 near afferent neurons are
maximally stimulated simultaneously than the algebraic sum of the responses
obtained each afferent.
@ Subliminal fringe summation (Facilitation):
It is the occurrence of a greater response when 2 afferent neurons (that are not very
close to each other) are sbumaximally stimulated simultaneously than the algebraic
sum of the responses obtained when each afferent is stimulated separately.
(6) Fatigue
Decrease rate of discharge in post synaptic neuron due to rapid repetitive stimulation.
Mainly due to exhaustion of chemical transmitter in presynaptic terminal.
(7) Recruitment
Recruitment is the gradual increase to a maximum in a reflex when a stimulus
of unaltered intensity is prolonged.
There is progressive increase in the activity of the interneurons, leading to an
increase in the excitability of more and more motor neurons, until spatial
summation raises the excitability to the threshold value to discharge.
Synaptic Transmitters
Class I: Acetylcholine.
Class II: The Amines:
Norepinephrine. Epinephrine. Dopamine. Serotonin. Histamine.
Class III: Amino Acids:
gamma aminobutyric acid (GABA). Glycine. Glutamate. Aspartate.
Class IV: Nitric oxide (NO).
Acetylcholine (ACh)
Sources:
- neurons in many areas of the brain,
- motor neurons that innervate skeletal muscles,
-preganglionic neurons of the ANS,
- postganglionic neurons of the parasympathetic nervous system,
- some of the postganglionic neurons of the sympathetic nervous system.
Effects:
ACh has an excitatory effect, though it has inhibitory effects at some peripheral
parasympathetic nerve endings.
Norepinephrine (NE)
Is secreted by many neurons located in the brain reach widespread areas of the brain.
In most of these areas, NE probably activates excitatory receptors, but in few areas, it
activates inhibitory receptors.
NE is also secreted by most of the postganglionic neurons of the sympathetic neurons
system.
Dopamine
Sensory 14
Is secreted by neurons that originate in the substantia nigra and which terminate
mainly in the basal ganglia. The effect of dopamine is usually inhibition.
Serotonin
Is secreted by neurons that originate in the median raphe of the brain stem, and
project to many brain and spinal cord areas. Serotonin is inhibitory.
Glycine
Is secreted mainly at synapses in the spinal cord. It is an inhibitory transmitter.
Glutamate
Is secreted by presynaptic terminals in many sensory pathways, and in many
areas in the cortex. It causes excitation.
Functions
It gives information & knowledge to the individuals about any change in
environment & position of the individual.
Sensory 16
Def
Specialized structures at the peripheral end of the afferents which receive and convert
different stimuli into action potentials (nerve impulse).
Function s
1. Detectors: i.e detect changes in the surrounding environment.
2. Transducers: i.e transform stimulus energy into potential changes.
With generation of action potentials in the afferent fibres.
Sensory 17
(1) Excitability
The receptors have the ability to convert energy into action potential in the
sensory nerves.
When the receptor is stimulated by an adequate stimulus, it generates
adepolarizing potential called receptor or generator potential which is
localized, non propagated potential change.
The amplitude of the generator potential is related to the intensity of the
stimulus.
Mechanism of stimulation of receptors
- It is studied in paccinian corpuscle.
Pacinian corpuscle: It is a straight non-myelinated nerve endings surrounded by
connective tissue concentric layers giving it an onion like appearance, first node of
Ranvier starts just before leaving the capsule.
- Application of weak pressure to receptor, open voltage gated Na+ channels and
increase Na+ influx, produce local nonpropagated potential at the receptor site.
When reaching threshold value, it activates the first node of Ranvier and generates
propagated action potential along the nerve fiber.
Properties of RP
Sensory 18
► Definition:
It is the decrease in the amplitude of R.P. and the frequency of action potential with
constant continuous stimulus.
► Cause: Ea ch rece ptor ha s it s ow n pr ope rty of ada ptat ion e.g .
►Def
It is the ability of the CNS to recognize the modality (type), locality & intensity of
sensation.
Muller’s law
Each receptors give one type of sensation, irrespective of the method of stimulation.
► according to:
Weber-Feshner principle
Which states that sensation felt (interpreted stimulus intensity = log intensity of the
stimulus x constant).i.e. The frequency of impulses α log intensity of the stimulus.
Phantom limb;
This is the false sensation from a limb when the limb does not really exist. It
occurs in amputees who complain of pain, touch, itching or pressure sensation
felt in the absent limb. This false sensation is due to irritation of the cut ends of
the afferent nerves of the amputated limb which send impulses up to the brain.
The brain projects the sensation on to the absent limb as if it were existing.
Classification of receptors
According to mode of stimulation
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1. Mechanoreceptors. 2. Thermoreceptors.
3. Chemoreceptors. 4. Electromagnetic: Photoreceptors (rods & cones).
5. Nociceptors (pain receptors) i.e. free nerve endings.
(1) Mechanoreceptors:
Stimulated by mechanical forms of energy. e.g Touch, pressure, vibration,
acceleration and stretch.
They are found in skin, mucous membrane, muscles, tendons, Joints, blood vessels,
lungs and inner ear.. etc.
Stimulated by chemical forms of energy. Carotid and aortic chemoreceptors, Taste &
smell.
According to Adaptation
a. Slowly adapting (tonic) receptors:
Pain receptors, muscle spindle, alveolar stretch receptors.
The slow adaptation keeps the brain continuously alerts due to their important
postural & protective signals.
According to Situation
A) Exteroceptors:
- Cutaneous receptors: Pain, touch and temperature.
- Teleceptors: Vision, hearing, and smell.
B) Interoceptors:
- Proprioceptors: muscle spindle and golgi tendon organs.
- Visceroceptors: Baroreceptors and chemoreceptors.
- Hypothalamic receptors: Glucoreceptors and osmoreceptors.
Sensory unit
-Single sensory axon with peripheral branches & its receptors.
-The receptors of sensory unit are sensitive to the same type of stimulus & density of
receptors is higher at the centre of the receiptive field.
- the receiptive field of sensory unit is the area from which stimulus produces
a response in that unit.
-There is overlap between receptive sensory fields.
Somato-sensory nerves
Classification of peripheral nerves:-
Sensory 23
TYPES OF SENSATIONS
Sensation is the feeling produced by change in the environment or by the
application of stimulus to the receptors, or nervous pathways.
Physiological Classification
[1] Pain sensation.
[2] Thermal sensation.
[3] Mechano-receptive sensations.
(a) Tactile sensation:
Touch : crude & fine.
Pressure.
Vibration.
(b) Position Senses:
Static : sense of position.
Kinetic : sense of movement.
Anatomical Classification
1. Exteroceptive sensations; pain, touch and temp.
2. Interoceptive sensations.
- Proprioceptive sensations; position & movement.
- Deep sensations; deep pressure. deep pain & vibration.
- Visceral sensations; Visceral pain, bladder & rectal distention.
tr act
This tract transmits crude touch and pressure as well as tickle and
ascend in the anterior column of spinal cord, and terminate at the ventral
posterolateral nucleus.
a) paleospinothalamic pathway
This transports slow pain sensation as well as thermoreceptive sensations
B) Neospinothalamic pathway
This transports fast pain as well as thermoreceptive sensations specially cold,
and it consists of the following 3 neurons:
۞ First order neurons
These are mainly A-delta afferent nerve fibres. terminate at laminae 1 & V of
the dorsal horn
۞ Second order neurons
These constitute the tract. They start at the dorsal horns, cross to the opposite
side and ascend in the lateral column of the spinal cord. Finally terminate at
the thalamic VpLN
۞ Third order neurons
These are similar to ventral spinothalamic tract.
a) Crude touch:
Touch sensation with poor identification of site & number of stimuli..
Tested by a piece of cotton passed on the skin. (Cotton wool test)
Receptors; Hair end organs & free nerve endings.
Afferent: A delta fibres. (5-30 m/sc)
Tract: Ventral spinthalamic tact and some fibres pass through
dorsal column.
Centre: Thalamus.
b) Fine touch
Touch sensation with accurate identification of site & number of stimuli.
Receptors; Meissner’s & Paccinian corpouscles, Merkel’s discs & Ruffini
endings.
Afferent: A beta fibres (30-70 m/sc).
Tract: dorsal column tract.
Centre: sensory cortex.
3. Texture of material.
Ability to know the texture of material with eyes
closed e.g silk, wool, cotton.
4. Stereognosis
Ability to know familiar object put in the hand with both eyes closed.
Sensory 34
- It depends on:
1) All cutaneous & deep sensations.
2) past cortical experience regarding the object.
- Stereognosis is carried on dorsal column tract.
- Its centre mainly in somatic association area (area 5,7).
Astereognosis
- damage of dorsal column tract tracts by:
Syphilis and vitamin B12 deficiency (pernicious anaemia).
- Also due to lesion in the somatic association area.
Afferent: A beta.
Tract: dorsal column tract.
-Slowly adapting
muscle spindle, Golgi tendon organ & Ruffini endings.
-Rapidly adapting
e.g paccinian to detect rate of movement.
►Types
1) Sense of position.
2) Sense of movement.
Sensory ataxia
A) Stamping gait; patient raises his legs too high & drops them forcefully.
B) +ve Romberg’s sign: the patient cannot maintain his erect
position with closed eyes.
C) Patient cannot walk in the dark .
D) Patient walk with broad base .
Sensory 37
►Adaptation of Thermoreceptors
- Cold receptors adapt more slowly than warm receptors. (Both moderately
adapting.
- There is no adaptation above 45 ºC and below 10 ºC.
Reactions to pain
Sensory 41
Appreciation of pain
- Fast pain; is appreciated in thalamus and cortex.
►Ischaemic pain
Type of deep pain felt in muscles when their blood supply is decreased.
The Patients complains of severe pain in the muscles upon walking or
running due to accumulation of pain producing
substances as lactic acid.
Examples
1. Cardiac muscle: angina pectoris.
2. Skeletal muscle: intermittent claudication.
Ref er r ed pain
Definition
Pain originating from viscera but felt in somatic structures which supplied by
the same spinal dorsal root ( the same dermatome) of the diseased viscus.
Examples
1. Cardiac pain: is felt in left shoulder.
b. Facilitation theory
Afferents of diseased viscera, give facilitation to cutaneous
pain cells in Substantia Gelatinosa of Rolandi (SGR),
Which leads to facilitation of their stimulation.
Sensory 45
Impulses from
1. A beta fibres: (rubbing of skin inhibits pain).
2. A delta fibres; counter irritant and acupuncture inhibit pain.
They stimulate cutaneous receptors which send impulses through A delta
fibres stimulate the PIC.
3. Cortico-fugal fibres: (thinking decrease pain).
All these fibers causes presynaptic inhibition of pain by activating an
interneurone which secrete (GABA).
Sensory 47
2)Thalamic gate:
The same "gating" mechanism for pain is found also at the thalamus where
pain signals could be blocked by corticofugal fibers or facilitated by
intralaminar thalamic nuclei. In this way,
the thalamus considered as a secondary gate far pain transmission.
Activity in fast fibers tends to close the gate (touch but no pain) and
slow fibers open the gate (pain)
A light touch accompanying a noxious stimulus partially closes
gate (reduces pain) — rub skin to alleviate pain
Psychological factors? Modify gate via descending pathway
and/or release of endogenous opiates (e.g. endorphins) in the CNS
producing analgesic effects.
Ignore pain to escape from greater danger (e.g. death!)
Headac he
Sensory 49
5. Alcoholic headache
al coh ol pr odu ces dir ect meni nge al irrita tio n.
6. Constipation.
Ab sorp tion of tox ins pro duce s di rect me nin geal irri tati on.
Hyperalgesia
= Incr eas ed pain se nsat ion.
Sensory 50
1. primary hyperalgesia;
It occurs in the inflammed skin due to decreased threshold of pain receptors
by bradykinin, K, Histamine and prostaglandins.
So non painful stimuli become painful.
2. Secondary hyperalgesia;
It occurs in normal skin due to increased threshold of pain receptors. So pain receptors
need stronger stimulus, but once pain is elicited, it is very severe
Impulses from the injured area facilitate a central neuron. Impulses from the area of
secondary hyperalgesia converge on same central neuron. The convergence on a central
facilitated neuron explains the exaggerated pain sensibility.
► Representation
Crossed representation i. e re ceiv es sens atio n fr om the opp osit e ½.
Inverted representation i.e bod y is repr ese nte d u psid e d own
Large areas for thumb & lips i.e area α nu mber of rec epto rs.
► Modality orientation
- Ant erior col umn s fo r m uscl e, tend ons and joi nt move men t & str etch
(pro prio cept ive) .
- More po steri orly for slo wly ada ptiv e re cep tors an d pr essu re.
-Mos t p oste rior for mov ing obj ects on the ski n.
► Functions It rec eive th e fo llowi ng sen sati ons.
1. Fin e t ouch : Tact ile loca liza tion & discr imin ati on, ster eog nosi s &
te xtur e o f ma teri als.
2. Dis crimi nati on of vario us weig hts (pre ssur e sens e).
3. Vib rati on sens e.
4. Se nse of posi tion an d m ove ment s o f joi nts .
5. Discri min atio n of var iou s gr ade s of te mper atur e.
►Destruction of sensory area I
A) The person loses ability for:
1. Dis cret e (fi ne) but no t cr ude loc aliz atio n.
2. per cep tion of the ab ove sen sati ons .
B) Temperature; sens ati on is mo der atel y a ffe cte d.
C) Pain; sens ati on is po orly a ffec ted .
T hala mus
[I] Specific projection nuclei to specific portions of cortex.
Sensory 54
Lesion of thalamus
(Thalamic Syndrome)
Sensory 55
► Lesion
Postroventral nucleus 3rd order neurone for all sensation.
Lateral ventral nucleus only motor nucleus in thalamus.
► Effects
1. Sensory
- Loss of all sensations on the opposite side of the body initially, then
Return of some crude sensations later on.
- Return of pain after few months i.e thalamic pain; which needs a
stronger stimulus to produce it, and once it is produced, it is very
severe. (Secondary hyperalgesia).
2. Ataxia:
a) Sensory ataxia: due to loss of proprioceptive sensations.
- Positive Romberg sign.
- Stamping gait.
b) Motor ataxia: due to cutting of connection between
cerebellum and cortex. (This connection passes through the
lateral ventral nucleus).
- Dysmetria. - Adi adokokinesi a. - Dysarthe ria.
- Nys tagm us . - Rebo und. - Drunken ga it .
3. Emotional disturbance
Sensory 56
►Effects
- Loss of pain and temperature on both sid es at the leve l of th e le sion
→ jacket like Dissociated sensory loss.
- LMNL du e to d ama ge of a nter ior horn cel ls at t he level of the les ion.
►Cause
It attacks the dorsal roots central to the dorsal root ganglion of
lumbo-sacral region of spinal cord.
►Manifestations
Ataxia:
Inco-ordination of voluntary movement in absence of paralysis
characterized by the following manifestations;
A) Stamping gait ; patient raises his legs too high &drops them forcefully.
Sensory : loss of all sens ati ons at the corr esp ondi ng derm ato me .