Chapter 60 Assessment of Neurologic Function 1827

The thinner (a fused mass of five vertebrae). con. This barrier Sensory and Motor Pathways: The Spinal Tracts. and the coccygeal vertebrae. which is posterior lateral horn. white matter of the cord is composed of myelinated and which form continuous tight junctions. Before reaching the medication for CNS disorders as well as serving a protective cerebral cortex. fine touch. The fast-conducting myelinated macromol. The two corticospinal tracts that extend beyond the conus.untary muscle shaped struc. as well as the sacrum and reflex activity of the muscles they innervate.ture with nerve cell bodies (gray matter) movement. and pia layers. tracts conduct impulses involved with invol. and laminae all en. temperature. 60-8). 2003). The last two extending from the cerebral hemispheres and serving as the spinothalamic tracts are responsible for conduction of pain. principally the cerebral edema. lumbar segments. and vibratory sense Approximately 45 cm (18 in) long and about the thickness of from the upper body to the brain. Between the dura mater and the level of the brain stem. Fasciculus gracilis White matter Fasciculus cuneatus Posterior spinocerebellar Lateral corticospinal Rubrospinal Anterior spinocerebellar Lateral spinothalamic Anterior corticospinal Tectospinal FIGURE 60-8 Cross-sectional dia. They ascend essentially The spinal cord and medulla form a continuous structure uncrossed and terminate in the cerebellum. the The thoracic region of the spinal cord has a projection sacral. 60-8). by white matter (Fig.case the vertebral canal.nection between the brain and the periphery. Anterior spinothalamic Vestibulospinal gram of the spinal cord showing major spinal tracts. The vertebral body. Similar to the brain. Two conduct sensation. The two spinocerebellar tracts conduct sensory impulses from muscle spindles. The bones of the vertebral column surround than the upper portion and corresponds to the anterior horns. the blood brain perception of touch.ecules and many compounds. 2003). position. ascending tracts. pedicles. and terminate in the thalamus the skull to the lower border of the first lumbar vertebra. Gray matter in activity. cross to the a finger. medulla. The three vestibulospinal tracts descend uncrossed the brain is external and white matter is internal. proprioception. where it tapers to a fibrous band called the conus medullaris. The vertebrae are relay station in the sensory/reflex pathway. dura. these fibers cross to the opposite side in the function. pressure. and passive barrier has implications in the treatment and selection of motion from the same side of the body. seven of which are Continuing below the second lumbar space are the nerve roots engaged in motor function. The rubrospinal and reticulospinal vertebral canal is the epidural space. providing necessary input ANATOMY OF THE SPINAL CORD for coordinated muscle contraction. Often altered by trauma. which are called the cauda conduct motor impulses to the anterior horn cells from the equina because they resemble a horse’s tail. it extends from the foramen magnum at the base of opposite side of the brain.ment or arch. cord through the anterior roots in the thoracic and upper arch. vibration.rons of the CNS because of the bloodbrain barrier. Descending fibers Ascending fibers Gray matter . Fiber bundles entering the CSF must filter through the capillary endothelial with a common function are called tracts. and 5 lumber vertebrae. and protect the spinal cord and normally consist of 7 The anterior horns contain cells with fibers that form the cervical. Each vertebra has a ventral from each side at the crossbar of the H of gray matter called the solid body and a dorsal seg. creating a barrier to unmyelinated nerve fibers. They ascend. voluntary head and facial muscle movement and crosses at the arachnoid. All substances fibers form bundles that also contain glial cells. in the spinal and are involved in some autonomic functions (sweating. The arch is composed of two pedicles and fibers of the sympathetic division. (Hickey. The corticobulbar tract conducts impulses responsible for The spinal cord is surrounded by the meninges. anterior (motor) root end and are essential for the voluntary 12 thoracic. The fibers leave the spinal two laminae supporting seven processes. and circulation) and involuntary muscle control. except for the first and second cervical. separated by disks. surrounded by ascending and descending tracts (white matter) (see Fig. The is formed by the endothelial cells of the brain’s capillaries. There are six cells and astrocytes (Hickey. posterior (upper horns) portion contains cells with fibers that Nerve roots exit from the vertebral column through the enter over the posterior (sensory) root end and thus serve as a intervertebral foramina (openings). It contains the cells that give rise to the autonomic to the body. The spinal cord is an H. The lower portion of the H is broader Vertebral Column. opposite side of the brain and control voluntary muscle the spinal cord consists of gray and white matter. and cerebral hypoxemia. gray matter is in the center and is surrounded on all sides pupil dilation. There are eight descending tracts. and terminate in the coccyx. cord.

the Table 60-2 • Cranial Nerves .1828 Unit 14 NEUROLOGIC FUNCTION The Peripheral Nervous System The peripheral nervous system includes the cranial nerves.

larynx. . VI. These fibers are also either somatic or trapezius muscles vis. neck. XI. The cranial nerves are numbered in the IV (trochlear) Motor accommodation V Mixed Muscles that move the eye order in which they arise from the brain. III (oculomotor) Motor Muscles that move the Three are entirely sensory (I. 60-10). and body surfaces. Hickey. and the parasympathetic nervous nal organs such as the heart. temperature. blood vessels. brain stem. corneal nerves I and II attach in the cerebral hemispheres. VI (abducens) Mixed Muscles that move the eye 60-9). and position sense parasympathetic inner- (proprioception) from the tendons. The right column shows the anatomic location of the connection of each cranial nerve to the central ner. most notably the “fight The autonomic nervous system regulates the activities of inter. CRANIAL NERVE TYPE FUNCTION CRANIAL NERVES I (olfactory) Sensory Sense of smell There II (optic) Sensory Visual acuity surfaceare 12 pairs of the brainofand cranial pass nerves throughthat theemerge from foramina in the the lower skull. it is regulated by centers in the spinal cord. lungs. lens 1998. tearing.ceral. information about pain. For example. Table 60-2 lists the names and movement. pharyngeal cervi cal. larynx. five are motor (III. or flight” response. carrying information from the internal organs. spinal nerve has a ventral root and a dorsal root (Fig. and the autonomic nervous system. and soft palate. Although usually considered part of the peripheral nervous system. and XII).The dorsal roots are sensory and transmit sensory impulses sensation in external ear. cranial (trigeminal) Facial sensation. and VII (facial) Facial expression and muscle special sense structures. from specific areas of the body known as dermatomes (Fig. which controls mostly visceral functions. II.vous system. and XII attach at the medulla (Fig. whereas Motor reflex. 5 sacral. IV. sensation in Sensory the ear SPINAL NERVES VIII (acoustic) Mixed Hearing and equilibrium IX (glossopharyngeal) Taste. There are two major divisions: the nervous system. constriction. sympathetic nervous system.spinal nerves. VII. 12 thoracic. vation of thoracic and or visceral. VIII). digestive system. The visceral fibers include autonomic fibers that XII (hypoglossal) Motor Movement of the tongue control the cardiac muscles and glandular secretions. AUTONOMIC NERVOUS SYSTEM with predominantly excitatory responses. and X) as they pupillary have both sensory and motor functions (Downey & Leigh. touch. XI. abdominal organs The ventral roots are motor and transmit impulses from the XI (spinal accessory) Motor Sternocleidomastoid and spinal cord to the body. 2003). X. and glands. Each X (vagus) Mixed Muscles of pharynx. taste. carrying abdominal viscera. Maintenance and restoration of internal The autonomic nervous system innervates most body homeostasis is largely the responsibility of the autonomic organs. and Name Location Optic II Cerebral hemisphere Olfactory I Oculomotor III Midbrain Trochlear IV Trigeminal V Abducens VI Facial VII Pons Acoustic VIII Glossopharyngeal IX Vagus X Hypoglossal XII Medulla FIGURE 60-9 Diagram of the base of the Spinal accessory XI brain showing entrance or exit of the cranial nerves. thoracic and to the dorsal ganglia. IX. . 5 lumbar. eye and lid. sensation in pharynx The spinal cord is composed of 31 pairs of spinal nerves: 8 muscles and tongue. The sensory fiber may be somatic. Most cranial nerves innervate the head. and four are mixed (V. mastication cranial nerves IX. organs. 60-11) pharynx. and 1 coccygeal. joints. salivation and primary functions of the cranial nerves.