Systema nervosum

Nervous system
 Systema nervosum
• Central nervous system– CNS:
brain (encephalon, cerebrum)
spinal cord (medulla spinalis)
• Peripheral nervous system
PNS:
cranial nerves (nervi craniales)
spinal nerves (nervi spinales)
• Autonomic nervous system:
sympathetic part (pars
sympathica)
parasympathetic part (pars
parasympathica)
Development of nervous system
• Ectoderm
• Neural plate
↓
• Neural fold →
neural crest
↓
• Neural tube
sulcus limitans
Development of nervous system
 Neural tube
• Sulcus limitans
• alar plate – sensory
• basal plate - motor
 Development of CNS
• Medulla spinalis
• Encephalon:
• Rhombencephalon →
myelencephalon (medulla
oblongata)
metencephalon (pons
Varoli, cerebellum)
• Mesencephalon
• Prosencephalon →
diencephalon
telencephalon
Subdivision of CNS
 Neurone
• Soma – perikaryon
• Nucleus (DNA) -
nucleolus
• Cytoplasma - Nissl
granules (RNA),
neurofibrils
• Dendrites - afferent
system
• Axon – efferent system
→ bouton terminal →
synapses
Chemical synapses of neurones
• Change of resting potential (60-70mV) in action potential
• Opening of calcium channels in praesynaptic membrane
in bouton terminal
• Emptying of praesynaptic vesicles with neurotransmitter
into the synaptic gap
• Action on postsynaptic membrane of a dendrite or body
of the next neurone with change in electrical potential -
depolarization → excitation of postsynaptic neurone
hyperpolarization → inhibition
• Inactivation of neurotransmitter by an enzyme (eg.
acetylcholinesterase) or neuroglia
 Neurotransmitters
• acetylcholine
• catecholamines – adrenaline,
noradrenaline, dopamine
• histamine
• monoamines - serotonin
• Amino acids – GABA, glutamate,
aspartate, glycine ….
Synapses
 Neurones
• bipolar
• multipolar
• pseudounipolar
 Neuroglia (CNS)
• Oligodendroglia –
production of myelin
sheath of axons
• Astrocytes – selective
barrier between blood
and neurones
• Microglia -
phagocytosis
Neuroglia
 Schwann cells (PNS)
• Neurilemma -
Schwann sheath:
Schwann cells →
myelin
• Ranvier´s nodes:
saltatory conduction
of action potentials
 Receptors
• Interoreceptors
• Proprioreceptors
• Exteroreceptors
free endings
corpuscles
muscle spindles
 Muscle spindle
• Intrafusal fibres
• Extrafusal fibres
 Reflex (Procháska)
• receptor
• afferent fibres of
sensory neurone
• CNS
• interneurones
• efferent fibres of
motoneurones
• effector
 Neurones

• Substantia grisea – grey matter: perikarya + glia

nucleus of origin – motor
of termination - sensory
ganglion (PNS)
• Substantia alba – white matter: axons with
myelin sheath
• Tracts: afferent, ascendent, sensory
efferent, descendent, motor
 Medulla spinalis – spinal cord
• Length: 40-50 cm
foramen magnum – L1/2
• Width: 10-13 mm
• Intumescentia cervicalis
(enlargement) C3-T2
(max. C5)
• Intumescentia lumbalis
T9-L1 (max.T12)
• Conus medullaris L1-L2
• Filum terminale →Co
 Medulla spinalis – spinal cord
• Fissura mediana anterior
• Sulcus medianus
posterior
• Sulcus anterolateralis
• Sulcus posterolateralis
• Sulcus medianus
posterior
• Canalis centralis –
ventriculus terminalis
 Grey matter of spinal cord
• Cornu anterius -
anterior horn
(columna anterior)
• Cornu laterale -
lateral horn (C8-L12)
(columna lateralis)
• Cornu posterius –
posterior horn
(columna posterior)
Grey matter of spinal cord
 Anterior horn
• Alpha motoneurones –
extrafusal muscular fibres
• Gamma motoneurones –
intrafusal muscular fibres
• Nucleus centralis
• Nucleus anterolateralis
(extremities, extensors)
• Nucleus posterolateralis
(exremities, flexors)
• Nucleus anteromedialis
• Nucleus posteromedialis
- medial nuclei – neck,
trunk)
 Posterior and lateral horns
• Apex – nucleus apicalis
• Caput – substantia gelatinosa
Rolandi
• Cervix – nucleus proprius
(tractus spinothalamicus)
• Basis – nucleus dorsalis
Stilling-Clarke (tractus
spinocerebellaris)
• Cornu laterale – nucleus
intermediolateralis
nucleus intermediomedialis
(sympathicus)
• Formatio reticularis spinalis
Laminae Rexedi
 Segments of spinal cord
• Cervical: C1-C8
• Thoracic: T1-T12
• Lumbar: L1-L5
• Sacral: S1-S5
• Coccygeal: Co 1-Co3
 White matter of spinal cord
• Funiculus posterior
• Funiculus lateralis
• Funiculus anterior
 Funiculus posterior medullae
spinalis
• ascendent tracts:
fasciculus gracilis Golli
fasciculus cuneatus
Burdachi
descendent
(associaciation) tracts:
fasciculus
septomarginalis
(fasciculus ovalis
Flechsigi)
fasciculus interfascicularis
Schultze
 Funiculus lateralis medullae
spinalis
• descendent tracts:
tractus corticospinalis
lateralis
tractus rubrospinalis
(Monakow)
• ascendent tracts:
tractus spinocerebellaris
anterior (Gowers)
tractus spinocerebellaris
posterior (Flechsig)
tractus spinothalamicus
lateralis
 Funiculus anterior medullae
spinalis
• descendent tracts:
tractus corticospinalis
anterior
tractus tectospinalis
tractus vestibulospinalis
tractus reticulospinalis
• ascendent tracts:
tractus spinothalamicus
anterior
• association tracts:
fasciculus longitudinalis
medialis
White matter of spinal cord
 Nervus spinalis
• Fila radicularia – root filaments
• Radix anterior – motoria
(anterior root)
• Radix posterior – sensoria
(posterior root)
ganglion spinale - sensorium
• Truncus nervi spinalis
ramus meningeus
ramus posterior – r. medialis
r. lateralis
ramus anterior
r. communicans albus
r. communicans griseus
(sympathicus)
Nervus spinalis
 Structure of peripheral nerves
• Axon – myelin sheath
– Schwann´s cells
• Endoneurium –
between fibres
• Perineurium – sheath
of a bundle of fibres
• Epineurium – external
sheath of a nerve
Peripheral nerve
 Vertebromedullary topography
• Chipault´s rule:
processus spinosus
cervicalis + 1 = number of
spinal root
processus spinosus
thoracicus + 3 = number
of spinal root
processus spinosi T11-T12
= roots L3-L5
below T 12 – roots S1-S5
Cauda equina
 Vertebromedullary topography
• Vertebral body spinal segment
C1 – C4 C1 – C4
C5 – T2 C5 – T1
T2 – T9 T2 – T12
T10 – T12 L1 – L4
L1 L5 – S2
L2 S3 - Co
Cauda equina
 Anterior branches of spinal nerves
• Plexus cervicalis – C1–C4
• Plexus brachialis – C5 -T1
• Nn. intercostales – T1–T11
• N. subcostalis – T12
• Plexus lumbosacralis
plexus lumbalis - T12–L4
plexus sacralis – L4–S4
• Plexus coccygeus - S4-Co
Nervi cervicales C1-C8 – posterior
branches
• ramus medialis
• ramus lateralis
• ramus cutaneus
posterior

n. suboccipitalis - C1
n. occipitalis major -
C2
n. occipitalis tertius -
C3
 Plexus cervicalis – rr. anteriores
C1-C4
• Ansa cervicalis (C1-3) –
radix superior
(r.descendens n.
hypoglossi), radix inferior
• N. occipitalis minor (C1-2)
• N. auricularis magnus
(C1-2)
• N. transversus colli (C3)
• Nn. supraclaviculares
(C3-4) mediales,
intermedii, laterales
• N. phrenicus (C3-5)
Plexus cervicalis
Plexus cervicalis
 N. phrenicus
• C 4, additional C 3
and C5
• nn. phrenici
accessorii C5-6 via n.
subclavius
• r. pericardiacus
• rr.
phrenicoabdominales
N. phrenicus
 Plexus brachialis:
rr. anteriores C5 – T1
• Truncus superior (upper
trunk) C5 - C6
• Truncus medius (middle
trunk) C7
• Truncus inferior (lower
trunk) C8 -T1
• ↓
• Fasciculus lateralis
(lateral cord) C5 – C7
• Fasciculus medialis
(medial cord) C8 – T1
• Fasciculus posterior
(posterior cord) C5 - T1
 Plexus brachialis –
supraclavicular part
• N. dorsalis scapulae C5
• N. thoracicus longus C5-
C7
• N. subclavius C4-C6
• N. suprascapularis C5-C6
• Nn. subscapulares
• N. thoracodorsalis C6-C8
• N. pectoralis medialis C8-
T1
• N. pectoralis lateralis C5-
C7
 Infraclavicular part – lateral cord
• N. musculocutaneus
(C5-C7)
rr. musculares (mm.
coracobrachialis,
biceps brachii,
brachialis)
n. cutaneus
antebrachii lateralis
• Radix lateralis n.
mediani
 Infraclavicular part – medial cord
• Radix medialis n.
mediani
• N. cutaneus brachii
medialis C8-T1
• N. cutaneus
antebrachii medialis
C8-T1
• N. ulnaris C7-T1
 Median nerve C6-T1
• N. interosseus
antebrachii anterior
• Rr. musculares (pronator,
flexors, thenar)
• R. palmaris
• Nn. digitales palmares
communes → nn.
digitales palmares proprii
(3 ½ digit, dorsal tips 2½)
 Ulnar nerve C7 – T1
• Rr. musculares (flexor carpi
ulnaris, flexor dig. profundus
4.5.)
• R. dorsalis – nn. digitales
dorsales (2½ digit)
• R. palmaris
• R. superficialis - nn. digitales
palmares communes → proprii
(1 ½ digit)
• R. profundus (hypothenar,
interossei, adductor pollicis,
caput profundum flexoris
pollicis brevi)
Palma manus
Digitus
Infraclavicular part – posterior cord
• N. axillaris C5-C6
rr. musculares
(deltoideus, teres
minor)
n. cutaneus brachii
lateralis superior
• N. radialis C5 – T1
 Radial nerve C5 – T1
• N. cutaneus brachii posterior
• N. cutaneus brachii lateralis
inferior
• N. cutaneus antebrachii
posterior
• Rr. musculares (triceps,
anconeus, brachioradialis,
extensor carpi radialis longus)
• R. profundus (supinator,
extensors)
n. interosseus antebrachii
posterior
• R. superficialis – nn. digitales
dorsales (2 ½ digit)
N. radialis – r. superficalis
N. radialis – r. profundus
Cutaneous nerves of the upper
extremity
Areae radiculares (dermatomes) et
areae nervinae
 Nervi thoracici T1 – T12
• Rami posteriores:
r. muscularis medialis / lateralis
r. cutaneus posterior
• Rami anteriores:
nn. intercostales T1-T11,n. subcostalis T12
rr. musculares
r. collateralis
n. intercostobrachialis T2 – T3
rr. cutanei laterales – r. anterior / r. posterior
(rr. mammarii laterales T4 –T6)
rr. cutanei anteriores - r. anterior /r. posterior
pectorales / abdominales
(rr. mammarii mediales T2 – T4)
Nervi thoracici
Nervi thoracici
 Nervi lumbales L1-L5, sacrales S1
– S5, n. coccygeus Co – rami
posteriores
• r. medialis / r. lateralis
r. cutaneus posterior
• Nn. clunium
superiores L1-L3
• Nn. clunium medii S1-
S3
 Plexus lumbosacralis
• Plexus lumbalis T12 –
L4
• Truncus
lumbosacralis L4-5 –
S1
• Plexus sacralis L4 –
S4
 Plexus lumbalis T12 – L4
• N. iliohypogastricus
T12 – L1
• N. ilioinguinalis L1
• N. genitofemoralis L1-
L2
• N. cutaneus femoris
lateralis L2-L3
• N. obturatorius L2-L4
• N. femoralis L2-L4
 Plexus lumbalis
• N. iliohypogastricus T12-
L1
r. cutaneus lateralis
r. cutaneus anterior
• N. ilioinguinalis L1
nn. scrotales/labiales
anteriors
• N. genitofemoralis L1-L2
r. genitalis
r. femoralis
• N. cutaeus femoris
lateralis L2-L3
 N. obturatorius L2-L4
• R. anterior
rr. musculares
(adductors,gracilis,
obturatorius ext.)
r. cutaneus
• R. posterior
rr. musculares
(adductor magnus,
brevis)
r. articularis
 N. femoralis L2-L4
• Rr. musculares
(sartorius, pectineus,
quadriceps)
• Rr. cutanei anteriores
• N. saphenus
r. infrapatellaris
rr. cutanei cruris
mediales
 Plexus sacralis L4 – S4
• N. m. obturatorii int. L5-
S2
• N. m. piriformis S1-S2
• N. m. quadrati femoris
L4-S1
• N. gluteus superior L4-S1
• N. gluteus inferior L5-S2
• N. cutaneus femoris
posterior S1-S3
• N. ischiadicus L4-S3
• N. pudendus S2-S4
Plexus sacralis
 N. cutaneus femoris posterior
S1 – S3
• Nn. clunium inferiores
• Rr. perineales
 N. pudendus S2 – S4
• Nn. anales (rectales)
inferiores (m. sphincter
ani externus)
• Nn. perineales
nn. scrotales/labiales
posteriores
rr. musculares
(diaphragma pelvis,
diaphragma urogenitale,
m. sphincter urethrae
externus)
n. dorsalis penis/clitoridis
 N. ischiadicus – sciatic nerve
L4 – S3
• Rr. musculares
• Rr. articulares
(biceps,
semitendinosus,
semimembranosus,
adductor magnus)
• N. tibialis
• N. fibularis (peroneus)
communis
 Tibial nerve
• Rr. musculares
(flexors)
• N. interossesus cruris
• N. cutaneus surae
medialis (+ r.
communicans
fibularis) → n. suralis
• Rr. calcanei mediales
• N. plantaris medialis
• N. plantaris lateralis
 Sural nerve
• N. cutaneus surae
medialis + r.
communicans
fibularis
• Rr. calcanei laterales
• N. cutaneus dorsalis
lateralis
 Tibial nerve (planta pedis)
• N. plantaris medialis
nn. digitales plantares
communes → nn.
digitales plantares
proprii
• N. plantaris lateralis
r. superficialis - nn.
digitales plantares
communes→ proprii
r. profundus
 Common fibular (peroneal) nerve
• N. fibularis superficialis
rr. musculares (mm.
fibulares)
n. cutaneus dorsalis
medialis
n. cutaneus dorsalis
intermedius →
nn. digitales dorsales
pedis
• N. fibularis profundus
rr. musculares (extensors)
nn. digitales dorsales(1+2)
 Plexus coccygeus S4 - Co
• N. anococygeus
Lower extremity dermatomes
Protrusion of nucleus pulposus –
disc herniation
Protruson of nucleus pulposus
lateral – medial
Lumbar disc herniation