THE NERVOUS

SYSTEM
Lecture Outline: Spinal Cord and Somatic and
Autonomic Nervous System

Case Presentation
Introduction
-Peripheral Nervous System
-Cranial Nerves and Spinal Nerves
-Somatic and Autonomic Nervous system
-Sympathetic and Parasympathetic
-Developmental Aspects of the NS
CASE
PRESENTATION
Brown-Sequard Syndrome
Park, S. D., Kim, S. W., & Jeon, I. (2015). Brown-
Sequard Syndrome after an Accidental Stab
Injury of Cervical Spine: A Case Report. Korean
journal of neurotrauma, 11(2), 180–182.

A 42-year-old woman was brought into the emergency department after a stab
injury on the right side of the posterior neck from a knife that was lying in a
fruit basket after slipping. The patient complained of hemiparesis of the right-
side extremities, and ipsilateral hypoesthesia and contralateral sensory loss
of pain and temperature were also found on neurological examination. MRI
showed a signal change of the C6-7 cord level and the tract of the stab wound
through the posterior neck. Irrigation and primary closure of the laceration was
performed under the impression of BSS. The neurologic deficit was improved with
rehabilitation therapy.
Magnetic resonance imaging (MRI) reveals an injured
tract, through the posterior neck (arrow). B: MRI
reveals disruption of the C6-7 interlaminar structures
and ligamentum flavum (arrow).
Central Nervous System

Segmentation of Spinal Cord

Spinal Cord Cervical (C1-C8)
Thoracic (T1-T12)
Extends from the foramen
Lumbar (L1-L5)
magnum of the skull to the first or
Sacral (S1-S5)
second lumbar vertebra
Coccygeal
Cauda equina is a collection of
31 pairs segmentally issue from SP
spinal nerves at the inferior end
8 cervical
Provides a two-way conduction
12 thoracic
pathway from the brain
5 lumbar
31 pairs of spinal nerves arise from
the spinal cord
5 sacral
1 coccygeal
Peripheral Nervous System

Peripheral Nervous System

PNS consist of nerves and ganglia
outside the CNS
Structure of a Nerve
Nerves- bundle of neurons found
outside the CNS
Endoneurium - is a connective
tissue sheath that surrounds each
fiber
Perineurium - wraps groups of
fiber bound into as fascicle
Epineurium - binds groups of
fascicles
Peripheral Nervous System

Kinds of Nerve
Mixes Nerves- contain
both sensory and motor
fibers
Sensory (afferent)
nerves - carry impulses
toward the CNS
Motor (efferent) nerves
- carry impulses away from
the CNS
Peripheral Nervous System

Cranial Nerves Mnemonic Device

Cranial Nerves Olfactory CN I
12 pairs of nerves serve mostly the Optic CN II
head and neck Oculomotor CN III
Only the pair of vagus nerves Trochlear CN IV
extends to thoracic and abdominal Trigeminal CN V
cavities Abducens CN VI
Mostly are mixed nerves, but three Facial CB VII
Vestibulocochlear CN VIII
are sensory only:
Glassopharyngeal CN IX
Optic (CN II)
Vagus CN X
Olfactory (CN I)
Accessory CN XI
Vestibulocochlear (CN VIII) Hypoglossal CN XII
 Peripheral Nervous System

1. Olfactory Nerve (CN I)

Special afferent impulses - Olfaction
Functional Component:
Sensory neurons - olfactory cells
Secondary neurons located in olfactory bulb
Olfactory cortex and amygdala via olfactory tracts
Clinical Consideration:
Anosmia
Causes: Sinusitis, Hay fever, Influenza, common cold,
obstruction of nasal passages (polyps and tumors) and now,
COVID-19
2. Optic Nerve (CN II)
Special afferent impulses - Vision
Clinical Consideration:
Blindness
Visual Field impairment
Loss of pupillary constriction
Impaired by MS
Causes: Tumor, stroke, lesions, optic
neuritis
Peripheral Nervous System

3. Oculomotor Nerve (CN III)

General Somatic Efferent - extraoculo muscles
General Visceral Efferent - constriction of pupil, accomodation
of lens for near vision
Clinical Consideration:
Dilation of pupil
Oculomotor nerve palsy
Ptosis
Loss iof pupillary reflex
Causes: Compression from neighboring aneurysmal
artery, tumor, infarction, cavernous thrombosis,
meningitis

4. Trochlear Nerve (CN VI)

General Somatic Efferent - Superior Oblique muscle
Clinical Consideration:
Trochlear nerve lesion
Causes: Microvasculopathy, tumor, aneurysm
Peripheral Nervous System

5. Trigeminal Nerve (CN V)

Anatomic components:
Opthalmic nerve (V/1)
Maxillary nerve (V/2)
Mandibular nerve (V/3)
Functional Components:
General somatic afferent - skin of the face,
mucosa, nose, and mouth
Branchial efferent (1st pharyngeal arch) -
Muscles for mastication
Clinical Consideration:
Herpes Zoster Opthalmicus
Cause: Varicella virus
Trigeminal Neuralgia (Tic Douloureux)
Causes: Compression by superior cerebellar
artery (pulsation), tumors, aneurysms,
infarcts
Peripheral Nervous System

6. Abducens Nerve (CN VI)

General Somatic Efferent - Lateral rectus of EOM
Clinical Consideration:
Unable to abduct the eyes
Causes: Tumor, infarct, aneurysm

7. Facial Nerve (CN VI)

General Somatic Afferent - External acoustic meatus
Special Afferent - Taste from posterior 2/3 of the
tongue
General Visceral Efferent - Lacrimal gland,
submanibular and sublingual salivary glands, mucous
membranes of nasal cavity, hard and soft palate
Branchial efferent - Facial expression
Clinical Consideration:
Bell's Palsy
Causes: Viral Infection
 Peripheral Nervous System

8. Vestibulocochlear Nerve (CN VIII)

Special Afferent - Hearing and Balance
Clinical Consideration:
Tinnitus
Hearingloss
Impairment of equilibrium
Causes: Tumor, infarct, drugs,
infection
9. Glassopharyngeal Nerve (CN IX)
General Visceral Afferent - Sensory from Carotid body and sinus
Special Afferent - Taste from posterior 1/3 of the tongue
General Somatic Afferent - sensation from tounge, palatine
tonsils, oropharynx, mucosa of middle artery,
pharyngotympanic tube, mastoid air cells.
General Visceral Efferent - Parotid gland (saliva production)
Branchial efferent - stylopharengeus
Clinical Consideration:
Loss of taste
Loss of sensation from soft palate - gag reflex
Pain
Causes: Tumor, infarct, demyelination
Peripheral Nervous System

10. Vagus Nerve (CN X)

Functional Components:
General somatic afferent - Larynx, layngopharynx,
deeper parts of auricle, dura of posterior cranial
fossa
Visceral Afferent - Aortic arch baroreceptors,
esophagus, abdominal viscera, bronchi, lungs,
heart
Special Afferent - Taste from epiglottis and
pharynx
Branchial efferent - palatoglossus
Clinical Consideration:
Loss of gag reflex
Vocal cord paralysis
Dysphagia
Causes: Tumor, infarct, penetrating neck injury
Peripheral Nervous System

11. Accessory Nerve (CN XI)

General Somatic Efferent - sternocleidomastoid
and trapezius
Clinical Consideration:
Shoulder pain
Impairment of abduction at shoulder - glenoid
cavity
Weakness in turning chin to opposite side
Causes: penetrating/blunt injury, tumor

12. Hypoglossa Nerve (CN XII)

General Somatic Efferent - most of the tongue
muscles: Hyoglossus, genioglossus, styloglossus, other
intrinsic tongue mucles
Clinical Consideration:
Difficulty with speech
atrophy of ipsilateral
Deviation of tongue
Causes: Tumor, infarct, infection, neck injury,
ALS
Peripheral Nervous System

Spinal Nerves
31 pairs
Formed by the combination of the
ventral and dorsal roots of spinal
cord
Named for the region of the spinal
cord from which they arise
Peripheral Nervous System

Spinal nerves divide soon as they

after leaving the spinal cord into a
dorsal ramus and a ventral ramus
Ramus - Branch of a spinal nerve;
contains both motor and sensory
fibers
Dorsal rami - serve the skin and
muscles of the posterior trunk
Ventral rami (T1-T12) - form the
intercostal nerves that supply
muscles and skin of the ribs and
trunk
Ventral rami (except T1-T12) - form
a complex of networks (plexus) for
the anterior
Peripheral Nervous System

Dermatomes
Cutaneous nerves that supply the
skin
Cutaneous innervation:
Touch
Pain
Temperature
Each dermatome is innervated by a
specific segment of spinal cord
They are of great diagnostic
importance, as they allow the
clinician to determine whether
there is damage to the spinal cord,
and to estimate the extent of a
spinal injury if there is one present.
Peripheral Nervous System

Plexus
Networks of nerves serving motor
and sensory needs of the limbs
Form the ventral rami of spinal
nerves in the cervical, lumbar and
sacral regions
Four plexuses
Cervical
Brachial
Lumbar
Sacral
Peripheral Nervous System

Cevical Plexus
Origin from C1-C5
Important nerve is the phrenic
nerve
Clinical consideration:
Respiratory Paralysis
Causes: Phrenic nerve
injury, neuromuscular
junction disease, Motor
neuron disease
Peripheral Nervous System

Brachial Plexus
Origin from C5-C8 and
T1
Important nerves are
axillary, radial, median,
musculocutaneous, ulnar
Clinical consideration:
Paralysis and motor
neuron disease of
the upper
extremities
Peripheral Nervous System

Lumbar Plexus
Origin from L1-L4
Important nerve is femoral and
obturator
Clinical consideration:
Inability to move in anyway
the lower extremities as well
as their cutaneuos
innervations
Peripheral Nervous System

Sacral Plexus
Origin from L4-L5, S1-S4
Sciatic nerve (biggest and longest
nerve in the body) splits to common
fibular and tibial. Superior and
inferior gluteal nerves
Clinical consideration:
Inability to move in anyway the
lower extremities (leg and
glutes) as well as their
cutaneuos innervations
Peripheral Nervous System

The two divisions of the Peripheral

Nervous System:

1. Autonomic Nervous System 2. Somatic Nervous System

Without conscious control Motor neuron cell bodies
Chain of two motor neurons: originate inside the CNS
Preganglionic neuron is in Axons extends to skeletal
the brain and spinal cord
muscles that are served
Postganglionic neuron
extends to the organ
Has two arms:
Sympathetic
Parasympathetic
Peripheral Nervous System

Anatomy of the Parasympathetic

Division
Parasympathetic division is also
known as Craniosacral division
Preganglionic neurons originate in:
Cranial nerves III. VII, IX, X
S2 and S4 regions of the spinal
cord
Preganglionic neurons synapse with
terminal ganglia; from there, post
ganglionic axons extend to organs
that are serves
Produces ACETYLECHOLINE
It has Muscarinic Receptors
Vagus Nerve (CNX)
Contains 75% of all the
parasympathetic fibers
It greatly affects the functions of
the heart ---SA and AV nodes
Peripheral Nervous System

Anatomy of the Sympathetic Division

Sympathetic division is also known as Thoracolumbar division
Preganglionic neurons originate in:
T1-L2
After synapsing at the ganglion, the axon may synapse with second
neuron at the same or different level
Or, preganglionic neuron may pass through the ganglion without
synapsing and form part of the splanchnic nerves
Splanchnic nerves travel to the collateral ganglion
Collateral ganglia serve the abdominal and pelvic organs
Binds with Adrenergic receptors
Produces Norepinephrine and Epinephrine
Peripheral Nervous System

Anatomic Functioning

Sympathetic - "Fight or Flight" Paraympathetic - "Rest and

Response to unusual stimulus Digest"
when emotionally or physically Conserves energy
stressed or threatened Maintains daily necessary body
Takes over to increase activities functions
Remember as the "E" division Remember as the "D" division
Exercise Digestion
Excitement Defecation
Emergency Diuresis
Embarrassment
Peripheral Nervous System

Developmental Aspects of the Nervous System

The nervous system is formed during the first month of the embryonic
development
Any maternal infection can have extremely harmful effects
Oxygen deprivation destroys brain cells
The hypothalamus is one of the last areas of tha brain to develop
CLINICAL
CORRELATION
Anencephaly
Mai CT, Isenburg JL, Canfield MA, Meyer RE,
Correa A, Alverson CJ, Lupo PJ, Riehle‐Colarusso
T, Cho SJ, Aggarwal D, Kirby RS. National
population‐based estimates for major birth
defects, 2010–2014. Birth Defects Research. 2019;
111(18): 1420-1435.

Anencephaly happens if the upper part of the

neural tube does not close all the way. This
often results in a baby being born without
the front part of the brain (forebrain) and
the thinking and coordinating part of the
brain (cerebrum). The remaining parts of the
brain are often not covered by bone or skin.