Richelle Ann S.

Santiano, MD
Cuéllar, Cruz, A. , Muncada, Panganiban, Torre, M., Torre, Q.

1S1L: ORGANIZATION OF THE NERVOUS SYSTEM

OUTLINE CENTRAL NERVOUS SYSTEM
I.
II.
REVIEW
CENTRAL NERVOUS SYSTEM
A. Layers of the Scalp (to skull)
•
0€
Mainly composed of the brain and spinal cord:
o Are the main centers where correlation and
integration of nervous information occur
B. Parts of the CNS ⇐

a. Forebrain
i. Cerebrum
ii. Diencephalon Brain FMH

b. Midbrain 1. ②
Forebrain
c. Hindbrain a) Cerebrum
i. Pons and Medulla b) =
Diencephalon (between brain)
ii. Cerebellum Named “between the brain”
o
d. Spinal Cord bc when you cut the brain
III. PERIPHERAL NERVOUS SYSTEM sagittally in the midline, you
A. Cranial Nerves and their Ganglia can see the diencephalon
B. Spinal Nerves and their Ganglia which is mainly composed of
C. Ganglia the hypothalamus, thalamus -

IV. AUTONOMIC NERVOUS SYSTEM and epithalamus

V. VENTRICULAR SYSTEM AND CSF CIRCULATION 2. Midbrain
VI. EARLY DEVELOPMENT OF THE NERVOUS SYSTEM 3. Hindbrain
A Primary Neurulation a) Medulla oblongata
B Development of Neural Tube: General Concepts b) Pons
C Congenital Nervous System Defects of Primary c) Cerebellum
Neurulation Spinal cord CTLSC
Cervical segments

÷
D Secondary Neurulation
a. Differentiation Thoracic segments
b. Differentiation of the Forebrain Lumbar segments
c. Differentiation of the Midbrain Sacral segments
d. Differentiation of the Rostral and Caudal Coccygeal segments ,
Hindbrain
e. Differentiation of the Spinal Cord • Both brain and spinal cord are:
E The Primary Divisions of the Developing Brain o Covered with a system of membranes called
F The Ventricular System of the Brain
VII. SUMMARY É⑥
meninges
o Suspended in the cerebrospinal fluid asf
o Further protected by the bones of the skull and the
vertebral column
REVIEW
LAYERS OF THE SCALP (TO SKULL)
* coronal art (anterior & posterior arts)

SCALP
1. Skin
2. Connective tissue
3. Galea aponeurotica
4. -
Loose areolar tissue

②
A. Dorsal: view from above (anterior= front; posterior= back)
o Harbor for potential infection that can spread to the

Iinteñ-
B. Ventral: view from below
C. Lateral: looking from the outermost side meninges

¥
D. Medial: looking from the inner side o Called the danger zone of the skull
o The tissue contains valveless emissary veins that
Anatomical Planes: have direct access to the cranial cavity
§ Subgalean hematoma: Tearing of the emissary

8
• Horizontal (axial): dividing into ventral and dorsal sides
veins in the loose areolar connective tissue layer
•
• =
Coronal (front): dividing into anterior and posterior sides
Sagittal: dividing into medial and lateral sides
causes build up of blood that gets trapped
between the tense galea aponeurotica and
pericranium; the hematoma accumulates below

1
 ORGANIZATION OF THE NERVOUS SYSTEM

the galea aponeurotica o Surface layer of each hemisphere (cortex) is

• Can present in adults secondary to trauma composed of gray matter
Usually occurs in 0
• neonates after delivery
with vacuum-assistance
§
_#
Cerebral cortex is thrown into folds/ gyri, to
separated by fissures/ sulci
• Surface area of cortex is greatly increased
5. Pericranium
6. Skull by this means
7. Dura mater • Lobes are named from the cranial bones they are under
o Latin: “hard mother” due to its leather-like consistency o Under frontal bone = frontal lobe, etc.
8. Arachnoid membrane o Central sulcus of Rolando: separates frontal from
• Greek: “spider” due to its consistency and appearance as parietal lobe
a spider web o Sylvian fissure/ lateral fissure: separates frontal and
9. Pia mater parietal from temporal lobe
• Latin. “gentle mother” • Lies above the tentorium cerebelli
• Thin membrane that adheres closely to the surface of the o Cerebrum and cerebellum are separated by this
brain membrane
• Subarachnoid space
⇐
o
o
Just below the arachnoid
A real space because it contains the cerebrospinal
fluid
§
⇐
In leptomeningitis = inflammation of the arachnoid
and pia in CNS infections, the subarachnoid space
may also be involved

E-
• Subdural and Epidural Spaces
o Potential space = not a real space
o Epi: outside the dura
o Sub: below the dura
§ May be filled with blood secondary to head trauma

€
Central Core of White Matter
o Within the Hemisphere
o Containing several large masses of Grey matter
within the White matter
• Basal Nuclei / Basal Ganglia
o Subcortical region
• Corona Radiata
o Fan-shaped collection of nerve-fibers
o Passes from the White matter to and from the
PAD (internal à external) = Pia, Arachnoid, Dura Cerebral Cortex to the Brainstem
• These protective coverings continue up to the spinal cord o Converges on the Basal Nuclei/Ganglia and passes
between them as them as the Internal Capsule
PARTS OF THE CNS • Caudate Nucleus
• Contains a large number of excitable nerve cells and their o Tail of a Nucleus
processes called neurons o Medial Side of the Internal Capsule

⇐⇐
o Neurons are supported by specialized tissue called • Lentiform Nucleus
neuroglia o Lens-shaped nucleus
• Interior of CNS is organized into gray and white matter o Lateral Side of the Internal Capsule
o Gray matter o Comprised of Putamen and Globus Pallidus
§
:
Nerve cells embedded in neuroglia • Lateral Ventricle
o Cavity present within each Cerebral hemisphere
o White matter
§ =
Nerve fibers embedded in neuroglia o Communicated with the Third Ventricle through the
§ White in color d.t the presence of lipid material Interventricular Foramina
in the myelin sheaths of the nerve fibers • Corpus Callosum
• Cerebrum has outer grey & inner white matter
-
o Connects the 2 Cerebral Hemispheres
o Massive bundle of fibers
FOREBRAIN

CEREBRUM
• Largest part of forebrain
• 2 hemispheres extends form the frontal to the occipital
bones in the skull posteriorly
o Hemispheres are separated by a deep cleft
(longitudinal fissure); into which projects the falx
cerebri
o Connected by corpus callosum (a mass of white
matter)

2
 ORGANIZATION OF THE NERVOUS SYSTEM

MIDBRAIN
•
DIENEPHALON
• “Mesencephalon”

F-
• Narrow part of the Brain
• Completely hidden from the surface of the brain • Connects the Forebrain the Hindbrain
_ po-w
BA&DNF
• Dorsal Thalamus, Ventral Hypothalamus and •
£
Contains many Nuclei, Cranial Nerves, and Bundles of
Epithalamus Ascending & Descending Nerve Fibers
o Composed of Pineal Gland, Habenular Nuclei, and
Stria Medullaris Thalami • Cerebral Aqueduct of Midbrain
o A narrow cavity
• Control of visceromotor (autonomic) functions
o Connects the Third Ventricle (rostrally) to the
• Thalamus Fourth Ventricle (caudally)
o Large egg-shaped mass of Grey matter
o Lies on either side (lateral side) of the Third
Ventricle

-
• Anterior End of the Thalamus
o forms the posterior boundary of the Interventricular
Foramen
o Opening between Lateral and Third Ventricle
• Hypothalamus
o Forms the lower part of the Lateral Wall and Third
Ventricle
• -
Dorsal Thalamus
o Conscious sensation and motor control
• ②
-

Ventral Thalamus
o Includes subthalamic nucleus w/c is linked to the
basal nuclei of the forebrain and functions in the

E-
motor sphere
o Lesions in Subthalamus is responsible for
involuntary movement disorders
• Epithalamus HINDBRAIN
o Limbic system
-
PONS AND MEDULLA
• Narrow part of the Brain
• Situated on the Anterior Surface of the Cerebellum
• Inferior to the Midbrain above and Superior to the Medulla
Oblongata below (Pons )
-

• Both Pons and Medulla contains:

o Nuclei, Cranial Nerves, and Bundles of
Ascending & Descending Nerve Fibers
• Pons
o Latin: “bridge” - large number of transverse fibers
on its Anterior aspect connecting the 2 Cerebral
Hemispheres
o Comprises of 1.3% of the brain weight
o The motor and sensory nuclei and the exit points
of CNs V to VIII are associated with the pons
• Medulla Oblongata
o Conical in shape
o Connect the Pons Superiorly to the Spinal Cord
Inferiorly
o - Most caudal segment of the brainstem — extends

3
 ORGANIZATION OF THE NERVOUS SYSTEM

¥ _→
from the Foramen Magnum to the Pons-Medulla CEREBELLUM
junction. • Not part of the brainstem, rather is considered a
o It’s size (0.5% of the brain) belies its importance suprasegmental structure because it is located

5-
o All tracts passing to or from the spinal cord traverse superior to the brainstem
the medulla, and 6 of the 12 nerves (VI to X, XII)
are associated with the medulla.
• Comprises 10.5% of the brain weight
o It influences heart rate and respiration • Part of the motor system
• The blood supply to the pons and cerebellum arises .
from the branches of the Basilar and Cerebellar Arteries
.

• Ascending Pathways
o Major ascending pathways seen in the medulla • 2 Hemispheres connected by Vermis
continuous into the pons o Laterally-placed hemispheres
o Fibers w/c continue through pons: Medial o Vermis: worm-shaped
Lemniscus, Antero-lateral system, Anterior
trigeminothalamic fibers, and anterior
spinocerebellar tract
o Restiform Body
§ Prominent structure in the rostral medulla,
sweeps posteriorly in the cerebellum in the
caudal pons
§ Largest part of the inferior cerebellar
peduncle
Connected to:
• Descending Pathways
o Midbrain by the Superior Cerebellar Peduncles
o Most prominent groups of descending fibers arise
(Brachium Conjunctivum)
-from cells located in the midbrain or forebrain w/c
transverse the pons
o Pons by the Middle Cerebellar Peduncles
(Brachium Pontis)
o Corticospinal fibers, Central tegmental and
Rubrospinal tracts, and the Tectobulbospinal o Medulla by the Inferior Cerebellar Peduncles
(Restiform Body)
System
o Medial Longitudinal Fasciculus o A structure that lies within the Posterior Cranial Fossa of
the Skull
§ Occupies a characteristic position near the
o Posterior to the Pons and Medulla
midline in the floor of the fourth (4th)
ventricle
Pons-Medullary Junction Descending Fibers • Cerebral Cortex
Rostral Pons Ascending Fibers o Surface Layer of each Cerebral Hemisphere
o Composed of Grey Matter
o Thrown into folds called Folia
§ Separated by Closely-set Transverse
Fissures
• •
Arbor Vitae
o Latin: “tree of life”
o Cerebral White Matter
o Branch-tree like strands
• 4th Ventricle
o Medulla Oblongata, Pons, Cerebellum surround a
cavity-filled with CSF (Cerebrospinal Fluid)
o Connected Superiorly to the Third (3rd) Ventricle
by the Cerebral Aqueduct
o Inferiorly it is continuous with the Central Canal of
the Spinal Cord
o Communicated with the Subarachnoid Space
I t

through three (3) openings in the inferior part of the

Roof
o Passes through an opening — Median Aperture
(Foramen of Magendie) and Lateral Aperture
(Lateral Foramina of Luschka)
• Interior of the Cerebellum
o Contains certain masses of Grey matter
o Embedded in the White Matter like the Basal
Ganglia in the Cerebral Cortex

4
 ORGANIZATION OF THE NERVOUS SYSTEM

-
4 DEEP CEBELLAR NUCLEI (MEDIAL à LATERAL)
•
Lumbar Puncture
Minimally invasive procedure to get CSF
• Cells which receive input from branches of
cerebellar afferent fibers • Our goal is to get fluid below the Spinal Cord
Fastigial Nucleus Innermost Nucleus
Globose Nucleus pg Since Subarachnoid Space is quite longer and ends below
Interposed Nuclei S2 — using Iliac Crest as a landmark. While the patient is
Emboliform Nucleus
Dentate Nucleus e. Largest and Outermost Nucleus
lying on his side, we draw an imaginary line from the Iliac
Crest then we can approximate the 4th Lumbar Spine. We
can puncture from the space above or below L4.
DON’T EAT GREASY FOOD (lateral → medial)
= Dentate, Emboliform, Globose, Fastigial
• Spinal Nerves
- -

o Thirty-one (31) pairs attached along the entire length

of the spinal cord
o Attached by anterior/motor roots or posterior/sensory
roots.
§ Each root is attached to the cord by a series of
rootlets, which extends the whole length of the
corresponding segment of the cord
§ Each posterior nerve root has a posterior root
ganglion, cells of which give rise to peripheral
and central nerve fibers
§ When the anterior and posterior roots and the
=
mixed spinal nerves have combined, are part of
SPINAL CORD the peripheral nervous system.

¥→
• Situated within the Vertebral Canal of the Vertebral
___

Column Ganglion = collection of neuronal bodies in the PNS

• Surrounded by 3 meninges: Nucleus = collection of neuronal bodies in the CNS
•
→
Further protections are provided by the CSF which
surrounds the Spinal Cord in the Subarachnoid Space • Gray Matter
o Composes the inner core of the spinal cord, which is
• Roughly Cylindrical
surrounded by an outer covering of white matter
• F-
Begins: Superiorly at the Foramen Magnum (opening of o It can be seen in the cross-section as an H-shaped
the skull) it continues at the Medulla Oblongata of the pillar, with anterior and posterior columns or horns
Brain

¥
and united by a thin gray commissure containing the
• o
Terminates: Inferiorly in the Lumbar Region
- small central canal. as a
-

• White matter
Terminate Region o Located outside
SPINAL CORD LEVEL o May be divided into anterior, lateral, and posterior
Adults Below L1 white columns or funiculi
Infant Below L3 o Contains different ascending and descending tracts
Subarachnoid Space Below S2 • Cauda Equina
o Continuation of nerve roots that looks like a horse tail

gy
• Conus Medullaris
o Below the Spinal Cord tapers off into the Conus
Medullaris
• Filum Terminale
o From the Apex of which a prolongation of the Pia
o Spinal cord terminates below L1, nerve roots for
Mater
lumbar and sacral regions continue downward and it
o Attached to the back of the Coccyx
sits in their respective segments below.

5
 ORGANIZATION OF THE NERVOUS SYSTEM

PERIPHERAL NERVOUS SYSTEM

• Cranial and spinal nerves, which consists of bundles of
nerve fibers/ axon, conduct information to and from the
CNS.
• Composed of cranial nerves, spinal nerves, and their
ganglia

CRANIAL NERVES AND THEIR GANGLIA

• Twelve (12) pairs that exit the skull through the foramina
Cranial Nerves
1 Olfactory Oh Some

2 Optic Oh Say
3 Oculomotor Oh Marry
4 Trochlear To Money
5 Trigeminal Touch But

6 Abducent And My
7 Facial Feet Brother

8 Vestibulocochlear Very Says

9 Glossopharyngeal Green Big
10 Vagus Vegetables Brain

11 Accessory Ah
Matter

More
12 Hypoglossal Heaven

SPINAL NERVES AND THEIR GANGLIA

• Thirty-one (31) pairs that exit the vertebral column and
-
through the intervertebral foramina
• Named according to the regions of the vertebral columns
they are associated with
• 8 Cervical, 12 Thoracic, 5 Lumbar, 5 Sacral, and 1

§gg
Coccygeal ( these (confused toddlers lost spinal nerves childishly ) • Anterior Root
o Eight cervical nerves but only seven cervical o Motor fibers
vertebrae. o Consists of bundles of nerve fibers (efferent fibers)
o One coccygeal nerve and four coccygeal vertebrae carrying nerve impulses away from the nervous
• Due to the disproportionate growth and length of the system
vertebral column during development compared to that of o Go to the skeletal muscles and causes them to
the spinal cord, the length of the roots increases contract

←-
=
progressively from above going downward. o Cells of origin lie in the anterior gray horn of the spinal
o Spinal nerve roots in the cervical region are short and cord
are almost horizontal. • Posterior Root
o The spinal nerve exits above the respective vertebra. o Sensory fibers

-_→
o Because there are seven cervical vertebrae, C8 exits o Consists of bundles of nerve fibers (afferent fibers)
carrying nerve impulses from the periphery towards
-

below C7 and above T1.

the nervous system

5-0=-0
o As you go down further, the nerve needs to go down
a few segments before reaching their respective o Concerned with conveying information about
foramina sensations of touch, pain, temperature, and vibration
• Connected to the spinal cord by two roots: anterior root o Cell bodies of these nerve fibers are situated in a
and posterior root swelling in the posterior root called posterior root
• Spinal nerve roots pass from the spinal cord to the level of
RELATIONSHIP OF SPINAL CORD SEGMENTS TO their respective intervertebral foramina, where they unite
to form a spinal nerve.
VERTEBRAL NUMBERS
• Spinal nerves are a mixture of both motor and sensory
fibers.
• Posterior Ramus

⇐
Vertebrae Spinal Segment
o Arises from the mixed spinal nerve
Cervical vertebrae Add 1
o Passes posteriorly around the vertebral column
Upper thoracic vertebrae Add 2 o Supplies the muscles and skin of the back
Lower thoracic vertebrae (7-9) Add 3 • Anterior Ramus
10th thoracic vertebra L1-2 cord segments o Bigger
11th thoracic vertebra L3-4 cord segments o Continues anteriorly to supply the muscles and skin
12th thoracic vertebra L5 cord segment =
over the anterolateral body wall and all the muscles
Sacral and coccygeal cord and skin of the limbs
1st lumbar vertebrae
segments

É
o Anterior rami join one another at the root of the limbs
to form complicated nerve plexuses.
§ Cervical and brachial plexuses: found at the
root of the upper limbs
§
TE Lumbar and sacral plexuses: found at the root
of the lower limbs
-

6
 ORGANIZATION OF THE NERVOUS SYSTEM

o Cranio meaning cranial nerves

GANGLIA

0€
• Sensory Ganglia
o Fusiform swellings on posterior root of each spinal • The figure shows the:
nerve proximal to the root’s junction with a o Efferent parts of the ANS
corresponding anterior root o Autonomic fibers and organs that they innervate
o Referred to as posterior root ganglia o The RED ones from the thoracolumbar are the
o Similar ganglia found along the course of CN V, VII, sympathetic fibers
VIII, IX, X are called the sensory ganglia. They have o The BLUE ones from the craniosacral are the
sensory functions. parasympathetic fibers
• Autonomic Ganglia o The solid lines are preganglionic
o Irregular in shape o The interrupted lines are postganglionic
o Situated along the course of efferent nerve fibers of o To compare,
the ANS
o Found in the paravertebral sympathetic chains around
§ The sympathetic have short preganglionic
portion and long postganglionic :*
the roots of the great visceral arteries and close to or § The parasympathetic have long preganglionic
embedded within the walls of various viscera. portion and shorter postganglionic such that the
ganglion is closer to the visceral organ
AUTONOMIC NERVOUS SYSTEM
• Some books include ANS under the PNS, but the VENTRICULAR SYSTEM AND CSF CIRCULATION
previously discussed cranial and spinal nerves and In summary
ganglia are grouped under the somatic PNS. 1. Choroid plexus
• And the ANS, which is the other subgroup is also called 2. Lateral ventricles
=
the visceral PNS 3. Interventricular foramina
4. 3rd ventricle
But for our lectures, we will be considering the ANS as a 5. Cerebral aqueduct
separate part of the nervous system 6. 4th ventricle
A. Median Aperture and Lateral Foramina à
• Concerned with the innervation of involuntary structures Cerebellomedullary cistern, pontine cisterns à
o Structures such as, the heart, smooth muscle, and Inferior cerebrum then lateral Cerebrum
glands within the body B. Subarachnoid Space around Spinal Cord
o Distributed throughout the central and peripheral 7. Arachnoid Villi
nervous systems
• It may be divided into two parts:
o Sympathetic and parasympathetic
§ In both parts there are afferent and efferent
nerve fibers
• The activities of the sympathetic part prepare the body

•
⇐
for an emergency, which is the fight or flight response
The activities of the parasympathetic part are aimed at
conserving and restoring energy, which is the rest and
digest

-8--8:
• Sympathetic fibers come from the thoracolumbar
segments.
• Parasympathetic fibers come from the cranio and sacral
regions.

7
 ORGANIZATION OF THE NERVOUS SYSTEM
• -
CSF Circulation
o The circulation begins with the formation of the CSF,
which is produced from the choroid plexuses in the
€
ventricles. However, a small amount comes from the
⇐
brain surface.
o Once produced by the choroid plexus, the CSF
passes from the lateral ventricles into the 3rd
ventricle through the interventricular foramina (of
Monro)
o Then passes to the 4th ventricle through the cerebral
aqueduct
o The circulation is aided by
§ the arterial pulsations of the choroid
plexuses and
§ by the cilia on the ependymal cells lining the
ventricles
o From the 4th ventricle, the fluid passes slowly through
the median aperture and lateral foramina of the
lateral recesses of the 4th ventricle
€o
o After which, it enters the subarachnoid space
o The fluid then moves to the cerebellomedullary
cistern and pontine cisterns
o Then, it flows superiorly through the tentorial notch of
the tentorium cerebelli to reach the inferior surface of
cerebrum
o Moves superiorly over the lateral aspect of each
cerebral hemisphere
§ This flow is assisted by the pulsations of the
cerebral arteries
o While some CSF moves inferiorly in the
subarachnoid space around spinal cord and the
cauda equina
o So here, the fluid is at the dead end and its further
circulation relies on the pulsations of the spinal
arteries and movements of vertebral column e.g.
respiration, coughing and changing positions of the
body.
o The CSF not only bathes the ependymal surfaces of
the brain and spinal cord, but also penetrates the
nervous tissues along the blood vessels
o The main obstruction sites of the CSF are the
§ Arachnoid villi that project into the Dural
venous sinuses, especially the superior
sagittal sinus
§ The arachnoid villi tend to be
grouped together to form
elevations known as arachnoid
•
granulations
EARLY DEVELOPMENT OF THE NERVOUS SYSTEM
• Before the formation of the NS in the embryo, three main
cell layers become differentiated.
PRIMARY NEURULATION
Primary Cell Layers
¥ _
Ectoderm
Nervous system and skin
(outermost)
Muscle, connective tissue,
Mesoderm
vascular system
Gastrointestinal tract, lungs,
Endoderm (innermost)
liver
• The notochord arises from the axial mesoderm at about
16 days and is completely formed by the beginning of the
4th week
• Notochord
o defines the longitudinal access of the embryo
o determines the orientation of the vertebral column
o persists as the nucleus pulposus of the intervertebral
discs
o one important function is induction
§ to direct the overlining ectoderm to form the
neural plate
• During the 3rd week of development/gestation, the
ectoderm in the dorsal surface of the embryo becomes
0€
thickened. It thickens to form the neural plate.
• Neural plate
o pear-shaped and wider cranially
o develops a longitudinal neural groove in the midline
• By about day 18 after fertilization, the neural plate begins
to thicken at its lateral margins.
o this thickening elevates the edges of the neural plate
to form neural folds
o the groove deepens so that it is bounded in either side
by the neural folds
•
=
At about 20 days the neural folds first contact each other
to begin the formation of the neural tube.
o This fusion initially takes place on the dorsal midline
at what will become a cervical level of the spinal cord
and proceeds zipperlike in rostral and caudal
directions
o During the process the lumen of the neural tube; the
neural canal is open to the amniotic cavity both
rostrally and caudally
o_0
§ Rostral opening is called the anterior
neuropore
8
 ORGANIZATION OF THE NERVOUS SYSTEM

¥8
§ Caudal opening is called the posterior • Schwann cells
neuropore • Melanocytes
§ Anterior neuropore closes at 24 days. • Odontoblasts
§ Posterior neuropore closes at 26 days. Nonneural • Satellite cells of peripheral ganglia
Elements • Cartilage of the pharyngeal arches
• Ciliary and pupillary muscles
• Chromaffin cells of the adrenal
medulla
• Pia and arachnoid of the meninges

DEVELOPMENT OF NEURAL TUBE:

GENERAL CONCEPTS
• -
Normally, the 0
neural tube closure is complete within 28
•
days
• During the invagination of the neural plate to form the
neural groove, the cells forming the lateral margin marked
the lateral margin of the plate do not become
incorporated in the neural tube, but instead form a strip of
ectodermal cells that lie between the neural tube and
ectoderm.

•
o
← Strip of ectoderm is called neural crest
Neural Crest
o All neurons with cell bodies in the PNS are derived
from the neural crest
o The neural crest develops in close association with
the underlying mesoderm
o The mesoderm at this stage, forms prominent bulges
on either side of the neural tube, which is called the
somites
o From the somites the 33 individual vertebrae of the
spinal column and related skeletal muscles will • After the formation of the neural tube, three layers—the
develop ventricular, marginal, and intermediate zones—appear
o The nerves that innervate the skeletal muscles are in rapid succession
←called somatic motor nerves o although these zones are transient in their embryonic
forms, they give rise to important adult derivatives

-=
• Early Stages: these closing neural plates and tubes
consist of a single layer: Ventricular Zone
o composed of pseudostratified layer of fusiform-
shaped cells undergoing DNA replication and cell
proliferation
o the nuclei in these cells migrate in a to-and-fro
manner within the cell as mitosis takes place
§ Progenitor Cells will give rise to the future
neurons and some glial cells of the mature

#
nervous system and to the ependymal cells
lining the ventricles
• After ventricular zone is formed, Marginal Zone appears
o located at the abluminal aspect of the neural tube
m o consists of the processes of the cells from the
ventricular zone but it does not contain their nuclei

E-
• Primary Neurulation o contains almost no cell bodies

o the process by which neural plate becomes the
neural tube
Principal Structures Derived from Neural Crest
• Posterior root ganglia
• Paravertebral (sympathetic chain)
ganglia
• Prevertebral (preaortic) ganglia
Neural Elements • Enteric ganglia
• Parasympathetic ganglia of cranial
nerves II, VII, IX, and X
• Sensory ganglia of cranial Nerves
V, VII, VIII, IX and X
F-
o this zone will be invaded by axons of neurons that are
located in the intermediate zone later on
• Third Zone to appear: Intermediate Zone
o forms between the ventricular and the marginal zones
as the progenitor cells from the ventricular zone gives
rise to the immature post-mitotic neuron
§ these immature neurons may be into the area
immediately external to the ventricular zone
o the processes of some intermediate zone neurons go
into the marginal zones
o generally corresponds to what we previously call as
the mantle layer
• Subventricular Zone forms at the interface of the
ventricular and intermediate zones
o unlike the nuclei in the cells of the ventricular zone,
nuclei at the subventricular zones do not migrate
o the progenitor cells of the subventricular zone gives
rise to the macroglial cells of the CNS and to

9
 ORGANIZATION OF THE NERVOUS SYSTEM

specific population of developing neurons in the

brainstem and forebrain

The three-zone configuration of ventricular zone, intermediate

zone, and marginal zone is the basic organizational plan from
which the spinal cord will arise

• There are individual developmental events limit to regions

in the CNS. In certain regions, the basic plan of the neural
tube is modified to accommodate:
o ② Cerebellum —> development of Cerebellar Cortex
-

o Forebrain —> development of Cerebral Cortex ABNVV

←
o Spinal Cord —> the posterior part of the ventricular
zone and adjacent intermediate zone becomes the
€ Alar Cell Column or Alar Plate
§ will differentiate or develop into Posterior
• AFTER THE NEURULATION OF THE SPINAL CORD
o Alar Plate (later on forms the Posterior Horn)
o Basal Plate (later on forms the Anterior Horn)
o Neural Tube
o Vertebral Arch

EEE
Horn
§ sensory component of the future spinal cord o Vertebral Body with Notocohord (later on will be
o Corresponding layers in the anterior region of the Nucleus Pulposus)
developing nerves will become the Basal Cell
Column or the Basal Plate CONGENITAL NERVOUS SYSTEM DEFECTS OF
§ will differentiate or develop into Anterior PRIMARY NEURULATION
Horn
§ motor aspect of the spinal cord • -
Dysraphic Defects
• As development proceeds, the ventricular zone will o congenital malformations associated with defective
essentially disappear while the intermediate zone with neurulation
mature neurons will progressively enlarge to form the adult o a common birth defect is the failure of appropriate
-

derivative closure of the neural tube

-
ANENCEPHALY

• The modification of the neural tube to accommodate the

cerebral cortex is the appearance of the cortical plate and • failure of anterior neuropore closure
the subplate • the brain is not formed as well as the surrounding

E-
o Cortical Plate meninges in the skull and there are facial abnormalities
§ forms at the interface between the marginal zone

I
and the intermediate zone ENCEPHALOCELE
§ composed of neurons that are made from the • a herniation of the intracranial contents through a defect
ventricular zone through the cranium (crania bifidum) or the skull
§ these post mitotic immature neurons traverse the • specific enlarged structure may contain:
intermediate zone from the ventricular zone using o only meninges — meningocele
the radially oriented processes of radial glia
§ they use the glia as a scaffold to become the
cortical plate
• cell migration of the radial glia is
characteristically seen in all portions of
the developing nervous system
o Subplate
§ a narrow region located immediately internal to
=
the cortical plate

• Cerebral Cortex develops from the Cortical Plate and the

marginal zone

=
• The histogenesis of the Cerebellar Cortex is a slight
modification of what happened in the cerebral cortex plan
due to the presence of an external germinal layer
o external germinal layer originate from the rhombic
lip which is an alar plate derivative and is located
within the marginal layer

10
 ORGANIZATION OF THE NERVOUS SYSTEM

o →
meninges plus the brain — meningoencephalocele SECONDARY NEURULATION

o meninges with the brain and part of the ventricular

=
system — meningohydroencephalocele

1. Cut Edge of Amnion

2. Anterior Neuropore
3. Future Brain
4. Initial Closure of Neural Tube
5. Somite
6. Future Spinal Cord
7. Posterior Neuropore
8. Region of Secondary Neurulation
• are most common in the occipital region but they may also 9. Neural Plate
occur in the frontal and parietal location
• When the sacrococcygeal segment of the spinal cord

¥=¥¥¥
MYELOSCHISIS
• defects in the closure of the posterior neuropore cause
this range of malformation
• defect always involves failure of the vertebral arch and
affected levels to form completely or to fuse as to cover
the spinal cord
o if this happens, spina bifida occurs
SPINA BIFIDA
• Spina Bifida Occulta
o if that is the only defect and the skin is closed over it
o occulta – occult : not seen
o at the site of the defect, it is usually marked by a
patch of dark coarse hair.
• Spina Bifida Aperta
o malformation where the skin is not closed over the
vertebral defect it will leave a patent aperture opening
• Spina Bifida Cystica
o as with occipital encephaloceles, a cystic mass, spina
bifida cystica, may also accompany spina bifida
o this saccular structure may contain:
§ only meninges + CSF — meningocele
§ meninges + CSF + spinal neural tissue —
meningomyelocele
and their corresponding dorsal and ventral lobes are
formed, this process begins on day 20 and is
completed on day 42.
o Formation of sacrococcygeal segment of the
spinal cord and their corresponding dorsal and
ventral lobes
o Process begins – day 20
o Process is completed – day 42
• A cell mass called the caudal egg eminence appears
just caudal to the neural tube. This mass enlarges and
cavitates.
• Later on, it joins the neural tube and its cavity becomes
continuous with the neural canal.
• Malformations related to secondary neurulation are
called Myelodysplasia.
o the malformation is covered with skin in most
cases but the site may be marked by unusual
pigmentation, hair growth like in spina bifida
occulta, large superficial capillaries, or a
prominent dimple.

• A common abnormality is what we call Tethered cord

syndrome (left side of the pic)
o The conus medullaris and filum terminale are
abnormally fixed to the defective vertebral
column
o In tethered cord syndrome, the conus medullaris
and filum terminale are pulled downwards to
the defective vertebral column
o Normally (right side of the pic), it appeared like
that.

11
 ORGANIZATION OF THE NERVOUS SYSTEM

o However, in tethered cord syndrome, the conus

medullaris and filum terminale are pulled
→
o The secondary vesicles are the two optic vesicles
and the two telencephalic vesicles
o The essential structure that remains in the midline is
downwards to the defective vertebral column. the diencephalon
o With this, it sustained traction damages to the
spinal cord and causes variable weakness, DIFFERENTIATION OF THE FOREBRAIN
sensory loss, and asymmetric growth of the
legs and feet, and problems with bowel and
bladder control.

DIFFERENTIATION

• The optic vesicles grow and invaginate.

• They fold in to form the optic stalk and the optic cup.
• Later on, the structures will ultimately become the optic
nerves and the two retinas in the adult.
1. Rostral: front or anterior
2. Caudal: back or posterior
3. Prosencephalon or Forebrain
a. Telencephalic vesicles
b. Diencephalon
c. Optic vesicles
4. Mesencephalon or Midbrain
5. Rhombencephalon or Hindbrain

←⇐
• Differentiation
• The telencephalic vesicles together form the
o The process by which the structures become
telencephalon or the endbrain.
more complex and functionally specialized

during development.
• The first step in the differentiation of the brain is the
development at the rostral end of the neural tube of the
3 primary swellings (3 primary swellings or also called
as 3 primary vesicles)
E-
o Telencephalon – consists of two cerebral
hemispheres)
o The telencephalic vesicles grow posteriorly so that
they lie over in lateral to diencephalon.
• Another pair of vesicles sprout off the ventral surfaces of
the cerebral hemispheres, giving rise to the olfactory
bulbs.
• The olfactory bulbs in related to structures participate in
the sense of smell.

• Prosencephalon or Forebrain
o Rostral most vesicle (rostral means front or
anterior)
o Pro – Greek for before
o Cephalon – Greek for brain 1. Main Divisions
• Mesencephalon or Midbrain a. Telencephalon
o Behind the forebrain b. Diencephalon
• Rhombencephalon or Hindbrain 2. Ventricles
o Caudal to forebrain (caudal means back or a. Lateral ventricles
posterior) b. Third ventricle
o The rhombencephalon connects to the caudal 3. Gray Matter Structures
neural tube which gives rise to the spinal cord a. Cerebral cortex and Basal telencephalon
(telencephalon)
b. Thalamus and Hypothalamus (diencephalon)
4. White Matter Structures
a. Corpus callosum: continuous with the
cortical white matter and forms an axonal
bridge that links cortical neurons of two
cerebral hemispheres
b. Cortical white matter: contains all axons
that run to and from the neurons in the
• The next important development (2nd development)
cerebral cortex; also continuous with the
occurs in the forebrain where the secondary vesicles internal capsule
sprout off on both sides of Prosencephalon. c. Internal capsule: which links to cortex with

12
 ORGANIZATION OF THE NERVOUS SYSTEM

the brainstem and the thalamus cross section is a simple tube.

• In subsequent weeks, the tissue along the dorsal lateral

⇐
• Lateral Ventricles
o The fluid spaces within the cerebral hemispheres
• Third Ventricle.
o The space on the center of the diencephalon
• The walls of the telencephalic vesicles appear swollen due
to proliferation of neurons.
o These neurons perform two different types of gray
matter in the telencephalon (cerebral cortex and basal
telencephalon)
o The diencephalon (thalamus and hypothalamus)
o The neurons of the developing forebrain extend axons
to communicate with other parts of the nervous
system.
o The axons bundle together to form 3 major white
matter systems (corpus callosum, cortical white
matter, internal capsule)
wall called the rhombic lips grows dorsally and medially
until it fuses with its twin on the other side resulting to a
flat tissue which grows into the cerebellum.
• The ventral wall of the tube differentiates and swells to
form the pons.
• Less dramatic change occurs in the differentiation of the
caudal half of the hindbrain.
• The ventral and lateral walls of these regions swell, thus
leaving the roof covered with thin layer of non-neuronal
ependymal cells.
• Along the ventral surface of each side of the medulla runs
a major white matter system.
• -
Medullary Pyramids
o When you cut across this system, bundles of axons
appear somewhat triangular in shape
-

o important because this is the point of decussation of

the fissure motor tract
DIFFERENTIATION OF THE MIDBRAIN
DIFFERENTIATION OF THE SPINAL CORD

• Unlike the Forebrain, the midbrain differentiates relatively

little during subsequent brain development.
• The transformation of the caudal neural tube to the spinal

¥=
• Tectum
o The dorsal (back) surface of the mesencephalic cord is somewhat straightforward compared to the
vesicle becomes a structure differentiation of the brain.
o Latin for roof • With the expansion of the tissue on the walls, the cavity of
• Tegmentum the tube constricts to form the tiny CSF-filled spinal canal
o The floor of the midbrain • Cut in cross section, the gray matter of spinal cord where
• Cerebral aqueduct the neurons are as the appearance of the butterfly.
o the oblong or circle filled space in between constricts • Dorsal horn
into a thin narrow channel o Upper part
o Derived from the alar plate
DIFFERENTIATION OF THE ROSTRAL AND CAUDAL • Ventral horn
HINDBRAIN o Lower part
o Derived from the basal plate
• Intermediate zone
o The gray matter between the dorsal horn and ventral
horn
• White matter
o the rest (outside the butterfly)
o consists of columns of axons that run up and down of
the spinal cord

THE VENTRICULAR SYSTEM OF THE BRAIN

• Hindbrain differentiates the 3 important structures:
o Cerebellum Component Related Brain Structure
o Pons Lateral Ventricles Cerebral Cortex
o Medulla Basal telencephalon
• Cerebellum and Pons Third Ventricle Thalamus
o develop from the upper half or frontal half of the
Hypothalamus
hindbrain called metencephalon
• Medulla Cerebral Aqueduct Tectum
o develops from the lower half or caudal half of the Midbrain tegmentum
hindbrain called myelencephalon Fourth Ventricle Cerebellum
• The CSF tube becomes the fourth (4th) ventricle which is Pons
continuous with the cerebral aqueduct of the midbrain Medulla
• At the three-vesicle stage, the rostral of the hindbrain in

13
 ORGANIZATION OF THE NERVOUS SYSTEM

THE PRIMARY DIVISIONS OF THE SUMMARY

DEVELOPING BRAINS • Central Nervous System
o composed of brain and spinal cord
Table 1-2: The Primary Divisions of the Developing Brain • Brain
Primary Primary Division Subdivision Adult o subdivided to forebrain, midbrain, and hindbrain
Vesicle Structures • Spinal Cord
Forebrain Prosencephalon Telencephalon Cerebral o divided to the cervical, thoracic, lumbar, sacral, and
vesicle (forebrain) hemisphere, coccygeal segments
Basal ganglia, o has inner gray and outer white matter
• Cerebrum and Cerebellum
Hippocampus
o have outer gray and inner white matter
• Peripheral Nervous System
Thalamus, o composed of cranial nerves and spinal nerves with
Diencephalon Hypothalamus, their associated ganglia
Pineal body, • Autonomic Nervous System
Infundibulum o has sympathetic and parasympathetic divisions
Midbrain Mesencephalon Mesencephalon Tectum, • Cerebrospinal Fluid
Vesicle (midbrain) (midbrain) Tegmentum, o formed from the choroid plexus, circulates through the
ventricles, cisterns, and subarachnoid space, then
Crus cerebi
absorbed through the arachnoid villi
Hindbrain Rhombencephalon Metencephalon Pons, • Nervous System
vesicle (hindbrain) Cerebellum o developed through primary neurulation, secondary
Myelencephalon neurulation, and differentiation
Medulla
Oblongata
REFERENCES
Primary Vesicle Secondary Vesicle Some Adult
Derivatives Bear, M., et.al. (2015). Neuroscience: Exploring the Brain (4th
Forebrain Optic vesicle Retina ed.). Wolters Kluwer.
(prosencephalon) Optic Nerve
Haines, D. & Mihailoff, G. (2018). Fundamental Neuroscience
Thalamus Dorsal thalamus
for Basic and Clinical Applications (5th ed.). Elsevier,Inc
(diencephalon) Hypothalamus
Third ventricle University of Santo Tomas powerpoint presentation of Richelle
Telencephalon Olfactory bulb Ann S. Santiano, MD
Cerebral cortex
Basal telencephalon
Corpus callosum
Cortical white matter
QUICK QUIZ
Internal capsule
1. The Central sulcus of Rolando separates frontal from ______ lobe
Primary Vesicle Some Adult Derivatives
a. ) Temporal b.) Parietal
0
2. Arrange the following from external to internal
c.) Occipital

Midbrain (mesencephalon) Tectum (1) Arachnoid (2) Dura (3) Pia

Tegmentum a. ) 3-2-1
0
b.) 2-1-3 c.) 2-3-1
3. What is the largest part of forebrain? cerebrum
d.) 3-1-2

Cerebral aqueduct 4. What does Don’t Eat Greasy Food stands for? Dentante Emboliform Globose , ,
, Fasti gial

Hindbrain (rhombencephalon)
Cerebellum 5. Which of the following has the correct number of spinal nerves?
a.) 7 Cervical, 12 Thoracic, 5 Lumbar, 5 Sacral, 2 Coccygeal
Pons
O b.) 8 Cervical, 12 Thoracic, 5 Lumbar, 5 Sacral, 1 Coccygeal
Fourth ventricle c.) 8 Cervical, 11 Thoracic, 5 Lumbar, 5 Sacral, 2 Coccygeal
Medulla d.) 8 Cervical, 12 Thoracic, 4 Lumbar, 4 Sacral, 1 Coccygeal
6. It is referred to as the posterior root ganglia
Oa.) Sensory Ganglia b.) Autonomic Ganglia
c.) Anterior Ganglia d.) Posterior Ramus
7. The CSF is produced from the
a.) Cerebral Aqueduct
Ob.) Choroid plexus
c.) Arachnoid Villi
8. The anterior neuropore closes at
O a. ) 24 days b.) 28 days
9. The gray matter between the dorsal horn and ventral
c.) 26 days
horn is
called _____
a.) Primary Vesicle b.) Cortical White Matter

%
c.) Internal Capsule d.) Intermediate zone
10. ____ differentiates the three important structures
(Cerebellum, Pons, Medulla)
a.) Midbrain b.) Hindbrain
c.) Forebrain d.) Rhombencephalon

(1) B (2) B (3) CEREBRUM (4) Dentante, Emboliform, Globose, Fastigial (5) B (6) A (7) B (8) A (9) D (10) B

14
Prof Names
Transcribers

1S2L: NEURONS AND NERVE FIBERS

OUTLINE WHAT IS A NEURON?
I. WHAT IS A NEURON?
● Nerve cell and its processes
A. Types of Neurons
a. Based on the number, length, and ● Excitable cells specialized for the reception of stimuli and
mode of branching the conduction of the nerve impulse
b. Based on size ● Has a cell body from whose surface project one or more
processes called -
-

B. Structure of Neurons neurites (nerve fibers)

a. Cytoplasm
C. Excitation of the plasma membrane of the
nerve cell body
●
É
Dendrites receive information and conduct it toward the
cell body
● Axon conduct impulses away
F - from the cell body
D. Sodium and Potassium channels
E. Nerve cell processes ● Unlike most of the cells in the body, normal neurons in
F. Axon transport the mature individual do not undergo division and
a. Synapses replication.
G. Distribution and fate of Neurotransmitters ● Dendrites and axons are commonly referred to as nerve -

H. Neuromodulators at Chemical Synapses fibers.

-

I. Electric synapses
II. WHAT ARE NEUROGLIA?
TYPES OF NEURONS
A. Astrocytes
B. Oligodendrocytes
BASED ON THE NUMBER, LENGTH, AND MODE OF
C. Microglia
BRANCHING
D. Ependymal Cells
E. Extracellular Space
● Unipolar / pseudo unipolar round
III. NERVE FIBERS
○ Found in: posterior root ganglion.
A. Formation of Myelin -

○ The cell body has a single neurite that divides

B. Non-myelinated Nerve Fibers
the short distance from the cell body into two
IV. CLINICAL CORRELATE
branches (cell/nerve processes).
A. Axonal reaction and axonal degeneration
a. Axonal transport and the spread of ○ The branches of the single neurite have
disease
structural & functional characteristics of an
axon.
B. Disorders of neurotransmitter metabolism
V. PERIPHERAL NERVES ○ This type of neuron, the fine terminal
A. Spinal Nerves and Spinal Nerve Roots branches found in the peripheral end of the
B. Cranial Nerves axon at the receptor site, are often referred to

=
C. Sensory Ganglia and Autonomic Ganglia as dendrites.
D. Peripheral Nerve Plexus ● Bipolar
a. Brachial Plexus ○ Found in: (1) retinal bipolar cells, (2) cells of
E. Conduction in Peripheral Nerves sensory cochlear and (3) vestibular ganglia
VI. RECEPTOR ENDINGS ○ Possess an elongated cell body, from each
A. Nonencapsulated Receptors end a single neurite emerges.
B. Encapsulated Receptors ● Multipolar → found in most parts
C. Transduction of Sensory Stimuli Into Nerve ○ Number of neurites arising from the cell body.
Impulses ○ The big section of the long process is the
( only 1 long)
D. Joint Receptors Axon, the remainder of the neurites are
E. Neuromuscular Spindles Dendrites.
F. Stretch Reflex ○ Most neurons of the brain and spinal cord are
G. Control of the Intrafusal Fibers of the of this type. Such as (1) pyramidal neurons (of
Neuromuscular Spindle the cerebrum), and (2) Purkinje cells (of the
H. Neurotendinous Spindles (Golgi Tendon) cerebellum).
I. Innervation of Skeletal Muscle
J. Motor Unit
K. Segmental innervation of muscles
L. Muscle tone and movement
VII. CLINICAL CORRELATES
A. Traumatic Lesions of Peripheral Nerves
B. Examination of Individual Sensory Modalities
C. Abnormalities in Sensory Perception
D. Clinical Observation of Muscular Activity

1
 NEURONS AND NERVE FIBERS

Table 2.1 Classification of Neurons

Morphologic Arrangement of Location

Classification Neurites
BASED ON SIZE
Number, Length, and Mode of Branching of Neurites
●
€1M
Golgi Type I more processes
○ Has long axon (SIZE: 1 meter – longer in Unipolar Single neurite divides
a short distance from
Posterior root
ganglion
extreme cases)
cell body
○ Axons of this neuron form the lung fiber
tracts of the brain and spinal cord and the
Bipolar Single neurite Retina, sensory
nerve fibers of peripheral nerves.
emerges from either cochlea, and
Examples: end of cell body vestibular ganglia
1. Pyramidal cells of the cerebral cortex.
2. Purkinje cells of cerebellar cortex. Multipolar Many dendrites and Fiber tracts of
3. Motor cells of the spinal cord. one long axon brain and spinal
cord, peripheral

¥
● Golgi Type II nerves, and motor
○ Compared to golgi type 1 they are: cells of spinal
○ Smaller cord
○ Has short processes
○ Greatly outnumber golgi type 1. Size of Neuron
○ Star shaped.
Golgi Type I Single long axon Fiber tracts of
○ Most of the time inhibitory in function.
brain and spinal
Examples: cord, peripheral
1. Granule cells of cerebellum. nerves, and motor
2. Stellate cells of cerebellum. cells of spinal
cord

Golgi Type II Short axon that with Cerebral and

dendrites resembles cerebellar cortex

STRUCTURE OF NEURONS

E-
● Nerve cell body
○ Consists essentially of mass of cytoplasm in
which a nucleus is embedded, found
externally by the plasma membrane.

Note: Cytoplasm of the nerve cell body is far less than the
volume of the cytoplasm in the neurites.

0=_
● Nucleus
○ Stores the genes
○ Centrally located within the cell body
○ Typically large and rounded.
○ Mature neurons chromosomes no longer

E-
duplicate themselves and function only in
gene expression.

2
 NEURONS AND NERVE FIBERS

○ Chromosomes are not just in compact ■ Fatigue or neuronal damage

structures, but they exist in an uncoiled causes the Nissl substance to move
state
-
and become concentrated at the
○ Pale nucleus periphery of the cytoplasm →
○ Chromatin granules are widely dispersed. chromatolysis
○ Single prominent nucleolus ■ This phenomenon gives an
■ ribosomal ribonucleic acid (rRNA) impression that the nissl substance
synthesis and ribosome subunit has disappeared (aka
assembly chromatolysis).
■ Nucleolus is big because of the high ○ Golgi complex/ Golgi apparatus
rate of protein synthesis occurring. ■ Under the light microscope, it
○ Female: Barr body (composed of sex appears to be a network of irregular
chromatin) wave inference that runs around the
■ One of the two chromosomes which nucleus.
is compact. ■ In electron micrographs it appears
■ Situated in the inner surface of the as clusters of flattened cisternae
nuclear envelope. and small vesicles made up of
smooth-surfaced ER.
■ Protein produced by the nissl

←
● Nuclear envelope
○ Special portion of the rough endoplasmic substance is transferred to the inside
reticulum of the cytoplasm of the golgi complex in transport
○ Double-layered with nuclear pores vesicles. Temporarily stored there
○ Continuous portion of the RER of the and when carbohydrate is added to
cytoplasm. the protein, they form glycoprotein.
○ Double-layered and possesses fine nuclear ■ Proteins are believed to travel from
pores. one cisternae of the golgi complex to
another via transport vesicles.
■ In these nuclear pores, materials
can diffuse into and out of the FUNCTION:
nucleus. 1. Transport of
macromolecules to nerve
terminals
2. Lysosome production and
synthesis of cell
membranes
○ Mitochondria
■ Powerhouse of the cell.
■ Found scattered throughout the cell
body, dendrites and axons.
■ Spherical or rod shaped
■ In electron micrographs they have a
double membrane
● Inner membrane is thrown
into folds or cristae that
project into the center of
mitochondrion.
■ Possesses many enzymes which
are localized chiefly on the inner
mitochondrial membrane.
● Enzymes take part in
tricarboxylic acid Cycle
(aka Krebs Cycle) and
cytochrome chains of
respiration.
CYTOPLASM
■ Enzymes take part in tricarboxylic
acid cycle and cytochrome chains
○ Rich in granular and agranular endoplasmic
of respiration → Production of
reticulum (ER)
energy
○ Nissl substance
● Important in nerve cells
■ Composed of rough ER (RER)
and other cells for the
distributed throughout the
production of energy.
cytoplasm except for the axon
hillock and axon. ○ Neurofibrils
■ Synthesizes protein which flows ■ Numerous neurons parallel each
along the dendrites and the axon other through the cell body into the
and replaces the protein that are neurites.
broken down during cellular activity. ■ With electron microscope the
neurofibrils may be result into

3
 NEURONS AND NERVE FIBERS

bundles of neurofilaments (10 nm ■ Result of lysosomal activity

in diameter) → forms the main
component of cytoskeleton
■ Chemically very stable and belong to
the cytoskeleton, cytokeratin family.
○ Microfilaments (3-5 nm in diameter) found
-
■ Formed - f
of actin
■ Concentrated at the periphery of
■ Represents a harmless metabolic
product.
■ Accumulates with age
○ Melanin granules
here ■ Found in cytoplasm of cells and
certain parts of the brain such as
substantia nigra and locus coeruleus

=
the cytoplasm just beneath the
plasma membrane where they form
○ Plasma membrane (8 nm thick)
■ Is a continuous external boundary of
a dense network. the cell body and its processes and
○ Microtubules (25 nm) in the neuron it is the site of initiation
■ Interspersed among neurofilaments and conduction of the nerve impulse.
■ Largest ■ Site of initiation and conduction of

F-
○ Microtubules and microfilaments the nerve impulse
■ Play a key role in the formation of ■ Too thin to be seen with a light
new cell processes and retraction of microscope.
old ones
■ Axon transport ○ Composed of an inner and outer layer of
protein molecules (each 2.5 nm thick)
separated by lipid layer (3 nm thick).
○ Lipid layer has 2 rows of phospholipid
molecules with hydrophobic ends in contact
with each other and polar ends in contact with
protein layers
○ Certain protein molecules lie within the
phospholipid layer and span the entire width
of the lipid layer.
longitudinal
section → ○ Molecules provide the membrane with
hydrophilic channels through which inorganic
ions enter near the cell.
○ Glycocalyx or cell coat
■ Carbohydrate molecules attached to
outside of the plasma membrane
and linked to proteins or lipids
forming the cell coat or glycocalyx.

○ Lysosomes (8 nm in diameter)
■ Membrane bound vesicles.
■ Intracellular scavengers
■ Contain hydrolytic enzymes
■ Formed by budding off of Golgi
apparatus
■ 3 Forms:
● Primary – newly formed
● Secondary – partially
digested material
● Residual Bodies –
inactive enzymes, bodies
evolved from digestible
materials
○ Centrioles
■ Small, paired structures found in
immature dividing nerve cells?
■ Hollow cylinder with a wall that is
made up of bundles of microtubules.
■ Wall is made up of microtubules
■ Associated with the formation of
spindle (during cell division) and
microtubules
■ In mature neurons these centrioles
are believed to be involved in
maintenance of microtubules.
○ Lipofuscin (pigment materials)
■ Yellowish-brown granules within the
cytoplasm

4
 NEURONS AND NERVE FIBERS

from axon
hillock
and axon,
fatigue
and injury
result in
concentra
tion at
periphery

Golgi Wavy Smooth Close to Adds

complex threads; endoplas the carbohydr
clusters mic nucleus ate to
of reticulum protein
flattened molecule;
cisternae packages
and small products
vesicles for
transport
to nerve
terminals;
forms cell
membran
es

Mitochon Spherical, Double Scattered Form

dria rod- membran chemical
shaped e with energy
cristae

Neurofib Linear Run Run from Determin

rils fibrils parallel to dendrites es the
each through shape of
other; cell body the
compose to axon neuron
d bundles
of
microfila
ments,
each 10
Table 2.2 The Main Structure in a Nerve Cell Body nm in
diameter
Structure Shape Appeara Location Function
nce Microfila Linear Run Run from Cell
ments fibrils between dendrites transport
Nucleus Large, Pale, Centrally Controls neurofibril through
rounded chromatin placed, cell cavity s, 25 nm cell body
widely displaced in to axon
scattered; to diameter
single periphery
prominent in cell Lysosom Vesicles 8 nm in Througho Cell
nucleolus injury es diameter; ut the cell scavenge
; Barr three rs
body forms:
present in primary,
female secondar
y, and
Cytoplasmic organelles residual
bodies
Nissl Granules Broad Througho Synthesiz
Substan of rough cisternae; ut es protein Centriole Paired Wall Confined Take part
ce endoplas ribosome cytoplas s hollow made up to in cell
mic s are m and cylinders of cytoplas division;
reticulum basophilic proximal bundles m of cell maintain
part of of body microtubu
dendrites, microtubu les
absent

5
 NEURONS AND NERVE FIBERS

○ This impulse is self-propagated and the size

les and frequency do not alter.
Lipofusci Granules Yellowish Scattered Metabolic
n brown through by-
the product
cytoplas
m

Melanin Granules Yellowish Substanti Related

brown a nigra of to
midbrain formulatio
n of dopa

EXCITATION OF THE PLASMA MEMBRANE OF THE

NERVE CELL BODY

● Resting state
○ K ions diffuse through the plasma membrane
from the cell cytoplasm to the tissue fluid.
○ Passive efflux of K > influx of Na ( potassium > Sodium )
■ From inside to outside
○ Resting potential : -80 mv
-

○ Because the permeability of the potassium

ion is much greater compared to the sodium
ion, thus the passive reflux of potassium is
much greater than the influx of sodium.
○ Because of that we develop a steady potential
difference. (Resting potential) : - 80 mv
When stimulated:
○ By electrical, mechanical, chemical means of
excitation.
○ A rapid change in membrane permeability to
sodium ion takes place.
○ Na ions diffuse through the plasma
membrane into the cell cytoplasm from the
tissue fluid → membrane depolarized
○ From – 80 mv to 40 mv
○ Sudden influx of Na → Action potential (40
mV)
FIGURE:
● Ionic and electrical changes that occur in the neuron
when it is stimulated.
● Resting state: - 80 mv because of passive reflux of (K)
potassium outside of the nerve cell body.
● Once the nerve cell is stimulated, (Na) sodium ions
quickly diffuse to the nerve cell body making the inside
more positive. That is why it rises up from – 80 mv to
40 mv (aka depolarization). It is where action potential
occurs, when the potential reaches above the
threshold.
● Occurrence is quick/brief so that the potassium goes
back inside the cell leading it back to the resting state.
● Commonly start at the initial site of the axon and travel
along the axon where it is an all or none action
potential with transient reversal of polarity.
● Once the nerve impulse has spread over a given
region of plasma membrane, another action potential
cannot be elicited immediately

○ Sudden influx of (NA) sodium ions followed by ○ ②

Refractory period → need
strong stimulus
potential
to produce
the outer polarity produces action potential. an action

■ It is the duration of a non excitable

■ Brief and lasts only about 5 state
milliseconds. Increase membrane
permeability of (NA) sodium ions ■ It controls the maximum frequency
quickly ceases and membrane that the action potential can be
permeability for (K) potassium ions conducted along the plasma
increases. membrane.
○ K ions flow from cell cytoplasm and return the ■ Absolute refractory period-
localized area of the cell to resting membrane second stimulus is unable to
and goes back to resting state ( makes it more positive ) produce a further electrical change
due to the inability to get the
○ Action potential spreads over the plasma sodium channels open
membrane, away from the site of initiation, ■ Relative refractory period - very
and is conducted along neurites as the nerve strong stimulus can produce an
impulse. action potential presumably
because some sodium channels
○ Most of the time this nerve impulse starts from are already open.
the initial segment of the axon. the calcium channels
there is still an ability to open

6
 NEURONS AND NERVE FIBERS

● Multiple subthreshold excitatory applied to the should also consider the size of the shell
surface of a neuron can be summated and illicit of water surrounding the ion.
an action potential.
● Inhibitory stimuli by causing an influx of Cl ions o The potassium ions have weaker electric
through the plasma membrane into the neuron can fields than sodium ions.
produce hyperpolarization and reduce the excitatory
state of the cell. Thus potassium ions attract less water than
● (Cl) Chloride is a negative ion, once it goes inside the sodium ions.
cell it makes the cell more negative. That is why it is
hyperpolarization inhibitory.
o Therefore, potassium ions behave as if
they are smaller than sodium ions.
(explanation does not entirely account as
to why a channel is selective)

o Also possible that the channels have

narrow regions along their length that act
as sieves or filters.

o These ions may also participate in

electrostatic interactions with amino
acids and residues lining the walls of the
channel.

o The ion channels proteins are relatively

stable but they exist in two
conformational states which represent an
open functional state and a close
functional state. ↳ Gating

Two phases: ● K ion is larger than Na ion

● K ions have weaker electric fields than Na ions
1. Absolute refractory period ● Mechanism responsible for opening and closing of
channels is called gating.0 Gating may involve the
-

● Occurs at the onset of action potential. twisting and distortion of the channel, thus creating a
● When the second stimulus is unable to produce a =
wider or narrower lumen.
further electrical change due to the inability to get the ○ Occurs in pure response to stimuli such as
sodium channels open. voltage change, presence of a ligand, stretch
or pressure.
2. Relative refractory period
● In the non-stimulated state, the gates of the
● Occurs when a very strong stimulus can produce an potassium channels are open wider than those of the
action potential. Presumably because some sodium sodium channels to allow passive reflux of potassium.
channels are already opened. ● In the stimulated state, the gates of the sodium for
channels are at first wide open → gates of the reentry
● The greater the strength of the initial stimulus the larger
the initial depolarization and the greater will be the potassium channels are opened → gates of the
spread into the surrounding areas of the plasma sodium channels are nearly closed again.
membrane. ● It is the opening and closing of sodium and potassium
channels that is thought to produce depolarization and
repolarization of the plasma membrane.
SODIUM AND POTASSIUM CHANNELS
K weaker electric field than Na
larger ,

These are channels where the sodium and potassium ions

diffuse through the plasma membrane.

● They are protein molecules that extend to the full

thickness of the plasma membrane.
● Why does a particular channel permit the passage of
potassium ions while excluding? Sodium ions (difficult
to explain)
NERVE CELL PROCESSES
o Selectivity can't be due to the diameter of
ions. Because potassium ions are larger ● The processes of a nerve cell often called neurites:
than sodium ions. ○ if they are bundled together in the central
nervous system they are called/referred as
o The movement of ions and solutions nerve tracts
depends NOT only on the size but we

7
 NEURONS AND NERVE FIBERS

○ if they are bundled together in the peripheral

nervous system they are called/referred as
peripheral nerves.

DENDRITES

○ Receives information and carries it toward the

cell body.
○ Dendritic spines - small projections
○ Cytoplasm closely resembles that of cell
body

AXON

○ Carries information away from the cell body.

EXCEPT for the axons of posterior root
ganglion because they carry sensory
information from the periphery toward the cell
body.
○ Devoid of Nissl granules
○ Terminals - distal ends of terminal branches Axon transport
○ Varicosities - swellings at termination
(autonomic nerves) ● involves the movement of membrane organelles,
○ Size of the axon matters in terms of the secretory material, synaptic precursor membranes ,
conduction of impulses. large dense core particles, mitochondria and smooth
○ Large-diameter axons conduct impulses endoplasmic reticulum.
rapidly
○ Axolemma - plasma membrane Rapid transport
○ Axoplasm - cytoplasm
○ Initial segment (first 50-100 m after axon
● Occurs in both directions, the cell body and its
hillock)
processes. (aka Anterograde & Retrograde)
■ Where action potential originates
○ Axons of posterior root ganglion (toward cell
body) - exception Anterograde

AXON TRANSPORT ● Kinesin mediated

● Away from the cell body.

Rapid Transport (100-400 mm/day) Retrograde

● Dynein mediated.
①
Kinesin Protein Anterograde
- Proteins and ● Towards the cell body.
transmitter
substances or their
precursors SYNAPSES

0
Dyein
Slow Transport (0.1) - 3.0 mm/day)
Molecular motor not
identified (but they say that it
Retrograde
- Activated growth
●
●
Site of communication of 2 neurons
Most neurons may make synaptic connections to
factor receptors 1,000 or more other neurons and may receive up to
- Pinocytotic vesicles 10,000 connections from other neurons.
- Worn-out ● Communication at a synapse, under physiologic
organelles conditions, takes place in one direction only.
● Occurs in a number of forms.
● Most common type
○ between an axon of one neuron and the
dendrite or cell body of the second
Anterograde only
- Axoplasm and
-
neuron (aka axodendritic or axosomatic.)

is a part of Kinesin family)
includes the ● As the axon approaches the synapse, it may have a
microfilaments and terminal expansion (bouton terminal), or it may have a
microtubules series of expansions (bouton de passage), each of
which makes synaptic contact. In other types of
synapses, the axon synapses on the initial segment of
another axon. (aka axoaxonic).

8
 NEURONS AND NERVE FIBERS

● The manner in which an axon terminates varies

considerably in different parts of the nervous system. Presynaptic Cytoplasm often Polysaccharide
vesicles, contains parallel
● Bouton terminal (axonal terminal expansion) or mitochondria, and cisternae.
bouton de passage (series of expansions) occasional
● Axodendritic, axosomatic or axoaxonic lysosomes are
● Synaptic spines (extensions of surface of a neuron) present in the
form receptive sites for synaptic contact with afferent cytoplasm close
boutons. to the presynaptic
membrane.
● Synapses are of two types: chemical and electrical.

● Most synapses are chemical, in which a chemical

substance, the neurotransmitter, passes across the
narrow space between the cells and becomes attached
to a protein molecule in the postsynaptic membrane
called the receptor.

● In most chemical synapses, several neurotransmitters

may be present.

DIAGRAM - FIGURE 2.8

● Formation of neurotransmitters packaged into vesicles

and it’s released in attachment with the postsynaptic
receptors.
● An action potential arrives on the presynaptic region.
Once, presynaptic neuron is stimulated it causes the
opening of voltage-gated Ca2+ channels.
● When Ca2+ ions enter the cell it stimulates the vesicles
filled with neurotransmitters to fuse with the plasma
membrane of the presynaptic membrane. After fusing
it releases neurotransmitters inside to the synaptic
cleft.
● The neurotransmitters in the synaptic cleft bind to the
postsynaptic receptors. → nicotinic acetylcholine receptor
FIGURE:
● Receptors may be excitatory or inhibitory, or second
messenger mediated receptor.
A. axon of a neuron to a dendrite of another neuron. ● Since this is acetylcholine the way it will be broken
down is through hydrolysis by the acetylcholinesterase.
h e

B. axon of a neuron to the nerve cell body or soma of another ● The excitatory and inhibitory effects on the
neuron. postsynaptic membrane of a neuron will depend on the
summation of the postsynaptic responses at the
C. axon of a neuron to the axon of another neuron. different synapses.
● If the overall effect is one of polarization. Like excitatory
the neuron will be excited, if it is inhibitory the neuron
will not be excited or hyperpolarization may happen,
Presynaptic Postsynaptic Synaptic Cleft the nerve impulse may be inhibited from happening.

Dense cytoplasm Density often

is broken up into extends into a
DISTRIBUTION AND FATE OF
groups subsynaptic web NEUROTRANSMITTERS
● Acetylcholine

9
 NEURONS AND NERVE FIBERS

○ Found in neuromuscular junction, autonomic
ganglia, and parasympathetic nerve endings
○ Motor neuron collaterals to the Renshaw
cells
○ Ascending reticular pathways and the
afferent fibers for the visual and auditory
systems
○ Acetylcholinesterase (AChE) breaks down
acetylcholine
○ Widely distributed neurotransmitter in the
peripheral and central nervous system.
● Norepinephrine
○ Found in sympathetic nerve endings
○ High concentration in the hypothalamus
○ Norepinephrine transporter responsible for
reuptake of dopamine. → breakdown
● Dopamine
-
● They can co-exist with neurotransmitters at a single
synapse
○ Usually the neuromodulators are in separate
presynaptic vesicles
● Whereas unreleased into the synaptic cleft, the
neurotransmitters have a rapid brief effect on the
postsynaptic membrane. The neuromodulators
unreleased into the cleft do not have a direct effect on
the postsynaptic membrane; rather, they enhance,
prolong, inhibit, or limit the effect of the principal
neurotransmitter on the postsynaptic membrane.
That’s why they modulate or modify the activity
Table 2.3 Examples of Principal (Classic)

Neurotransmitters and Neuromodulators at Synapses

○ High concentration in basal ganglia
○ High concentration in the hypothalamus Neuromodulator Function Receptor
○ Dopamine transporter responsible for s Mechanism
reuptake of dopamine. → breakdown
-

Principal Neurotransmitters

Acetylcholine Rapid excitation

(niconitic), Ion channel
receptors
L-glutamate Rapid inhibition
GABA

Neuromodulators

Acetylcholine Modulation and G-protein-coupled

(muscarinic), modification of receptors
serotonin, activity
histamine,
adenosine

Neuromodulators Ionic Mechanism Location

Acetylcholine Opens cation

(niconitic), channel (fast Main sensory and
EPSP) motor systems

L-glutamate GABA Opens anion

channel for Cl
(fast IPSP)
● In this diagram, acetylcholine is released in the
synaptic cleft and can be hydrolyzed (broken down)
Neuromodulators
by acetylcholinesterase, while catecholamines are
taken up and recycled.
Acetylcholine Opens or closes Systems that
(muscarinic), K+ or Ca 2+ control
NEUROMODULATORS AT CHEMICAL SYNAPSES
serotonin, channels (slow homeostasis
● Certain substances, other than the neurotransmitters
histamine, IPSP and slow
are ejected from the presynaptic membrane into the
adenosine EPSP)
synaptic cleft
● Neuromodulators are capable of modulating and
modifying the activity of the postsynaptic neuron ● GABA
● Other receptor proteins bind the transmitter substance ○ Gamma-aminobutyric acid
and activate a second messenger system, usually ● EPSP
through a molecular transducer, a G-protein ○ Excitatory postsynaptic potential
● These receptors have a longer latent period, and the ● IPSP
duration of the response may last several minutes or ○ Inhibitory postsynaptic potential
longer
● Acetylcholine (muscarinic), serotonin, histamine, ELECTRIC SYNAPSES
neuropeptides, and adenosine are examples of
neuromodulators

10
 NEURONS AND NERVE FIBERS
● Gap junctions containing channels that extend from
the cytoplasm of the presynaptic neuron to that of the
postsynaptic neuron
● Rare in the human central nervous system
● Neurons communicate electrically and there’s no
chemical transmitter
● Bridging channels permit ionic current flow to take
place from one cell to the other with a minimum of
delay
● Rapid spread of activity from one neuron to another
ensures that a group of neurons performing an
identical function act together
● Bidirectional
○ In contrast to chemical synapses which are
unidirectional
WHAT ARE NEUROGLIA?
● Non-excitable cells that support the neurons
● Smaller than neurons and outnumber them by five to
ten times
● 4 types:
○ Astrocytes
○ Oligodendrocytes
○ Microglia
○ EPENDYMA
ASTROCYTES
● Small cell bodies with branching processes that
extend in all directions
● Fibrous astrocytes
○ Mainly in the white matter
○ Each process is long, slender, smooth, and
not much branched
○ The cell bodies and processes contain many
filaments in their cytoplasm
● Protoplasmic astrocytes
○ Mainly in the gray matter
○ The processes are shorter, thicker, and more
branched
○ The cytoplasm of these cells contains fewer
filaments
● Many of the processes of astrocytes end in
expansions on capillaries (perivascular feet)
○ Take part in blood-brain barrier
● Large numbers of astrocytic processes are
interwoven at the outer and inner surfaces of the CNS
where they form the:
○ Outer glial limiting membrane
■ Beneath the pia mater
○ Inner glial limiting membrane
■ Beneath the ependymal lining the
ventricles of the brain and the
central canal of the spinal cord
● Astrocytic processes around the initial segment of
most axons and at the nodes of Ranvier are also seen
● Functions:
○ Supporting framework for the nerve cells and
nerve fibers
○ Embryo: scaffolding for the migration of
immature neurons
○ Electrical insulators
■ Prevent the spread of nerve
impulses in the neighbouring or
unrelated neurons
○ Able to take up excess K ions from the
extracellular space for repetitive firing of a
neuron
○ Store glycogen
○ Act as phagocytes
○ Replacement gliosis
■ When there is neuronal death, the
astrocytes proliferate and fill in the
spaces
○ Conduit for the passage of metabolites or
raw materials from blood capillaries to the
neurons through their perivascular feet
○ Enable ions to pass from one cell to another
(gap junctions)
○ Secrete cytokines that regulate the activity of
immune cells
○ End feet of astrocytes (blood-brain barrier)
OLIGODENDROCYTES
● Small cell bodies and a few delicate processes
● No filaments in cytoplasm
● Found in rows along myelinated nerve fibers and
surround nerve cell bodies
● No basement membrane
● Functions:
○ Formation of myelin sheath of nerve fibers in
the CNS
■ Counterpart of schwann cells in the
PNS
○ 1 oligodendrocyte can support 60 internodal
segments (1:60)
○ Surround nerve cell bodies - satellite
oligodendrocytes
■ Influence the biochemical
environment of neurons
MICROGLIA
● Embryologically related to other neuroglial cells
○ Derived from macrophages outside the
nervous system
● Smallest of the neuroglial cells
● Scattered throughout the CNS
● From their small cell bodies arise wavy, branching
processes that give off numerous spine-like
projections
○ Closely resemble connective tissue
macrophages
● Migrate into the CNS during fetal life
● Increase in number in the presence of damaged
nervous tissue resulting from trauma and ischemic
injury and in the presence of (degenerative and
demyelinating) diseases including Alzheimer disease,
Parkinson disease, multiple sclerosis, and AIDS
○ Many of these new cells are monocytes that
have migrated from the blood
● Functions:
○ Normally inactive - resting microglial cells
■ Inactive when one has a CNS injury
○ Immune effector cells
■ Once there is inflammation in the
CNS, they retract their processes
and migrate to the site of the lesion.
In the site, they proliferate to
become antigen-presenting cells
which together with the T-
lymphocytes confront invading
organisms
○ Phagocytic
EPENDYMAL CELLS
● Line the cavities of the brain and central canal of the
spinal cord
11
 NEURONS AND NERVE FIBERS

● Form a single layer of cells that are cuboidal or

columnar in shape and possess microvilli and cilia
○ Cilia contribute to the flow of the
cerebrospinal fluid
● The basis of ependymal cells lie on the internal glial
limiting membrane

● Ependymocytes
○ Line the ventricles of the brain and the
central canal of the spinal cord and are in
contact with the cerebrospinal fluid
● Tanycytes
○ Line the floor of the third ventricle overlying
the median eminence of the hypothalamus
● Choroidal epithelial cells
○ Cover the surfaces of the choroid plexuses
○ Sides and bases are thrown into folds, and
near their luminal surfaces, the cells are held
together by tight junctions that encircle the
cells Table 2.4 The Structural Features, Location, and
■ These tight junctions prevent the Functions of the Different Neuroglial Cells
leakage of CSF
● Functions of Ependymal Cells: Neuroglial Cell Structure
○ Assist in the circulation of the cerebrospinal
fluid within the cavities of the brain and the Astrocytes
central canal of the spinal cord by the
movements of the cilia Fibrous Small cell bodies, long
○ Absorptive function through the microvilli slender processes,
○ Tanycytes - transport chemical substances cytoplasmic filaments,
from the cerebrospinal fluid to the perivascular feet
hypophyseal portal system
○ Choroidal epithelial cells - production and Protoplasmic Small cell bodies, short
secretion of cerebrospinal fluid from the thicks processes, many
choroid plexuses branches, few cytoplasmic
filaments, perivascular feet

Oligodendrocytes Small cell bodies, few

delicate processes, no
cytoplasmic filaments

Microglia Smallest of neuroglial cells,

wavy branches with spines

Ependyma

Ependymocytes Cuboidal or columnar in

shape with cilia and
microvilli, gap junctions

Tancytes Long basal processes with

end feet on capillaries

Choroidal epithelial cells Sides and bases thrown into

folds, tight junctions

Table 2.4 The Structural Features, Location, and

Functions of the Different Neuroglial Cells

Neuroglial Cell Location Function

Astrocytes

Fibrous White matter Provide supporting

framework, are
electrical insulators,

12
 NEURONS AND NERVE FIBERS

More more smth

myelin
=

○ Myelinated: surrounded by myelin sheath

limit spread of
neurotransmitters,
take up K+ ions
Protoplasmic Gray matter Store glycogen, have
a phagocytic function,
take place of dead
neurons, are a conduit
for metabolites or raw
materials, produce
■ Myelin sheath is not part of the
neuron but is formed by supporting
cells
CNS: Oligodendrocytes
PNS: Schwann cells
● The myelin sheath is a segmented, discontinuous
layer interrupted at regular intervals by the nodes of
Ranvier →channels
portion in axon that
are naked (no myelin)
,
alot of K & Na
is why many channels ; saltatory
○ Each segment of the myelin sheathbecause
that nodes jump

trophic substances
measures approximately 0.5 - 1 mm in
Oligodendrocytes In rows along Form myelin in CNS, length
myelinated influence biochemistry ○ In the CNS, each oligodendrocyte may form
nerves, of neurons and maintain myelin sheaths for as many as
surrounding 60 nerve cells or nerve fibers
neuron cell ○ In the PNS, there is only 1 schwann cell for
bodies each segment of 1 nerve

Microglia Scattered Are inactive in normal FORMATION OF MYELIN

throughout CNS, proliferate in ● PNS
CNS disease and ○ Axon first indents the side of a Schwann cell
phagocytes, joined by ○ Later on, the external plasma membrane of
blood monocytes the Schwann cell forms a mesaxon, which
suspends the axon within the Schwann cell.
Ependyma ○ The Schwann cell rotates on the axon so
that the plasma membrane becomes
wrapped around the axon in a spiral.
Ependymocytes Line Circulate CSF, absorb ○ To begin with, the wrappings are loose then
ventricles, CSF become tight with maturation.
central canal ■ Under an electron microscope, the
myelin is seen to be lamilated
Tancytes Line floor of Transport substances because of the continuous
third ventricle from CSF to wrappings
hypophyseal-portal ■ Some nerve fibers are surrounded
system by only a few turns while others
may have as many as 50
Choroidal epithelial Cover Produce and secrete ■ Each lamila measures 13 - 18 nm
cells surfaces of CSF thick
choroid ○ The dark major dense line (2.5 nm thick)
plexus consists of two inner protein layers of the
plasma membrane that are fused together.
EXTRACELLULAR SPACE ○ The lighter minor dense line (10 nm thick), is
formed by the approximation of the outer
WHAT ARE NEUROGLI surfaces of adjacent plasma membranes and
● When nerve tissue is examined under an electron
is made up of lipid.
microscope, there is a very narrow gap that separates
○ The fused outer protein layers of the plasma
the neurons of the neuroglial cells. These gaps are
membranes are very thin and form a thin
linked together and filled with tissue-fluid which is the
intraperiod line situated in the center of the
extracellular space
lighter lipid layer.
● In almost direct continuity with the cerebrospinal fluid
○ At the node of Ranvier, two adjacent
in the subarachnoid space externally and with the
Schwann cells terminate, and the myelin
cerebrospinal fluid in the ventricles of the brain and
sheaths become thinner.
the central canal of the spinal cord internally
■ As one approaches the node of
● Also surrounds the blood capillaries in the brain and
Ranvier, the myelin sheaths
spinal cord
become thinner
● Provides a pathway for the exchange of ions and
■ At these regions, the axolemma is
molecules between the blood and the neurons and
exposed.
glial cells
○ The incisures of Schmidt-Lanterman
● The plasma membrane of the endothelial cells of represent areas where the dark major dense
most capillaries is impermeable to many chemicals,
line is not formed as a result of the localized
and this forms the blood-brain barrier
persistence of Schwann cell cytoplasm
○ They just allow certain ions and molecules
■ The spiral of cytoplasm may
that will be able to pass through the barrier provide a pathway for the
conduction of metabolites from the
NERVE FIBERS surface region of the schwann cell
● Nerve fibers = Neurites = Nerve processes to the axon
● Myelinated and unmyelinated

13
 NEURONS AND NERVE FIBERS

● FIGURE A-D: cross-section showing the stages in the

formation of myelin sheath ● This diagram shows the relationship between an
● Yellow: axon, surrounded by schwann cell oligodendrocyte and myelinated nerve fibers
● Compared to PNS, there is absence of basement
● CNS membrane
○ The plasma membrane of the ● Wrapping of oligodendrocyte in the CNS is not typical
oligodendrocyte becomes wrapped around since it has something to do with the growth in the
the axon, and the number of layers will length of the nerve process itself
determine the thickness of the myelin
sheath.
■ The nodes of Ranvier are situated
in the intervals between adjacent
oligodendrocytes
○ Process of myelination occurs by the growth
in length of the process of the
oligodendrocyte
■ The process wrapping itself around
the axon is secondary to the growth
in length of the process of the
oligodendrocyte
○ Incisures of Schmidt-Lanterman in the nerve
fibers of CNS

Table 3.1 Myelination in the Peripheral and Central

Nervous System

Location Cell Responsible Number of Nerve

Fibers Served by
Cell

Schwann cell 1
Peripheral nerve
CNS tract
Oligodendrocytes Up to 60
● There are areas where the dark major dense line is
not formed as a result of the persistence of the
schwann cell cytoplasm
Location Nodes of Schmidt- Mesaxon
Ranvier Lanterman NONMYELINATED NERVE FIBERS
Inclaures ● Smaller axons of the CNS, the postganglionic axons
of the autonomic part of the nervous system, and
Peripheral Present Present Present some fine sensory axons associated with the
nerve CNS reception of pain
tract Present Present Absent

14
 NEURONS AND NERVE FIBERS

● PNS: Each axon, which is usually less than 1 μm in ■ In the PNS, this function is
diameter, indents the surface of the Schwann cell so performed by the local members of
that it lies within a trough. the reticuloendothelial system.
● As many as 15 or more axons may share a single ○ Chronic forms of injury:
Schwann cell, each lying within its own trough or ■ Size of cell body is reduced
sometimes sharing a trough. ■ Nucleus and cytoplasm show
● In some situations, the troughs are deep and the hyperchromatism
axons are embedded deep in the Schwann cells, ■ Nuclear membranes and
forming a mesaxon from the Schwann cell plasma cytoplasmic organelles show
membrane. irregularity
● The Schwann cells lie close to one another along the
length of the axons, and there are no nodes of AXONAL REACTION AND AXONAL DEGENERATION
Ranvier. ○ Take place in a nerve cell when the axon is
● CNS: Nonmyelinated nerve fibers run in small groups cut or injured
and are not particularly related to the ○ Changes start to appear within 24 to 48
oligodendrocytes. hours after injury
○ The degree of change will depend on the
severity of the injury to the axon and will be
greater if the injury occurred close to the cell
body
■ Nerve cell becomes rounded off
and swollen
■ Nucleus swells and becomes
extensionally placed
■ Nissl granules become dispersed
toward the periphery of the
cytoplasm like in neuronal injury
○ Same changes are seen like in neuronal
injury and these reach their maximum in
about 12 days
○ PNS: attempts at regeneration and
reparative changes take place in the cell
body
○ CNS: not followed by regeneration
CLINICAL CORRELATES ■ Example: if the corticospinal tracts
● Neuronal Injury are destroyed, the nerve cells that
○ Loss of function of the neuron give rise to these axons degenerate
○ Recovery or death depends on the severity and disappear completely
and duration of the damaging agent ■ Nerve cells of the posterior root
○ Morphologic evidence of cell injury requires ganglia of the spinal nerves -
a minimum of 6 to 12 hours of survival EXCEPTION
○ Nerve cell becomes swollen ● If the peripheral axons
○ Nucleus swells and is displaced toward are sectioned, the nerve
the periphery of the cell cells show degenerative
○ Nissl granules become dispersed toward changes
the periphery of the cytoplasm ○ The peripheral
■ At this stage, the neuron may axons are the
recover. But if the kind of neuronal ones that display
injury is not so severe, further regeneration
reparative change may happen ● If ever the central axons
○ Reparative changes: Cell would resume its are sectioned and
former size and shape, the nucleus would destroyed, the nerve cell
return to the center of the cell body, and the show degenerative
Nissl granules would take up their normal changes
position Axonal Transport and the Spread of Disease
○ Imminent cell death: Cell cytoplasm shows ○ Rabies
hyperchromatism, and the nuclear structure ■ Acute viral disease that is
becomes unclear. transmitted by a bite of an infected
■ Hyperchromatism: cell cytoplasm animal
stains dark with basic dyes ■ The virus present in the saliva,
○ Cell death: The cytoplasm becomes following a bite, travels to the CNS
vacuolated, and the nucleus and cytoplasmic by way of axonal transport
organelles disintegrate. ○ Herpes simplex and herpes zoster
○ The neuron now is dissolved and removed ■ Herpes zoster is a viral disease
by the activity of the phagocytes wherein the virus remains latent
■ In the CNS, this function is and when reactivated, it may affect
performed by the microglial cells the sensory neurons in the cranial
and spinal nerves

15
 NEURONS AND NERVE FIBERS

● Tumors of Neurons - quite rare or the presence of new

○ Neuroblastoma capillaries without fully
○ Ganglioneuroma formed blood-brain
○ Pheochromocytoma barriers
● Causes: infections,
● Reactions of Neuroglia to Injury trauma, and tumors
○ Caused by physical trauma or vascular ■ Cytotoxic edema
occlusion ● Accumulation of fluid
○ Hyperplasia and hypertrophy of the within the cells of nervous
astrocytes, which become fibrous tissue (neurons and glial)
○ Astrocytosis or gliosis ● Failure in the plasma
■ Proliferation of astrocytes occurs membrane (EEP) sodium-
■ The loss of neuronal tissue is not pump mechanism
compensated for in volume by the ● Causes: toxic or
glial hypertrophy metabolic, Stroke
○ The cytoplasm of the enlarged astrocytes ■ Interstitial edema
contains large numbers of fibrils and ● Obstructive hydrocephalus
glycogen granules ● Non-communicating
○ The dense feltwork of astrocytic processes hydrocephalus
that occurs in the areas of neuronal ● Two anatomical factors: (1) the brain volume is
degeneration produces gliotic scar restricted by the surrounding skull, and (2) the tissue
● Reactions of Neuroglia to Injury fluid is drained primarily into the venous sinuses via
○ Oligodendrocytes respond to injury cerebral veins because there is no lymphatic drainage
■ Expanding and showing vacuolation ● Monro-Kellie doctrine: The sum of volumes of brain,
of their cytoplasm CSF, and intracranial blood is constant. An increase
■ Pyknotic nuclei in one should cause a decrease in one or both of the
■ Severe damage: demyelination remaining two.
○ Microglial cells retract their processes and ○ The other two must compensate. If the
migrate to the site of the lesion. compensatory mechanism fails, increase
● Neoplasms of Neuroglia intracranial pressure may ensue
○ 40 to 50% of intracranial tumors
■ More common than neoplasms of DISORDERS OF NEUROTRANSMITTER
neurons METABOLISM
○ Examples: ○ Parkinson Disease
■ Gliomas ■ Affects (loss) dopamine-
● Astrocytomas and synthesizing neurons in the
neoblastomas substantia nigra
■ Ependymomas ■ Symptoms: tremor, rigidity,
●
a-
Multiple Sclerosis
○ One of the most common CNS diseases
slowness in movement, postural
instability
○ Characterized by patches of demyelination in ■ Treatment: L-dopa
the white matter of the CNS ● Replacement of dopamine
■ The myelin sheaths degenerate and through L-dopa
myelin is removed by the microglial ○ Alzheimer Disease
cells ■ Degeneration of neurons in basal
■ Generally it starts in the optic nerve, forebrain nuclei (cholinergic), the
spinal cord, or the cerebellum loss of synapses in the cerebral
○ Because the nerve fibers are demyelinated, cortex and hippocampus
conduction of the nerve impulses in the ■ Pathologoic structures to be seen:
axons is impeded neurofibrillary tangles and senile
○ Most cases occur between the ages of 20 plaques
and 40 years ■ Acetylcholinesterase inhibitor
● Cerebral Edema ● Drugs like donepezil better
○ Very common clinical condition that follows increase the levels of
head injury, infection, tumor, and stroke acetylcholine
■ Resultant swelling of the brain may
lead to flattening of the gyri, PERIPHERAL NERVES
herniation of the brain, and even ● Collective term for the cranial and spinal nerves
death ● Consist of parallel bundles of nerve fibers, which may
○ Defined as an abnormal increase in the be efferent or afferent axons, may be myelinated or
water content of the tissues of the CNS nonmyelinated, and are surrounded by connective
○ Three types: tissue sheaths
■ Vasogenic edema ● The nerve trunk is surrounded by a dense connective
● Most common type tissue sheath called epineurium
● Accumulation of tissue ● Bundles of nerve fibers surrounded by the
fluid in the extracellular perineurium.
space following damage to ● Individual nerve fibers surrounded by the
the vascular capillary walls endoneurium.

16
 NEURONS AND NERVE FIBERS

○ The connective tissue sheaths serve to

support the nerve fibers in their associated CRANIAL NERVES
blood vessels and lymph vessels
● Can be classified according to their speed of Entirely afferent 1. Olfactory
conduction and size 2. Optic
3. Vestibulocochlear

Entirely efferent 4. Oculomotor

5. Trochlear
6. Abducent
7. Accessory
8. Hypoglossal

Both afferent and 9. Trigeminal

efferent 10. Facial
11. Glossopharyngeal
12. Vagus

SENSORY GANGLIA AND AUTONOMIC GANGLIA

● Figure shows:
○ Epineurium: outermost covering; covers the
nerve trunk
○ Perineurium: covers the numerous nerve
bundles within the nerve trunk
○ Endoneurium: covers each nerve bundles
made of individual nerve fibers
SPINAL NERVES AND SPINAL ROOTS
● The peripheral nerves are composed of spinal nerves
and cranial nerves.
● 31 pairs of spinal nerves, which leave the spinal cord
and pass through intervertebral foramina
● Each spinal nerve is connected to the spinal cord by
two roots: the anterior root and the posterior root
● The anterior root consists of bundles of efferent
fibers.
● The posterior root consists of bundles of afferent
fibers.
○ It carries nerve impulses towards the CNS
○ Because these fibers are concerned with
conveying information to the CNS, they are
called sensory fibers.
● The cell bodies of these nerve fibers are situated in
the swelling posterior root called the posterior root
ganglion.
CRANIAL NERVES
● 12 pairs of cranial nerves
○ This leaves the brain nerves pass through
the foramina in the skull
● Each sensory ganglion is surrounded by a layer of
connective tissue that is continuous with the
epineurium and perineurium of the peripheral nerve.
● The neurons are unipolar, possessing cell bodies that
are rounded or oval in shape.
● Each nerve cell body is closely surrounded by a layer
of flattened cells called capsular cells or satellite
cells.
● The autonomic ganglia (sympathetic and
parasympathetic ganglia) are situated at a distance
from the brain and spinal cord.
● They are found in the sympathetic trunks, in
prevertebral autonomic plexuses and as ganglia in or
close to the viscera.
● The neurons are multipolar and possess cell bodies
that are irregular in shape.
● Each nerve cell body is closely surrounded by
capsular cells or satellite cells.
PERIPHERAL NERVE PLEXUS
● Network of nerves
● “Plexus” = collection or network of nerves
● The formation of a nerve plexus allows individual
nerve fibers to pass from one peripheral nerve to
another
○ In most instances, branching of nerve fibers
DOES NOT take place.
○ A plexus permits a redistribution of the nerve
fibers with the different peripheral nerves.
● At the root of the limbs, the anterior rami of the spinal
nerves form complicated plexuses
● The cervical and brachial plexuses are at the root of
the upper limbs and the lumbar and sacral plexuses
are at the root of the lower limbs.
○ These allow nerve fibers from the different
segments of the spinal cord to be arranged
and distributed efficiently in different nerve
trunks to various parts of the upper and
lower limbs.
● Cutaneous and autonomic nerves may also form fine
plexuses.
○ Cutaneous nerves, as they approach their
final destination, commonly form fine
plexuses.
○ The autonomic nervous system also
possesses numerous nerve plexuses that

17
 NEURONS AND NERVE FIBERS

consist of preganglionic and postganglionic ○ In the large motor fibers (alpha fibers), the
nerve fibers and ganglia. rate of conduction velocity is as high as 70
to 120 m/s.
○ The smaller sensory fibers have slower
BRACHIAL PLEXUS conduction rates.
● In nonmyelinated fibers, the action potential passes
continuously along the axolemma, progressively
exciting neigh- boring areas of the membrane.
● In myelinated fibers, the presence of a myelin sheath
serves as an insulator, and few ions can flow through
the sheath.
● Consequently, a myelinated nerve fiber can be
stimulated only at the nodes of Ranvier.
● The action potential at one node sets up a current in
the surrounding tissue fluid, which quickly produces
depolarization at the next node → saltatory
conduction (120.0 m/s in a large myelinated fiber
compared with 0.5 m/s in a very small unmyelinated
fiber)
○ Saltatory conduction is a more rapid
mechanism than what is found in
unmyelinated fibers.

Table 3.2 Classification of Nerve Fibers by Speed of

Conduction and Size

Fiber Type Conduction Fiber Diameter

Velocity (m/s) (µm)

A Fibers

Alpha 70-120 12-20

● Composed of the anterior rami of C5-C8, T1 Beta 40-70 5-12

● At the level of the roots, some nerves may already
emerge Gamma 10-50 3-6
○ e.g. Dorsal scapular nerve
○ e.g. Long thoracic nerve (combination of the Delta 6-30 2-5
C5, C6, and C7)
● The roots merge together to form trunks B Fibers 3-15 <3
○ Superior Trunk: merged C5 and C6 roots
○ Middle Trunk: continuity of C7 C Fibers 0.5-2.0 0.4-12
○ Inferior Trunk: merged C8 and T1 ↳ unmyelinated that is why it is the slowest
● Each trunk separates into anterior and posterior
divisions. Fiber Functions Myelin Sensitivity to
● The different divisions combine to form cords Type Local
○ Posterior Cord (located in the middle) is Anesthetics
formed by the three posterior divisions of the
trunks. A Fibers
○ Lateral Cord is formed from the anterior
divisions of the upper and middle trunks. Alpha Motor, skeletal Yes Least
○ Medial Cord is formed from the anterior muscle
division of the lower trunk.
● From the different cords, different nerves arise.
Beta Sensory, touch, Yes
○ The different nerves that innervate the
pressure, vibration
different muscles of the upper and lower
extremities come from different combinations
Gamma Muscle spindle Yes
of roots.
● Injuring the brachial plexus from its roots could have
an effect (i.e. weakening) to various muscles Delta Pain (sharp, Yes
localized),
CONDUCTION IN PERIPHERAL NERVES temperature, touch
● The conduction velocity of a nerve fiber is
proportional to the cross-sectional area of the axon, B Fibers Preganglionic Yes
with the thicker fibers conducting more rapidly than autonomic
those of smaller diameter.

18
 NEURONS AND NERVE FIBERS

fascia, ligaments, joint capsules, tendons,

C Fibers Pain (diffuse, deep), No Most periosteum, perichondrium, haversian
temperature, systems of bone, tympanic membrane,
postganglionic dental pulp; muscle
autonomic ○ Afferent nerve fibers are either myelinated or
nonmyelinated.
○ The terminal endings are devoid of a myelin
● The larger the fiber, the greater the diameter, the sheath, and there are no Schwann cells
more myelin it has = faster conduction velocity covering their tips = naked nerve endings
● A-Alpha fibers ○ Can MAINLY detect pain, while others detect
○ Fastest (70-120 m/s) crude touch, pressure, tickle sensations, and
○ Least sensitive to local anesthetics possibly cold and heat
● C fibers
○ Slowest (0.5-2.0 m/s)
○ Most sensitive to local anesthetics
○ Only unmyelinated nerve fiber

RECEPTOR ENDINGS
● Can be classified according to function and/ or
anatomically.

FUNCTIONAL TYPES

Mechanoreceptors mechanical deformation

Thermoreceptors changes in temperature

● Merkel Discs
Nociceptors damage to the tissue ○ Found in hairless skin (e.g. fingertips) and in
hair follicles
Electromagnetic receptors rods and cones of ○ The nerve fiber passes into the epidermis,
the eyes to changes in light and terminates as a disc-shaped expansion.
intensity and (*The green one)
wavelength ○ The disc-shaped expansion is applied
closely to a dark-staining epithelial cell in the
deeper part of the epidermis called the
Chemoreceptors chemical changes merkel cell.
associated ○ In hairy skin, clusters of merkel discs known
with taste and smell and as tactile domes are found in the epidermis
oxygen and carbon between the hair follicles.
dioxide concentrations in the ○ Slowly adapting touch receptors that transmit
blood information about the degree of pressure
exerted on the skin. (e.g. when holding a
pen)
ANATOMICAL TYPES ● Hair Follicle Receptors
○ Nerve fibers wind around the follicle in its
Nonencapsulated • Free Nerve outer connective tissue sheath below the
Endings sebaceous gland.
■ Some branches surround the follicle
• Merkel Discs
while others run parallel to its long
• Hair Follicle
axis.
Receptors
■ Many naked axon filaments
terminate among the cells of the
Encapsulated • Meissner’s outer root sheath.
Corpuscles ○ Bending of the hair stimulates the follicle
• Pacinian receptor
Corpuscles ○ Rapidly adapting group of mechanoreceptors
• Ruffini Corpuscles ○ While the hair remains bent, the receptor is
silent. But once it is released, further bursts
NONENCAPSULATED RECEPTORS of nerve impulses are initiated.
● Free Nerve Endings
○ Most numerous
○ Widely distributed throughout the body
○ Found in: Epithelial cells of the skin, the
cornea, and the alimentary tract, and in
connective tissues, including the dermis,

19
 NEURONS AND NERVE FIBERS

● Pacinian Corpuscles
○ Widely distributed throughout the body, but
are abundant in the dermis, subcutaneous
tissue, ligaments, joint capsules, pleura,
peritoneum, nipples, and external genitalia
○ Ovoid in shape, measuring about 2 mm long
and about 100 to 500 μm across
○ Consist of a capsule with numerous
concentric lamellae of flattened cells and a
central core containing the nerve ending
■ A large myelinated nerve fiber
enters the corpuscle and uses its
myelin sheath and its Schwann cell
covering.
■ The naked axon surrounded by
lamellae formed from flattened cells
passes to the center of the core and
terminates in an expanded end.
■ Rapidly adapting mechanoreceptor
that is particularly sensitive to
vibration. (Can respond to up to 600
stimuli/ second)

ENCAPSULATED RECEPTORS
● Meissner’s Corpuscles
○ Located in the Dermal papillae of the skin
especially that of the palm of the hand and
the sole of the foot; skin of the nipple and the
external genitalia
○ Ovoid in shape and consists of a stack of
modified flattened Schwann cells arranged
transversely across the long axis of the
corpuscle
○ Enclosed by a capsule of connective tissue
that is continuous with the endoneurium of
the nerves that enter it
○ Very sensitive to touch and are rapidly
adapting mechanoreceptors
■ Similar to hair follicle receptors ● Ruffini Corpuscles → vibration
○ Responds to two-point tactile discrimination ○ Located in the dermis of hairy skin
○ Consists of several large unmyelinated nerve
fibers ending within a bundle of collagen
fibers and surrounded by a cellular capsule.
○ Slowly adapting mechanoreceptors are
stretch receptors, which respond when the
skin is stretched.

20
 NEURONS AND NERVE FIBERS

● The intrafusal fibers of the spindles are of two types:

Rapidly Adapting Slowly Adapting ○ Nuclear bag fibers:
■ Numerous nuclei in the equatorial
● Hair Follicle ● Merkel Discs region; larger in diameter than the
Receptors ● Ruffini Corpuscles nuclear chain fibers
● Meissner’s ■ Cross striations are absent in this
Corpuscles region
● Pacinian ■ These extend beyond the capsule
Corpuscles at each end to be attached to the
endomysium of the extrafusal fibers
TRANSDUCTION OF SENSORY STIMULI INTO ○ Nuclear chain fibers:
NERVE IMPULSES ■ forms a single longitudinal row or
chain of nuclei in the center of each
● It is agreed that the type of sensation felt is
fiber.
determined by the specific area of the CNS to which
● Two types of sensory innervation of muscle fibers:
the afferent nerve fiber passes.
○ The annulospiral endings
○ e.g. When one stimulates a pain nerve fiber
■ are situated at the equator of the
by heat/cold/ touch, the individual will only
intrafusal fibers.
experience pain because the affected nerve
■ As the large myelinated nerve fiber
fiber is of pain.
purses the capsule, it loses its
● The stimulus, when applied to the receptor, means
myelin sheath, and the naked axon
about a change in potential in the plasma membrane
winds spirally around the nuclear
of the nerve ending.
bag/ chain, portions of the intrafusal
○ Since this process takes place in the
fibers.
receptor, it is referred to as the receptor
○ The flower-spray endings
potential.
■ are situated mainly on the nuclear
● The amplitude of the receptor potential is proportional
chain fibers some distance away
to the intensity of the stimulus.
from the equatorial region of the
● By opening more ion channels for a longer time, a
nuclear bag.
stronger mechanical pressure can produce a greater
■ A myelinated nerve fiber that is
depolarization than those of weaker pressures.
slightly smaller than that for the
● With chemoreceptors and photoreceptors, the
annulospiral ending pierces the
receptor potential is produced by second messengers
capsule and loses its myelin
activated.
sheath.
○ When a stimulus agent binds to the
■ The naked axon branches
membrane receptors coupled to G-proteins,
terminally and ends as varicosities,
and when it is large enough, the receptor
resembling a spray of flowers.
potential will generate an action potential
● Stretching of the intrafusal fibers results in stimulation
that will travel along the afferent nerve fiber
of the annulospiral and flower-spray endings, and
to the CNS.
nerve impulses pass to the spinal cord in the afferent
○
neurons.
● Motor innervation of the intrafusal fibers is provided
JOINT RECEPTORS by fine gamma motor fibers.
● There are four (4) types of sensory endings located
● The nerves terminate in small motor end-plates
in the capsule ligaments of synovial joints:
situated at both ends of the intrafusal fibers.
○ 3 of these are encapsulated and resembled
● Stimulation of the motor nerves causes both ends of
■ Pacinian
the intrafusal fibers to contract and activate the
■ Ruffini
sensory endings.
■ tendon stretch receptors
● Since the equatorial region has no striations, it is non-
○ The fourth type is nonencapsulated and is
contractile.
thought to be sensitive to excessive
● The extrafusal fibers of the remainder of the muscle
movements and transmit pain sensations.
receive the innervation in the usual large alpha-sized
axons.
NEUROMUSCULAR SPINDLES ● Muscular spindles form in muscle length and the
● Found in skeletal muscle and most numerous toward change in the rate of muscle length.
the tendinous attachment of the muscle.
● They provide the CNS with sensory information
regarding the muscle length and the rate of change
in the muscle length
○ This information is used by the CNS in the
control of muscle activity.
● Each spindle measures about 1-4 millimeters in
length and is surrounded by a fusiform capsule of
connective tissue.
● Within the capsule are 6 to 14 slender intrafusal
muscle fibers.
● The ordinary muscle fibers situated outside the
spindles are referred to as extrafusal fibers.

21
 NEURONS AND NERVE FIBERS

● These provide the CNS with sensory information

regarding the tension of muscles .

Neuromuscular Spindle = muscle length

Neurotendinous Spindles (Golgi Tendon) = muscle
tension

● Each spindle consists of a fibrous capsule that

surrounds a small bundle of loosely arranged
contractile tendons.
→ non
-

○ The tendon cells are larger and more

→ contractile
● Parts of a Neuromuscular Spindle:
○ Intrafusal fibers
○ Nuclear bag
○ Nuclear chain
○ Annulospiral endings (surround the nuclear
bag)
○ Flower-spray endings
○ Extrafusal muscle fiber
STRETCH REFLEX
● Stretching a muscle results in elongation of the
intrafusal fibers of the muscle spindle and stimulation
of the annulospiral and flower-spray endings.
● The nerve impulses reach the spinal cord in the
afferent neurons and synapse with the large alpha
motor neurons situated in the anterior gray horns of
the spinal cord.
● Nerve impulses now pass via the efferent motor
nerves and stimulate the extrafusal muscle fibers, and
the muscle contracts.
● The muscle spindle afferent impulses inhibit the alpha
motor neurons supplying the antagonist muscles. (aka
reciprocal inhibition)
numerous than those found elsewhere in the
tendon.
● One or more myelinated sensory nerve fibers pierce
the capsule, lose their myelin sheath, branch, and
terminate in club- shaped endings.
● The nerve endings are activated by being squeezed
by the adjacent tendon fibers within the spindle when
tension develops in the tendon.
● In case the muscle tension stimulates these spindles
and an increased number of nerve impulses reach the
spinal cord through afferent nerve fibers, these
fibers synapse also with the large alpha motor
neurons situated in the anterior gray horn.
○ This reflex is inhibitory unlike the muscle
spindle reflex.
● Inhibits muscle contraction
○ In this manner, the tendon reflex prevents
the development of too much tension in the
muscle.
○ Although this function is important as a
protective mechanism, its main function in
the CNS is still to provide information to
influence voluntary muscle activity.

CONTROL OF THE INTRAFUSAL FIBERS OF THE

NEUROMUSCULAR SPINDLE
● Other structures control the intrafusal fibers of the
neuromuscular spindle.
● Brain and spinal cord: centers that give rise to tracts
that synapse with the gamma motor neurons in the
spinal cord.
○ The reticular formation, the basal ganglia,
and the cerebellum that can greatly influence
voluntary muscle activity.
● The gamma efferent motor fibers cause shortening
of the intrafusal fibers which in turn, initiates the reflex
contraction of the extrafusal fibers.
● The nuclear bag fibers are concerned with dynamic Table 3.3 Classification and Comparison of Receptor
responses and are associated more with position and Types
velocity of contraction,
● The nuclear chain fibers are associated with slow Type of Receptor Location Stimulus
static contractions of voluntary muscle.
Nonencapsulated Receptors
STRUCTURE OF NEURONS
Neurotendinous Spindles (Golgi Tendon)
● These are found near the junctions of tendons with Free nerve Epidermis, Mechanoreceptor
muscles endings cornes, gut, s

22
 NEURONS AND NERVE FIBERS

○ Single innervation: limbs, head, and neck

dermis, ligaments, ○ Multiple innervation: large muscles (e.g.
joint capsules, abdominal wall)
bone, dental pulp, ● The nerve supply and blood supply to a muscle enter
etc. it at a more or less constant position called the
neurovascular hilus.
Merkel discs Hairless skin Mechanoreceptor ● The nerve to a muscle contains motor and sensory
s fibers.
● The MOTOR FIBERS are of three (3) types:
Hair follicle Hairy skin Mechanoreceptor ○ 1) Large alpha myelinated fibers
receptors s ■ supply the extrafusal fibers
○ 2) Small gamma myelinated fibers
■ supply the intrafusal fibers
○ 3) Fine unmyelinated C fibers
Type of Receptor Location Stimulus ■ supply the postganglionic
autonomic efferents
Encapsulated Receptors ● The SENSORY FIBERS are of three (3) types:
○ 1) Myelinated fibers
■ annulospiral and flower- spray
Meissner’s Dermal papillae of Mechanoreceptor endings
corpuscles skin of palm and s ○ 2) Myelinated fibers:
sole of foot ■ neurotendinous spindles
■ these originate from their
Pacinian Dermis, Mechanoreceptor neurotendinous spindles
corpuscles ligaments, joint s ○ 3) Myelinated and unmyelinated fibers
capsules, ■ originated from a variety of sensory
peritoneum, endings in the connective tissue of
external genitalia, the muscle
etc.
MOTOR UNIT
Ruffini corpuscles Dermis of hairy Mechanoreceptor
skin s

Neuromuscular Skeletal muscle Mechanoreceptor

spindles

Neurotendinous Tendons Mechanoreceptor

spindles s

Type of Sensory Adaptability Fibers

Receptor Modality

Encapsulated Receptors
● Defined by a single alpha motor neuron and the
=
muscle fibers that it innervates
Meissner’s Touch Rapid A beta ● The muscle fibers of a single motor unit are widely
corpuscles scattered throughout the muscle.
● Motor units where fine and precise muscle control are
Pacinian Vibration Rapid A beta required, possess only a few muscle fibers. (e.g. in
corpuscles the eyes)
● Motor units for large limb muscles require hundreds of
Ruffini Stretch Slow A beta muscle fibers for the said muscles to contract.
corpuscles ● A motor unit has:
○ An afferent neuron that rises from the
Neuromuscu Stretch-- Fast A alpha neuromuscular spindle
lar spindles muscle A beta ○ An efferent lower motor neuron from the
length anterior horn cell within the spinal cord that
proceeds to the motor end plate.
Neurotendin Compressio Fast A alpha
ous spindles n--muscle NEUROMUSCULAR JUNCTION IN SKELETAL
tension MUSCLE

INNERVATION OF SKELETAL MUSCLE

● It is innervated by one or more nerves.

23
 NEURONS AND NERVE FIBERS
● Skeletal muscle fibers are innervated by large alpha
myelinated nerve fibers
○ These are derived from the large motor
neurons in the anterior grey columns of the
spinal cord
● The number of branches of the myelinated fiber that
enters a skeletal muscle depends on the size of the
motor unit
○ So, a single branch then terminates on a
muscle fiber at a cite referred to as a
neuromuscular junction or motor end
plate (between the nerve and the muscle)
● The great majority of muscle fibers are innervated by
just one motor end plate
● So, on reaching the muscle fiber, the nerve loses its
myelin sheath and breaks up into a number of fine
branches.
○ Each branch ends as a naked axon and
forms a neural element of the motor end
plate
○ The axon is expanded slightly and contains
many mitochondria and vesicles
● The site of the motor end plate, the surface of the
muscle fiber, is elevated (sole plate - elevated
portion of the muscle)
○ The elevation is due to the local
accumulation of granular sarcoplasm
(beneath the sarcolemma) and presence of
numerous nuclei and mitochondria
● The expanded naked axon lies in a groove, on the
surface of a muscle outside the plasma membrane.
○ Each groove is formed by the folding of the
plasma membrane and the groove may
branch many times with each branch
containing a division of the axon
● It is important to realize that the axons are truly naked
○ The Schwann cells merely serve as a cap or
roof to the groove and never project to it
● The floor of the groove is formed by the plasma
membrane which is turned into numerous folds
○ These numerous small folds are turned to
junctional folds
○ These folds increase the surface area of the
plasma membrane that lies close to the
naked axon
● The plasma membrane of the axon, the axolemma, is
separated by a space around 30 to 50 nanometers
wide from the plasma membrane of the muscle fiber.
This space is the synaptic cleft.
○ The synaptic cleft is filled with basement
membranes of the axon and muscle fiber.
In Summary
ACh → Nicotinic type of ACh receptor, Ach-gated channels
opened → Na+ influx → End-plate potential created
End-plate potential (if large enough) → Na+ gated channels
opened → Na+ influx → Action potential created
Action potential → Increased release of Ca++ → Muscle fiber
contraction
Immediate hydrolysis of ACh by AChE → ACh-gated channels
closed → Muscle fiber repolarization
● Once an axon potential arrives in the presynaptic
region, this stimulates opening of Ca2+ channels
● Calcium entry into the presynaptic neuron leads to the
release or fusion of the vesicles into the presynaptic
plasma membrane and release of the
neurotransmitter (Acetylcholine: ACh)
● It binds with a nicotinic type of ACh receptor and it
promotes, since it is excitatory, Na+ influx and an
end-plate potential is created
● If that end-plate potential is large enough then, an
action potential may be generated
● Once action potential is generated, it will increase the
release of Ca2+ in the muscle fiber
● Once there is increase of Ca2+ in the muscle fiber,
the muscle fiber will contract
● ACh is broken down or hydrolyzed by
acetylcholinesterase
● The muscle fiber goes back to its resting state or
repolarizes
24
 NEURONS AND NERVE FIBERS

Levels to Remember (Dermatomal Chart):

T4 - nipple area
T6 - xiphoid area
T10 - umbilical area
T12 - inguinal area
.

This dermatomal distribution is very important and can be

applied especially in patients with spinal cord injury.

SEGMENTAL INNERVATION OF MUSCLES

Skeletal muscles also receive a segmental innervation. So,

most of these muscles are innervated by more than one spinal
nerve and therefore, by the same number of segments of the
spinal cord. Thus, to paralyze a muscle completely, it would be
necessary to section several spinal nerves or destroy several
segments of the spinal cord.

Example: If you injure the brachial plexus from the roots, many
muscles may be affected, weaken, or even be paralyzed.

To learn the segmental innervations of all the muscles of the

body is an impossible task but there are certain maneuvers
that would help us to test these muscles. This is through the
muscle reflexes or tendon reflexes.

● Biceps brachii tendon reflex (C5-6) - flexion of the

elbow joint by tapping the biceps tendon using a
reflex hammer

● Triceps tendon reflex (C6-7 and C8) - extension of

the elbow joint by tapping the triceps tendon

● The area of skin supplied by a single spinal nerve,

called a dermatome.
● On the trunk, the dermatomes extend round the body
from the posterior to the anterior median plane.
● Adjacent dermatomes overlap considerably.
○ To produce a region of complete anesthesia,
you will need to have at least three
contiguous spinal nerves to be sectioned or
injured before complete anesthesia occurs

The area of tactile loss is always greater than the area of loss of
painful and thermal sensations.

REASON: The degree of overlap of fibers pain and temperature ● Brachioradialis tendon reflex (C5-6 and C7) -
is much more extensive compared to touch or tactile sensations. supination of the radioulnar joints by tapping the
insertion of the brachioradialis tendon

25
 NEURONS AND NERVE FIBERS
● Abdominal superficial reflexes - contraction of
underlying abdominal muscles by stroking the skin
○ Upper abdominal skin T6-7;
○ Middle abdominal skin T8-9;
○ Lower abdominal skin T10-12
Example: If a patient has upper thoracic
cord injury, the levels below it will be
affected like the T6 - T12 that innervates
the abdominal muscles. If you have a
higher cord lesion, the expected
contraction of the abdominal muscles
using this particular maneuver may be
absent.
● Patellar tendon reflex (knee jerk) (L2, L3, and L4) -
extension of knee joint on tapping the patellar tendon
Posture
● The position adopted by the individual within his or
● In the standing position, the line of gravity passes
● In order to stabilize the body and prevent it from
● Achilles tendon reflex (ankle jerk) (S1 and 2) -
plantar flexion of ankle joint on tapping the Achilles
tendon— tendo calcaneus)
● In order to maintain posture, aside from the simple
MUSCLE TONE AND MOVEMENT
● Every skeletal muscle, while resting, is in a partial
state of contraction.
○ This condition is referred to as muscle tone
● Muscle fibers are either fully contracted or relaxed.
○ Because there is no intermediate stage
○ Few muscle fibers are fully contracted all the
time
■ To bring about this state, different
groups of motor units and thus,
different groups of muscle fibers are
brought into action at different
times.
■ This is accomplished by the
asynchronous discharge of nervous
impulses in the motor neurons in
the anterior gray horn of the spinal
cord.
● Muscle tone is dependent on the integrity of a simple
monosynaptic reflex arc.
○ Afferent comes from the neuromuscular
spindle
○ Efferent coming from anterior horn cell back
to the muscle end plate
● The lengthening and shortening in a muscle are
detected by sensitive sensory endings called muscle
spindles and the tension is detected by tendon
spindles.
● The degree of activity of the motor anterior column
cells and the degree of muscle tone depend on the
summation of the nerve impulses received by these
cells from other neurons of the nervous system.
● Muscle movement is accomplished by bringing into
action increasing numbers of motor units and
reducing the activity of the motor units of muscles that
will antagonize the movement.
○ If there is loss of muscle tone, it appears
flaccid. Upon palpation, it feels like a mass
of dough that has loss its resilience and later
on, it quickly reduces in bulk and volume
her environment.
through the
○ odontoid process of the axis
○ behind the centers of the hip joints, and
○ in front of the knee and ankle joints.
collapsing, the antigravity muscles are well
developed and exhibit the greatest degree of tone.
○ Therefore, posture depends on the degree of
distribution of muscle tone which in turn
depends on the normal integrity of the simple
reflex arc centered in the spinal cord
○ An individual may assume a particular
posture over long periods of time with little
evidence of fatigue. It is because of the
different groups of muscle fibers contracting
in relays with only a small number of muscle
fibers within a muscle being in a state of
contraction at any one time.
○ The active muscle groups are scattered
throughout the muscle
muscle reflex, on which muscle tone is dependent,
must receive adequate nervous input from higher
levels of the nervous system.
○ Example: Nerve impulses coming from the
information from the cerebellum, midbrain,
and cerebral centers, and general
26
 NEURONS AND NERVE FIBERS

information arising from other muscle groups ○ Following the amputation of a limb, the
and joints, as well as, skin receptors. patient may experience severe pain in the
○ These also affect the maintenance of the absent limb due to pressure on the nerve
body posture fibers at the end of the stump.

CLINICAL CORRELATES Table 3.8 Drugs and diseases Affecting the Motor End-
Plates in Skeletal Muscle
TRAUMATIC LESIONS OF PERIPHERAL NERVES
● Neuropraxia
Drugs or Increasing ACh Decreasing ACh
○ Mildest form
Disease Release Release
○ Transient block
○ The paralysis is incomplete, recovery is rapid
Drugs
and complete, and there is no microscopic
evidence of nerve degeneration.
○ Pressure is the most common cause. 4-Aminopyridines Yes
● Axonotmesis
○ Axons are damaged but the surrounding Guanidine Yes
connective tissue sheaths remain more or hydrochloride
less intact.
○ Functional recovery is more rapid and more Succinylcholine
complete
○ Crush injuries, traction, and compression are d-Tubocurarine
the most common causes.
● Neurotmesis dimethyl
○ Complete section of the nerve trunk tubocurarine
○ Worst
○ The muscles that are innervated show: gallamine
■ flaccid paralysis,
■ wasting, benzoquinonium
■ reflexes are lost,
■ total loss of cutaneous sensibility Physostigmine
_

over the area innervated by that

nerve neostigmine
○ Assuming that the transected peripheral
nerve has been carefully sutured together, Disease
regenerating motor axons grow at an
average rate of about 1.5 mm per day. Botulinum toxin Yes
○ Proximal muscles will recover first and the
distal muscles will recover later Myasthenia gravis
○ Sensory recovery occurs because before
there is return of voluntary movement and
recovery of deep cutaneous sensibility
that is pain caused by deep pressure, it is Acting on ACh Receptors
actually the first sign of recovery. This is
followed by:
■ return of poorly localized superficial
Drugs or Depolarizin Ach AChE
cutaneous pain,
Disease g Blockade Receptor Inhibition
■ vasomotor control, and
Blockade
■ the sensation of heat and cold are
recovered.
○ Light touch and tactile discrimination are Drugs
the last sensations to return (may be months
later and are often incomplete) 4-
● Polyneuropathy Aminopyridin
○ Impairment of function of many peripheral es
nerves simultaneously
○ Infection (endotoxin of diphtheria, Guillain- Guanidine
Barré syndrome, metabolic disorders hydrochlorid
(vitamins B1 and B12 deficiency, poisoning e
by heavy metals, drugs), and endocrine
disorders (diabetes) Succinylcholi Yes
○ Axon degeneration and/or segmental ne
demyelination may take place, and the
neuron cell body may be involved d- Yes
● Phantom Limb Tubocurarin
○ Encountered most commonly in amputee e
patients

27
 NEURONS AND NERVE FIBERS

dimethyl Yes
tubocurarine
EXAMINATION OF INDIVIDUAL SENSORY
MODALITIES
gallamine Yes
● Light touch
○ This is tested by gently touching the skin
benzoquinon Yes
with a wisp of cotton; the patient has the
ium
eyes closed and responds “yes” whenever
the stimulus is felt.
Physostigmi Yes
○ It is important to realize that different areas
=
ne
of the skin normally exhibit different
thresholds for touch
neostigmine Yes ■ Back and buttocks are usually less
sensitive than the face or fingertips
Disease ■ On hairy surfaces, the slightest
movement of a hair usually can be
Botulinum Yes felt
toxin ● Localization of touch.
○ After detecting the light touch with the eyes
Myasthenia Destruction of receptors closed, the patient is asked to place a finger
gravis on the exact site touched.
○ Failure to accomplish this may be due to
damage to the cerebral cortex
● Two-point tactile discrimination.
Explanation: ○ Two blunt points are applied to the skin
● 4-Aminopyridines and Guanidine increases ACh surface while the patient’s eyes are closed.
release Gradually, the points are brought closer
● Botulinum toxin is a presynaptic NMJ disease may together until the patient is unable to
decrease ACh release because it produces a toxin, distinguish two definite points.
clostridium botulinum toxin, that inhibits the release of ○ Normal person is able to distinguish two
ACh at the NMJ separate points on the tip of the index finger
● Death may result from paralysis of the respiratory when they are separated by a distance
muscles and the course of the disease can be greater than about 3 mm.
improved by the administration of Calcium ○ On the back, the two points have to be
Gluconate which promotes the release of ACh from separated as much as 3-4 cm
the nerve terminals ● Pain.
● Myasthenia gravis is a postsynaptic NMJ disease ○ It is important to know the pain threshold of
meaning it is an autoimmune disease that affects the your patient before applying this one
postsynaptic receptors. It destroys the receptors in ○ The skin may be touched with the sharp end
the postsynaptic region. of a pin. It is advisable to apply the stimulus
○ Antibodies interfere with the synaptic in an irregular manner, first using the sharp
transmission by: end of the pin and then the dull head, with
■ reducing the number of receptors or the patient responding “sharp” or “dull.”
■ blocking the interaction of the ACh ○ In certain diseases such as
with its receptors polyneuropathy, there is delay of up to 3
○ In this disease entity, the size of the secs before the patient recognizes the sharp
junctional folds is also reduced and the width pain
of the synaptic cleft is increased. Together, ● Pressure pain.
these changes result in reduced amplitude in ○ This poorly localized pain is perceived by
end-plate potentials. deep pressure on a muscle or by squeezing
○ Patients may have: a tendon.
■ drooping of the eyelids ● Temperature testing.
■ doubling of vision ○ Test tubes filled with hot or cold water may
■ difficulty in swallowing and talking be used.When the test tubes are applied to
■ generalized muscle weakness the skin, the patient responds with either
■ fatigue “warm” or “cold” with their eyes closed
○ This condition may be temporarily relieved ○ First, temperature threshold is established
by Acetylcholinesterase drugs such as then, the areas of diminished or lost
neostigmine or physostigmine temperature sensation are mapped out
○ If you inhibit AChE (Acetylcholinesterase) ○ Usually tuning fork is used (ex. placed in the
which is the enzyme that hydrolyzes ACh, refrigerator) because it is metal
you may increase the levels of ACh ● Vibration.
● Succinylcholine blocks the depolarization caused by ○ When the handle of a vibrating tuning fork is
ACh applied to the skin over bone, a tingling
● d- Tubocurarine, dimethyltubocucarine, sensation is felt. The patient is asked to
gallamine, benzoquinonium blocks the ACh respond when the first vibration is felt and
receptors when the vibration can no longer be
detected.

28
 NEURONS AND NERVE FIBERS
○Usually tests first the bone on the forehead
(glabella) then measures how many
seconds from when the vibration was felt
until it can no longer be detected or it ends.
Once recorded, compare it to the bony
surfaces and if there is a greater difference
from the one recorded on the forehead then
it is labeled as:
■ delayed or
■ abnormal or
■ absent
● Appreciation of form (stereognosis).
○ With the patient’s eyes closed, the examiner
places common objects, such as coins or
keys, in the patient’s hands.
○ Need to identify what object is in their hands
● Passive movements of joints.
○ With the patient completely relaxed and in
the supine position with eyes closed, the
digit is flexed or extended irregularly. After
each movement, the patient is asked,“Is the
digit ‘up’ or ‘down’?”
○ Fourth finger is usually used and the most
distal joint of the finger and move it up or
down and let the patient identify if it’s up or
down
● Postural sensibility.
○ This is the ability to describe the position of a
limb when it is placed in that position while
the patient’s eyes are closed. Another way to
perform the test is to ask the patient, with
eyes closed, to place the limb on the
opposite side in the same position as the
other limb.
ABNORMALITIES IN SENSORY PERCEPTION
Hypalgesia diminished pain sensation
Hyperalgesia heightened pain sensation
Hypesthesia diminished touch sensation
Hyperesthesia heightened touch sensation
Paresthesia pins and needles
Allodynia perception of an innocuous
stimulus as painful
CLINICAL OBSERVATION OF MUSCULAR ACTIVITY
● Muscular Power
○ Ask the patient to perform movements for
which the muscle under examination is
primarily responsible
○ Perform each movement against resistance
and compare the muscles on the two sides
of the body
○ Manual Muscle Testing from the Medical
Research Council Scale is usually used
wherein:
■ 0 = no contraction
■ 5 = normal motor strength
● Muscle Wasting
○ Occurs within 2-3 weeks after section of the
motor nerve
○ Meaning there is reduced or bulk or atrophy
of the muscle
○ In the limbs, it is easily tested by measuring
the diameter of the limbs at a given point
over the involved muscle and compare it with
the normal one or opposite limb
● Muscular Fasciculation
○ May also occur and it should be noted if
there is twitching of groups of muscle fibers
○ Same goes often in patients with chronic
diseases that affects the anterior horn cells
■ Example: progressive muscular
atrophy
● Muscular Contracture
○ Occurs most commonly in the muscles that
normally oppose paralyzed muscles
○ Muscles contract and undergo permanent
shortening
● Muscle Tone
○ Muscle without tone means that there is
failure or defect in the spinal reflex arcs
○ If there is loss of muscle tone, the muscle is
dough-like on palpation and non-contractile
○ Degrees of loss of tone may be tested by:
■ passively moving the joints and
■ comparing the resistance to the
movements by the muscles on the
two sides of the body
○ Increase in muscle tone can occur following
the removal of the cerebral inhibition under
the reticular formation
○ Clasp Knife
■ For increase muscle tone
■ If the initial resistance of the
movement suddenly overcome,
usually this occurs in upper motor
neuron lesions and then lead by
rigidity which is steady increase in
resistance throughout the
movement in extra pyramidal
lesions and ratchet-like increase in
resistance which we call,
Cogwheel Rigidity (the ones we
encounter in Parkinson’s disease
patients)
● Muscular Coordination
○ (1) Finger to nose test. Ask the patient to
touch, with the eyes open, the tip of the nose
and then the tip of the forefinger of the
examiner. Ask to repeat the process with
eyes closed
29
 NEURONS AND NERVE FIBERS

○ (2) Heel to shin. Ask to touch the tip of one D. All of the above
heel on the opposite knee. Then slide it
down the shin. Bring the leg up. Ask to 3. Bipolar neurons are NOT found in?
repeat the process with eyes closed. A. Retinal bipolar cells
○ (3) Pronation-supination Ask the patient to B. Cells of sensory cochlear
quickly supinate and pronate both forearms C. Posterior root ganglion
simultaneously. D. Vestibular ganglia
○ Failure to perform this test means
impairment in muscular coordination 4. The roots of a nerve plexus merge together to form __.
■ Ex. disease of the cerebellum
(important in muscle coordination) 5. This type of nonencapsulated receptor can mainly detect
pain.
A. Merkel Discs
B. Free nerve endings
C. Hair follicle receptors

6. __ spindles provide the CNS with sensory information

regarding the tension of muscles.

7. If the oligodendrocytes are responsible for forming the

myelin sheaths of nerve fibers in the CNS, then what
structure is responsible for myelin sheath formation in the
PNS?
A. Astrocytes
B. Schwann cells
C. Ependymal cells

8. Neuronal injury in the ____ is not followed by

regeneration except on the nerve cells of the posterior root
ganglia of the spinal nerves.

TRUE OR FALSE

9. Cytoplasm of the nerve cell body is greater in volume than of

the cytoplasm in the neurites.

10. Ruffini Corpuscles are located in the Dermal papillae of the

skin.

FREEDOM WALL

REFERENCES

University of Santo Tomas powerpoint presentation of

Richelle Ann S. Santiano, MD

Snell, R. (2019). Clinical Neuroanatomy (8th ed.). Lippincott

Williams: Philadelphia.

QUICK QUIZ
1. The human nervous system is capable of a wide range of
functions. What is the basic unit of the nervous system?
A. Glial cell
B. Meninges
C. Neuron
D. Cerebrospinal fluid

2. The neuron cell is made up of which of the following

parts?
A. Axon 1. C 2. D 3. C 4. Trunks 5. B 6. Neurotendinous 7. B 8. CNS 9. F 10. F
B. Dendrite
C. Nucleus

30
Richelle Ann S. Santiano, MD
De Mesa, Delgado, Lim, Miranda, Reyes, Thakur, Torralba

1S3L: SPINAL CORDS AND TRACTS

o Develops after birth as the child learns to sit up right,
OUTLINE
I. Vertebral Column stand, and walk
A. General Characteristics o Its direction is opposite to the original fetal curvature.
B. Cervical Vertebrae o Cervical Curve
C. Thoracic Vertebrae
D. Lumbar Vertebrae
▪ Develops in the neck region when the infant
E. Sacral and Coccygeal Vertebrae begins to hold their head upright when sitting.
F. Nerve Supply of Vertebral Joints o Lumbar Curve of the Lower Back
II. Spinal Cord ▪ Develops as the child begins to stand and walk
A. Nerve Cell Groups in the Anterior Gray Columns
B. Nerve Cell groups in the Posterior Gray Columns
C. Intermediolateral Group of Cells
III. Ascending Pathways
A. Ascending Tracts
a. Lateral Spinothalamic tract
b. Anterior Spinothalamic tract
c. Posterior White Column and CuneoCerebellar tract
d. Posterior Spinocerebellar tract
e. Anterior Spinocerebellar tract
f. Other Ascending Tracts
B. Visceral Sensory Tracts
C. Descending Tracts
a. Corticospinal tract
b. Rubrospinal tract
c. Reticulospinal tracts
d. Tectospinal tract
e. Vestibulospinal tract
D. Descending Autonomic fibers
IV. Blood Supply of the Spinal Cord
V. Upper versus Lower Motor Neuron Lesion
VI. Lesions of the Descending tracts other than the Corticospinal
tracts
VII. Spinal Shock syndrome
VIII. Spinal Cord syndromes
A. Complete cord transection syndrome
B. Anterior cord syndrome
C. Central cord syndrome
D. Brown- Sequard syndrome
E. Poliomyelitis
F. Amyotrophic lateral sclerosis
G. Cauda Equina syndrome
H. Conus Medullaris syndrome
IX. American Spinal Cord Injury Association (ASIA) Impairment
Scale

VERTEBRAL COLUMN
Vertebrae Spine
Cervical 7 8
Thoracic 12 12
Lumbar 5 5
Sacral 5 5
Coccygeal 4 1
33 31
• Primary Curve: Concave Anteriorly
o Thoracic Curve and Sacral Curve
o Fetus: During fetal development, the body is flexed
(concaved) anteriorly
▪ Give the entire vertebral column a single curvature
▪ Called the primary curve because it was retained
of the original vertebral column during fetal GENERAL CHARACTERISTICS
development • A typical vertebra consists of a rounded body (anterior)
o Adult: From the fetal curvature, the adult’s spine is and a vertebral arch (posterior) that encloses the
retained in the thoracic curve and sacrococcygeal vertebral foramen (space) through which the spinal cord
curve and its coverings runs
▪ Formed by the thoracic vertebrae (thoracic curve) • The vertebral arch gives rise to 7 processes:
and the sacrum and coccyx (sacrococcygeal o 1 spinous (posterior)
curve) o 2 transverse (lateral)
• Secondary Curve: Concave Posteriorly o 4 articular
o Cervical Curve and Lumbar Curve ▪ 1 pair of inferior articular process and 1 pair of
superior articular process

1
 SPINAL CORD AND TRACTS
o Consist of a pair of cylindrical pedicles and the
flattened laminae which completes the arch posteriorly
o The spinous process or the spine is directed posteriorly
from the junction of the 2 laminaes while the transverse
process are directed laterally from the junction of the
laminaes and the pedicles
o Articular processes (AP) are vertically arranged. It
consists of 2 superior and 2 inferior processes. They
arise from the junction of the laminae and the pedicles
wherein 2 superior AP articulate to the 2 inferior AP to
form 2 synovial joints
• Both the spinous and transverse process serve as levers
and receive attachments of muscles and ligaments
• The intervertebral foramen serves to transmit the spinal
nerves and blood vessels
o Formed by the superior notch of one vertebra and
inferior vertebral notch of another vertebra
o Interior and posterior spinal nerves unite within the
foramina with their coverings of the dura to form the
segmentus spinal nerves
• The vertebrae also articulate with each other with the
means of cartilaginous joints between their bodies
• Intervertebral discs (blue in the pic) serve as shock
absorbent when the load on the vertebral column is
suddenly increased
o Thickest in the cervical and lumbar region because this
is where the movements of the body are the greatest
o Its resilience and absorbent properties are gradually
lost due to aging
o Each disk consists of the peripheral part of the annulus
fibrosus which is composed of fibrocartilage and has
the essential part called the nucleus pulposus
▪ The fibrocartilage is strongly attached to the
vertebral bodies and the anterior and posterior
longitudinal ligaments to the vertebral column
• The nucleus pulposus in the young is an ovoid mass of
gelatinous material
o With advancing age, it becomes smaller and is
replaced by fibrocartilage
▪ It is replaced by fibrocartilage; collagen fibers of
the anulus degenerates and as a result, the anulus
cannot contain the nucleus pulposus under stress
o Normally under pressure, slightly near to the posterior
than the anterior margin of the disc
o Has a semi-fluid nature that allows it to change shape
and permits one vertebrae to rock forward and
backward on another
▪ A sudden increase in compression load on the
vertebral column causes the nucleus pulposus to
become flattened
▪ Accommodated by the resilience of the
surrounding anulus fibrosus
▪ In some cases, the outward thrust is too great for
the anulus fibrosus -> it ruptures; allowing the
anulus fibrosus to herniate and protrude to the
vertebral canal (it may press on the spinal nerve
roots, spinal canal, or the spinal cord)
o Upper and lower surfaces of the bodies of adjacent
vertebrae that attach to the disk are covered with
hyaline cartilage
o Due to aging: This becomes thin and less elastic which
makes it hard to distinguish the pulposus from the
annulus
• The anterior and posterior longitudinal ligaments run a
continuous band down the anterior and posterior surfaces
of the vertebral column from the skull to the sacrum
o Anterior ligament is wide and is strongly attached to
the front and sides of the vertebral bodies and to the
intervertebral discs
o Posterior ligament is weak and narrow which is
attached to the posterior border of the discs
o Supraspinous ligament runs between the tips of the
adjacent spines
o Interspinous ligament connects the adjacent spines
o Intertransverse ligament runs between adjacent
transverse processes
o Ligamentum flavum connects the laminae of adjacent
vertebrae
• In the cervical region, the supraspinous and interspinous
ligaments are greatly thickened to form the strong
ligamentum nuchae
2
 SPINAL CORD AND TRACTS

THORACIC VERTEBRAE

CERVICAL CHARACTERISTICS

• Larger body than cervical vertebrae

• Long spinous process, downward angle
o Can easily tell that it is thoracic vertebrae
o Causes to overlap the next inferior vertebrae
o Superior AP face anteriorly while the Inferior AP face
posteriorly
▪ The orientations are important for the type and
range of movement that are available in the
thoracic region
• Has a small vertebral body • Costal facets
o Reason: This region carry the least amount of body o Additional articulation sites
weight o Where rib is attached
o Has Y-shaped / “bifid” spinous process o Located at the lateral sides of the vertebral body
▪ C3 and C6 - short spinous process o (Most vertebral vertebrae has 2) Located at the lateral
▪ C7 - long spinous process sides of the vertebral body -> inferior and superior
• Transverse Process costal facets
o Sharply curved to allow passage of cervical spinal ▪ Articulations for the head and/ or end of a ribs
nerves o Another facet is located at the transverse process for
o Has an opening called Transverse foramen to allow the tubercle od the rib
passage of the vertebral artery, vein, and sympathetic
nerves.
• Superior and inferior articular processes
o Flattened
o Largely faced upward and downward respectively
• Atlas (C1)
o In reference to the Greek God Atlas; who carries the
world on his shoulder
o Vertebrae that supports the skull
o No body, No spinous process
o Ring-shaped and has an interior and posterior arch
o Longest transverse process in the cervical which
extends more laterally
o Superior AP face upward and are deeply curved for
articulation with occipital condyles on the base of the
skull
o Inferior AP face downward and are flat for articulation
with superior AP of the C2 vertebra. LUMBAR VERTEBRAE
• Axis (C2) • Large size and thick vertebral body
o Axis of rotation for turning the head left or right o Reason: Carries the greatest amount of body weight
o Easily distinguished by the “dens” or the odontoid • Short transverse processes
process which extends upward and held in place by the • Short, blunt spinous process that projects posteriorly
transverse ligament • Articular Processes (AP)
o Resembles a typical cervical vertebrae in most times o Large in size
but easily distinguished by the “dens” or the odontoid o Superior AP are facing backward
process o Inferior AP are facing forward
▪ Extends upward and held in place by the
transverse ligament

3
 SPINAL CORD AND TRACTS

• Sacral canal
o A bony tunnel that passing inferiorly through the
sacrum is a bony tunnel
o It terminates near the sacral hiatus (inferior tip of the
sacrum)
• Anterior and Posterior surfaces of the Sacrum
o Has a series of paired openings called “sacral
foramina” which allows the posterior and anterior
branches of the spinal nerves to exit the sacrum
o anterior/ventral sacral foramina and posterior/ventral
sacral foramina
• Superior Articular Process
o Found in either side of the sacral canal then articulates
to the inferior AP from the L5

SACRAL AND COCCYGEAL VERTEBRAE

COCCYX
• The “tailbone”
o Fusion of 4 very small coccygeal vertebrae
• Fusion of 4 very small coccygeal vertebrae
• Articulate with the inferior tip of the sacrum
• Not weight-bearing in the standing position but may receive
some body weight when sitting

NERVE SUPPLY OF VERTEBRAL JOINTS

• The joints between the vertebral bodies are innervated by
the small meningeal branches of each spinal nerve
• The joints between the articular processes are innervated
by branches from the posterior rami of the spinal nerves

SACRUM
• Triangular-shaped bone that is thick and wide from the
superior to inferior bases
o Superior base: weight-bearing
o Inferior Base: non-weight bearing apex
• Formed by the fusion of 5 sacral vertebrae process that
does not begin until after the age of 20
• Has 4 Transverse ridges, and 5 lines of vertebral fusion
• Posterior surface in the Midline
o Midline Sacral Crest—formed by bumpy ridge that is
the remnant of diffuse spinous process
Lateral Sacral Crest—formed by diffuse transverse
process of the sacral vertebrae
• Sacral Promontory
o Anterior to the superior base of the sacrum

4
 SPINAL CORD AND TRACTS

DISORDERS ASSOCIATED WITH THE CURVATURE

OF THE SPINE
• (a) Scoliosis—abnormal lateral curvature of the spine
• (b) Kyphosis—excessive posterior curvature of the
thoracic region; “kuba position” ( Gibas i pots disease )
( inward)
• (c) Lordosis—excessive anterior curvature of the lumbar
region; “liyad position”

• Bending forward causes compression of the anterior portion

of the disc but also expansion of the posterior disc
• If the posterior annulus fibrosus is weakened due to injury
or aging, the pressure exerted when bending forward and
lifting heavy objects can cause the nucleus pulposus to
protrude posteriorly which results to herniated disk,
ruptured/slip disk
o Other effects: compression of spinal nerve that results
to pain and muscle weakness

DISORDERS/ENTITIES THAT DAMAGE THE

STRUCTURE OF VERTEBRAL COLUMN
• Burst Fracture of C1 or “Jefferson fracture”
o Usually due to a vertical fall on an extended neck (e.g.
diving in shallow water)
o There is excessive axial loading in the neck
o It compresses lateral masses of the atlas between the
occipital condyle and the axis, causing them to be
driven apart, thus fracturing one or both the anterior
and posterior arches of the neck
• Hangman's fracture
o Fracture of the pars interarticularis (a bony column
between the superior and inferior articular facets of the
axis)
o Occurs bilaterally (e.g. sports, traffic accident, falls,
and people who hang themselves by the neck, thus its EXAMPLES OF DISC PROBLEMS
name) • Degenerated disc
o A result of high velocity, distraction, and • Bulging disc
hyperextension of the neck • Herniated disc
o Section injury are likely not to happen as either the • Thinning disc
fracture fragments or the force involved are likely to • Disc Degeneration with Osteophyte Formation
rupture the spinal cord causing: o Osteophytes—“bone spurs” which forms on the spine
▪ Deep unconsciousness over a long period of time
▪ Respiratory and Cardiac failure o A sign of aging “degeneration”

5
 SPINAL CORD AND TRACTS
OTHER DISEASES OF THE VERTEBRAL COLUMN
• Pars Interarticularis - narrow bridge of bone found in the
back portion of the vertebra in between the articular
processes
o Normally the spine look like this
• Spondylolysis—stress fracture from mechanical stress
from the pars interarticularis
o Due to repetitive load and stress: The stress
distribution at the pars interarticularis is highest in
extension and rotation movements
• Spondylolisthesis—forward slippage of one vertebral
body with respect to the one beneath it
o Commonly occurs at the lumbosacral junction (L5
slipping over S1)
o Can be congenital, acquired, secondary trauma,
regenerative changes, or pathologic
• Spondylosis—a wide range of degenerative changes that
affect all of components of cervical spine
THE SPINAL CORD
• Roughly cylindrical in shape
• Begins inferiorly at the foramen magnum of the skull where
it is continuous with the medulla oblongata of the brain
• Terminates at:
o For adults: inferiorly at the level of L1
o Young child: relatively longer and ends the upper
border of L3
• Occupies the upper 2/3rds of the vertebral canal of the
vertebral column; covered with meninges (PAD)
o Further protection by the CSF which surrounds the
spinal cord at the subarachnoid space
• Cervical region where it gives origin to the brachial plexus
and the lower thoracic and lumbar regions give the origin to
the lumbosacral plexus
o The spinal cord is fusiformly enlarged -> cervical and
lumbar enlargement
• Inferiorly, the spinal cord tapers off into the conus
medullaris and from the apex of which a prolongation of
pia mater, the filum terminale descends to be attached to
the coccyx
• The cord possesses a deep longitudinal fissure called the
anterior median fissure in the midline anteriorly
• Shallow furrow called the posterior median sulcus on the
posterior surface
• Along the entire length of the spinal cord are attached 31
pairs of spinal nerves
o Anterior—motor roots
o Posterior—sensory roots
o Each root is attached to the core where a series of
rootlets, which extend the whole length of the
corresponding segment of the cord
o Each posterior nerve root possesses a posterior root
ganglion
• The cells of which give rise to peripheral and central nerve
fibers.
• The spinal cord is composed of an inner gray matter and an
outer white
o Inner gray—anterior and posterior gray columns
joined in the midline by the gray commissure
containing the small central (sensory) canal
o The part of the gray commissure situated posterior to
the central canal is called the posterior gray
commissure; the one anterior to the canal is the
anterior gray commissure
• The white matter may be divided into the anterior, lateral
and posterior columns, which some would call funiculi
o The anterior column on each side lies between the
midline and the point of emergence on of the anterior
nerve roots
o The lateral column lies between the emergence of the
anterior nerve roots and the entry of the posterior nerve
roots
o The posterior column lies between the entry of the
posterior nerve roots and the midline
• Small lateral projection or lateral gray columnar horn
which is only present in the thoracic and upper lumbar
regions of the cord
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 SPINAL CORD AND TRACTS

o Its size is greatest within the cervical and o This nucleus constitutes the main bulk of cells present
lumbosacral cords which innervate the in the posterior gray column
skeletal muscles of the limbs • The nucleus dorsalis (Clark’s column) is a group of nerve
• The amount of gray matter present in any given level of the cells situated at the base of the posterior gray column.
spinal cord is related to the amount of muscle innervated at • The visceral afferent nucleus is a group of nerve cells of
the level medium size situated lateral to the nucleus dorsalis
• The central canal is present throughout the spinal cord o It is believed to be associated with receiving visceral
o Superiorly, it is continuous with the central canal of the afferent information
caudal half of the medulla
o Opens into the cavity of the fourth ventricle INTERMEDIOLATERAL GROUP OF CELLS
o Inferiorly in the conus medullaris, it expands into the T1-L2/L3 • Preganglionic sympathetic fibers
fusiform terminal ventricle and terminates below within S2-S4 • Preganglionic parasympathetic fibers
the root of the filum terminale
NERVE CELL GROUPS IN THE ANTERIOR GRAY • Intermediolateral group forms the small lateral gray
COLUMNS column
Medial • Most segments
• Skeletal muscle s of neck, trunk, intercostal, ASCENDING PATHWAYS
and abdomen
Central • Smallest; Cervical and lumbosacral segments
• Phrenic nucleus (C3-C5): innervate the
diaphragm
• Accessory nucleus (C1-C5/C6): innervate the
sternocleidomastoid and trapezius
• Lumbosacral nucleus (L2-S1): made up of
nerve cells whose axons have an unknown
distribution
Lateral • Cervical and lumbosacral segments
• Skeletal muscles of the limbs

• Most nerve cells are large and multipolar and their axons
ASCENDING PATHWAYS DESCENDING PATHWAYS
pass out in the anterior roots of the spinal nerves as alpha
efferents, which innervate skeletal muscles
Lateral spinothalamic tract Corticospinal tracts
• The smaller nerve cells are also multipolar and the axons
of many of these pass out in the anterior roots of t he spinal
nerves as gamma efferents, which innervate the intrafusal Anterior spinothalamic tract Reticulospinal tracts
muscle fibers of neuromuscular spindles.
Posterior white column Tectospinal tract
NERVE CELL GROUPS IN THE POSTERIOR GRAY COLUMNS
Posterior spinocerebellar Rubrospinal tract
Substantia • Receives afferent fibers concerned with tract
Gelatinosa pain, temperature, and touch from the
posterior root
Anterior spinocerebellar Vestibulospinal tract
• Receives input from descending fibers tract
from supraspinal levels axon for
sensory modality
Nucleus • Receives fibers from the posterior white Cuneocerebellar tract Olivospinal tract (?)
Propius column that are associated with the senses
of position and movements, two-point Descending Autonomic Fibers
discrimination, and vibration
Nucleus • C8-L3/L4 Spinotectal tract
Dorsalis • Associated with the neuromuscular
(Clarke’s spindles and tendon spindles golgi tendon
,
Spinoreticular tract
Column)
Visceral • T1-T3
Spino-olivary tract
Afferent visceral organs
Nucleus
Visceral sensory tracts
• Two nerve cell groups extend throughout the length of the
cord and two are restricted to the thoracic and lumbar
segments. ASCENDING TRACTS
• The substantia gelatinosa group is situated at the apex • Conduct afferent information, which may or may not reach
of the posterior gray column throughout the length of the consciousness. The information may be divided into two:
spinal cord. o Exteroceptive—originates from outside the body,
o It is largely composed of Golgi Type II neurons such as pain, temperature, and touch
o It is believed that the inputs of the sensations of pain o Proprioceptive—originates from inside the body;
and temperature are modified by excitatory or inhibitory muscles and joints
information from other sensory inputs and by • First order neuron
information from the cerebral cortex o Cell body in the posterior root ganglion of the spinal
• The nucleus propius is a group of large nerve cells nerve
situated anterior to the substantia gelatinosa throughout the o A peripheral process connects with a sensory receptor
spinal cord ending, whereas a central process enters the spinal

7
 SPINAL CORD AND TRACTS
cord through the posterior root to synapse on the
second-order neuron
• Second order neuron
o Give rise to an axon that decussates and ascends to a
higher level of the central nervous system
• Third order neuron
o Usually in the thalamus
o Gives rise to a projection fiber that passes to a sensory
region of the cerebral cortex
• The termination of these ascending tracts is the postcentral
gyrus
• Many of the neurons in the ascending pathways branch and
give a major input into the reticular information, which in turn
activates the cerebral cortex, maintaining wakefulness.
• Other branches pass to motor neurons and participate in
reflex muscular activity
LATERAL SPINOTHALAMIC TRACT
• Pain and temperature
o Pain and thermal receptors and other tissues are free
nerve endings
o Pain impulses are transmitted to the spinal cord in fast-
conducting delta A-type fibers and slow-
conducting C-type fibers
o The fast-conducting fibers alert the individual to initial
sharp pain
o The slow-conducting fibers are responsible for the
prolonged, burning, aching pain
o The sensations of heat and cold also travel by delta A
and C fibers
• The axons entering the spinal cord from the posterior root
ganglion proceed to the tip of the posterior gray column and
divide into ascending and descending branches
o These branches travel for a distance of one or two
segments of the spinal cord and form the
posterolateral tract of Lissauer
o Then it synapses with the cells of substantia gelatinosa
and the posterior gray horn
• First order neuron: posterior root ganglion
• Second order neuron: substantia gelatinosa and the
posterior gray horn
o The axons cross obliquely to the opposite side in the
anterior gray and white commissures within one spinal
segment of the cord, ascending in the contralateral
white column as the lateral spinothalamic tract
▪ Since it took one to two segments before the fibers
crossed to the opposite side, a lateral cord lesion
will affect a contralateral pain and temperature
sensation beginning a few segments below the
level of the lesion
▪ The white commissure is located just lining the
gray commissure in the midline
▪ As the lateral spinothalamic tract ascends through
the spinal cord, new fibers are added to the
anteromedial aspect of the tract. Thus, in the
upper cervical segments of the cord, the sacral
fibers are lateral and the cervical fibers are
medial.
▪ The fibers carrying pain are situated slightly
anterior to those conducting temperature
• Third order neuron: ventral posterolateral nucleus of the
thalamus then passes through the posterior limb of the
internal capsule and the corona radiata to reach the
somesthetic area in the postcentral gyrus of the cerebral
cortex
o Postcentral gyrus—main somatosensory cortex
▪ Termination of most of the sensory information of
the ascending tracts in the spinal cord
o The information is transmitted to other regions of the
cerebral cortex to be used by motor areas and the
parietal association area
o The role of the cerebral cortex is to interpret the quality
of the sensory information at the level of
consciousness
Conduction of Pain in the Central Nervous System
• Chemical substances that excite free nerve endings:
serotonin, histamine, bradykinin, lactic acid, and K+ ions
o The threshold for pain endings can be lowered by
prostaglandins and substance P
• The main excitatory neurotransmitter released by the A
delta fibers and the C fibers is the amino acid glutamate
• Substance P is also released from the C fibers
• Glutamate is fast-acting localized neurotransmitter while
substance P has a slow release and diffuses widley in the
posterior horn and can influence many neurons
• The repeated arrival of noxious stimuli through the C fibers
in the posterior gray horn during severe injury results in an
increased response of the second-order neurons →
winding up phenomenon
o This is attributed to the release of the neurotransmitter
glutamate from the C fibers
• The fast type of pain is precisely localized while the slow
type of pain is only poorly localized
o Fast type—ex. If one hits their thumb with a hammer,
you would know immediately that the injury is on the
thumb
o Slow type—ex. a patient with osteoarthritis of the hip
joint; the pain can only be vaguely localized at the hip
joint, not at the specific type of the disease
• Fast pain fibers directly ascend the spinal cord in the lateral
spinothalamic tract
• Slow pain fibers take part in multiple relays in the posterior
gray horn before ascending to higher centers
Other Terminations of the Lateral Spinothalamic Tract
• The majority of the slow pain fibers in the lateral
spinothalamic tract terminate in the reticular formation
which then activates the entire nervous system
• It is in the lower areas of the brain that the individual
becomes aware of the chronic, nauseous, suffering type of
pain
8
 SPINAL CORD AND TRACTS
• Sites concerned with reception and interpretation of the
nociceptor information:
o Postcentral gyrus—pain in relation to the past
experiences
o Cingulate gyrus—emotional aspect of pain
o Insular gyrus—pain stimuli from the internal organs of
the body and brings about an autonomic response
Gating theory
• Massage, acupuncture and electrical stimulation of the skin
to relieve pain
• At the site where the pain fiber enters the central nervous
system, inhibition could occur by means of connector
neurons excited by large, myelinated afferent fibers
carrying information of nonpainful touch and pressure
• The excess tactile stimulation produced by massage,
“closed the gate” for pain
• Once the nonpainful tactile stimulation was ceased, “the
gate was reopened”
o The information on the painful stimuli ascended the
lateral spinothalamic tract.
• Although the gate theory may partially explain the
phenomena, the analgesia system is probably involved in
the reduction of pain
Analgesia System
• Stimulation of the periventricular area of the diencephalon,
the periaqueductal gray matter of the midbrain, and midline
nuclei of the brainstem can reduce or block sensation of
pain
• It is believed that fibers of the reticulospinal tract pass down
to the spinal cord and synapse on cells concerned with pain
sensation in the posterior gray column
• The analgesic system can suppress both sharp pricking
pain and burning pain sensations
• Enkephalins, endorphins, and serotonin may inhibit the
release of substance P in the posterior gray column
ANTERIOR SPINOTHALAMIC TRACT
• Light touch and pressure
• First order neuron: posterior root ganglion
o The axons synapse with the second order neuron with
the substantia gelatinosa
• Second order neuron: substantia gelatinosa
o The axons cross very obliquely to the opposite side in
the anterior gray and white commissures within several
spinal segments
o Then ascend in the opposite anterolateral white
column as the anterior spinothalamic tract
▪ As the anterior spinothalamic tract ascend through
the spinal cord new fibers are added to the medial
aspect of the tract
▪ Sacral segments are located in the lateral portion
of the tract and the cervical segments are in the
medial portion
o As the anterior spinothalamic tract ascend to the
medulla, it accompanies the lateral spinothalamic tract
and the spinotectal tract, all of which form the spinal
lemniscus
▪ The spinal lemniscus ascends through the
posterior part of the pons, and the tegmentum of
the midbrain by synapsing with the third order
neuron in the ventral posterolateral nucleus of the
thalamus
• Third order neuron: ventral posterolateral nucleus of the
thalamus then pass through the posterior limb of the
internal capsule and corona radiata and terminates at the
postcentral gyrus
• Some fibers ascend ipsilaterally all the way to the midbrain
but they cross on the posterior commissure and project on
the intralaminar neurons of the thalamus
• Fibers only cross/decussates in the posterior commissure
in the midbrain and project on the intralaminar neurons of
the thalamus
POSTERIOR WHITE COLUMN AND
CUNEOCEREBELLAR TRACT
• Discriminative touch, vibratory sense, conscious muscle
joint sense
o Include precise location of touch (two-point
discrimnation)
• First order neuron: posterior root ganglion and passes
directly to the posterior white column fn the same side
o the fibers divide into long ascending and short
descending branches the descending branches branch
9
 SPINAL CORD AND TRACTS

down a variable number of segments giving off
collateral branches
o The long ascending fibers may also send by synapsing
with cells in the posterior gray horn with internuncial
neurons and with anterior horn cells.
• Second order neuron: nuclei gracilis and cuneatus
• Third order neuron: ventral posterolateral nucleus of
thalamus
• The descending branches pass down a variable number of
segments giving off collateral branches and the descending
branches synapse with cells in the posterior gray horn with
the interneurons and with the anterior horn cells.
• Many of the long ascending fibers travel upward in the
posterior white column as the fasciculus gracilis and
cuneatus.
• Fasciculus gracilis—present throughout the length of the
spinal cord and contains the long ascending fibers from the
sacral, lumbar, and lower 6 thoracic spinal nerves.
• Fasciculus cuneatus – situated laterally in the upper
thoracic and cervical segments of the spinal cord.
• Thus, the fibers that form the fasciculus gracilis come from
the lower extremities because it is from T6 down while for
the fasciculus cuneatus, since it is T6 up, it receives
information from the upper extremities.
• And then the fibers of the fasciculus gracilis and cuneatus
go up until the medulla oblongata wherein they become the
nucleus gracilis and nucleus cuneatus (second order
neuron).
• In the medulla oblongata, they cross the median plane
decussating with the corresponding fibers of the opposite
side in the sensory decussation in the medulla.
• They ascend as a single compact bundle which is called the
medial lemniscus.
• Through the medulla oblongata, the pons, and the midbrain,
and then it terminates by synapsing on the third order
neuron in the ventral posterolateral nucleus of the
thalamus.
• Then, the axons of the third order neuron pass the
posterior limb, the internal capsule, and corona radiata
to reach the somesthetic area in the postcentral gyrus of the
cerebral cortex.
• Many fibers in the fasciculus cuneatus from the cervical and
upper thoracic segments having terminated on the second
order neuron of the nucleus cuneatus are relayed and travel
as the axons of the second order neuron to enter the
cerebellum through the inferior cerebellar peduncle.
• Some of the axons from the nucleus cuneatus relay or travel
as the axons are to lead to the cerebellum through the
inferior cerebellar peduncle.
• So, the pathway is now referred to as the cuneus
cerebellar tract and the fibers are known as the posterior
external arcuate fibers.
• The function of these arcuate fibers is to convey
information of muscle joint sense to the cerebellum.
• The tract joins the inferior cerebellar peduncle and
terminates on the cerebellar cortex.
• Note that it does not ascend to the cerebellar cortex.
• Because the nucleus dorsalis extends only from C8-L3 or
L4, axons entering the spinal cord from the posterior roots
of the lower lumbar and sacral segments ascend in the
posterior white column until they reach the 3rd or 4th lumbar
segment where they enter the nucleus dorsalis.
• For the posterior spinocerebellar fibers, they receive
muscle joint information from the muscle spindles,
tendons, and joint receptors of the trunk and lower limbs.
• This information concerning tension of the muscles,
tendons, and the movements of the muscles and joints is
used for the cerebellum in the coordination of limb
movements and maintenance of posture
• The axons enter the spinal cord via posterior root ganglion
and synapses on the second order neuron in the nucleus
dorsalis at the base of the posterior gray column and the
majority of the axons of the second order neuron cross the
opposite side.
• In contrast to the posterior spinocerebellar tract, the anterior
spinocerebellar tract crosses to the other side and the
majority of the axons ascend as the anterior spinocerebellar
tract in the lateral white column of the same side.
• These fibers having ascended through the medulla
oblongata enter the cerebellum through the superior
cerebellar peduncle and terminate in the cerebellar cortex.
• It is believed that those fibers that cross over to the opposite
side in the spinal cord cross back within the cerebellum
(double cross) – up to the midbrain and then passes
through the superior cerebellar peduncle and then to the
cerebellar cortex
• The anterior spinocerebellar tract conveys muscle joint
information from the muscle spindles, tendon organs, and
joint receptors of the trunk and the upper and lower limbs.
• It is also believed that the cerebellum receives information
from the skin and superficial fascia by this tract.

POSTERIOR SPINOCEREBELLAR TRACT

• Unconscious muscle joint sense
• First Order Neuron: Posterior root ganglion
• Second Order Neuron: Nucleus dorsalis
• Destination: Cerebellar cortex
• The axons entering the spinal cord enter the posterior root
ganglion and terminate by synapsing on the second order
neuron which is the nucleus dorsalis or Clarke column.
• The axons of the second order neuron enter the
posterolateral part of the lateral white column on the same
side so it is not crossed and ascend as the posterior
spinocerebellar tract on the same side ascends and
terminates on the cerebellar cortex.

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 SPINAL CORD AND TRACTS
OTHER ASCENDING TRACTS
Spinotectal tract
• Spinovisual reflexes
• First Order Neuron: Posterior root ganglion
• Second Order Neuron: Unknown
• Destination: superior colliculus
• For the spinotectal tract, the axons again enter the spinal
cord from the posterior root ganglion and travel to the gray
matter of an unknown second order neuron.
• They cross the median plane and ascend as the spinotectal
tract in the anterolateral white column line close to the
lateral spinothalamic tract and after passing through the
medulla oblongata and pons, they terminate by synapsing
with the neurons in the superior colliculus in the midbrain
that’s why it’s called spinotectal.
• This pathway provides afferent information for spinovisual
reflexes and brings about movements of the eyes and the
head toward the source of stimulation.
Spinoreticular tract
• Influences level of consciousness
• First Order Neuron: Posterior root ganglion
• Second Order Neuron: Unknown
• Destination: reticular formation
• For spinoreticular, the axons again enter the spinal cord
from the posterior root ganglion and terminate on an
unknown second order neuron and then ascend the spinal
cord as the spinoreticular tract and the lateral white column
mix with the lateral spinothalamic tract and most of the
fibers are uncrossed, so same side, and terminate by
synapsing with neurons of the reticular formation in the
medulla oblongata, pons, midbrain, and it provides a
pathway for the reticular formation which we all know
plays an important role in influencing levels of
consciousness.
Spino-olivary tract
• Conveys information to the cerebellum from cutaneous and
proprioceptive organs
• First Order Neuron: Posterior root ganglion
• Second Order Neuron: Unknown
• Third Order Neuron: inferior olivary nuclei
• Destination: cerebellum
• For spino-olivary tract, the axons again enter the spinal cord
from the posterior root ganglion and terminate on an
unknown second order neuron and it also crosses to the
opposite side, crosses the midline and ascend as spino-
olivary tract in the white matter and the junction of the
anterolateral column.
• The axons end by synapsing on the 3rd order neurons in the
inferior olivary nuclei in the medulla oblongata.
• Axons of the third order neurons cross the midline and enter
the cerebellum through the inferior cerebellar peduncle
because we are at the level of the medulla.
• The spino-olivary tract conveys information to the
cerebellum from cutaneous and proprioceptive organs
involved in the control of movements of the body and
limbs.
VISCERAL SENSORY TRACTS
• Sensations that arise in viscera located in the thorax and
abdomen enter the spinal cord through the posterior roots.
• First Order Neuron: Posterior root ganglion
• Second Order Neuron: Probably posterior or lateral gray
columns
• Third Order Neuron: Ventral posterolateral nucleus of
thalamus
• Destination: Probably postcentral gyrus of the cerebral
cortex
• Many of the visceral afferent fibers that enter the spinal cord
branch participate in reflex activity.
• Cell bodies of the first order neuron are situated in the
posterior root ganglia.
• The peripheral processes of these cells receive nerve
impulses from pain and stretch receptor endings in the
viscera.
• The central processes enter the spinal cord synapse with
the second order neurons probably in the posterior or
lateral gray columns.
• The axons of the second order neuron are believed to join
the spinothalamic tract and terminate on the third order
neuron which is the ventral posterolateral nucleus of the
thalamus.
• This figure represents the sensory and motor homunculus
in the brain.
• Homunculus – the representation of the different body
parts in the cerebral cortex.
• Red – precentral gyrus; for motor function
• Blue – postcentral gyrus; for sensory function; behind the
central sulcus of Orlando
• For both the sensory and motor functions, the tongue, the
face, are placed in the most lateral portion in the temporal
region.
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 SPINAL CORD AND TRACTS
• As you go medially, the face, the thumb, the hand, the arm,
the head, neck, trunk, the hip, and the most medial ones
are the legs and the genitals.
• Understanding this representation means we can decipher
a certain deficit on a particular portion of the brain.
DESCENDING TRACTS
• First Order Neuron: cell body in the cerebral cortex
o Coming from above going down
o Its axons descend to synapse on the 2nd order neuron,
an interneuron in the anterior grey column of the spinal
cord
• Second Order Neuron: interneuron in the anterior gray
column of spinal cord
• Third Order Neuron: lower motor neuron in the anterior
gray column
• For the descending tracts, the motor neurons are situated
in the anterior gray columns of the spinal cord.
• The axons innervate skeletal muscles through the anterior
roots of the spinal nerves.
• These motor neurons are sometimes referred to as the
lower motor neurons and constitute the final common
pathway to the muscles.
• The nerve fibers that descend the white matter from the
different supraspinal nerve centers are segregated into
nerve bundles called the descending tracts.
• These supraspinal neurons and their tracts are sometimes
referred to as the upper motor neurons and they provide
numerous separate pathways that can influence motor
activity.
• Axon of the second order neuron is short and synapses with
the third order neuron.
• Axon of the third order neuron innervates a skeletal muscle
through the anterior root and spinal nerve and in some
instances, the axon of the first order neuron terminates
directly on the third order neuron.
• Corticospinal tract – major descending tract; largest;
comes from the primary motor, premotor, prefrontal and
primary somatosensory cortices.
• 2/3 of the fibers arise from the precentral gyrus
• 1/3 arise from the postcentral gyrus
• The descending fibers converge in the corona radiata and
then pass to the posterior limb of the internal capsule.
• It continues to the middle 3/5 of the basis pedunculi of the
midbrain or the cerebral peduncle.
• Here, the fibers concerned with cervical portions of the body
are situated medially while those concerned with the leg are
placed laterally.
• On entering the pons, the tract is broken into many bundles
with the transverse cerebellar fibers.
• In the medulla oblongata, the bundles become grouped
together along the anterior border to form a swelling known
as the pyramid. Hence, it has an alternative name –
pyramidal tract.
• On the junction of the medulla, the cervico-medullary
junction, most of the fibers cross to the other side and enter
the white lateral column to form the lateral corticospinal
tract.
• The remaining fibers which do not decussate eventually
cross the midline and terminate in the anterior gray column
of the spinal cord segments in the cervical and upper
thoracic regions but most of the fibers still decussate.
• The lateral corticospinal tract descends the length of the
spinal cord and its fibers terminate on the anterior gray
column of all the spinal cord segments.
• Most corticospinal fibers terminate synapse with the
interneurons which in turn synapse with the alpha motor
neurons and some gamma motor neurons.
• Only the largest corticospinal fibers synapse directly with
the motor neurons.
• The corticospinal tracts are not the sole pathway for serving
voluntary movements, rather they form the pathway that
confers speed and agility to voluntary movements and is
thus used in performing rapid-skilled movements.
• Branches are given off early in their descent and return to
the cerebral cortex to inhibit the activity in adjacent regions
of the cortex.
• These branches keep the subcortical regions informed
about the cortical motor activity
• Subcortical regions may react and send their own nervous
impulse to the alpha and gamma motor neurons by other
descending pathways.
CORTOSPINAL TRACT
Function: Rapid skilled movement
Decussation: Pyramidal decussation (cervico-medullary
junction)
Branches:
• Early in their descent and return to the cerebral cortex
• Pass to the caudate and lentiform nuclei, the red nuclei, and
the olivary nuclei and the reticular formation
• Major descending tract; largest; comes from the primary
motor, premotor, prefrontal and primary somatosensory
cortices.
• 2/3 of the fibers arise from the precentral gyrus
• 1/3 arise from the postcentral gyrus
• The descending fibers converge in the corona radiata and
then pass to the posterior limb of the internal capsule.
o The fibers are organized so that the closest genum
[bend] are concerned with the cervical portions of the
body while those situated more posteriorly are
concerned with the lower extremity
• It continues to the middle 3/5 of the basis pedunculi of the
midbrain or the cerebral peduncle.
• Here, the fibers concerned with cervical portions of the body
are situated medially while those concerned with the leg are
placed laterally.
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 SPINAL CORD AND TRACTS

• On entering the pons, the tract is broken into many bundles • The neurons of the red nucleus receive afferent impulses
with the transverse cerebellar fibers. through connections with the cerebral cortex and
• In the medulla oblongata, the bundles become grouped cerebellum.
together along the anterior border to form a swelling known • This is believed to be an important indirect pathway by
as the pyramid. Hence, it has an alternative name which the cerebral cortex and cerebellum can influence the
‘pyramidal tract’. activity of the alpha and gamma motor neurons of the spinal
• On the junction of the medulla, the cervico-medullary cord.
junction, most of the fibers cross to the other side and enter
the white lateral column to form the lateral corticospinal
tract.
• The remaining fibers which do not decussate eventually
cross the midline and terminate in the anterior gray column
of the spinal cord segments in the cervical and upper
thoracic regions but most of the fibers still decussate.
• The lateral corticospinal tract descends the length of the
spinal cord and its fibers terminate on the anterior gray
column of all the spinal cord segments.
• Most corticospinal fibers terminate synapse with the
interneurons which in turn synapse with the alpha motor
neurons and some gamma motor neurons.
• Only the largest corticospinal fibers synapse directly with
the motor neurons.
• The corticospinal tracts are not the sole pathway for serving
voluntary movements, rather they form the pathway that
confers speed and agility to voluntary movements and is
thus used in performing rapid-skilled movements.
• Branches are given off early in their descent and return to
the cerebral cortex to inhibit the activity in adjacent regions
of the cortex.
• These branches keep the subcortical regions informed
about the cortical motor activity
• Subcortical regions may react and send their own nervous
impulse to the alpha and gamma motor neurons by other
descending pathways

RETICULOSPINAL TRACT
Function: Influence voluntary movements and reflex activity
Decussation: Some ross at various levels
• The reticulospinal fibers are also thought to include the
descending autonomic fibers.
• The reticulospinal tracts provide a pathway by which
the hypothalamus can control the sympathetic outflow
and the sacral parasympathetic outflow.

• The pontine and medullary nuclei give rise to the

RUBROSPINAL TRACT
Function: Facilitates the activity of the flexor muscles and
inhibits the activity of the extensor or antigravity muscles
Decussation: Immediately
• Rubro—comes from the red nucleus which is situated in
the pigmenting of the midbrain
• Axons of the neurons in the nucleus cross the midline at the
level of the nucleus and descend as the rubrospinal tract
through the pons and medulla to enter the lateral white
column of the spinal cord.
• The fibers terminate by synapsing the interneurons on the
anterior gray column of the cord.
reticulospinal tract, receive cortical input from the premotor
and to a lesser extent from the supplementary motor cortex.
• Because reticulospinal systems primarily influence
extensor muscles, including the paravertebral extensors
as well as those of the limbs, the corticoreticulospinal
system may provide the cortex with the means to influence
extensor muscles in parallel with its regulation of flexors.
• The cerebellar nuclei also project to the motor related areas
of the reticular formation thus, providing cerebellar
influence on extensor musculature.
• Throughout the midbrain, pons, and medulla are scattered
nerve cells and nerve fibers that are collectively known as
reticular formation.
• From the pons, neurons and axons which are mostly
uncrossed and down into the spinal cord, form the pontine
reticular formation.
• From the medulla, it also sends down fibers which are
crossed and uncrossed to the spinal cord.
• Reticulospinal fibers from the pons descend through the
anterior white column of the spinal cord while those from
the medulla oblongata descend on the lateral white column.
•

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 SPINAL CORD AND TRACTS
Pons —> Anterior White Column
Medullary Reticulary Spinal Tract —> Lateral White Column
• Both sets of fibers enter the anterior gray columns of the
spinal cord and may facilitate or inhibit the activity of the
alpha and gamma motor neurons.
• By this means, they influence voluntary movements and
reflex activity.
TECTOSPINAL TRACT
Function: Coordination of head and eye movement
Decussation: Soon after origin
• From the superior colliculus to the spine
• Fibers of this tract arise from the nerve cells and superior
colliculus in the midbrain and most of the fibers cross the
midline.
• It descends to the anterior white column. It is close to the
anterior median fissure.
• It synapses with the interneurons as well and it is believed
to be concerned with reflex postural movements in
response to visual stimuli.
• Some books say that it decussates in the dorsal tegmental
decussation in the midbrain.
VESTIBULOSPINAL TRACT
Function: Facilitates the activity of the extensor muscles and
inhibits the activity of the flexor muscles in association with
maintenance of balance
• Like the reticulo spinal tract that we discussed which mostly
facilitates the extensor muscles, it also facilities of the
extensor muscles.
• Vestibular nuclei are situated in the pons and the medulla,
beneath the floor of the 4th ventricle.
o It will receive afferents from the inner ear through the
vestibular nerve and from the cerebellum.
• The neurons of the lateral vestibular nucleus gives rise to
the axons that form the vestibulospinal tract
o Anin crossed tract that travels down to the medulla and
through the length of the spinal cord and in the anterior
white column.
• The fibers terminate by synapsing with the internotion
neurons of the anterior grey column of the spinal cord
• The inner ear and the cerebellum by means of this tract
facilitate the activity of the extensor muscles and inhibit the
activity of the flexor muscles in association with the
maintenance of balance.
DESCENDING AUTONOMIC FIBERS
• The higher centers of the central nervous system
associated with the control of autonomic activity are
situated in the cerebral cortex, hypothalamus, amygdaloid
complex, and reticular formation.
• The fibers from neurons in the higher centers cross the
midline in the brainstem.
• They descend in the lateral white column of the spinal cord
and terminate by synapsing on the autonomic motor cells in
the lateral gray columns in the thoracic and upper lumbar
(sympathetic outflow) and midsacral (parasympathetic)
levels of the spinal cord.
• In the fruition/lamubatuib of the spinal cord lesions as
demonstrated that DAT do exist and probably form part of
the retinulo spinal tract
FIGURE:
• Left: Different descending tracts
• Right: Different ascending tracts
• LCL The lamination of Cervical region is placed medially
compared to the sacral region which is located laterally.
o These same lamination is observed in the anterior
spinothalamic tract and the lateral spinothalamaic tract
• Opposite is true for the posterior column
o Sacral region = medially
o Cervical region = laterally
BLOOD SUPPLY OF THE SPINAL CORD
• Comes from the anterior and posterior spinal arteries and
the radicular arteries, and radiculospinal arteries
• ANTERIOR & POSTERIOR Arteries
o Come from the vertebral arteries
o Anterior spinal artery fuse to form a single anterior
spinal artery in front of the anterior median fissure
▪ Their branches are given alternately to the left and
right sides of the spinal cord
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 SPINAL CORD AND TRACTS

o Posterior Spinal arteries descend along the line of the

attachment of dorsal nerve roots on each side.
• The three spinal arteries are boosted by several
reticulospinal branches from the vertebral arteries and
intercostal arteries.
• Reticulospinal Artery
o Distinguishable from the smaller retinacular arteries
w/c enter every intervertebral foramen to nourish the
nerve roots. through the intervertebral
• Artery of Adamkiewicz
o Largest radiculospinal artery
o Arises from a lower intercostal artery or upper lumbar • Differentiation:
artery on the left side o Upper motor neuron: the motor system that’s confide
o Supplies the lumbar enlargement and conus medullaris in the CNS and responsible for the initiation of
voluntary movement.
▪ It’s also responsible for the maintenance of muscle
tone for support of the body against gravity and the
regulation of posture
o Lower motor neuron—is the efferent neuron of the
peripheral nervous system that connects the central
nervous system with the muscle to be innovated.

LESIONS IN THE UPPER MOTOR NEURON BABINSKI

• Scratching the skin along the lateral aspect of the sole of
the foot
o (+) the great toe become dorsally flexed and other toes
fan outward
o Normal response: Plantar flexion of all toes
• REMEMBER: Babinski is normally present during the first
year of life because the corticospinal tract is not myelinated
until the end of the first year of life
• Normally in the corticospinal tracts produce plantarflexion
of the toes in response to sensory stimulation of the skin of
the sole
o But when the corticospinal tracts become non-
functional the influence of the other descending tracts
on the toes become apparent and a kind of withdrawal
reflex takes place in response to stimulation of the sole
with the greater toe being dorsiflexed and other toes
fanning out.
ABSENT SUPERFICIAL REFLEXES
• The venous drainage of the cord is by means of the anterior • Superficial abdominal reflex—stroking the skin overlying
and posterior spinal veins w/c drain outward along the the abdominal muscles
nerve root. o Normal: contraction
o Any obstruction to the venous outflow is liable to o Lesion in the upper motor neuron (ex: in the spinal
produce edema of the cord with progressive loss of cord)—there is absence (-) of that contraction
function. • Cremasteric Reflex—stimulating the side the cremasteric
muscle
UPPER VERSUS LOWER MOTOR NEURON LESION o (-) : the cremasteric muscle fails to contract when the
skin on the medial side of the thigh stroke
UMN LMN o Normal: cremasteric muscle will contract and the
Babinski Atrophy testicle will go up
Absent superficial reflexes Fasciculation
Weakness Below Level Of Lesion
Weakness of below level of Flaccid paralysis
lesion • Hypertonia—increased tone
Hypertonia Hypotonia • Hyperreflexia—increased response in the deep tendon
reflex
Hyperreflexia Hypo/areflexia
Lesions In The Lower Motor Neuron
Atrophy
• Fasciculation—involuntary twitching of the muscles
because of injury to the lower motor neuron
• Flaccid paralysis—wherein the muscles are paralyzed
and look slim
• Hypotonia—decreased tone
• Hypo/Areflexia—decreased or absent reflexes

Figure: Different Types Of Paralysis

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 SPINAL CORD AND TRACTS
Plegia → paralysis while PHARISES → weakness
• Monoplegia—paralysis of one limb
• Hemiplegia—paralysis of one side of the body
• Diplegia—there is paralysis of two limbs
• Paraplegia—paralysis of both lower limbs
• Quadriplegia—all 4 limbs are paralyzed s
LESIONS OF THE DESCENDING TRACTS OTHER
THAN THE CORTICOSPINAL TRACTS
(EXTRAPYRAMIDAL TRACTS)
• Severe paralysis with little or no muscle atrophy
• Spasticity of the muscles
o Spasticity is characterized by a velocity dependent
increase in tonic stretch reflexes or muscle tone
• Exaggerated deep muscle reflexes and clonus
o Clonus—indicated when you apply a sudden and
sustained flexion to the ankle a few oscillatory beats
occur and persists.
• Clasp-knife reaction
o When passive movement of a joint is attempted there
is resistance going to spasticity of the muscles and the
muscles on stretching suddenly give way to
neurotendinous organ mediated inhibition.
SPINAL SHOCK SYNDROME
• A clinical syndrome which follows severe damage to the
spinal cord.
• All cord functions below the level of the lesion become
depressed or lost, and sensory impairment and a flaccid
paralysis occur.
• The segmental spinal reflexes are depressed.
• When the lesion is at a high level of the cord, it may also
cause severe hypotension from loss of sympathetic
vasomotor tone.
It’s very crucial to have fluid resuscitation for these patients
and if it occurs in higher cervical lesions, you should observe
for breathing problems and respiratory arrest because the
phrenic nerve, w/c innervates the diaphragm, comes from the
cervical roots
• In most patients, the shock persists for less than 24 hours,
whereas in others, it may persist for as long as 1 to 4 weeks.
• As the shock diminishes, the neurons regain their
excitability, and spasticity and exaggerated reflexes, will
make their appearance.
• The presence of spinal shock can be determined by testing
for the activity of the anal sphincter reflex.
• Anal sphincter reflex
o Initiated by placing a gloved finger in the anal canal
and stimulating the anal sphincter to contract by
squeezing the glans, penis, or clitoris or gently tugging
on an inserted foley catheter
o Absent (-) anal reflex would indicate the existence of
spinal shock.
o Exception: a cord lesion involving the sacral
segments of the cord would nullify this
SPINAL CORD SYNDROMES
COMPLETE CORD TRANSECTION SYNDROME
• The whole spinal cord is involved
• All descending and ascending tracts here in the spinal cord
are affected
Symptoms:
• Bilateral lower motor neuron paralysis and muscular
atrophy in the segment of the lesion
o This is because there is damage to the neurons and
anterior grey columns and possibly damage to the
nerve roots of the same segment
• Bilateral spastic paralysis below the level of the lesion
o There is also a bilateral babinski sign
o Depending on the level of the segments of the spinal
cord damage, bilateral loss of superficial abdominal
and cremasteric reflexes occurs
o All of the signs are caused by interruption of the
corticospinal tracts of both sides of the cord
o Bilateral spastic paralysis is produced by cutting the
descending tracts other than the corticospinal tracts
• Bilateral loss of all sensations below the level of the lesion
o Because the ascending tracts are involved
• Impaired bowel and bladder functions
o Since all of the descending autonomic fibers have been
destroyed
ANTERIOR CORD SYNDROME
• Anterior portion of the cord is affectedIt
• May involve the following: Anterior grey horn and Anterior
and lateral spinothalamic tracts
• Bilateral lower motor neuron paralysis in the segment of
the lesion and muscular atrophy
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 SPINAL CORD AND TRACTS

• Bilateral spastic paralysis below the level of the lesion

• Bilateral loss of pain, temperature, and light touch
sensations below the level of the lesion
• Tactile discrimination and vibratory and
proprioceptive sensations are preserved
o Because the posterior columns are not involved in this
type of injury

• Ipsilateral lower motor neuron paralysis

• Ipsilateral spastic paralysis below the level of the lesion
• Ipsilateral band of cutaneous anesthesia in the segment of
the lesion
• Ipsilateral loss of tactile discrimination and of vibratory and
proprioceptive sensations below the level of the lesion.
• Contralateral loss of pain and temperature
sensations below the level of the lesion
CENTRAL CORD SYNDROME • Contralateral but not complete loss of tactile sensation
below the level of the lesion
• The peculiar thing about this is there is a sacral sparing in
terms of a spastic paralysis and loss of pain, temperature,
light, touch and pressure sensation
o Because the lamination of the sacral region in the
corticospinal tract and in the spinothalamic tracts are
located in the most lateral regions compared to your
cervical, thoracic and probably the lumbar
• We often hear this term in intramedullary lesions meaning
the lesion started inside the cord.

POLIOMYELITIS
• An acute viral infection of the neuron of anterior view
columns of the spinal cord and the motor nuclei of the
cranial nerves
• In severe forms, respiration may be threatened due to
paralysis spreading to the intercostal muscles and
• Bilateral lower motor neuron paralysis in the segment of
diaphragm. Muscles of the face pharynx larynx and tongue
the lesion and muscular atrophy
may also be paralyzed
• Bilateral spastic paralysis below the level of the lesion
• Manifestations are Paralysis and wasting of the muscles
with characteristic sacral “sparing.”
• Bilateral loss of pain, temperature, light touch, and pressure
sensations below the level of the lesion with
characteristic sacral “sparing.”

BROWN-SEQUARD SYNDROME
• Hemi section of the cord which can be caused by fracture
dislocation of the vertebral column, a bullet, stab wound or
an expanding tumor
• All of the manifestations are ipsilateral except for loss of
pain and temperature sensations and tactile sensation
o Because it takes a several spinal segments before
these tracts (lateral and anterior spinothalamic tract)
cross to the other side
• That’s why the manifestation is contralateral for the pain
and temperature and tactile sensation

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 SPINAL CORD AND TRACTS
AMYOTROPHIC LATERAL SCLEROSIS
• AKA: ALS or Lou Gehrig’s disease
• Familiarized with this disease because of the ice bucket
challenge which is to raise awareness for this particular
disease
• This is a disease confined on the corticospinal tracts and
the motor neurons of the anterior view columns of the spinal
cord
• You can observe a lower motor neuron lesion—lower motor
neuron manifestation will have progressive muscular
atrophy paresis and fasciculations
o Upper motor neuron manifestation: Paresis,
spasticity, and Babinski response
o Lower motor neuron manifestation: Progressive
muscular atrophy, paresis, and fasciculations
CAUDA EQUINA SYNDROME
• It refers to a characteristic pattern of neuromuscular and
neurological symptoms resulting from the simultaneous
compression of multiple lumbosacral nerve roots below the
level of conus medullaris
• Pain in the dermatomes supplied by the affected roots
• Saddle anesthesia (asymmetric)
• Weakness in muscles supplied by affected nerves
• Bladder and rectal sphincter dysfunction (late)
• Impairment in erection and ejaculation
CONUS MEDULLARIS SYNDROME
• It's an injury located around T12 to L2
• It displays various symmetrical lower limb deficits
• Low back pain
• Saddle anesthesia (symmetric)
• Muscle weakness (symmetric)
• Bladder and rectal sphincter dysfunction (early)
• Impotence
Saddle Anesthesia—loss of sensation in the perinium and
saddle region (buttocks, anus, groin, and upper thighs)
AMERICAN SPINAL CORD INJURY ASSOCIATION
(ASIA) IMPAIRMENT SCALE
• A universal classification tool for spinal cord injuries based
on a standardized sensory and motor assessment
• We need to test for:
o Sensory
o Motor
o Determine the sensory and motor level
• For the keys sensory points, they are readily located in
relation to bony anatomical landmarks in the dermatomes
o They are tested by bilaterally using light touch and
pinprick
o We test both the right and the left
• Scores from the result of your exams here are written in the
columns
• Motor function are also tested bilaterally
• improper positioning and stabilization of such can use a
substitution from the other muscles but it will not actually
reflect the muscle function being graded
o Different muscle function Grading
▪ (0) no movement at all
▪ (5) normal full action of movement of the muscle
against gravity and against resistance
o Sensory grading—where (2) is normal (0) is absent
o Determine your neurological level of injury by
identifying the most caudal segments of the cord with
intact sensation—meaning that is the sensory level
o Antigravity muscles function strength which is grade
three or more—(Grade 3) meaning it is a muscle
activity against gravity or more
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 SPINAL CORD AND TRACTS

▪ On both sides of the body provided that there is QUICK QUIZ

normal intact sensory and motor function roastery
grade five so there so 1. What tract localizes pain and temperature? lateral Spino thalamic Tract

2. In the corticospinal tract, where do the descending fibers

converge? Corona Radiata
3. What type of fibers conduct pain? Delta A- type and C- type fibers
4. Has a semi-fluid nature that allows rocking forward and
backward Nucleus Pnlposus
5. What is a type of pain that can be precisely localized? Fast type

FREEDOM WALL

AIS GRADE

REFERENCES

University of Santo Tomas powerpoint presentation: Richelle

Ann S. Santiano, MD

Nucleus Pulposus) (5) Fast type

(1) Lateral Spinothalamic Tract (2) Corona Radiata (3) Delta A-type and C-type fibers (4)

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