Clinical Neurophysiology

A. CNS
a. Composed of
i. Brain
ii. Brainstem
iii. Spinal Cord
b. Processes information, initiates activity and makes adjustments
B. PNS
a. Composed of
i. Spinal nerves - 31 pairs
ii. Cranial nerves - 12
iii. Receptors
b. Carries information to/from CNS and body
C. Brain
a. Frontal lobes
i. Motor function, problem solving, spontaneity, memery, language,
initiation, judgement, impulse control, and social and sexual behavior
b. Parietal lobes
i. Sensation/perception and sensory integration
c. Temporal lobes
i. Auditory perception, speech, emotion, visual integration
d. Occipital lobe
i. Visual processing
D. Brain Stem
a. Midbrain
b. Pons
c. Medulla
d. Contains important nuclei involved in:
i. Basic body functions: breathing, swallowing, heart rate, blood pressure,
consciousness, conscious alertness and sleep
ii. Postural control and locomotion
iii. Cranial nerves - control head, eyes, face and are critical to the functions
of hearing, taste and the perception of movement
iv. Contains ascending/descending pathways connecting and body and brain
E. Reticular formation
a. Complex neural network in the brain stem
i. Nuclei and its connections
ii. Ascending and descending pathways
b. Main function
i. Integrates sensory and cortical information
ii. Modulates nociceptive (pain) information
iii. Regulates autonomic and consciousness
iv. Regulates somatic motor activity (muscle tone)
 F. Neurons
a. Specialize in the reception, conduction, and transmission of electrochemical
signals, allowing for communication between nerves
i. Basic components of a neuron
1. Cell body and cell membrane
a. Metabolic center of the neuron
2. Dendrites
a. Short processes emanating from the cell body to receive
input from other cells
3. Axon hillock
a. Junction between the axon and the cell body
4. Axon
a. Long process that projects from the cell body to carry
electrochemical impulse
5. Myelin and Nodes of Ranvier
a. Myelin is the fatty insulation around many parts of the
axon, with gaps between myelin called Nodes of Ranvier
6. Buttons
a. Button like endings of the axon branches that release
chemicals into synapses
G. Neuron function and communication
a. Action potential
i. Energy conversion from the outside world or self, stimulating a neuron
demonstrated by rapid changes in electrical potential within that nerve
1. Flash of light within the nerve that allows for communication with
other nerves
b. Saltatory conduction (hop or leap)
i. Propagation of action potentials along an axon from node to node,
bypassing all myelinated sections
c. Synaptic communication
i. Communication between two nerve cells via neurotransmitters being
released within the space (synapse) between two cells
H. Glial cells
a. Support cells of the nervous system (most abundant cell in the NS)
i. Microglia
1. Immune support cells of the NS
ii. Astrocytes
1. Broad roll in the brain from synaptic support to blood brain barrier
control
iii. Oligodendrocytes
1. Myelin producing cells of the CNS
iv. Schwan cells
1. Myelin producing cells of the PNS
Sensation and Perception
 A. The visual system
a. Visual pathway
i. Retina converts light into neural signals
1. Axons from neurons in the retina travel in the optic nerve
a. Optic nerve cross and merge at the optic chiasm, starting
the optic tract
ii. Signals in the optic tract travel and synapse with neurons in the lateral
geniculate nucleus of the thalamus
iii. Post-synaptic neurons travel from the LGN of the thalamus to the visual
cortex
iv. INformation is then sent to the various visual association areas within the
occipital, parietal and temporal lobe
B. Cortical processing of visual information
a. Over 30 different visual association areas
i. Occipital, parietal, and temporal lobes
b. Where pathway
i. Analyzes visual stimulus about where a structure is located in visual
space
c. What pathway
i. Analyzes what the stimulus is
d. Areas responsible for things such as:
i. Color, movement, faces, etc.
C. The somatosensory system
a. Somatosensation contributes to an understanding of the external world
i. Allows us to control and adjust movement
ii. Plays a role in the prevention and minimization of injury
b. Perceived both at the conscious and unconscious level
i. Sensation vs perceptions
D. Receptors
a. Mechanoreceptors
i. Perceive pressure, vibrations, texture of the skin (Meissner’s corpuscles,
Merkle cells, Pacinian corpuscle, Ruffini endings)
b. Proprioceptors
i. Detects information related to the position of the body in relation to the
environment and other parts of the body (muscle spindle and golgi tendon
organs)
c. Nociceptors
i. Detect pain or sensations that can or does cause damage to the skin or
other tissues or the body
d. Thermoreceptors
i. Detect thermal (heat) and cryo (cold) modalities
Sensory detection and receptors
A. Modality
 a. A general class of stimulus, determined by the type of energy transmitted by the
stimulus and the receptors specialized to sense that energy
B. Location
a. Represented by the set of sensory receptors within the sensory system that are
active
C. Intensity
a. Signaled by the response amplitude of each receptor, which reflects the total
amount of stimulus energy delivered to the receptor
D. Timing
a. Defined by when the receptor starts and stops and is determined by how quickly
the energy is received or lost by the receptor
E. Receptors
a. Muscle spindle
i. Slowly adapting receptors located within the muscle fibers to detect the
amount of change in length, as well as the speed of change in length in
the muscle
1. Sensory and motor components that play a role in the production
of smooth controlled movement
b. Golgi tendon organ
i. Receptors located near the musculotendon junction that detects and
responds to contraction and load of tendon
1. Have a high threshold and serve to protect the muscle and tissues
from injury
Peripheral Nerves
A. The spinal nerve
a. Main function to carry information via electrical impulses, for communication
between the body and CNS
B. Connective tissue
a. Endonerim
i. Delicate connective tissue directly covering each nerve fiber within its
fascicle
b. Perineurium
i. Soft tissue surrounding fascicles, or bundles of nerve fibers
c. Epineurium
i. Outermost layer of connective tissue encasing the nerve. Protects
multiple nerve fascicles and blood vessels
C. Blood vessels
a. High vascularized
Spinal cord
A. Gray matter
a. Posterior horn
i. Contains afferent (sensory) neurons
b. Anterior horn
i. Contains efferent (motor) neurons
 B. White matter
a. Nerve fibers (axons) that make up tracts in the spinal cord and peripheral nerves
C. Spinal nerve/nerve root
a. Most proximal part of the PNS that connect to the spinal cord
Thalamus
A. Main function ss to serve as a relay station for sensory input
a. Receives information from the body and different subcortical areas to be sent to
the appropriate area of the brain for perception and interpretation
B. Dorsal column/Medial lemniscus: Afferent sensory
a. Sensory quality
i. Discriminative touch, vibration, pressure, stretch, conscious perception
b. Information is carried ipsilateral through the spinal cord, crosses in the lower
medulla to travel to the contralateral thalamus via the medial meniscus
c. Information is important for recognizing objects by touch, controlling fine
movements and making movements smooth
C. Anterolateral (Spinal thalamic)
a. Sensory quality
i. Pain, temperature, crude touch, tickle, itch, sexual sensations
b. Information enter the dorsal horn of the spinal cord, crosses in the spinal cord
and revels in the contralateral spinothalamic tract within the anterolateral column
of the spinal cord
i. Information is then projected to the thalamus, synapses and is then
projected to the cortex
c. Important for transmitting more noxious or mechanical or thermal stimulation