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Part I 1 Anatomy 2

Anatomy and 2 Assessment 30

Assessment of the

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Nervous System

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Anatomy and Assessment of the Nervous System

1 Anatomy
Denita Ryan

Abstract
Knowledge of the anatomy of the nervous system is crucial for nurses caring
for patients with neurologic diseases or disorders because they must thor-
oughly understand the normal neuroanatomy to make meaningful correlations
between anatomical and clinical findings. The nervous system consists of the
central nervous system and the peripheral nervous system. This overview of
the normal neuroanatomy includes basic surface structure, the ventricular sys-
tem, and the vasculature of both the brain and the spine.

Keywords: autonomic nervous system, brain, cranial nerves, peripheral

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nervous system, spinal cord, vertebrae

1.1 Nervous System

The nervous system, widely thought to be the most complicated system in the
human body, is divided into two parts: the central nervous system (CNS) and
the peripheral nervous system (PNS) (Box 1.1 Components of the Nervous Sys-
tem). Nurses caring for patients with neurologic diseases or disorders must
possess a thorough knowledge of normal neuroanatomy, including the cranial
nerves (CN), so that they can recognize anatomical abnormalities. This knowl-
edge will allow nurses to make meaningful correlations between anatomical
and clinical findings.

Box 1.1 Components of the Nervous System

● Central nervous system
○ Brain
○ Spinal cord
● Peripheral nervous system
○ Spinal nerves
○ Cranial nerves
○ Autonomic nervous system

– Sympathetic nervous system

– Parasympathetic nervous system

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1.1.1 Cellular Anatomy

The nervous system comprises two fundamental cell types: neurons
(▶ Fig. 1.1) and neuroglial cells (▶ Fig. 1.2).

Neurons
● Fundamental building blocks
● Highly specialized
● Conduct and receive nerve impulses, as well as release chemical
transmitters
○ Soma: Cell body of the neuron

○ Dendrites: Receive impulses

○ Axons: Carry impulses away from the cell

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Fig. 1.1 Neuron.

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Fig. 1.2 Neurons and neuroglial cells.

● Myelin sheath (Box 1.2 Clinical Correlation: Demyelinating Disease)

○ Formed by Schwann’s cells
○ Composed of a lipid substance
○ Provides insulation for nerve impulses

● Synapse
○ The junction between neurons, in which impulses are transmitted
● Neurotransmitters
○ Chemical substances that promote, inhibit, or alter cellular response
○ Over 100 neurotransmitters have been identified, including

– Amines (e.g., acetylcholine and serotonin)

– Catecholamines (e.g., dopamine and norepinephrine)

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Box 1.2 Clinical Correlation: Demyelinating Disease

● Multiple sclerosis is an example of a demyelinating disease
● In demyelination, the protective Schwann’s cells lose their myelin sheaths,
making them less effective in shielding the nerves

Neuroglial Cells
● Specialized support cells. They include
○ Astrocytes: Supply nutrients to the brain
○ Ependymal cells: Line the ventricles and help produce cerebrospinal fluid

(CSF)
○ Oligodendrocytes: Form protective myelin sheath around the axons

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○ Microglial cells: Scavengers; associated with immune response

○ Schwann’s cells: Form the myelin sheath around the peripheral nerves

1.2 Central Nervous System

The CNS includes the brain and spinal cord (Video 1.1). Of all the systems in the
body, the CNS has the largest number of axons and synapses. The brain alone
consists of approximately 100 billion cells. The brain is encased and protected by
the skull. In turn, the skull is covered and cushioned by the scalp, which consists
of multiple layers. Both the scalp and the skull protect the brain.

1.2.1 Scalp
The scalp consists of several layers that cover the skull.
● Skin (dermal) layer
○ Protects the skull
○ Contains hair

● Subcutaneous layer
○ Vascular; may bleed profusely
● Galea

○ Tough innermost layer

○ Subgaleal space: Potential location for blood to collect, commonly called a

goose egg
● Periosteum
○ Thin layer of connective tissue that covers the skull

1.2.2 Skull
The skull (▶ Fig. 1.3) is composed of eight fused bone plates.

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Fig. 1.3 Skull.

Cranial Bones (n = 8)
● Frontal
● Temporal (n = 2); thinnest portion of bone
● Parietal (n = 2)
● Occipital
● Sphenoid
● Ethmoid

Fourteen facial bones form the anterior portion of the skull.

Other Important Bone Segments

● Clivus: The thin bone that rests against the brainstem
● Sella turcica: Houses the pituitary gland, which is not considered part of the
brain

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1.2.3 Brain
The brain (Box 1.3 Just the Facts: The Brain), largely recognized as the most
complex organ in the human body, has a complicated anatomy. Sulci (singular,
sulcus) are small separations between brain tissue. Gyri (singular, gyrus) are
folds (i.e., wrinkles) on the surface of the brain. The purpose of the sulci and
gyri is to increase the surface area of the brain.
Fissures are deep separations between the cerebral hemispheres (or lobes)
of the brain, commonly used as geographical markers. The best-known fissures
are as follows:
● Great longitudinal fissure

● Lateral fissure of Sylvius

● Central fissure of Rolando
● Parieto-occipital fissure

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Box 1.3 Just the Facts: The Brain
● The adult brain weighs about 3 lb
● Brain tissue is also called parenchyma
● The brain is composed of 78% water, 10% fat, 8% protein, and 4% organic and
inorganic substances
● The brain makes up only about 2% of the body’s total weight, but it uses
about 20% of its oxygen supply and 20% of its blood flow
● The brain consists of 40% gray matter and 60% white matter
● The adult brain has the consistency of thickened JELL-O

Meninges
The meninges (▶ Fig. 1.4) are the three layers of thick connective tissue that
cover the entire brain and spinal cord.
● Pia mater

○ Delicate innermost layer

○ Adheres to the brain
● Arachnoid mater

○ Situated above the pia mater

○ Space below the arachnoid is called the subarachnoid space (Box 1.4

Clinical Correlation: Subarachnoid Hemorrhage)

○ Contains CSF
● Dura mater
○ Latin for “tough mother”

○ Tough, fibrous layer between the arachnoid mater and the skull bone

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Fig. 1.4 Layers of the meninges.

○ Spaces above (epidural) and below (subdural) the dura are typical locations
for dural hematomas, a common type of brain injury (Box 1.5 Clinical
Correlation: Dural Hematomas)
– The tentorium, a tent-like fold of dura that separates the cerebrum and
cerebellum, serves as an important anatomical marker

Box 1.4 Clinical Correlation: Subarachnoid Hemorrhage

● Defined as bleeding into the space below the arachnoid layer
● Common causes of subarachnoid hemorrhage are trauma and aneurysmal
rupture

Box 1.5 Clinical Correlation: Epidural and Subdural Hematomas

● The main cause of cerebral and spinal hematomas is trauma
● This common traumatic brain injury involves bleeding into the space above
or below the dura
○ Epidural hematoma: Bleeding above the dura

○ Subdural hematoma: Bleeding below the dura

● May result from surgery or rapid decompression of ventricles

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Ventricular System
The ventricular system produces and circulates CSF (Box 1.6 Cerebrospinal
Fluid). It includes four cavities (i.e., ventricles) that contain CSF and the trans-
port system that circulates CSF throughout the brain and spinal cord (Box 1.7
Clinical Correlation: Disorders of the Ventricular System). The components of
the ventricular system are
● Ventricles
○ Situated in the center of the brain
○ The four ventricles include the right and left lateral ventricles, the third

ventricle, and the fourth ventricle (▶ Fig. 1.5. and ▶ Fig. 1.6)
○ Communicate with other ventricles
○ Composed of ependymal cells

● Choroid plexus

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○ Refers to the group of blood vessels in each ventricle
○ Produces CSF (approximately 22 mL/h)

Fig. 1.5 Ventricles, lateral view.

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Fig. 1.6 Ventricles, posterior

view.

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● Cisterns
○ CSF reservoirs
● Foramina of Monro
○ Connect the lateral ventricles with the third ventricle

○ Also called the interventricular foramina

● Cerebral aqueduct of Sylvius
○ Passageway from the third to fourth ventricle

○ Also called the sylvian aqueduct

● Foramen of Magendie and foramen of Luschka
○ Openings from the fourth ventricle into the subarachnoid space

● Arachnoid villi
○ Reabsorb CSF into blood
○ Transport CSF to dural sinus

Box 1.6 Cerebrospinal Fluid

● Produced by the choroid plexus
● Circulates through the ventricular system and in the subarachnoid space
● Cushions the brain and spinal cord
● Produced at a rate of 500 mL/day
● The body contains about 150 mL of CSF at any one time
● Absorbed by the arachnoid granules
● Intracranial pressure is commonly measured in the ventricular CSF

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Box 1.7 Clinical Correlation: Disorders of the Ventricular

System
● Hydrocephalus
● Ventriculitis

Cerebrum
The cerebrum consists of two cerebral hemispheres, right and left.
● Separated by the great longitudinal fissure
● Surface of the brain is covered by gray matter, which is composed of millions

of neurons

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● Deeper brain tissue contains white matter, which is composed of millions of

highly specialized neuroglial cells

● Pathways carrying information to the cerebral hemispheres cross over from

one hemisphere to the other (Box 1.8 Clinical Concern)

The hemispheres are further divided into two parts.

● Supratentorial (above the tentorium)
● Infratentorial (below the tentorium)

Box 1.8 Clinical Concern

● CNS pathways carrying sensory or motor information to the cerebral
hemispheres cross to the opposite hemisphere
● Each hemisphere therefore controls the movement of, and perceives
sensation from, the contralateral (opposite) side

Supratentorial Region
The supratentorial area of the brain consists of the frontal, parietal, temporal,
and occipital lobes (▶ Fig. 1.7) and the corpus callosum.
● The frontal lobe controls
○ Emotions and behavior
○ Attention
○ Motivation

○ Judgment
○ Broca’s area: Motor aspect of speech (i.e., expressive speech)
○ Initiation of motor integration

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Fig. 1.7 Lobes of the brain.

○ Problem-solving
○ Bowel and bladder function
● The parietal lobe controls
○ Interpretation of characteristics of sensory input (e.g., pain, temperature,

and touch)
○ Processing of visual–spatial information (nondominant hemisphere)
○ Praxis (dominant hemisphere)

● The temporal lobe controls

○ Hearing
○ Wernicke’s area: Interpretation of language (i.e., receptive speech)

○ Memory
○ Musical awareness
○ Sequencing
● The occipital lobe controls
○ Visual perception
○ Interpretation of the written word
● The corpus callosum is a thick band of nerve fibers running longitudinally
that connects the hemispheres

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Diencephalon
Located in the posterior portion of the forebrain, the diencephalon (▶ Fig. 1.8)
contains several important structures, primarily the thalamus and the hypo-
thalamus that form the floor of the third ventricle.

Thalamus
● Sensory relay system
● Integrative center that connects various areas of the brain
● Pain awareness

Hypothalamus
● Deep structure forming the wall of the third ventricle

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● Regulates basic instincts such as hunger, thirst, sex drive, anger, and
aggression (part of limbic system)
● Controls secretion of pituitary hormones
● Autonomic nervous system (ANS) center (sympathetic), which regulates
○ Body temperature
○ Water metabolism (antidiuretic hormone)

○ Sleep cycles; see also section on ANS in this chapter

Fig. 1.8 Diencephalon (consisting primarily of the thalamus and hypothalamus),

brainstem (consisting of medulla, pons, and midbrain), and cerebellum.

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Internal Capsule
The internal capsule is a large bundle of nerve fibers, both motor and sensory,
that connect the various areas of the brain and spinal cord.
● Composed of white matter
● Anatomically critical; controls major motor and sensory functions

● Occupies a very small area of the brain

Pituitary Gland (Hypophysis)

● Endocrine gland (▶ Table 1.1) located in the sella turcica, at the base of the
brain
● Connected to the hypothalamus

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Basal Ganglia
The basal ganglia (▶ Fig. 1.9) are located deep within the cerebrum (Box 1.9
Clinical Correlation: Disorders of the Basal Ganglia). They control fine motor
function, particularly in the hands and arms. The basal ganglia consist of sev-
eral subcortical nuclei.

Table 1.1 Pituitary gland function

Lobe of pituitary Hormone secreted Implications of hormone
gland deficiency
Anterior Adrenocorticotropic hormone Cushing’s syndrome
Adrenal hyperplasia
Growth hormone Acromegaly
Thyrotropin Thyrotoxicosis (rare)
Prolactin Galactorrhea
Amenorrhea
Infertility
Follicle-stimulating hormone Usually does not produce clinical
symptoms
Luteinizing hormone Usually does not produce clinical
symptoms
Posterior Vasopressin or antidiuretic Controls rate of water secretion
hormone into urine
Implicated in diabetes insipidus
and SIADH
Oxytocin Uterine contraction
Abbreviation: SIADH, syndrome of inappropriate antidiuretic hormone.

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Fig. 1.9 Thalamus and basal

ganglia.

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● Lenticular nuclei
○ Globus pallidus (regulates voluntary movement)
○ Substantia nigra (stores dopamine)
○ Putamen (affects learning and helps regulate voluntary movement)

● Caudate nucleus
● Amygdala

Box 1.9 Clinical Correlation: Disorders of the Basal Ganglia

● Parkinson’s disease
● Athetosis
● Hemiballismus
● Huntington’s chorea

Infratentorial Region
Brainstem
The brainstem is a very small area of the brain that contains extremely
eloquent brain tissue. The brainstem is composed of
● Midbrain
○ Origin of oculomotor and trochlear nerves (cranial nerve [CN] III and CN IV)

● Pons
○ Origin of trigeminal, abducens, facial, and vestibulocochlear nerves (CNs

V-VIII)
○ Located between the midbrain and medulla

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● Medulla
○ Located below the pons and above the spinal cord
○ Origin of CN glossopharyngeal, vagus, spinal accessory, and hypoglossal

nerves (CNs IX-XII)

○ Includes the cardiac and respiratory centers, as well as the ANS, which

regulate
– Heart rate
– Blood pressure
– Respiration

Cerebellum
The cerebellum, located in the posterior fossa and attached to the brainstem,
influences the following:

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● Coordination and fine motor movement
● Balance and equilibrium

● Tone and posture

● Eye movement (ocular disorders such as nystagmus may result from damage

to the cerebellum) (Box 1.10 Clinical Correlation: Disorders of the

Cerebellum)

Box 1.10 Clinical Correlation: Disorders of the Cerebellum

● Ataxia
● Nystagmus
● Tremors (intention)

Specific Systems in the Brain

Reticular Activating System
● Diffuse system within the deep structures of the brain
● Extends from the cerebral cortex to the brainstem
● Controls sleep–wake cycles
● Regulates consciousness

Limbic System
● Complex system that includes
○ Hypothalamus
○ Hippocampus
○ Amygdala

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● Regulates primitive emotions and instincts

○ Behavior and emotions (e.g., fear and anger)
○ Sex drive
○ Short-term memory

○ Self-preservation (e.g., hunger and sleep)

Vasculature of the Brain

Arterial System
Circle of Willis
● Located at the base of the brain (▶ Fig. 1.10)
● Consists of anterior (carotid) and posterior (vertebrobasilar) components
● Connects the anterior and posterior circulations

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○ Anterior component

– Middle cerebral arteries (n = 2)

– Anterior cerebral arteries (n = 2)
– Anterior communicating artery
○ Posterior component

– Posterior communicating arteries (n = 2)

– Posterior cerebral arteries (n = 2)

Fig. 1.10 Circle of Willis.

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Fig. 1.11 Blood supply to cerebrum and cerebellum.

Anterior Circulation
The anterior circulation supplies the cerebrum anterior to the posterior edge of
the temporal lobe (▶ Fig. 1.11). It includes arteries originating from the carotid
arteries.
● Internal carotid arteries
● Middle cerebral arteries

● Anterior communicating artery

● Anterior cerebral arteries
● Posterior communicating artery

Posterior Circulation
The posterior arterial circulation supplies the inferior portion of the temporal
lobe, the brainstem, the cerebellum, and the spinal cord (Box 1.11 Clinical Cor-
relation: Disorders of the Cerebrovascular System). It consists of arteries arising
from the subclavian artery.
● Vertebral arteries
● Basilar artery
● Posterior cerebral arteries

● Superior cerebellar arteries

● Anterior inferior cerebellar arteries
● Posterior inferior cerebellar arteries

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Box 1.11 Clinical Correlation: Disorders of the

Cerebrovascular System
● Aneurysms
● Arteriovenous malformations
● Atherosclerosis
● Arteritis
● Hemorrhagic stroke
● Ischemic stroke
● Moyamoya disease
● Stenosis

Venous System

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The venous circulation courses primarily through the dural sinuses.
● Cavernous sinus
○ Includes oculomotor, trochlear, trigeminal, and abducens nerves (CN III-VI)
○ Internal carotid arteries pass through the cavernous sinus

○ Collects blood from the inferior surface of the brain, including orbits
● Superior sagittal sinus
○ Collects blood from the cortical veins on the convexity of the brain

○ Drains CSF
● Bridging veins
○ Connect the brain and the dural sinuses

○ Common location of subdural hemorrhage

1.2.4 Spine
● Consists of multiple bony structures called vertebrae (▶ Fig. 1.12)
● Vertebrae are stacked on top of each other, providing support for the head
and the body
● The 33 vertebrae make up the 5 areas of the spine
○ Cervical (n = 7)

○ Thoracic (n = 12)
○ Lumbar (n = 5)
○ Sacrum (n = 5, fused into 1 segment)

○ Coccyx (n = 4, fused into 1 segment)

Anatomy and Sections of Individual Vertebra

Body
● Anterior portion of the vertebra
● Largest portion of the vertebra

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Fig. 1.12 The spine.

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Arch
● Posterior portion of the vertebra
● Each arch consists of
○ Pedicles
○ Lamina

○ Spinous and transverse processes

○ Articulating surfaces or facets

Articulation
● Vertical alignment of the vertebral bodies, with the disk in between and the
facets on either side

Cervical Vertebrae

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● Topmost vertebrae (n = 7) (▶ Fig. 1.13)
● Smallest vertebrae
● The first cervical vertebra (C1) is called the atlas
● The second cervical vertebra (C2) is called the axis
○ C2 contains the odontoid process, on which the atlas rests

Thoracic Vertebrae
● Trunk-level vertebrae (n = 12) (▶ Fig. 1.14)
● Slender part of the spinal cord

Lumbar Vertebrae
● Low-back vertebrae (n = 5) (▶ Fig. 1.15)
● Largest vertebrae
● End at conus medullaris (i.e., the cone-shaped end of the spinal cord)

Sacral Vertebrae and Coccyx

● Bottommost vertebrae (n = 5)
● Include the conus medullaris

Supportive and Protective Structures

Ligaments
● Control spine movements
● Best-known spinal ligaments
○ Anterior longitudinal ligament
○ Posterior longitudinal ligament

○ Ligamenta flava

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Fig. 1.13 Cervical vertebrae.

Meninges
● Membranes that cover the spinal cord and the brain

Intervertebral Disks
● Cartilaginous cushions between vertebrae; center of disk is nucleus pulposus
(Box 1.12 Clinical Correlation: Herniated Disk)
● Differ in size and shape, depending on the size of vertebrae
● Serve to cushion and absorb movement and stress

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Fig. 1.14 Thoracic vertebrae.

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Fig. 1.15 Lumbar vertebrae.

Box 1.12 Clinical Correlation: Herniated Disk

● The nucleus pulposus loses moisture and becomes dry (i.e., desiccates) with
age or trauma
● Herniated nucleus pulposus is a common spine disorder; see also Chapter 11,
Spine Disorders

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Spinal Cord
● Elongated mass of nerve tissue
● Extends from C1 to L1 or L2 in adults
● Terminates at the conus medullaris, around L1
● Serves as the primary pathway between the peripheral (nonvisceral) areas of
the body and the brain
● Segmented by region and groups of nerves, and numbered by level of
vertebral column
● Covered by meninges and cushioned by CSF, which fills the central canal of
the spinal cord and the space between the spinal cord and the meninges
● A cross-section of the spinal cord reveals a butterfly- or H-shaped central
area of gray matter (dorsal and ventral horns) surrounded by white matter
(myelinated axons)

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● Protected by the vertebrae

Spinal Nerves
● Part of the PNS; see also section on PNS in this chapter
● Exit the spinal cord in bilateral pairs

Sensory Pathways
● Afferent (i.e., ascending) pathways carry sensory information from specific
areas of the body (i.e., dermatomes) to the sensory cortex in the brain
● These sensations travel along one of the two major pathways
○ The dorsal column: Pain and temperature sensations travel via the dorsal

column to the medulla, where they cross to the opposite side and enter the
thalamus (▶ Fig. 1.16)
○ The ganglia: Touch, pressure, and vibration sensations travel via the ganglia to

the medulla, where they cross to the opposite side and enter the thalamus
● The thalamus is the relay station that transmits all impulses to the sensory
cortex for interpretation

Motor Pathways
● Ventral, efferent, and descending motor pathways transmit motor impulses
from the brain to specific muscles
● These pathways originate in the motor cortex of the frontal lobe of the brain
● Voluntary motor activity is regulated by the interaction between the
pyramidal and extrapyramidal systems
○ Pyramidal: Responsible for fine motor movement (▶ Fig. 1.17)
○ Extrapyramidal: Responsible for gross motor movement
● Motor impulses cross at the medulla to the opposite side and progress along
descending pathways, affecting contralateral motor function

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Fig. 1.16 Dorsal column.

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Vasculature of the Spine
Arterial System
The vertebral arteries first supply the upper cervical spinal cord and then sup-
ply the anterior (n = 1) and posterior (n = 2) spinal arteries. All three arteries
run along the length of the spinal cord.
● The radicular and radiculospinal arteries also contribute blood to various

nerve roots
● The artery of Adamkiewicz, which originates from the aorta, supplies about

one-third of the superior portion of the spinal cord

Venous System
● Intradural system: Consistent with arterial pathways
● Extradural system: Empties into the vena cava

1.3 Peripheral Nervous System

The PNS connects the CNS with the motor and sensory structures.

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Fig. 1.17 Pyramidal pathway.

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1.3.1 Spinal Nerves

● Bilateral pairs (n = 31)
○ Cervical (n = 8)

○ Thoracic (n = 12)
○ Lumbar (n = 5)
○ Sacral (n = 5)

○ Coccygeal (n = 1)
● Transmit sensory stimuli from receptors in skin, muscles, viscera, and
sensory organs to the dorsal column of the spinal cord

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Cauda Equina
● Means “horse’s tail” in Latin
● Collective term for nerve root cluster at inferior edge of spinal cord

1.3.2 Cranial Nerves

● Exist in pairs (n = 12) (▶ Table 1.2)
● Transmit the motor and sensory impulses
● Originate in the brainstem, except for the olfactory (CN I) and optic (CN II)
nerves (▶ Fig. 1.18)

Table 1.2 Origin and function of cranial nerves

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Cranial nerve Origin Function
Olfactory (CN I) Olfactory tract Smell
Optic (CN II) Retina Vision
Oculomotor (CN III) Midbrain Eye movement (medial, superior, and
inferior)
Pupil constriction
Elevation of eyelids
Trochlear (CN IV) Midbrain Eye movement (downward and inward)
Trigeminal (CN V) Pons Corneal reflex
Facial sensation
Chewing
Abducens (CN VI) Pons Eye movement (lateral)
Facial (CN VII) Pons Elevation of forehead (wrinkling forehead
and raising eyebrows)
Eye closure
Taste
Vestibulocochlear (CN Pons Hearing
VIII)
Glossopharyngeal (CN IX) Medulla Swallowing
Taste
Vagus (CN X) Medulla Swallowing
Gag reflex
Visceral sensations (peristalsis and heart
rate)
Spinal accessory (CN XI) Medulla Shoulder shrug
Hypoglossal (CN XII) Medulla Tongue protrusion
Abbreviation: CN, cranial nerve.

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Fig. 1.18 Origin of cranial nerves.

1.3.3 Autonomic Nervous System

The ANS contains neurons that can detect changes in, and maintain control of,
the viscera (i.e., internal organs). Its purpose is to provide a stable internal
environment within the body. The ANS is further divided into the sympathetic
and parasympathetic nervous systems. Awareness of the ANS and its role is
essential when caring for patients with spinal cord injuries.

Sympathetic Nervous System

● Acts globally to activate body responses in fight-or-flight situations

Parasympathetic Nervous System

● Acts focally to activate basic instincts, such as hunger and sex drive
(▶ Table 1.3)

1.4 Anatomy of the Nervous System

An in-depth understanding of neuroanatomy is critical for nurses who care for
patients with neurologic disorders. In fact, the rest of the information in this

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Anatomy

Table 1.3 Sympathetic and parasympathetic responses to stimulus

Structure Sympathetic response Parasympathetic response
Eyes Pupil dilation Pupil constriction
Heart Increased heart rate Decreased heart rate
Lungs Bronchodilation Bronchoconstriction
Digestive tract Decreased peristalsis Increased peristalsis
Salivary glands Decreased secretion Increased secretion
Urinary system Decreased urine production Contracted bladder
Increased urine production

handbook builds on the information provided in this chapter. Although the

basics of neuroanatomical structures and components have been briefly

Downloaded by: Universite Laval. Copyrighted material.

described here, this chapter is intended to serve as a handy, basic reference for
the bedside care of patients with neurologic disorders. The references below
may offer additional information, and the reader is encouraged to refer to them
to learn more about this challenging, awe-inspiring topic.

Video
Video 1.1 The brain and spinal cord.

Suggested Readings
[1] Goldberg S, Ouellette H. Clinical Anatomy Made Ridiculously Simple. Miami, FL: MedMaster;
2016
[2] Grigaitis M. Nursing assessment of patients with neurological disorders. In: Osborn KS, Wraa CE,
Watson A, eds. Medical Surgical Nursing: Preparation for Practice. 2nd ed. Boston, MA: Pearson; 2013
[3] Hansen JT. Netter’s Clinical Anatomy. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2014
[4] Hickey J. Clinical Practice of Neurological and Neurosurgical Nursing. 7th ed. Philadelphia, PA:
Wolters Kluwer Health; 2013
[5] Iannotti JP, Parker R. The Netter Collection of Medical Illustrations: Musculoskeletal System,
Volume 6, Part II—Spine and Lower Limb. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013
[6] McIlwain H, Bachelard HS. Biochemistry and the Central Nervous System. 5th ed. Edinburgh:
Churchill Livingstone; 1985
[7] Netter FH. The CIBA Collection of Medical Illustrations. Summit, NJ: CIBA-Geigy Corp.; 1991
[8] Wilson-Pauwels L, Akesson EJ, Stewart PA, Spacey SD. Cranial Nerves in Health and Disease. 3rd
ed. Shelton, CT: People's Medical Publishing House—USA; 2010
[9] Inner Body. http://www.innerbody.com. Accessed June 9, 2017
[10] University of British Columbia. Anatomy of the brain. http://www.neuroanatomy.ca. Accessed
June 9, 2017

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