The Nervous System

NA SHAO
Approach to the patient

 1st: Detailed history and physical examination

 2nd： topical diagnosis

 3rd: etiologic diagnosis

 4th： evaluate neurological deficit is temporary or

permanent.
Topical Diagnosis：
To locate lesion structure :
 To identified the impaired level of nervous
system ；
 To notice the lesions are local or more than
one site or affect the whole body. Usually
we base on the principle of monism；
 Patients’ elementary symptom is valuable
for topical diagnosis ；
The clinical feature of different neurological lesions：

 Muscular Lesion

 Peripheral Nervous Lesion

 Spinal Lesion

 Brainstem Lesion

 Cerebellar Lesion

 Cerebral Hemisphere Lesion

 Basal Ganglia Lesion

 Etiologic Diagnosis:
 Determinating nature of diseases.

 Infectious diseases, trauma, vascular diseases, tumor,

hereditary disease, nutritional and metabolic disease, toxic
disease, demyelinating diseases, neurodegenerative
diseases, birth trauma and hypogenesis, systematical
disease companying with nervous lesions.
Topical Diagnosis
 Let’s start from neuroanatomy……..
Overview of the Nervous System
Two major anatomical divisions
 The central nervous system (CNS)
1) Brain
2) Spinal Cord
 The peripheral nervous system (PNS)
1) Afferent Division
2) Efferent Division
 Somatic Nervous System
 Autonomic Nervous System
The Brain

 Forebrain
 Largest and most superior portion of the brain
 Divided into right and left hemispheres
 Consists of the Cerebrum and Diencephalon
 Cerebellum
 Located inferior to the forebrain
 Functions include motor coordination, balance, and
feedback systems
 Brainstem
 Connects the forebrain and cerebellum to the spinal cord
 Consists of the Midbrain, Pons, and Medulla Oblongata
The Brain – Cerebrum (Forebrain)

 Cerebral Cortex
 Thin, highly convoluted layer gray matter
 Responsible for conscious initiation of voluntary
movements
 Regions of the Cerebral Cortex
 Frontal Lobes
 Parietal Lobes
 Temporal Lobes
 Occipital Lobe
Cranial Nerve system
Frontal lobe

 Function:  Lesion:

 voluntary  paralysis,
movement;  dementia,
 language;  dysphrenia,
 mentation  personality change
Occipital lobe

 Function  Lesion
 Loss of sensory
 Sensory function  epilepsy
Temporal lobe

 Function  Lesion

 Hearing  Aphasia

 Language  Epilepsy

 memory  Memory disorder

Occipital lobe

 Function  Lesion

 vision  vision changes

 visual hallucination

 metamorphopsia
Limbic lobe

 Function  Lesion

 Memory  emotional disorder

 Mental  behavior disorder

 Emotion  slow response

Brain stem

 Function  Lesion
 Reticular formation
 Coma
 vital center
 Wallenberg syndrome

 Locked-in syndrome
cerebellum

 Function  Lesion

 Keep balance  ataxia

Spinal cord

 Function  Lesion

 Conduction  Brown-sequard syndrome

 Reflex  transected spinal lesion

Cranial Nerves
 Characteristic：

1. The brain has 12 Cranial Nerves which usually

expressed with Roman numerals.

2. The cranial nerves (with the exception of I and

II) originate in the brainstem. Sensory nerve
nuclei tend to be located in the lateral brainstem,
while motor nuclei tend to be located medially.
Characteristic：

3. Component fibres:
• Each Cranial Nerve contains either sensory
fibres, motor fibres, or both sensory and motor
fibres.
• Some also have a parasympathetic component.
Characteristic：
4. Most of cranial nerves are innervated by both
side of corticobulbar tract, but lower part of
facial nuclear and hypoglossal nuclear are only
innervated by corticobulbar tract of opposite
side.
5. The nucleus of Ⅲ、 Ⅳ are located in the
midbrain; Ⅴ、Ⅵ、Ⅶ、Ⅷ in the pons and
Ⅸ、Ⅹ、 Ⅺ、 Ⅻ in the medulla.
Ⅰ. Olfactory nerve
• olfactory nerve
• olfactory sensation
• sensory nerve
 Anatomy
olfactory receptor cells olfactory nerve
(first-order neurons)
olfactory bulb olfactory tract
(second-order neurons)
prepyriform :
(third-order neurons):

The three olfactory areas of the cortex

Ⅱ Optic nerve
Ⅲ. Oculomotor N.
Ⅳ. Trochlear N.
Ⅵ. Abducens N.
Ⅲ. Oculomotor Nerve

Oculomotor Nerve
Trochlear nerve( Ⅳ. )& Abducens nerve ( Ⅵ. )
Ⅴ. Trigeminal Nerve
• Sensory from face, cornea, mouth, nasal
passages, teeth, tongue, meninges, sinuses,
eardrum.
• Motor to muscles of mastication
Ⅶ. Facial Nerve
• Sensory: receive homolateral taste sense
from first two thirds of tongue.

• Motor: command homolateral muscles of

face.
Characteristic：

Most of cranial nerves are innervated by both

side of corticobulbar tract, but lower part of
facial nuclear and hypoglossal nuclear are only
innervated by corticobulbar tract of opposite side.
Upper part: innervated by
both side of corticobulbar
tract.

Lower part: only

innervated by corticobulbar
tract of opposite side.
Ⅷ. Auditory Nerve
 Cochlear Nerve (the nerve of hearing)：

bipolar cells internal

organ of Corti spiral Cochlear auditory
ganglion Nerve meatus
peripheral fibers central fibers

pons cochlear lateral

nucleus medial geniculate body
lemniscus

Auditory radiation Auditory center

superior temporal gyrus, transverse temporal gyrus

 Vestibular Nerve:

Utricle and bipolar cells

three vestibular
semicircular Vestibular nerve
ganglion
ducts peripheral fibers central fibers

internal
auditory pons Vestibular nucleus
meatus
 Cochlear nerve lesion:

1. Tinnitus, hyperacusis and hearing

hallucination:
2. Hearing diminished or hearing lose:
 Vestibular nerve lesion：

1. Vertigo:
Vertigo is a type of dizziness that's characterized
by the sensation of spinning. It's sometimes
referred to as a hallucination of motion.
 The three balance systems:
• visual system
• Deep sensory system
• Vestibular system
Ⅸ. Glossopharyngeal Nerve
Ⅹ. Vagus Nerve
Ⅺ. Spinal accessory Nerve
Ⅻ. Hypoglossal Nerve
Motor system
Pyramidal Tracts

 Axons of neurons in these tracts terminate

in the ventral horn of the spinal cord
 Called Upper Motor Neurons
 Axons of neurons in these tracts cross over
to the opposite side of the CNS in the area
of the medulla
 Called Medullary Pyramids
Pyramidal Tracts

 Lateral and Ventral Corticospinal Tracts

 Carry nerve impulses for skilled, voluntary
contraction of the skeletal muscles
 Large motor pathways that descend from
the cerebral motor cortex to the motor
neurons in the ventral horn of the spinal
cord
 The largest and most important motor tracts in
the body
Pyramidal Tracts

 The Lateral Corticospinal tracts cross over

in the region of the medulla, called the
medullary pyramids
 The Ventral Corticospinal tracts cross over
in the spinal cord
Pyramidal Tracts
 From the medulla, the corticospinal tracts
descend to the spinal cord level of the muscle
to be innervated
 Both lateral and ventral corticospinal tracts synapse
with either:
1) Interneurons, or
2) Motor neurons in the ventral horn of the spinal cord
 Interneurons synapse with lower motor
neurons that travel directly to the
neuromuscular junction of the skeletal muscle
the CNS wants to activate
Pyramidal Tracts
 The Corticospinal Tracts connect the left cerebral
motor cortex with the muscles on the right side of the
body and vice versa
 For example:
 The brain has received and processed sensory information that
causes it to direct the biceps muscles to contract to lift a weight
 The brain sends impulses down the corticospinal tracts to the
C5-C7 levels of the spinal cord to synapse with the appropriate
motor neurons
 The nerve impulse is propogated along the ventral roots of the
brachial plexus, to the musculocutaneous nerve, which
innervates the biceps
 The biceps muscle contracts to lift the weight
Sensory system
The Somatosensory System

 Somatosensory Pathways
 Dorsal Column-Medial Lemniscus
1) Transmit sensory impulses from mechanoreceptors and
proprioceptors to the thalamus
2) Crosses over in the region of the medulla
 Spinothalamic Tract
1) Transmits sensory impulses from thermoreceptors and
nocioceptors to the thalamus after crossing to the other side
in the spinal cord
2) Crosses over in the spinal cord
Spinothalamic Tracts

 The Lateral and Anterior Spinothalamic

Tracts are sensory (afferent, ascending)
 Travel from the spinal cord to the thalamus
 Receive sensory input from the receptors
for:
 Pain (from free nerve endings)
 Temperature (from Pacinian corpuscles)
 Deep pressure (from Meissners corpuscles)
 Touch (from End bulbs of Krause )
 For example:
 A heat receptor (free nerve ending) located in the L3
dermatome on the anterior thigh is stimulated by the heating
pad you have put on the quadriceps muscle group of your sore
right thigh
 The impulse travels along the peripheral nerve through the
sensory neuron in the dorsal root ganglion and on to a synapse
with an internuncial neuron in the dorsal horn of segment L3
 From there the fiber carrying the next impulse crosses over to
the left side of the spinal cord to the lateral spinothalamic tract,
and ascends to the thalamus.
 Another synapse occurs in the thalamus and the next impulse is
sent to the sensory cortex of the cerebrum where the brain will
perform its integrative and decision making functions.
 A decision will be made whether to instruct the muscles of your
hands and arms to remove the heating pad because it is too hot
or leave it in place.
The Autonomic Nervous System

 Controls the following:

 Smooth muscle of the blood vessels;
 Abdominal and thoracic viscera;
 Certain glands; and
 Cardiac muscle.
 Serves an important role in maintaining:
 Heart rate
 Blood pressure
 Breathing
 Body temperature
Reflexes system
Definition :

Reflexes are involuntary but formed

responses of body to environmental
stimulations. The anatomical basis are
reflex arcs.

The compositions of reflex arc:

Intercalated neurons
Receptor Afferent nerve
(interneurons)

Efferent nerve Effector

Superficial Reflexes:

 Corneal Reflex；
 Pharyngeal Reflex；
 Abdominal Reflexes
(upper T7~8、middle T9~10、lower 11~12)；
 Cremasteric Reflex；
 Plantar Reflex；
 Anal Reflex.
Deep Reflexes:

 Radius Reflex：
 Bicept Reflex:
 Tricept Reflex:
 Knee Reflex:
 Achillis Reflex:
Thank you!