NEUROLOGY

EMERITA C. MENDOZA, R.N., M.D.

PRINCIPAL DIVISIONS:
1.

Central Nervous System (CNS)
a. 

brain & the spinal cord serves as control mechanism for the entire organism

2.

Peripheral Nervous System (PNS)
a. b. c.

12 cranial nerves (CN) 31 spinal nerves autonomic nerves
a. b.

sympathetic parasympathetic

Glial cells & Neuron

Nervous tissue is composed of two main cell types: Neurons transmit nerve messages. Glial cells direct contact with neurons and often surround them.

The Neuron
 

functional unit dendrites – receive neural msgs & transmit towards cell body axon – transmits neural msgs away from cell body cell body – contains nucleus, mitochondria, & other organelles myelin & cellular sheath produced by Schwann

Axons are wrapped in a myelin sheath formed from the plasma membranes of specialized glial cells known as ( Schwann cells). -supportive, nutritive, and service facilities for neurons. Node of Ranvier, gap between Schwann cells, points along the neuron for generating a signal. Signals jumping from node to node travel hundreds of times faster than signals traveling along the surface of the axon. This allows your brain to communicate with your toes in a few thousandths of a second.

TYPES OF NEURONS

Sensory neurons typically have a long dendrite and short axon, carry messages from sensory receptors  central nervous system. Motor neurons have a long axon and short dendrites, transmit messages from central nervous system muscles (or to glands).

Nerves & Ganglia

nerve – a large bundle of axons wrapped in CT tracts or pathways – bundle of axons within the CNS ganglia – aggregation of nerve cell bodies w/in the PNS nuclei – collection of cell bodies w/in the CNS

Neural circuits

NEURAL CIRCUITS- neurons organized into sequences -arranged so that the axon of one neuron in the circuit forms junctions with the dendrites of the next neuron in the circuit. synapse - junction between two neurons. synaptic cleft -separates synapse by a tiny gap (less than one-millionth of an inch) presynaptic neuron -ends at a specific synapse

Synapses

The junction between a nerve cell and another cell is called a synapse. Messages travel within the neuron as an electrical action potential. The space between two cells is known as the synaptic cleft. To cross the synaptic cleft requires the actions of neurotransmitters. Neurotransmitters are stored in small synaptic vessicles clustered at the tip of the axon.

Reflex Action
simplest example of a neural response predictable, automatic response to stimuli  4 processes: -reception of the stimuli, - transmission of information, -integration (interpretation & determination of appropriate

CNS: the BRAIN

complex organ that allows us to think, move, feel, see, hear, taste, and smell. It controls our body, receives information, analyzes information, and stores information (our memories).

average human brain weighs about 3 pounds (13001400 g). At birth, the human brain weighs less than a pound (0.78-0.88 pounds or 350-400 g). The human brain reaches its full size at about 6 years of age.

BRAIN

The brain consists of gray matter (40%) and white matter (60%) contained within the skull. Brain cells include neurons and glial cells. 4 MAJOR PARTS: the cerebrum, the diencephalon, the cerebellum, and the brain stem.

BRAIN

 

2% of the body's weight, it uses 20% of the oxygen supply gets 20% of the blood flow. Blood vessels (arteries, capillaries, and veins) supply the brain with oxygen and nourishment, and take away wastes. If brain cells do not get oxygen for 3 to 5 minutes, they begin to die. Cerebrospinal fluid (CSF)

Medulla

Formally known as medulla oblongata Most inferior portion of the brain stem continuous with the spinal cord; 4th ventricle is continuous with the central canal 80% of the pyramidal fibers cross or decussate to the other side (so R side of the brain controls movement of the left side of the

Vital reflex centers within the medulla:
Cardiac centers – control heart rate  Vasomotor centers – control blood pressure  Respiratory centers – regulate breathing  Centers for vomiting, sneezing, coughing, & swallowing  Centers for reflexes mediated by CNs IXXII

The Pons

A bulge on the anterior (ventral) surface of the brain stem, just above the medulla Acts as a bridge/link connecting various parts of the brain Contains one of the respiratory centers & centers for reflexes mediated by the CNs V-VII

The Midbrain
   

Also known as mesencephalon Extends from the pons to the diencephalon I the cerebral aqueduct, connects the 3rd & 4th ventricle Consists of 4 rounded bodies, the corpora quadrigemina:  Paired upper bodies: serve as visual reflex centers for head & eyeball movements

Paired lower bodies: serve as relay centers for auditory information

The Diencephalon

 

Part of the brain between the cerebrum & the midbrain Its cavity is the 3rd ventricle Contains the following important structures:
1. 2. 3.

Thalamus Hypothalamus Pineal body (an endocrine gland)

The Thalamus
 

Consists of two oval masses, one on each side of the 3rd ventricle Afferent neurons coming from all sense organs (except olfactory) & motor neurons synapse with nuclei found within the thalamus  cerebrum A person becomes vaguely aware of sensory impulses when they reach the thalamus The thalamus also helps one associate feelings of pleasantness or unpleasantness with sensory impulses

The Hypothalamus

Lies inferior to the thalamus, forms the floor & part of the lateral walls of the 3rd ventricle Optic chiasma – crossing part of each optic nerve Infundibulum – a stalk of tissue that connects the pituitary gland to the hypothalamus

Mechanisms of the hypothalamus that maintain homeostasis:
1.

2.

3.

4. 5.

6.

Connects the cerebral cortex & the lower autonomic centers. Link bet the nervous & endocrine systems. Helps maintain fluid balance. ( ADH & presence of thirst center) Body temperature is regulated. The appetite & satiety centers within regulate food intake. Influences sexual behavior & the affective (emotional) aspects of

The Cerebellum

 

2nd largest part of the brain w/c consists of 2 hemispheres & a connecting portion, the vermis responsible for coordination of muscle movements functions:
1. 2. 3.

helps make muscular movement smooth instead of jerky & trembling helps maintain muscle tone & posture impulses from the vestibular apparatus are continuously delivered to the cerebellum to help maintain equilibrium

The Cerebrum
 

seat of consciousness the largest & most prominent part of the brain governor of all higher mental processes: interprets sensation, controls motor activities, & serves as center of intellect, reason, memory, language, and consciousness convolutions or gyri & grooves: sulci or fissures

Basic structure of Cerebrum

The cerebrum, the largest part of the human brain, is divided into left and right hemispheres connected to each other by the corpus callosum. The hemispheres are covered by a thin layer of gray matter known as the cerebral cortex, the most recently evolved region of the vertebrate brain.

The cortex in each hemisphere of the cerebrum is between 1 and 4 mm thick. Fissures & sulci divide the cortex into six lobes: occipital, temporal, parietal, frontal, central (insula), and limbic. No region of the brain functions alone, although major functions of various parts of the lobes have been determined

The occipital lobe (back of the head) receives and processes visual information. The temporal lobe receives auditory signals, processing language and the meaning of words. The parietal lobe is associated with the sensory cortex and processes information about touch, taste, pressure, pain, and heat and cold. The frontal lobe conducts three functions:
1. 2. 3.

motor activity and integration of muscle activity speech thought processes

The limbic lobe is thought to be a link bet emotional & cognitive (thought)

Associated structures:

Just anterior to the central fissure lies the precentral gyrus of the frontal lobe. Because voluntary movements of skeletal muscles are controlled from this area, it is known as the motor cortex or primary motor area. One part of the premotor area, known as Broca's speech area, is concerned with directing the formation of words. The parietal lobe has a primary sensory area, the postcentral gyrus, that receives information from the sensory receptors in the skin and joints.

Homunculus (Motor/Sensory)

It is the literal representation of connected parts of the human body on the surface of the brain. The surface of the postcentral gyrus provides the literal somatosensory homunculus, while the surface of the precentral gyrus provides the literal motor homunculus. Please note that the sensory homunculus is almost a mirror image of the motor

White Matter of the Cerebrum

The white matter of the cerebrum is composed of myelinated fibers. These connect the cortical areas with one another and with other parts of the nervous system. A large band of white matter, the corpus callosum, connects the right and left hemispheres The

Limbic system
 

limbic system emotional responses, autonomic responses, subconscious motor and sensory drives) sexual behavior, biological rhythms, and motivation, including feelings of pleasure and punishment. Certain structures of the cerebrum and diencephalon make up the limbic system

CNS: The Spinal Cord

2 main functions:

controls many reflex activities of the body transmits information back & forth from peripheral nerves to the brain via its ascending & descending tracts

it emerges from the base of the brain at the level of the foramen magnum & extends caudally to L2 vertebra (average length 45 cms/17 in)

Cervical & Lumbar enlargements – supply UE & LE respectively at caudal end: tip is known as the conus medullaris  extends as the filum terminale w/c attaches to the coccyx SC ends as the cauda equina (horse’s tail) a fan of nerve fibers found below L2 vertebra of the spinal column; carries all the nerves that affect the

Cross section of Spinal Cord

A cross section of the spinal cord reveals an inner section of gray matter (containing cell bodies and dendrites of peripheral nerves) and an outer region of white matter (containing the nerve fiber tracts with myelin sheaths) conducting impulses to and from the brain.

MENINGES

 

connective tissue membranes covering the CNS (in conjunction with CSF) outermost: dura mater – tough, white fibrous CT subdural space – potential space middle: arachnoid – thin, delicate, cobweb-like membrane subarachnoid space – filled with CSF & blood vessels innermost: pia mater – thin, vascular membrane tightly bound to the brain

Cerebrospinal Fluid

shock-absorbing CSF fills the ventricles, brain cavities, and the subarachnoid spaces produced by clusters of capillaries, the choroid plexuses which project from the pia mater into the ventricles circulates through the ventricles  through small apertures into the subarachnoid space  reabsorbed into the blood through arachnoid granulations

Peripheral Nervous System

made up of the sense organs, the sensory neurons, & the nerves that link the CNS with the effectors 2 systems:

somatic system – responsible for body balance in relation to outside world autonomic system – responsible for internal body balance

Comparison of Efferent Components of Somatic and Autonomic Nervous Systems
Somatic System Structures Innervated Effect on Effector General Role Skeletal (voluntary) muscle Excitatory Autonomic System Smooth (involuntary) muscle, cardiac muscle, glands Excitatory or inhibitory

Adjustments to Adjustments within internal environment external environment (homeostasis) Two

Number of Neurons One from CNS to Effector Ganglia Outside CNS Neurotransmitter Effect of Nerve Destruction on Effector None Acetylcholine Paralysis and atrophy

Chain ganglia, collateral ganglia, or terminal ganglia (near effector) Acetylcholine; norepinephrine by sympathetic postganglionic neurons Effector remains functional but is not able to respond to changing needs of body.

Comparison of Sympathetic and Parasympathetic Actions on Selected Effectors
Sympathetic Action Effector Heart Bronchial tubes Iris of eye Sex organs Blood vessels Sweat glands Intestine Liver metabolism Adipose tissue Increases rate and strength of contraction Dilates Dilates (pupil becomes larger) Constricts blood vessels; ejaculation Generally constricts Stimulates Inhibits motility Stimulates glycogen breakdown Stimulates free fatty acid release from fat cells Decreases rate; no direct effect on strength of contraction Constricts Constricts (pupil becomes smaller) Dilates blood vessels; erection No innervation for many No innervation Stimulates motility and secretion No effect No effect No effect Stimulates profuse, water secretion Parasympathetic Action

Adrenal medulla Stimulates secretion of epinephrine and norepinephrine Salivary glands Stimulates thick, viscous secretion