Nervous System

• The branch of medical science that deals with the normal functioning and
disorders of the nervous system is neurology.
• A neurologist is a physician who specializes in the diagnosis and treatment
of disorders of the nervous system.
• The nervous system is one of the smallest and the most complex of the 11
body systems. The nervous system is a highly organized network of two
types of cells; it contains billions of neurons and even more neuroglia.
• The structures that make up the nervous system include the brain, cranial
nerves and their branches, the spinal cord, spinal nerves and their
branches, ganglia, enteric plexuses, and sensory receptors.
Anatomical Organization
• Anatomically the nervous system consists of two main interconnected divisions:
(1) the central nervous system and (2) the peripheral nervous system.
CENTRAL NERVOUS SYSTEM
• The central nervous system (CNS) is composed of the brain and spinal cord. The
brain is enclosed and protected by the skull in the cranial cavity and contains
about 85 billion neurons. The spinal cord is enclosed and protected by the
bones of the vertebral column in the vertebral canal and contains about 100
million neurons.
• The brain and spinal cord are continuous with one another through the
foramen magnum of the occipital bone. The CNS processes many different kinds
of incoming sensory information.
• PERIPHERAL NERVOUS SYSTEM
• The peripheral nervous system (PNS) is composed of all nervous structures outside the
CNS, such as cranial nerves and their branches, spinal nerves and their branches, and
sensory receptors.
• These structures link all parts of the body to the CNS. Twelve pairs (right and left) of
cranial nerves, numbered I through XII, emerge from the base of the brain.
• A nerve is a bundle of hundreds to thousands of axons (nerve cell fibers) plus associated
connective tissue and blood vessels that lies outside the brain and spinal cord.
• Thirty-one pairs of spinal nerves emerge from the spinal cord.
• Sensory receptors are structures that monitor changes in the internal and external
environment, such as receptors in the skin that detect touch sensations, photoreceptors
in the eyes, and olfactory (smell) receptors in the nose.
Functional Organization
• The nervous system carries out a complex array of tasks. It allows you
to sense various smells, produce speech, and remember past events;
it also provides signals that control body movements, and regulates
the operation of internal organs. These diverse activities can be
grouped into three basic functions: sensory (input), integrative
(control), and motor (output).
1. Sensory function; Sensory receptors detect internal stimuli, such as
an increase in blood pressure, and external stimuli, such as a raindrop
landing on your arm. Neurons called sensory or afferent neurons carry
this sensory information into the brain and spinal cord through cranial
and spinal nerves.
2. Integrative function; The nervous system processes sensory
information by analyzing and storing some of it and by making
decisions for appropriate responses—an activity known as integration.
An important integrative function is perception, the conscious
awareness of sensory stimuli. Perception occurs in the brain. Many of
the neurons that participate in integration are interneurons. The vast
majority of neurons in the body are interneurons. These neurons make
up the majority of the central nervous system.
3. Motor function; Once sensory information is integrated, the nervous
system may elicit an appropriate motor response, such as muscular
contraction or glandular secretion. The neurons that serve this function
are called motor or efferent neurons. Motor neurons carry information
from the brain toward the spinal cord or out of the brain and spinal
cord to effectors (muscles and glands) through cranial and spinal
nerves. Stimulation of the effectors by motor neurons causes muscles
to contract and glands to secrete.
• The peripheral nervous system is divided into a somatic nervous system and an
autonomic nervous system.
SOMATIC NERVOUS SYSTEM
• The somatic nervous system (SNS) of the PNS consists of sensory neurons, called
somatic sensory neurons, that convey information to the CNS from sensory receptors
in the skin, skeletal muscles, and joints, and from the receptors for the special senses
(vision, hearing, equilibrium, taste, and smell). These somatic sensory pathways are
involved in the input of information to the CNS for integration (processing). The SNS
also consists of motor neurons, called somatic motor neurons, that convey information
from the CNS to skeletal muscles only. These somatic motor pathways are involved in
the output of information from the CNS that results in a muscular contraction. Because
these motor responses can be consciously controlled, the actions of these parts of the
SNS are voluntary.
AUTONOMIC NERVOUS SYSTEM
• The autonomic nervous system (ANS) of the PNS also has sensory and
motor components. Sensory neurons, called autonomic (visceral)
sensory neurons, convey information to the CNS from autonomic
sensory receptors, located primarily in the visceral organs (smooth
muscle organs in the thorax, abdomen, and pelvis). Autonomic motor
neurons convey information from the CNS to smooth muscle, cardiac
muscle, and glands and cause the muscles to contract and the glands
to secrete. Because its motor responses are not normally under
conscious control, the action of the ANS is involuntary.
• The two main subdivisions of the ANS are the sympathetic division and the
parasympathetic division. Usually the two divisions have opposing actions.
For example, sympathetic neurons increase heart rate, and parasympathetic
neurons slow it down. In general, the sympathetic division helps support
exercise or emergency actions, so-called “fight-or-flight” responses, and the
parasympathetic division controls “rest and-digest” activities.
• A third subdivision of the ANS is the enteric nervous system (ENS) also called
the “brain of the gut”. It consists of over 100 million neurons that occur
throughout most of the length of the gastrointestinal (GI) tract. The ENS also
has both sensory and motor components. Like the two main subdivisions of
the ANS, the ENS is involuntary.
Neurons
• Neurons or nerve cells possess electrical excitability, the ability to
respond to a stimulus and convert it into a nerve impulse.
• A stimulus is any change in the environment that is strong enough to
initiate a nerve impulse.
• A neuron typically consists of two basic parts: (1) the cell body and (2) a
variable number of processes called nerve fibers. The nerve fibers
exhibit great variation in length and size and are classified, based on
distinct structural and functional differences, as dendrites or an axon.
• Dendrites; toward cell body
• Axon; away from cell body
Brain
Major Parts of the Brain
• The adult brain consists of four major parts: brainstem, cerebellum,
diencephalon, and cerebrum.
• The brainstem is continuous with the spinal cord and consists of the
medulla oblongata, pons, and midbrain.
• Posterior to the brainstem is the cerebellum (little brain).
• Superior to the brainstem is the diencephalon, which consists of the
thalamus, hypothalamus, and epithalamus.
• Supported on the diencephalon and brainstem is the cerebrum, the
largest part of the brain.
PROTECTION AND BLOOD SUPPLY
Protective Coverings of the Brain
• The cranium and the cranial meninges surround and protect the
brain. The cranial meninges are continuous with the spinal meninges.
The outer dura mater, the middle arachnoid mater, and the inner pia
mater.
• (1) The falx cerebri (falx=sickle-shaped) separates the two
hemispheres (sides) of the cerebrum. (2) The falx cerebelli separates
the two hemispheres of the cerebellum. (3) The tentorium cerebelli
separates the cerebrum from the cerebellum.
Cerebrospinal Fluid
• Cerebrospinal fluid (CSF) is a clear, colorless liquid comprised primarily
of water that protects the brain and spinal cord against chemical and
physical injuries.
• CSF circulates slowly and continuously through cavities in the brain and
spinal cord and around the brain and spinal cord in the subarachnoid
space (space between the arachnoid mater and pia mater).
• The total volume of CSF is 80 to 150 mL in an adult. CSF also contains
small amounts of proteins, lactic acid, urea, ions and some white blood
cells.
Functions
1. Mechanical protection
• Serve as a shock-absorbing medium
• It protects the delicate tissues of the brain and spinal cord from jolts that would
otherwise cause them to hit the bony walls of the cranial cavity and vertebral canal.
2. Chemical protection
• CSF provides an optimal chemical environment for efficient neuronal signaling.
3. Circulation
• CSF is a medium for the minor exchange of nutrients and waste products between the
blood and adjacent nervous tissue. Also provide a lymphatic function for the tissue of
the brain.
Blood–brain barrier
• The blood–brain barrier (BBB) consists mainly of tight junctions. Astrocytes press up
against the capillaries and secrete chemicals that maintain the strength of the tight
junctions.
• The BBB allows certain substances in blood to enter brain tissue and prevents
passage to others. Lipid-soluble substances and water molecules easily cross the
BBB by diffusing across the lipid bilayer of endothelial cell plasma membranes. A few
water-soluble substances, such as glucose, quickly cross the BBB by facilitated
transport.
• Other water-soluble substances, such as most ions, are transported across the BBB
very slowly. Still other substances—proteins and most antibiotic drugs—do not past
at all from the blood into brain tissue. Trauma, certain toxins, and inflammation can
cause a breakdown of the BBB. Because it is so effective, the BBB prevents the
passage of helpful substances as well as those that are potentially harmful.
THE BRAINSTEM
• The brainstem is the part of the brain between the spinal cord and
the diencephalon. It consists of three structures:
(1) medulla oblongata
(2) pons
(3) midbrain
Medulla Oblongata
• The medulla oblongata is a continuation of the superior part of the
spinal cord; it forms the inferior part of the brainstem.
• The medulla begins at the foramen magnum and extends to the inferior
border of the pons, a distance of about 1.2 inches.
• This short region of the central nervous system resembles the spinal
cord in many ways.
• Like the spinal cord, it gives rise to many nerve roots; however, these
are the roots of cranial nerves rather than spinal nerves. Six of the 12
pairs of cranial nerves arise from this region.
Pons
• The pons (bridge) lies directly superior to the medulla and anterior to
the cerebellum and is about 1 inch long.
• As its name implies, the pons is a bridge that connects parts of the
brain with one another. These connections are provided by bundles of
axons.
• Some axons of the pons connect the right and left sides of the
cerebellum.
• The pons also contains nuclei associated with four pairs of cranial
nerves.
Midbrain
• This short segment of the brainstem sits just superior to the pons.
• The midbrain (mesencephalon) extends from the pons to the
diencephalon and is about 1 inch long.
• Nuclei in the midbrain are associated with two pairs of cranial nerves
THE CEREBELLUM
• The cerebellum, the second-largest part of the brain, occupies the inferior
and posterior aspects of the cranial cavity.
• The cerebellum is posterior to the medulla and pons and inferior to the
posterior portion of the cerebrum.
• Each hemisphere consists of lobes separated by deep and distinct fissures.
The anterior lobe and posterior lobe govern subconscious aspects of
skeletal muscle movements.
• The primary function of the cerebellum is to evaluate how well movements
initiated by motor areas in the cerebrum are actually being carried out.
• The cerebellum is the main brain region that regulates posture and balance.
THE DIENCEPHALON
• The diencephalon forms a central core of brain tissue just superior to
the midbrain.
• It is almost completely surrounded by the cerebral hemispheres and
contains numerous nuclei involved in a wide variety of sensory and
motor processing between higher and lower brain centers.
• It includes the thalamus, hypothalamus, and epithalamus.
• Projecting from the hypothalamus is the hypophysis, or pituitary
gland.
THE CEREBRUM
• The cerebrum is the “seat of intelligence.” It provides us with the
ability to read, write, and speak; to make calculations and to
remember the past, plan for the future, and imagine things that have
never existed before.
• The largest portion of the human brain
• The right and left halves of the cerebrum, called cerebral
hemispheres, are separated by a deep groove called the longitudinal
fissure that is occupied by the falx cerebri.
• Cerebrum contains many sensory and motor areas such as broca’s
(motor) area for speech
SPINAL CORD
Protective Structures
• The first layer of protection for the central nervous system is the hard
bony skull and vertebral column. The skull encases the brain and the
vertebral column surrounds the spinal cord, providing strong
protective defenses against damaging blows or bumps.
• The second protective layer is the meninges, three membranes that
lie between the bony encasement and the nervous tissue in both the
brain and spinal cord.
• Vertebral Column; The spinal cord is located within the vertebral canal
of the vertebral column. The vertebral foramina of all the vertebrae,
stacked one on top of the other, form the vertebral canal. The
surrounding vertebrae provide a sturdy shelter for the enclosed spinal
cord
• The meninges are three protective, connective tissue coverings that
encircle the spinal cord and brain. From superficial to deep they are
the: (1) dura mater; (2) arachnoid mater; and (3) pia mater. Between
these two meninges is a space, the subarachnoid space, which contains
the shock-absorbing cerebrospinal fluid. The spinal meninges surround
the spinal cord.
External Anatomy of the Spinal Cord
• The spinal cord is roughly oval in shape, being flattened slightly in the
anterior–posterior axis. In adults, it extends from the medulla
oblongata (the most inferior part of the brain) to the superior border of
the second lumbar vertebra (L2).
• In newborn infants, the spinal cord extends to the third or fourth
lumbar vertebra. During early childhood, both the spinal cord and the
vertebral column grow longer as part of overall body growth.
Elongation of the spinal cord stops around age 4 or 5, but growth of the
vertebral column continues, which explains why the spinal cord does
not extend the entire length of the vertebral column. The length of the
adult spinal cord ranges from 16–18 inches.
• There are 31 pairs of spinal nerves: 8 cervical, 12 thoracic, 5 lumbar, 5
sacral, and 1 coccygeal.
• The spinal cord terminates as a tapering, conical structure called the
conus medullaris (cone). The conus medullaris ends at the level of the
intervertebral disc between the first and second lumbar vertebrae
(L1–L2) in adults .
• Arising from the conus medullaris is the filum terminale, an extension
of the pia mater that extends inferiorly and fuses with the arachnoid
mater and dura mater to anchor the spinal cord to the coccyx.
Internal Anatomy of Spinal Cord
• Butterfly shaped gray matter
• Surrounded by white matter
Plexuses
• Axons from the anterior rami of spinal nerves, except for thoracic
nerves T2–T12, do not go directly to the body structures they supply.
Instead, they form networks on both the left and right sides of the
body by joining with various numbers of axons from anterior rami of
adjacent nerves. Such a network of axons is called a plexus (network).
• The principal spinal nerve plexuses are the cervical plexus, brachial
plexus, lumbar plexus, and sacral plexus. A smaller coccygeal plexus is
also present.
Brachial Plexus
• The rami of spinal nerves C5–C8 and T1 form the roots of the brachial plexus,
which extends inferiorly and laterally on either side of the last four cervical
and first thoracic vertebrae. It passes above the first rib posterior to the
clavicle and then enters the axilla.
• The roots of the brachial plexus are the anterior rami of the spinal nerves.
• The roots of several spinal nerves unite to form trunks in the inferior part of
the neck. These are the superior, middle, and inferior trunks.
• Posterior to the clavicles, the trunks divide into divisions called the anterior
and posterior divisions.
• In the axillae, the divisions unite to form cords called the lateral, medial, and
posterior cords.
• The branches of the brachial plexus form the principal nerves of the brachial plexus. The
brachial plexus provides almost the entire nerve supply of the shoulders and upper
limbs.
• Five large terminal branches arise from the brachial plexus:
(1) The axillary nerve supplies the deltoid and teres minor muscles.
(2) The musculocutaneous nerve supplies the anterior muscles of the arm.
(3) The radial nerve supplies the muscles on the posterior aspect of the arm and forearm.
(4) The median nerve supplies most of the muscles of the anterior forearm and some of
the muscles of the hand.
(5) The ulnar nerve supplies the anteromedial muscles of the forearm and most of the
muscles of the hand.
Sacral and Coccygeal
Plexuses
• The anterior rami of
spinal nerves L4–L5 and
S1–S4 form the roots of
the sacral plexus. This
plexus is situated largely
anterior to the sacrum.
The sacral plexus
supplies the buttocks,
and lower limbs.
Sciatic Nerve
• The largest nerve in the body—the sciatic nerve—arises from the lumbo-
sacral plexus.
• Nerve roots: L4-S3.
• Motor functions:
• Innervates the muscles of the posterior thigh (biceps femoris, semimembranosus
and semitendinosus) and the hamstring portion of the adductor magnus.
• Indirectly innervates (via its terminal branches) all the muscles of the leg and foot.
• Sensory functions: No direct sensory functions. Indirectly innervates (via
its terminal branches) the skin of the lateral leg, heel, and both the dorsal
and plantar surfaces of the foot.
• Anatomical Course
• The sciatic nerve is derived from
the lumbosacral plexus. After its formation, it
leaves the pelvis and enters the gluteal region
via greater sciatic foramen. It emerges inferiorly
to the piriformis muscle and descends in an
inferolateral direction.
• As the nerve moves through the gluteal region,
it crosses the posterior surface of different
muscles. It then enters the posterior thigh by
passing deep to the long head of the biceps
femoris.
• When the sciatic nerve reaches the apex of
the popliteal fossa, it terminates by bifurcating
into the tibial and common fibular nerves.
Sciatica
• The most common form of back pain is caused by compression or
irritation of the sciatic nerve, the longest nerve in the human body.
• Injury to the sciatic nerve results in sciatica, pain that may extend
from the buttock down the posterior and lateral aspect of the leg and
the lateral aspect of the foot.
• The nerve may be injured because of a herniated (slipped) disc,
dislocated hip, osteoarthritis of the lumbosacral spine, or an
improperly administered gluteal intramuscular injection.
• Treatments for sciatica are similar to those for a herniated (slipped)
disc—rest, pain medications, exercises, ice or heat, and massage.