1 Neorologic Review

Neurological disorders
3rd year comprehensive nursing
Chanyalew W.
Feburuary,2024
1
Presentation outlines
Anatomy &physiology overview
Assessment overview
Neurologic disorders and their management
2
Anatomy and physiology of NS
Structures protecting brain & spinal cord

Scalp
Skull
Facial Bones
Meningeal Layers
Blood-Brain Barrier(BBB)
Cerebrospinal Fluid (CSF):
3
Anatomy and physiology of NS…
Scalp:
Very vascular & prone to profuse hemorrhage: due to the

veins & arteries inability to vaso-constrict adequately.
Wound must be palpated and explored to for a skull fracture

& cleaned prior to the repair
4
Skull:
◦ Protects the brain
◦ Periosteum is a dense white fibrous membrane that covers

the bone.
◦ Very vascular and sends branches into the bone to provide nutrition to
the bone cells.
◦ Foramen magnum an opening of the occipital bone at

the base of the skull of which the spinal cord passes. 5
Anatomy/Physiologic over view…
6
Cranial Vault:
Cranial vault is used to describe where the cerebrum,

cerebellum, and brainstem are housed.
Three components of the cranial vault include:

Brain tissue (80%)
CSF (10%)
Blood within blood vessels (10%).

7
Meningeal Layers:
Three meninges that cover the brain and spinal cord are:
1. Dura mater(outermost)
◦ Outermost , tough, thick, inelastic, fibrous, &
gray
2. Arachnoid mater
◦ Middle & extremely thin
3. Piamater.
◦ Inner & thin
8
Blood-Brain Barrier(BBB):
The area where capillaries meet
Permeable to CO2, O2, C6H12O6, and lipid soluble substances.
Intact BBB restricts the movement of larger, potentially

harmful substances from the bloodstream.
Trauma, cerebral edema & cerebral hypoxemia; this has

implications in the treatment & selection of medication for
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CNS disorders
Cerebrospinal Fluid (CSF):

Clear & colorless fluid produced by ependymal cells on the
choroid plexus in the lateral ventricles.
Approximately 250 –500cc’s are produced Q day.

CSF bathes the entire brain and spinal cord.
Provide nutrients
Remove waste products
Act as a shock absorber.
10
Nervous system: consists of two major parts:
Central NS Peripheral NS
◦ Brain ◦ Cranial nerves
◦ Spinal cord ◦ Spinal nerves
◦ autonomic NS
11
Brain Tissue
Occupies 80% of the cranial vault.
Accounts for 2% of body weight
Weigh 1.4kg in young adult & 1.2kg in elderly
Neurons are the functional units of brain.
Neurons transmit sensory and motor impulses to and from

the PNS and CNS. 12
Brain three major areas:
Each two paired
Two hemispheres lobes
1.Cerebrum Thalamus Pariet Occipita

Frontal l
Hypothalamus al
Tempora
Basal ganglia l
Midbrain
2. Brain stem Pons
Medulla
3. Cerebellum located under the cerebrum &

behind the brain stem
13
14
15
1. Cerebral Lobes
•Largest Concentr Abstract Memory/Infon Motor
Frontal •Broca’s ation thought storage activity
area(Lt
Hem) Affect Judgment Personality Inhibition
Predominantly
Aware body Size & shape
sensory/sense & Rt-Lt
position in discriminati
Parietal interpret
space on
orientation
information
Understanding
Occipital Contains auditory Memory
Of language and
receptive areas of sound music
Temporal visual interpretation and memory

16
Frontal lobe
Parietal lobe
Anatomy/Physiologic over view…
17
Temporal lobe Occipital lobe

Basal ganglia(corpus striata)

◦ Deep in cerebral hemispheres
◦ Control automatic body movements/ fine motor

movements
Diencephalon
◦ Thalamus –primarily as a relay station for all sensation
except smell
◦ Hypothalamus- hunger center 18
2. Brain stem: Central core of brain

Midbrain (center for auditory &visual reflexes), origin of CN-
III & IV
Pons (its portion regulate respiration),origin of CNs-V-VIII
Medulla oblongata – contains motor fibers from brain to

spinal cord & sensory fibers from spinal cord to brain, origin of
CNs-IX- XII ,reflex centers for respiration, BP, HR, coughing,
vomiting, swallowing, & sneezing, reticular formation,
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responsible for arousal and the sleep–wake cycle, begins in this
3. Cerebellum
◦ Posterior to the midbrain and Pons, and below the occipital
lobe
◦ Motor coordination of voluntary(fine) movements,
equilibrium/balance, muscle tone, posture/ position , sense
or proprioception (awareness of where each part of the
body is).
20
Spinal Cord
Links peripheral nervous system and the brain
Contained in and protected by the vertebrae
Extends from foramen magnum ( base of skull )to the lower
border of 1st lumbar vertebra
Ends b/n the 1st & 2nd lumbar vertebrae
45 cm (18 inches) long about thickness of a finger in adult
Helps to coordinate impulses within the CNS.
21
Cross-sectional view, the spinal cord has an H-shaped

Central core of nerve cell bodies (gray matter) surrounded
by ascending and descending tracts (white matter)
w/c consist of:
◦ 7 cervical,
◦ 12 thoracic,
◦ 5 lumbar vertebrae, as well as the
◦ 5 sacrum (a fused mass of 5 vertebrae),
◦ 1 coccyx (terminate)
22
23
Peripheral nervous system
Cranial nerves
Spinal nerves
Autonomic nervous system
24
Cranial nerves
12 pairs emerge from the lower surface of the brain and pass
through openings in the base of the skull.
Numbered in the order in which they arise from the brain.
Innervate the head, neck, and special sense structures

◦ 3- entirely sensory (I, II, VIII),
◦ 5 - entirely motor (III, IV, VI, XI, and XII),
◦ 4- mixed sensory & motor (V, VII, IX,& X).
25
Cranial nerves
26
27
Spinal nerves
31 pairs of spinal nerves
◦ 8 pairs of cervical nerves
◦ 12 pairs of thoracic nerves
◦ 5 pairs of lumbar nerves
◦ 5 pairs of sacral nerves
◦ 1 pair of coccygeal nerves
28
Spinal nerves …..
• Dermatome:
band of skin
innervated by
the sensory
root of a single
spinal nerve
29
30
Autonomic Nervous System
Regulates the activities of internal organs such as the
heart, lungs, blood vessels, digestive organs, and glands.
Maintenance and restoration of internal homeostasis
Two major divisions:

 Sympathetic NS, with predominantly excitatory responses,
most notably the “fight-or-flight” response,
 Parasympathetic NS, which controls mostly visceral functions.

31

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Neurological disorders

3rd year comprehensive nursing

Anatomy &physiology overview

Neurologic disorders and their management

Structures protecting brain & spinal cord

Cerebrospinal Fluid (CSF):

Very vascular & prone to profuse hemorrhage: due to the

Wound must be palpated and explored to for a skull fracture

◦ Periosteum is a dense white fibrous membrane that covers

◦ Foramen magnum an opening of the occipital bone at

Cranial vault is used to describe where the cerebrum,

Three components of the cranial vault include:

Blood within blood vessels (10%).

The area where capillaries meet

Permeable to CO2, O2, C6H12O6, and lipid soluble substances.

Intact BBB restricts the movement of larger, potentially

Trauma, cerebral edema & cerebral hypoxemia; this has

Cerebrospinal Fluid (CSF):

Approximately 250 –500cc’s are produced Q day.

Nervous system: consists of two major parts:

◦ Brain ◦ Cranial nerves

◦ Spinal cord ◦ Spinal nerves

Occupies 80% of the cranial vault.

Accounts for 2% of body weight

Weigh 1.4kg in young adult & 1.2kg in elderly

Neurons are the functional units of brain.

Neurons transmit sensory and motor impulses to and from

1.Cerebrum Thalamus Pariet Occipita

3. Cerebellum located under the cerebrum &

Temporal visual interpretation and memory

Anatomy/Physiologic over view…

Temporal lobe Occipital lobe

Basal ganglia(corpus striata)

◦ Control automatic body movements/ fine motor

2. Brain stem: Central core of brain

Medulla oblongata – contains motor fibers from brain to

Cross-sectional view, the spinal cord has an H-shaped

Peripheral nervous system

Autonomic nervous system

Numbered in the order in which they arise from the brain.

Innervate the head, neck, and special sense structures

◦ 8 pairs of cervical nerves

◦ 12 pairs of thoracic nerves

◦ 5 pairs of lumbar nerves

◦ 5 pairs of sacral nerves

◦ 1 pair of coccygeal nerves

Regulates the activities of internal organs such as the

heart, lungs, blood vessels, digestive organs, and glands.

Maintenance and restoration of internal homeostasis

Two major divisions:

most notably the “fight-or-flight” response,

 Parasympathetic NS, which controls mostly visceral functions.

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