THE NERVOUS SYSTEM

Ef Clarianes Jr. MD, DPPS

General Pediatrician
 FUNCTIONS OF NERVOUS SYSTEM
• Sensory input
• gathered information
• changes = stimuli
• Integration
• Motor output
· response/effect to stimuli
· activates muscles or glands
 ORGANIZATION OF NERVOUS SYSTEM
STRUCTURAL CLASSIFICATION
• CENTRAL NERVOUS SYSTEM
• Brain
• Spinal cord
• PERIPHERAL NERVOUS SYSTEM
• Outside the CNS
• Spinal nerves
• Cranial nerves
• Carries impulse from sensory receptors
• CNS glands/ muscles
 ORGANIZATION OF NERVOUS SYSTEM
FUNCTIONAL CLASSIFICATION
• SENSORY/AFFERENT
• to the CNS
• SSA - skin, skeletal muscles and
joints
• VSA – visceral organs
• MOTOR/ EFFERENT
• from the CNS to effector organs
• Effect/ cause motor response
 SUBDIVISION OF MOTOR DIVISION
• Somatic Nervous System/ SNS
• consciously/ voluntarily
• skeletal muscles
• Stretch reflex
• Autonomic Nervous System/ ANS
• automatic/ involuntary
• smooth muscle/ cardiac/ glands
• Sympathetic /Parasympathetic
 SUPPORTING CELLS
• ASTROCYTES
· abundant, star-shaped cells
· brace / anchor neurons
· barrier between capillaries
and neurons
· capillary permeability
· control the chemical
environment of CNS
 SUPPORTING CELLS
• MICROGLIA
• Spiderlike, phagocytes
• dispose of debris – dead
cells and bacteria
 SUPPORTING CELLS

• EPENDYMAL CELLS
 Line cavities of the brain and SC
 Circulate CSF with cilia
 SUPPORTING CELLS
• OLIGODENDROCYTES
• Produce myelin sheath around
nerve fibers in CNS
 SUPPORTING CELLS - PNS
• SHWANN CELLS
• Myelin sheath in PNS
• SATELLITE CELLS
• Protective, cushioning cells
 NEURONS/ NERVE CELLS
• basic unit of structure and
function NS
• conduct nerve impulses
• all have cell body and
processes
 NEURONS/ NERVE CELLS
• CELL BODY
• metabolic center
• transparent nucleus with
large nucleolus
• lacks centrioles
• Nissl bodies
• Neurofibrils
 NERVE CELL PROCESSES/ FIBERS
• Dendrites • neuron - hundreds of dendrites - axon
• conduct impulses toward the cell
body
• Axons
• away from the cell body
• axon hillock
• axon terminal
• Tiny vesicles – NTA’s
NERVE CELL PROCESSES/ FIBERS
· Axonal terminals are separated
from the next neuron by a gap
· Synaptic cleft – gap between
adjacent neurons
· Synapse – junction between
nerves
 NERVE FIBER COVERINGS
• MYELIN
• whitish, fatty/ waxy appearance
• protects/ insulates fibers
• increase transmission rate
• Schwann cells
• produce myelin sheaths in jelly-roll
• Neurilemma – “neuron husk”
• Nodes of Ranvier
• gaps in myelin sheath along the axon
 MULTIPLE SCLEROSIS
• Autoimmune disease
• Immune system cells attack myelin
• Demyelination – damage to myelin
and nerve fibers
• Sclerosis – scar tissue
• Slow or block electrical signals
between CNS and the rest of the
body
 MULTIPLE SCLEROSIS
• 20 – 50 years old
• M < W 3x
• MCC : Unknown
• Blurry or double vision
• MRI – plaques or scarring
• No treatment
• Interferon
 NEURON CELL BODY LOCATION
• NUCLEI – found in CNS in clusters
• Tracts - bundles of nerve fibers
• Gray matter – cell bodies and unmyelinated fibers
• White matter – myelinated fibers
• GANGLIA – PNS
• Nerves
 Functional Classification of Neurons

• Direction of the nerve impulse travels relative to the CNS

• SENSORY NEURONS/AFFERENT NEURONS
• Cell bodies found in a ganglion
• Carry impulses from sensory receptors to CNS
• Cutaneous sense organs – simplest type
• Proprioceptors – propia “one’s own”
• Pain receptors – bare nerve endings/ least specialized
 Functional Classification of Neurons

• MOTOR NEURONS/EFFERENT NEURONS

• Cell bodies found in the CNS
• Carry impulses from CNS to visceral organs/muscles and glands
• INTERNEURONS/ ASSOCIATION NEURONS
• Connect the motor and sensory neurons
• Cell bodies found in the CNS
Functional Classification of Neurons
 Structural Classification of Neurons
• MULTIPOLAR
• MC structural type
• many extensions from the cell body
 Structural Classification of Neurons
• BIPOLAR
• one axon and one dendrite
• Special sense organs ( eye and nose)
 Structural Classification of Neurons
• UNIPOLAR
• short single process emerging from the cell body
• Sensory neurons in the PNS
 FUNCTIONAL PROPERTIES OF NEURON

• IRRITABILITY
• Respond to stimulus and convert it to nerve impulse
• CONDUCTIVITY
• Transmit the impulse to other neurons, muscle/glands.
• ELECTRICAL CONDITION OF A RESTING NEURON’S MEMBRANE
• The plasma membrane at rest is polarized
• Fewer positive ions ( K+) are inside the cell than outside the cell (Na+)
STARTING A NERVE IMPULSE
How Neurons Communicate at Synapses
 REFLEX PHYSIOLOGY
• REFLEXES
• Rapid, predictable, involuntary response
• REFLEX ARC – CNS/PNS
• direct route from a sensory neuron, to an
interneuron, to an effector
• SOMATIC REFLEXES
• skeletal muscles – involuntary reflex
• AUTONOMIC REFLEXES
• Smooth muscle, glands/ heart
 REFLEX ARC
FIVE ELEMENTS

Receptor
Effector
Sensory neurons
Motor neurons
Integration center
SIMPLE RELEX ARCS
PATELLAR REFLEX/ KNEE REFLEX
• L3, L4 and L4 segments of SC
• Striking patellar tendon with reflex
hammer just below the patella
• Stretches the muscle spindle of
quadriceps muscle
• RESULT: leg extended and muscle
contract
PATELLAR REFLEX/ KNEE REFLEX

GRADING OF REFLEXES
0 absent LMN lesion
1+ present but depressed Normal/ neuropathy
2+ present/ brisk Normal
3+ very brisk/ increased Normal/ UMN
lesion
4+ clonus UMN lesion
 CENTRAL NERVOUS SYSYTEM

• 4 MAJOR REGIONS
• Cerebral hemispheres
• Diencephalon
• Brain stem
• Cerebellum
 CEREBRAL HEMISPHERES
CEREBRUM
 Paired (left and right)
superior parts of the brain
 More than half of the brain
mass
 CEREBRUM
• Gyri
• “twisters”
• elevated ridges of tissue
• Sulci
• “furrows”
• shallow grooves
• Fissures
• deeper grooves
 CORPUS CALLOSUM
• thick band of neural fibers
connecting 2 hemispheres
• 200 million axons
• Lateralization
 CORPUS CALLOSUM
• Commisural fibers
• White matter fiber tracts
• FUNCTIONS
• communication among brain
hemispheres
• maintaining balance of arousal and
attention
• eye movement and vision
• tactile localization
 CORPUS CALLOSUM
• rostrum and genu
• Frontal lobe
• body and splenium
• Temporal lobe and occipital lobe
 FRONTAL LOBES
• Central sulcus
• Posterior border
• FUNCTIONS
• Attention
• Critical thinking
• Impulse control
• Primary motor cortex
• Precentral gyrus
• Planning and executing movement
 BROCA’S AREA
• Motor speech area
• Brodmann’s area 44, 45
• Base of precentral gyrus
• language loop
• bundle of nerve fibers
• produce intelligible speech
• Broca’s aphasia
• expressive or non- fluent aphasia
 PARIETAL LOBE
• FUNCTION
• visual processing
• Primary somatosensory cortex
• postcentral gyrus
• touch and pain perception
• proprioception
• khj
 TEMPORAL LOBES
• FUNCTION
• Sensory processing
• hearing
• smell
• taste
• visual processing
 WERNICKE’S AREA
• Brodmann’s area 22, 29, 40
• Wernicke’s aphasia
• receptive or fluent aphasia
• trouble in understanding speech
and written language
 OCCIPITAL LOBE
• Most caudal
• Smallest
• FUNCTION
• Processing of visual stimuli
• Primary visual cortex V1
• objects in motion
• object orientation
• color
SPECIALIZED AREA IN CEREBRUM
• Primary motor area
• Brodmann’s area 4
• Voluntary, skilled movements
• Premotor area
• Brodmann’s area 6
• Prepare movement
• Proximal muscle
SPECIALIZED AREA IN CEREBRUM
• Primary somatosensory cortex
• Brodmann’s area 3, 1, 2
• Processing of somatic sensation
SPECIALIZED AREA IN CEREBRUM
• Primary gustatory area
• Brodmann’s area 35
• Perception of smell
• Primary olfactory area
• Brodmann’s area 43
• Perception of taste
 SPECIALIZED AREA IN CEREBRUM
• Primary visual area
• Brodmann’s area 17
• occipital lobe
• vision
• Primary auditory area
• Brodmann’s area 22
• Superior temporal gyrus
• Language and auditory processing
 SPECIALIZED AREA IN CEREBRUM
• Primary visual area
• Brodmann’s area 17
• occipital lobe
• vision
• Primary auditory area
• Brodmann’s area 22
• Superior temporal gyrus
• Language and auditory processing
BASAL NUCLEI/GANGLIA
 DIENCEPHALON/ Interbrain
· Sits on top of the brain
stem
· Parts
· Thalamus
· Hypothalamus
· Epithalamus
 THALAMUS
• Relay station
• FUNCTIONS
• Relaying sensory information except
smell
• Relaying motor information
• Prioritizing information
• Consciousness
• Role in thinking and memory
 LIMBIC SYSTEM
“Emotional- visceral – brain”
• Hippocampus
• control center of memory
• Alzheimer's disease
• Amygdala
• memories driven by emotions
• regulate emotions and emotional responses
• Hypothalamus
• homeostasis
 LIMBIC SYSTEM
• Cingulate gyrus
• Regulate emotions
• Predict/ avoid negative stimuli
• Expressing emotions to gestures
• Limbic region of basal ganglia
• Response to rewards
• Habit formation
• Addictive behaviors
 HYPOTHALAMUS
• Pituitary gland/hypophysis
• Anterior floor of hypothalamus
• Anterior lobe
• ACTH, FSH, GH, LH, TSH
and Prolactin
• Posterior Lobe
• ADH, Oxytocin
 HYPOTHALAMUS
• Mamillary body
• Recollective memory
• Anterograde amnesia
• Wernicke Korsakoff syndrome
• altered mental status
• nystagmus
• ataxia
 EPITHALAMUS
• Pineal gland
• Circadian rhythm
• Melatonin “ sleep hormone”
 EPITHALAMUS
• Choroid plexus
• Knots of capillaries within 4th
ventricle
 BRAIN STEM
· Attaches to the spinal cord
· Parts
· Midbrain
· Pons
· Medulla oblongata
 MIDBRAIN
• Extends to mamillary body to the pons
• Cerebral aqueduct
• Connects 3rd ventricle to the 4th
ventricle
• Cerebral peduncle / 2 bulging tracts
• Convey descending and ascending
impulses
• Corpora quadrigemina/ 2 pairs of twins
• Vision and hearing
 PONS
• bulging center part of brainstem
• composed of fiber tracts
• controls breathing
 MEDULLA OBLONGATA
• most inferior part
• merges into SC
• fiber tracts cross over in opposite parts
• regulates vital visceral activities
• HR/ BP regulation
• Breathing
• Swallowing
• Vomiting
 RETICULAR FORMATION
• Entire length of brain stem
• Diffuse mass of gray matter
• Motor control of visceral organs
• Prolonged unconsciousness/coma
• FUNCTIONS
• consciousness/ awake- sleep cycle
 CEREBELLUM
• Large- cauliflower like
• 2 hemispheres/ convoluted surface
• Outer cortex – gray matter
• Inner – white matter
• ataxia
• FUNCTIONS
• Precise timing for skeletal muscle activity
• Controls our balance
 PROTECTION OF THE CNS
Meninges
• Layered unit of membranous connective tissue
 Meninges
• Dura mater
• “tough or hard mother”
• outermost/ double layered
• periosteal and meningeal layer
• Falx cerebri and tentorium cerebelli
• Dural venous sinuses
Falx cerebri and tentorium cerebelli
 Meninges
• Arachnoid Mater
• “spider”
• middle layer
• translucent and pliable
• Subarachnoid space
• CSF
 Meninges
• Arachnoid granulations
• Arachnoid villi/ paccchionian
granulations
• Small protrusions of arachnoid
mater
• Allow CSF to exit the
subarachnoid space and enter the
bloodstream
 Meninges
• Pia mater
• “gentle mother”
• Innermost layer
• Thin and fragile
• Gyri and sulci
 Spaces
• Epidural/ extradural space
• skull and outer layer of dura
• Subdural space
• Inner layer of dura and arachnoid
mater
• Subarachnoid space
• Between arachnoid and pia
• CSF
CRANIAL NERVES
CEREBROSPINAL FLUID FLOW
 NORMAL COMPOSITION OF CSF
APPEARANCE Clear, colorless
TOTAL VOLUME 100 – 150 ml
DAILY SECRETION 450 – 500 ml
PRESSURE 70 – 180 mmH20
SPECIFIC GRAVITY 1.006 – 1.007
TOTAL PROTEIN 15 - 45 mg/dl
GLUCOSE 50 – 80 mg/dl
CELL COUNT No RBC, 0- 5 WBC/ ul
CHLORIDE 118 – 130 meq/l
GRAM STAIN No microorganism
 BLOOD BRAIN BARRIER
• brain endothelial cells
• pericytes
• astrocytes
• Impermeability of the brain
capillaries
• Water soluble substances
• Fat soluble molecules, fats and
respiratory gases
 SPINAL CORD
• Major reflex center
• Two- way conduction pathway
• Foramen magnum of skull to the L1/L2
• Meninges beyond the end of SC in the
vertebral canal
• Enlargements - cervical and lumbar
• VC grows faster than SC
• Cauda equina
 GRAY MATTER OF SPINAL CORD
• 2 dorsal horn/ 2 ventral horn
• Central canal – CSF
• Cell bodies of the sensory neurons
– dorsal root – dorsal root ganglion
• Cell bodies of the motor neurons -
ventral root – ventral root ganglion
• Spinal nerves – mixed nerves
WHITE MATTER OF SPINAL CORD
• Composed of myelinated efferent tracts
fibers
• Dorsal column
• Ventral column
• Lateral column
• Sensory afferent tracts / motor
 PERIPHERAL NERVOUS SYSTEM

• Nerves and ganglia

• Nerve – neuron fiber
outside CNS
• Endoneurium
• Perineurium
• Epineurium
CRANIAL NERVES
 SPINAL NERVES
• 31 spinal nerves
• region of the cord they arise
 SPINAL NERVES
• Z
Somatic VS Autonomic Nervous System
SOMATIC NERVOUS SYTEM AUTONOMIC NERVOUS SYTEM

Voluntary nervous system Involuntary nervous system

Skeletal muscles Smooth muscles, cardiac muscles and glands

Smell, noise, taste, light, touch, pain and BP, salinity and pH
temperature

Excitatory response Excitatory or inhibitory

Acetylcholine Acetylcholine or NE

Single neuron between CNS and effector organ 2 neurons with single synapse between CNS and
effector organ

Thick myelinated fibers Thin and thick myelinated fibers

Spinal and CN are 2 branches Sympathetic and parasympathetic are 2 branches

Posture and movement Secretion and control of metabolism

 PARASYMPHATETIC DIVSION
• Craniosacral division
• Preganglionic neurons
• CN III, VII, IX, X and S2 to S4
 SYMPATHETIC DIVISION
• Thoracolumbar division
• Preganglionic
• Gray matter T1 to L2
SYMPATHETIC DIVISION
DIFFERENCES BETWEEN SYMPATHETIC AND PARASYMPATHETIC NERVOUS
SYTEM
 AUTONOMIC FUNCTIONING
• Sympathetic division
• “fight or flight”
• response to unusual stimulus
• Remember as the “E”- exercise,
excitement, emergency, and
embarrassment
• Blood vessels, skins, some glands
and adrenal medulla
 AUTONOMIC FUNCTIONING
• Parasympathetic division
• “rest and digest”
• housekeeping system of the body
• conserves energy
• Maintains daily necessary body
functions
• Remember as the “D” –
digestion, defecation, and diuresis