The Nervous System

Tan Zhao Xun; Edwin Liang 10S78

Overview
Basic Neuroanatomy

Somatic Nervous System

Autonomic Nervous System

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BASIC NEUROANATOMY

The Nervous System

*CN XI

Central Nervous System

Brain: 12 pairs of cranial nerves* Spinal cord: 31 pairs of spinal nerves

Peripheral Nervous System

Peripheral nerves
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Spinal Cord: General Features

Location:

Upper 2/3 of vertebral canal until L1/L2

Enlargements:
Cervical (C5-T1) Lumbar (L2-S2)

Spinal segments spinal nerves Caudal end conus medularis

Cauda equina

(caudal continuation of spinal nerves) Filum terminale (extension of pia mater)

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Spinal Cord: General Functions

SYSTEMIC level function
Highways to transmit information

between brain and other parts of the body

Sensory Motor

Autonomic

LOCAL level function

Reflex arc

Modulation of information (e.g. pain)

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Spinal vs. Vertebral Segments

Spinal segment Vertebral segment
Spinal segment Vertebral segment

Region of the spinal cord to which is attached the anterior and posterior roots of the spinal nerve

Vertebra column

of

vertebral

Vertebral Segments
33 Vertebral segments
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Cervical

12
5 5

Thoracic
Lumbar Sacral (fused)

Coccygeal (fused)

31 Spinal Segments
3131 pairs of spinal nerves
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Cervical

12
5 5

Thoracic
Lumbar Sacral

Coccygeal

PIA * ARACHNOID DURA

* SUBARACHNOID SPACE 10

Spinal Cord: Basic Anatomy

Meninges

1.
2. 3.

Pia mater
Arachnoid Dura mater

Cerebrospinal fluid (CSF)

1.

Protection

2.
3.

Cushion spinal cord

Remove some metabolites from spinal cord

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* SUBARACHNOID SPACE

WHITE MATTER GREY MATTER

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Spinal Cord: Grey & White Matter

GREY matter: GREY MATTER
Unmyelinated axons Dorsal horn: sensory Ventral horn: motor

Lateral horn: autonomic

WHITE matter: WHITE MATTER

Myelinated axons Structurally columns Functionally tracts
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Spinal Cord: Grey Matter

Based on

cytoarchitectonics of the neurons (cell size, location, dendrites)

Dorsal horn, intermediate

zone, ventral horn

10 laminae 6 in dorsal horn 3 in ventral horn 1 around central canal

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Histology of the Nervous Systems

CNS
NEURONS

PNS
NEURONS

Oligodendrocytes Astrocytes Ependymal cells Microglia

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Schwann cells Satellite cells

Synapses

1. Sensory 2. Motor 3. Autonomic

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Sensory Neurons
Primary afferent fibres (1o sensory neuron) Dorsal root Dorsal root ganglion

Cell body in dorsal root ganglion (DRG)

Central axonal process in dorsal roots spinal cord (dorsal horn) General sensory (skin, joints, muscles) Visceral sensory (viscera)
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Motor Neurons
Ventral root

Upper / Lower motor neuron

Synapse with skeletal muscle Neuromuscular junction
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Autonomic Neurons
Ventral root

Pre-ganglionic neuron
Begins at lateral horn; ends at white communicantes

Post-ganglionic neuron
Begins at gray communicantes
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Spinal Nerves: Functional Components

Sensory Afferent
General Somatic Afferent: Skin, tendons, muscles, joints etc. General Visceral Afferent: Viscera

Motor Efferent
General Somatic Efferent: Skeletal muscles

General Visceral Efferent: Viscera, glands, smooth muscles

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Question 1 Nerve fibres that carry sensory impulses from skeletal muscles to the brain and spinal cord are called:
A. Somatic efferent fibres B. Visceral efferent fibres C. Visceral afferent fibres D. Somatic afferent fibres

E. None of the above

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Question 1 Nerve fibres that carry sensory impulses from skeletal muscles to the brain and spinal cord are called:
A. Somatic efferent fibres B. Visceral efferent fibres C. Visceral afferent fibres D. Somatic afferent fibres

E. None of the above

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Question 2 __________ is an inflammation of the brain coverings.

A. Encephalitis B. Meningitis

C. Poliomyelitis
D. Cerebral Palsy

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Question 2 __________ is an inflammation of the brain coverings.

A. Encephalitis B. Meningitis

C. Poliomyelitis
D. Cerebral Palsy

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Question 3 A spinal cord CSF sample is usually taken from the:

A. Brain B. Peripheral nerves

C. Lumbar subarachnoid space

D. Cervical subarachnoid space

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Question 3 A spinal cord CSF sample is usually taken from the:

A. Brain B. Peripheral nerves

C. Lumbar subarachnoid space

D. Cervical subarachnoid space

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Treasure the little things in life.

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SOMATIC NERVOUS SYSTEM

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Reflex Arc: Features

Automatic, rapid response to a stimulus
Action is involuntary Occurs without any involvement of thought or the brain In humans, this action occurs through a neural pathway called

the reflex arc

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Reflex Arc: Types

1. Spinal
Connections and processing occur in spinal cord

2. Cranial
Occurs in the brain

3. Somatic
Involuntary control of skeletal muscular system

4. Visceral
Involuntary control of glands, smooth muscle and cardiac muscle
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Reflex Arc: Components

COMPONENT 1. Receptor 3. Integrating centre FUNCTION Responds to a stimulus Integrates information in CNS (involves synapse(s)) Monosynaptic: 1 synapse; rapid Polysynaptic: 2 synapses; slower and complex Carries impulse to effector

2. Afferent sensory neuron Carries impulse to CNS

4. Efferent motor neuron

5. Effector

Carries out action

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Reflex Arc: Stretch Reflex

The Stretch reflex
Reciprocal innervation of

agonist/antagonist muscle groups

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Dermatomes and Myotomes

Dermatomes
Areas of sensory innervation

on the skin for 1 particular spinal root/spinal nerve

Myotomes
Muscles (motor innervation)

that 1 particular spinal root supplies

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Neuromuscular Junction (NMJ)

Synapse between a motor neuron and skeletal muscles

Motor unit: 1 motor neuron and all the muscle fibres it innervates

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NMJ: Clinical Conditions

WEAK Myasthenia gravis

+ [K ] + [K ]

Hyperkalemia Hypokalemia
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NMJ: Clinical Conditions

1. Myasthenia gravis CAUSE
Decrease in number of available receptors at muscle end plate

Release of transmitter is normal

SYMPTOMS
Weakness of muscles and myasthenic fatigue with repeated activity

Muscles of the eyes are affected early

Diplobia and ptosis Weakness may generalise subsequently
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NMJ: Clinical Conditions

2. Abnormal K+ Levels HYPOKALEMIA
Hypokalemic Periodic Paralysis (HypoKPP)

Muscle weakness felt with periods of normal muscle function

Observed in patients with impaired calcium channels Accompanied with low serum potassium

HYPERKALEMIA
High potassium levels block muscle repolarisation
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Example: Brachial Plexus

M A R M U
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Example: Brachial Plexus

Major nerve network supplying upper limb C5-T1 nerves are roots of brachial plexus
Union of anterior rami of C5-C8, T1

Some important branches:

Musculocutaneous nerve Axillary nerve Radial nerve Median nerve Ulnar nerve

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Example: Brachial plexus Clinical conditions

Injuries result in paralysis and anesthesia

Complete paralysis
No movement detectable

Incomplete paralysis
Not all muscles paralysed but movements are weak

Injuries to different parts have different consequences*

Superior injury (C5, C6) Inferior injury (C8, T1)

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Example: Brachial plexus Clinical conditions

Injuries to superior parts (C5, C6) Erb-Duchenne palsy
Due to excessive increase in angle between neck and shoulder Can also occur in newborn from excessive stretching of neck

during delivery
Waiters tip position:

Limb hangs by side in medial rotation

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Example: Brachial plexus Clinical conditions

Injuries to inferior parts (C8, T1) Klumpke paralysis
Upper limb is suddenly pulled

superiorly
Newborns upper limb pulled

excessively during delivery

Claw hand: short muscles of hand

affected

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Question 1 A patient with severe kyphoscoliosis presents with increasing dyspnea consistent with a decrease in chest wall compliance. With contraction of the external intercostal muscles during inspiration, the Golgi tendon organ (GTO) provides the central nervous system information about which of the following?
A. The length of the muscle being moved B. The velocity of the muscle movement C. The blood flow to the muscle being moved D. The tension developed by the muscle being moved E. The change in joint angle produced by the movement
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Question 1 A patient with severe kyphoscoliosis presents with increasing dyspnea consistent with a decrease in chest wall compliance. With contraction of the external intercostal muscles during inspiration, the Golgi tendon organ (GTO) provides the central nervous system information about which of the following?
A. The length of the muscle being moved B. The velocity of the muscle movement C. The blood flow to the muscle being moved D. The tension developed by the muscle being moved E. The change in joint angle produced by the movement
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Question 2 A 32 y/o man sees his physician after collapsing suddenly without any other physical distress. Lab results demonstrate an elevated serum concentration of K+ and he is diagnosed with periodic hyperkalemic paralysis, a clinical condition in which a sudden increase in extracellular K+ concentration results in muscle weakness. Which of the following is most likely to cause muscle weakness as a result of increased extracellular K+ concentration?
A. Hyperpolarization of muscle cells B. Inactivation of sodium channels in muscle cells

C. Increased release of neurotransmitters from motorneurons

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Question 2 A 32 y/o man sees his physician after collapsing suddenly without any other physical distress. Lab results demonstrate an elevated serum concentration of K+ and he is diagnosed with periodic hyperkalemic paralysis, a clinical condition in which a sudden increase in extracellular K+ concentration results in muscle weakness. Which of the following is most likely to cause muscle weakness as a result of increased extracellular K+ concentration?
A. Hyperpolarization of muscle cells B. Inactivation of sodium channels in muscle cells

C. Increased release of neurotransmitters from motorneurons

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The harder the struggle, the more glorious the triumph.

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AUTONOMIC NERVOUS SYSTEM

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ANS: Features
Ventral root

PRE-ganglionic neuron
Begins at lateral horn; ends at white communicantes

POST-ganglionic neuron
Begins at gray communicantes
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ANS: Features
Nervous system supplying viscera / organs ANS Supply:

1.
2. 3.

Smooth muscles
Cardiac muscles Glands

Autonomic neurons located in lateral horn 2 neurons to go from spinal cord to target tissue PRE- & POST-ganglionic neurons
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ANS: Pre- & Post-ganglionic Neurons

PRE-ganglionic neuron
Cell body in CNS (brainstem/spinal cord autonomic nuclei)
Nerve fibre or axon is myelinated (white)

POST-ganglionic neuron
Cell body in PNS (autonomic ganglia aka preganglionic synpase) Nerve fibre or axon is NON-myelinated (grey) Target organ/tissue (a.k.a. postganglionic synpase)

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ANS: Features
Ventral root

PRE-ganglionic neuron
Begins at lateral horn; ends at white communicantes

POST-ganglionic neuron
Begins at gray communicantes
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SYMPATHETIC

PARASYMPATHETIC

T1

L2

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Sympathetic NS
Fight or flight More widespread

Parasympathetic NS
Rest or repose
More localised
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Neurotransmitters of the ANS

Preganglionic synapse
Sympathetic: acetylcholine (ACh) Parasympathetic: acetylcholine (ACh)

Postganglionic synapse
Sympathetic: noradrenaline (NA) adrenergic nervers

(EXCEPTION: sweat gland- ACh)

Parasympathetic: acetylcholine (ACh) cholinergic nerves

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Receptors for ANS Neurotransmitters

Acetylcholine receptors (AChR)
Nicotinic (nAChR) Muscarinic (mAChR)

Adrenergic receptors (NA)

1: most widespread (except heart) ; Excitation 2: GIT 1: heart 2: bronchi
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; Inhibition ; Excitation ; Inhibition

SYMPATHETIC Nervous System

THORACO-LUMBAR Outflow PRE-ganglionic neurons
In lateral horn of spinal cord

(T1-L2 level)
POST-ganglionic neurons
Mainly in sympathetic

chain/trunk ganglia/paravertebral ganglia Some in prevertebral ganglia (e.g. celiac plexus, superior mesenteric ganglia) Adrenal medulla

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SYMPATHETIC Nervous System

Splanchnic nerves
Preganglionic axons that do

not synapse in the sympathetic trunk ganglia

Thoracic: Greater, Lesser,

Least Lumbar Sacral Pelvic (only splanchnic nerve that carries parasympathetic fibres; S2-S4)
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PARASYMPATHETIC Nervous System

CRANIO-SACRAL Outflow
PRE-ganglionic neurons
Brainstem nuclei (CNIII, VII, IX, X) Sacral parasympathetic nucleus

(lateral horn of spinal cord from S2-S4)

POST-ganglionic neurons
Parasympathetic ganglia located

near/within organs it supplies

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Nerve Plexuses
Somatic
Brachial plexus Lumbo-Sacral plexus

Visceral/Autonomic
Cardiac plexus

Pulmonary plexus
Esophageal plexus

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Autonomic Nerve Plexuses

Network of sympathetic

and parasympathetic nerve fibres

Occasional ganglia

interspersed
Transmit motor and

sensory fibres to and from viscera

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Autonomic Nerve Plexuses

Thoracic
Cardiac plexus
Pulmonary plexus Esophageal plexus

Abdomino-pelvic
Celiac plexus Superior mesenteric plexus Inferior mesenteric plexus
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Hypogastric plexus

Thoracic Autonomic Nerve Plexuses

Viscero-Motor (EFFERENT) E.g. Cardiac plexus
Sympathetic
Preganglionic:
Postganglionic:

Lateral horn of spinal cord Cardiac ganglia

Parasympathetic
Preganglionic:
Postganglionic:

Vagus nerve (dorsal motor nuclei) Cardiac ganglia

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PREganglionic Sympathetic POSTganglionic Sympathetic PREganglionic Parasympathetic POSTganglionic Parasympathetic

Cardiac Plexus
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Thoracic Autonomic Nerve Plexuses

Viscero-Sensory (AFFERENT)
1. VISCERAL PAIN
Pain originates from bodys viscera/organs
Manifestation:
Widespread (difficult to localise)

Referred pain (convergent inputs)*

Fibres travel mainly through sympathetic fibres

Sensory (afferent) nerve fibres: follow sympathetic nerve fibres

Sensory ganglion: dorsal root ganglia

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Referred Pain
Pain perceived at a site

adjacent to or at a distance from the site of an injurys origin

Pain arising in viscera may also

be felt in the skin or other somatic tissues, supplied by somatic nerves arising from the same spinal segment

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Thoracic Autonomic Nerve Plexuses

Viscero-Sensory (AFFERENT)
2. VISCERAL REFLEX
For local or higher visceral reflexes Does not reach consciousness Fibres travel mainly through parasympathetic nerve fibres Sensory (afferent) nerve fibres: follow parasympathetic nerve

fibres (CNIX, CNX)

Sensory ganglion: inferior ganglion of glossopharyngeal nerve

and vagus nerve

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Abdomino-Pelvic Autonomic Nerve Plexuses

Viscero-Motor (EFFERENT)
SYMPATHETIC Preganglionic:
Thoracic splanchnic nerves (Great, Lesser, Least) Lumbar splanchnic nerves

Postganglionic:
Celiac ganglion Aortico-renal ganglion

Adrenal medulla
Superior mesenteric ganglion
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Abdomino-Pelvic Autonomic Nerve Plexuses

Viscero-Motor (EFFERENT)
PARASYMPATHETIC Preganglionic:
Vagus nerve Pelvic splanchnic nerve

Postganglionic:
Celiac ganglion Aortico-renal ganglion

Adrenal medulla
Superior mesenteric ganglion
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Abdomino-Pelvic Autonomic Nerve Plexuses

Viscero-Sensory (AFFERENT)
Visceral Pain
E.g. Appendicitis: referred pain to umbilical region

Visceral-reflex
Receptors along digestive tract sensitive to stretch Control sphincters for movement of food

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Abdomino-Pelvic Autonomic Nerve Plexuses

Viscero-Sensory (AFFERENT)

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Question 1 The cell bodies of preganglionic parasympathetic neurons are located in the:
A. Cervical and thoracic spinal cord B. Brain and lumbar spinal cord C. Thoracic and lumbar spinal cord D. Brain and sacral spinal cord

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Question 1 The cell bodies of preganglionic parasympathetic neurons are located in the:
A. Cervical and thoracic spinal cord B. Brain and lumbar spinal cord C. Thoracic and lumbar spinal cord D. Brain and sacral spinal cord

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Question 2 Norepinephrine is released from _______ nerves.

A. All autonomic
B. Parasympathetic C. The vagus D. Sympathetic

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Question 2 Norepinephrine is released from _______ nerves.

A. All autonomic
B. Parasympathetic C. The vagus D. Sympathetic

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Question 3 Sympathetic nerves arise from the __________ and __________ regions.
A. Cervical; Lumbar
B. Cranial; Sacral C. Cranial; Thoracic D. Thoracic; Lumbar

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Question 3 Sympathetic nerves arise from the __________ and __________ regions.
A. Cervical; Lumbar
B. Cranial; Sacral C. Cranial; Thoracic D. Thoracic; Lumbar

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Question 4 What kind of peripheral nerve fibre carries motor impulses outward to smooth muscles and glands of internal organs?
A. General somatic efferent fibres B. General visceral efferent fibres C. General somatic afferent fibres

D. General visceral afferent fibres

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Question 4 What kind of peripheral nerve fibre carries motor impulses outward to smooth muscles and glands of internal organs?
A. General somatic efferent fibres B. General visceral efferent fibres C. General somatic afferent fibres

D. General visceral afferent fibres

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Everything is good at the end; If things are not good yet, its not the end.
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SUMMARY
Basic Neuroanatomy

Somatic Nervous System

Autonomic Nervous System

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CASE STUDIES

References
1. 2. 3. 4. 5. NUS YLLSoM Nervous System notes by Ng Yee Kong Physiology Fourth Edition Textbook by Linda S. Costanzo Physiology Fourth Edition Cases and Problems by Linda S. Costanzo http://ohsu2015.wikispaces.com/8.24.11+-+Peripheral+Nervous+System http://anatomyandart.com/blog/wpcontent/uploads/2009/08/brachial_plexus11.jpg 6. http://fc02.deviantart.net/fs71/f/2011/150/8/9/the_brachial_plexus_by_ilexd3hlg39.png 7. http://www.valiant.com/wp-content/uploads/2012/02/Megu1.jpg 8. http://o.quizlet.com/i/XBgTcTr9YMcoleCQMT87ig_m.jpg 9. http://www.scripps.org/encyclopedia/graphics/images/en/9196.jpg 10. http://cdn.funcheap.com/wp-content/uploads/2011/07/candcads23.jpg 11. http://cdn.funcheap.com/wp-content/uploads/2011/07/candcads24.jpg

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