Introduction &

organization of the
nervous system
Dr. Mitchelle P. Gabuya, MD, OTRP
NeuroamatomyEmilio Aguinaldo College

Central & Peripheral Nervous

System
Nervous System:
1. Central Nervous System: Brain & Spinal cord.
Covered by meninges
Surrounded by the CSF
Excitable nerve cells: neurons
Supporting structures: neuroglia
Interior of the nerve cells are divided into grey and
white matter
2. Peripheral Nervous System
Bundles of nerve fibers or axons

Autonomic Nervous System

Innervation of involuntary structures (heart, smooth
muscle, and glands).
Two parts: sympathetic and the parasympathetic

Major Divisions of the Central

Nervous System: Spinal Cord
Located within the vertebral canal
of the vertebral column
Surrounded by three meninges (QUIZ
#1): What are the meninges of
the brain and spinal cord?
Roughly cylindrical
Begins superiorly at the foramen
magnum in the skull, where it is
continuous with the medulla
oblongata of the brain

 Terminates inferiorly in the

lumbar region (conus
medullaris)
The apex of which a
prolongation of the ________,
the filum terminale,
descends to attach to the back
of the coccyx.
BONUS #1: where does the
spinal cord end in children?
BONUS #2: where does the
spinal cord in adults?
BONUS #3: what is that
meninx which is the
prolongation of the filum
terminale?

Clinical Correlation: Conus Medullaris

Syndrome versus Cauda Equina Syndrome
Spinal Cord Injury

Clinical Correlation: Tethered

Cord Syndrome
Associated with the fixation
(tethering) effect of inelastic
tissue on the caudal spinal cord,
limiting its movement.
This abnormal attachment is
associated with progressive
stretching and increased tension
of the spinal cord as a child
ages.
Secondary to the development
of excess fibrous connective
tissue (fibrosis) in the filum
terminale.

 31 pairs of spinal
nerves by the
anterior or motor
roots and the
posterior or sensory
roots

Afferent fiber

Efferent fiber

Major Divisions of the Central

Nervous System: Brain
It is surrounded by three meninges
Three major divisions: Hindbrain, the midbrain, and the
forebrain.
Hindbrain: medulla oblongata, the pons, and the
cerebellum.
Forebrain: diencephalon (between brain), which is the
central part of the forebrain, and the cerebrum.
Brainstem (a collective term for the medulla oblongata, pons,
and midbrain) is that part of the brain that remains after the
cerebral hemispheres and cerebellum are removed.

Major Divisions of the Central

Nervous System: Cerebrum
Largest part of the brain, consists of
two cerebral hemispheres, connected
by a mass of white matter called the
corpus callosum.
Cerebrum lies above the tentorium
cerebelli.
The hemispheres are separated by a
deep cleft, the longitudinal fissure,
into which projects the falx cerebri.
BONUS #4: what suture is
represented by the red line?

Clinical Correlation: Traumatic

Brain Injury

QUIZ #2-#7: What is the Brodmann representation of

each area?
#2: Wernickes
#3: Brocas
#4: Primary motor area
#5: Primary sensory area
#6: Visual cortex
#7: Frontal eye field

 The cortex is composed of

gray matter.
The folds of the brain (gyri)
are separated by fissures, or
sulci.
The role of the infolding is
to increase the surface
area of the cortex
Quiz #8: What are the
LOBES of the brain?
A fan-shaped collection of
nerve fibers: corona radiata
converges on the basal
nuclei and passes between
them as the internal
capsule.

Clinical Correlation: Weakness in

Stroke
Pure motor involvement

 The cavity present within each cerebral

hemisphere is called the lateral
ventricle.
The lateral ventricles communicate
with the third ventricle through the
interventricular foramina.

Major Divisions of the Peripheral Nervous

System: Cranial & Spinal Nerves
12 pairs of cranial nerves (QUIZ #9-#20: What are
your 12 cranial nerves?)
31 pairs of spinal nerves
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal.

Clinical Correlation: Herniated

Nucleus Pulposus
BONUS #5: What is the
usual direction of
herniation of the
central disc?

Neurobiology of the
neuron & neuroglia

What is a neuron?
Neuron = nerve cell and all its
processes
Neurons are excitable cells that are
specialized for the reception of stimuli
and the conduction of the nerve
impulse.
Parts of the neuron:
Cell body
Neurites: responsible for receiving
information and conducting it
toward the cell body (dendrites)
The single long tubular neurite that
conducts impulses away from the
cell body is called the axon.

 Unlike most other cells in the body, normal neurons in the mature
individual do not undergo division and replication.
QUIZ #21: What is the golden period of recovery in stroke
patients?

Varieties of neurons

Unipolar neurons:
Single neurite that divides a short distance from the cell body
into two branches, one proceeding to some peripheral structure
and the other entering the central nervous system.
The branches of this single neurite have the structural and
functional characteristics of an axon.
Examples of this form of neuron are found in the posterior root
ganglion.

 Bipolar neurons possess an elongated cell body, from each end

of which a single neurite emerges.
Examples of this type of neuron are found in the retinal bipolar
cells and the cells of the sensory cochlear and vestibular
ganglia.

Multipolar neurons have a number of neurites arising from the

cell body.
Most neurons of the brain and spinal cord are of this type.

Structure of the Neuron

In the female, one of the two X chromosomes is compact and is
known as the Barr body. It is composed of sex chromatin and
is situated at the inner surface of the nuclear envelope.

 NISSL SUBSTANCE:
responsible for
synthesizing protein, and
replaces the proteins that
are broken down during
cellular activity.
Fatigue or neuronal
damage causes the Nissl
substance to move and
become concentrated at
the periphery of the
cytoplasm
(chromatolysis).

Excitation of the Plasma Membrane

of the Nerve Cell Body
Depolarization: QUIZ #22: What ion is responsible for this
phenomena?
Depolarization leads to production of an action potential, which
is approximately +40 mV.
Repolarization: permeability for K+ ions increases.

The nerve cell process

Dendrites are the short processes of the cell body

Dendritic spines are extensions of the cell body to increase the
surface area for the reception of axons from other neurons.
Later are reduced in number and size in response to altered
functional demand from afferent axons.
There is evidence that dendrites remain plastic throughout life
and elongate and branch or contract in response to afferent
activity.

 Axon = longest process of the cell body and arises from the
axon hillock.
Distal ends of the terminal branches of the axons are often
enlarged (terminals).
Some termination show a series of swellings resembling a string
of beads (varicosities).

 The initial segment of the axon is the most excitable part of

the axon and is the site at which an action potential
originates.

Axon Transport
Materials are transported from the cell body to the axon
terminals (anterograde transport) and to a lesser extent
in the opposite direction (retrograde transport).
Retrograde transport explains how the cell bodies of
nerve cells respond to changes in the distal end of the
axons.
Worn-out organelles can be returned to the cell body for
breakdown by the lysosomes.

Synapses
Functional interneuronal
communication occurs
Communication at a synapse
takes place in one direction
only
The most common type is
that which occurs between an
axon of one neuron and the
dendrite or cell body of the
second neuron
Different types:
Axodendritic
Axosomatic
Axoaxonic

 2 types synapses: chemical and

electrical.
Most synapses are chemical ~
neurotransmitter.
Several neurotransmitters may be
present.
One neurotransmitter is usually the
principal activator and acts directly
on the postsynaptic membrane,
while the other transmitters function
as modulators and modify the
activity of the principal transmitter.
QUIZ #23: What
neurotransmitter is involved in
myasthenia gravis?

Ultrastructure of Chemical
Synapses
The apposed surfaces of the terminal axonal expansion and the

neuron are called the presynaptic and postsynaptic

membranes, respectively, and they are separated by a synaptic
cleft.

 Presynaptic terminal: presynaptic vesicles that contain the

molecules of the neurotransmitter(s).
Neurotransmitter(s) are discharged into the synaptic cleft
by a process of exocytosis.

Neurotransmitters at Chemical
synapses
Adenosine triphosphate (ATP) is needed for the synthesis of new
transmitter substance.
Most neurons produce and release only one principal transmitter
at all their nerve endings. (EX: acetylcholine).
The following chemical substances act as neurotransmitters, and
there are many more: acetylcholine (ACh), norepinephrine,
epinephrine, dopamine, glycine, serotonin, gamma-aminobutyric
acid (GABA), enkephalins, substance P, and glutamic acid.

Distribution and Fate of

Neurotransmitters
Acetylcholine: neuromuscular junction, in autonomic
ganglia, and at parasympathetic nerve endings.
Renshaw cells: motor neuron cells.
Norepinephrine: sympathetic nerve endings,
hypothalamus.
The effect produced by a neurotransmitter is limited by its
destruction or reabsorption.
Acetylcholine ~ destruction of the transmitter in the
synaptic cleft by the enzyme acetylcholinesterase
(AChE).
QUIZ #24: What neurotransmitter is involved in the
pathophysiology of Parkinsons Disease?

What is a neuroglia?
Nonexcitable cells, support structure of the neurons.
Smaller than neurons and outnumber them by five to ten
times; they comprise about half the total volume of the brain
and spinal cord.
4 types of neuroglial cells
(1) astrocytes
(2) oligodendrocytes
(3) microglia
(4) ependyma

Astrocytes

Have small cell bodies with

branching processes that extend in
all directions.
Two types:
Fibrous astrocytes.
Protoplasmic astrocytes.
(+) expansions on blood vessels
(perivascular feet).
Has an outer and inner glial
limiting membranes.

 Supporting framework for the nerve cells and nerve fibers.

Electrical insulators preventing axon terminals from
influencing neighboring and unrelated neurons.
Barriers for the spread of neurotransmitter substances
released at synapses.
Take up excess K+ ions from the extracellular space so that
they may have an important function during repetitive
firing of a neuron. They store glycogen within their
cytoplasm.
Astrocytes may serve as phagocytes by taking up
degenerating synaptic axon terminals.
Following the death of neurons due to disease, astrocytes
proliferate and fill in the spaces previously occupied by the
neurons, a process called replacement gliosis.

Oligodendrocytes
Oligodendrocytes have small
cell bodies and a few delicate
processes with no filaments
in their cytoplasm.
Oligodendrocytes are
frequently found in rows
along myelinated nerve fibers
and surround nerve cell
bodies.

 Formation of the myelin sheath of nerve fibers in the

central nervous system, much as the myelin of peripheral
nerves is formed from Schwann cells.
Oligodendrocytes have several processes, they can each
form several internodal segments of myelin on the same or
different axons.
Not surrounded by a basement membrane.
Quiz #25: Name the disease that involves
demyelination of the nerve fibers?

Microglia
Derived from macrophages outside
the nervous system.
Smallest of the neuroglial cells and
give off numerous spinelike
projections.
Closely resemble connective tissue
macrophages.
Increase in number in the presence
of damaged nervous tissue resulting
from trauma and ischemic injury
and in the presence of diseases
including Alzheimer disease,
Parkinson disease, multiple
sclerosis, and AIDS.

 Appear to be inactive and are sometimes called resting

microglial cells.
They may proliferate and become antigen presenting cells,
which together with the invading T lymphocytes confront
invading organisms.
Actively phagocytic; their cytoplasm becomes filled with
lipids and cell remnants.

Match the function with the appropriate lobe of the brain:

A. Frontal lobe
B. Parietal lobe
C. Temporal lobe
D.Occipital lobe
.QUIZ #26: A stroke patient presenting with inability to recognize
different musical tones
.QUIZ #27: A traumatic brain injury is being interviewed, but kept
punching the walls and destroying hospital material
.QUIZ #28: A stroke patient lost his vision after the stroke
.QUIZ #29: A patient with right hemiplegia also presenting with
unilateral neglect
.QUIZ #30: Teaching a traumatic brain injury patient to learn new
materials