review of anatomy and physiology of the nervous
TRANSCRIPT
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Review of Anatomy and Review of Anatomy and Physiology of the Nervous Physiology of the Nervous
SystemSystem
Anthony P. Toledo, MD, RN, MAN, FPAFPAnthony P. Toledo, MD, RN, MAN, FPAFP
Chairman, MS2Chairman, MS2
Our Lady of Fatima UniversityOur Lady of Fatima University
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ObjectivesObjectives Review the anatomy and physiology of the Review the anatomy and physiology of the
nervous systemnervous system Identify specific topics for consideration during Identify specific topics for consideration during
health history assessment interview of the health history assessment interview of the client with neurologic disorders.client with neurologic disorders.
Describe assessment of neurologic function, Describe assessment of neurologic function, including examination of mental status, cranial including examination of mental status, cranial nerves, sensory nerves, motor nerves, nerves, sensory nerves, motor nerves, cerebellar dysfunction and reflexes.cerebellar dysfunction and reflexes.
Describe special neurologic examinations.Describe special neurologic examinations. Identify abnormal findings that may indicate Identify abnormal findings that may indicate
impairment of neurologic functions.impairment of neurologic functions.
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Nervous SystemNervous System
initiates actions and coordinates the initiates actions and coordinates the activity of the musclesactivity of the muscles
monitors the organsmonitors the organsconstructs and also stops input from the constructs and also stops input from the
sensessenses
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Organization of theNervous System
Peripheral
Somatic
Autonomic
Sympathetic
Parasympathetic
Enteric
Central
Parts of the Nervous SystemParts of the Nervous System
The nervous system is The nervous system is divided into the central divided into the central nervous system nervous system (consisting of the brain (consisting of the brain and spinal cord) and the and spinal cord) and the peripheral nervous peripheral nervous system (consists of system (consists of nerves made up of nerves made up of neurons that carry neurons that carry information to and from information to and from the central nervous the central nervous system).system).
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Neuron StructureNeuron Structure
Cell body Cell body Large vesicular Large vesicular
nucleus nucleus Single prominent Single prominent
nucleolus nucleolus Mitochondria & other Mitochondria & other
organelles organelles Abundant RER (Nissl Abundant RER (Nissl
substance) substance) Microtubules & Microtubules &
neurofilaments neurofilaments
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Neuron StructureNeuron Structure
Dendrites Dendrites Receive information Receive information
and transmit it to the and transmit it to the cell body cell body
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Neuron StructureNeuron Structure
Axon Axon Thin, cylindrical Thin, cylindrical
process arising from process arising from the axon hillock the axon hillock
Contain abundant Contain abundant microtubules and microtubules and neurofilaments neurofilaments
Terminate as synaptic Terminate as synaptic boutons which contain boutons which contain vesicles of vesicles of neurotransmitter neurotransmitter
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Neuron StructureNeuron Structure
Node of RanvierNode of Ranvier Discontinuity in the Discontinuity in the
myelin myelin Exposed to Exposed to
extracellular space extracellular space Action potential skips Action potential skips
from node to node from node to node "saltatory conduction" "saltatory conduction"
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Neuron StructureNeuron Structure
Myelin Myelin Unmyelinated axons Unmyelinated axons
Seen in peripheral nerves Seen in peripheral nerves Surrounded by cytoplasm Surrounded by cytoplasm
of Schwann cells of Schwann cells Small diameter Small diameter Slow conduction velocity Slow conduction velocity
Myelinated axons Myelinated axons Larger diameter Larger diameter Ensheathed in myelin Ensheathed in myelin Rapid conduction velocityRapid conduction velocity
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Neuron StructureNeuron Structure
Myelin Forming CellsMyelin Forming Cells Schwann Cells Schwann Cells
Myelin forming cells of the peripheral nervous system Myelin forming cells of the peripheral nervous system Formed during fourth month of development Formed during fourth month of development One Schwann cell myelinates only one axon One Schwann cell myelinates only one axon
Oligodendrocytes Oligodendrocytes Myelin-forming cells of the CNS Myelin-forming cells of the CNS Begin formation during fourth month of development and Begin formation during fourth month of development and
continue until second decade of life continue until second decade of life Individual oligodendrocyte able to myelinate many axons Individual oligodendrocyte able to myelinate many axons Degeneration results in multiple sclerosis Degeneration results in multiple sclerosis
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Classification of Neurons by Classification of Neurons by Neuronal ProcessesNeuronal Processes
Unipolar neurons -- one axon, no dendrites; Unipolar neurons -- one axon, no dendrites; occur only during development occur only during development
Bipolar neurons -- found in cochlear and Bipolar neurons -- found in cochlear and vestibular ganglia, retina and olfactory mucosa vestibular ganglia, retina and olfactory mucosa
Multipolar neurons -- one axon and multiple Multipolar neurons -- one axon and multiple dendrites, found in ventral horndendrites, found in ventral horn*Most neurons in body are multipolar *Most neurons in body are multipolar
Pseudounipolar neurons -- found in dorsal root Pseudounipolar neurons -- found in dorsal root ganglia and most cranial ganglia ganglia and most cranial ganglia
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Classification of Neurons by Classification of Neurons by Functional RoleFunctional Role
Motor Neurons - Motor Neurons - Control effector organs Control effector organs and muscle fibers and muscle fibers
Sensory Neurons - Sensory Neurons - Receive sensory Receive sensory stimuli from internal or external stimuli from internal or external environment; Relay them to CNS environment; Relay them to CNS
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Action PotentialAction Potential
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Synapse Synapse
Synapses - Synapses - Specialized membrane Specialized membrane junctions designed for unidirectional junctions designed for unidirectional communication between neurons or communication between neurons or between neurons and effector cells. Pre- between neurons and effector cells. Pre- and postsynaptic membranes separated and postsynaptic membranes separated by 20 nm. space called synaptic cleft.by 20 nm. space called synaptic cleft.
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Synaptic Vesicles Synaptic Vesicles Synaptic vesicles - Synaptic vesicles - Contain Contain
neurotransmitter. neurotransmitter. Release NT into synaptic cleft when Release NT into synaptic cleft when
vesicles fuse with presynaptic membrane. vesicles fuse with presynaptic membrane. NT may excite (depolarize) or inhibit NT may excite (depolarize) or inhibit (hyperpolarize) the postsynaptic membrane.(hyperpolarize) the postsynaptic membrane.
Certain NT are inactivated in synaptic cleft Certain NT are inactivated in synaptic cleft by Enzymatic degradation (e.g., ACh by by Enzymatic degradation (e.g., ACh by AChE). Reuptake by presynaptic cell (e.g., AChE). Reuptake by presynaptic cell (e.g., NE) NE)
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Synaptic TransmissionSynaptic Transmission
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Neuromuscular JunctionNeuromuscular Junction
Occurs at the motor end plateOccurs at the motor end plateSynapse between neurons and muscle Synapse between neurons and muscle
cells cells ACh released from axon depolarizes ACh released from axon depolarizes
sarcolemma via the acetylcholine nicotinic sarcolemma via the acetylcholine nicotinic receptors receptors
Autoimmune response causes myasthenia Autoimmune response causes myasthenia gravisgravis
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Neuromuscular JunctionNeuromuscular Junction
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NeurogliaNeuroglia
"Nerve glue""Nerve glue" In CNS: microglia, astrocytes, In CNS: microglia, astrocytes,
oligodendrocytes, and ependymal cells oligodendrocytes, and ependymal cells In PNS: Schwann cells In PNS: Schwann cells
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Types of NeurogliaTypes of Neuroglia Astrocytes Astrocytes
Important in controlling microenvironment of nerve cells Important in controlling microenvironment of nerve cells Participate in maintenance of the blood-brain barrier Participate in maintenance of the blood-brain barrier
Oligodendrocytes Oligodendrocytes Myelinate axons of the CNS Myelinate axons of the CNS
Microglia Microglia Phagocytic, part of the mononuclear phagocyte system Phagocytic, part of the mononuclear phagocyte system Unlike other neuroglial cells which originate from neuroectoderm Unlike other neuroglial cells which originate from neuroectoderm Originate from mesoderm Originate from mesoderm
Ependymal cells Ependymal cells Line the ventricular cavities of the brain and central canal of spinal Line the ventricular cavities of the brain and central canal of spinal
cord cord Cilia present on cells helps move cerebrospinal fluid through Cilia present on cells helps move cerebrospinal fluid through
ventricles ventricles Schwann cells Schwann cells
Myelinate peripheral axons Myelinate peripheral axons
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Derivatives of the Brain VesiclesDerivatives of the Brain Vesicles
Forebrain Forebrain Telencephalon — Telencephalon —
cerebral hemispheres cerebral hemispheres and lateral ventricles and lateral ventricles
Diencephalon — Diencephalon — thalamus, thalamus, hypothalamus, and hypothalamus, and epithalamus including epithalamus including the pineal gland, the pineal gland, mammilary bodies, mammilary bodies, retina, and optic nerve retina, and optic nerve
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Derivatives of the Brain VesiclesDerivatives of the Brain Vesicles
Midbrain Midbrain Mesencephalon — Mesencephalon —
midbrain and cerebral midbrain and cerebral aqueduct aqueduct
Hindbrain Hindbrain Metencephalon — Metencephalon —
pons and cerebellum pons and cerebellum Myelencephalon — Myelencephalon —
medullamedulla
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The BrainThe Brain
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The BrainThe Brain
Cerebral Cortex Cerebral Cortex Surface is highly convoluted with bulges Surface is highly convoluted with bulges
referred to as gyri and spaces referred to as gyri and spaces separating the gyri called sulci separating the gyri called sulci
Two prominent sulci Two prominent sulci Sylvian fissure — divides the fontal and Sylvian fissure — divides the fontal and
temporal lobes temporal lobes Central sulcus of Rolando — separates Central sulcus of Rolando — separates
the parietal and temporal lobes the parietal and temporal lobes
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The BrainThe Brain
Frontal LobeFrontal Lobe Primary motor cortex Primary motor cortex
— damage causes — damage causes contralateral spastic contralateral spastic paresis. Located in the paresis. Located in the precentral gyrusprecentral gyrus
Premotor cortex —Premotor cortex —damage causes damage causes apraxias apraxias
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The BrainThe Brain
The motor homunculus The motor homunculus in precentral gyrusin precentral gyrus Muscles of head Muscles of head
represented most ventrally represented most ventrally closest to lateral fissure closest to lateral fissure
Dorsally, regions of neck, Dorsally, regions of neck, upper limb, and trunk on upper limb, and trunk on lateral aspect lateral aspect
Medial aspect motor Medial aspect motor representation for the representation for the pelvis and lower limb pelvis and lower limb
Supplied by branches of Supplied by branches of anterior cerebral artery anterior cerebral artery
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The BrainThe Brain Prefrontal Cortex Prefrontal Cortex
Located in front of premotor area Located in front of premotor area Represents ¼ of entire cerebral cortex in Represents ¼ of entire cerebral cortex in
human brain human brain Involved in organizing and planning the Involved in organizing and planning the
intellectual and emotional aspects of behaviorintellectual and emotional aspects of behavior Lesions to prefrontal area Lesions to prefrontal area
Cannot concentrate Cannot concentrate Easily distracted Easily distracted General lack of initiative, foresight, and General lack of initiative, foresight, and
perspective perspective Apathy Apathy Suckling and grasp reflexes evidentSuckling and grasp reflexes evident
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The BrainThe Brain
Expressive Aphasia Expressive Aphasia Area in left or dominant hemisphere Area in left or dominant hemisphere
affected.affected. Damage to Broca’s area produces Damage to Broca’s area produces
a motor, nonfluent, or expressive a motor, nonfluent, or expressive aphasia that reflects a difficulty in aphasia that reflects a difficulty in piecing together words to produce piecing together words to produce expressive speech expressive speech
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The BrainThe Brain
Parietal Lobe Parietal Lobe Primary Somatosensory Cortex Primary Somatosensory Cortex
Begins posterior to central sulcus with Begins posterior to central sulcus with postcentral gyrus postcentral gyrus
Contains primary somatosensory Contains primary somatosensory cortex cortex
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The BrainThe Brain
The sensory The sensory homunculus in homunculus in
postcentral gyruspostcentral gyrus Similar somatotopic Similar somatotopic
representation of bodyrepresentation of body Head, neck, upper Head, neck, upper
limbs, and trunk limbs, and trunk laterally laterally
Pelvis and lower limb Pelvis and lower limb mediallymedially
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The BrainThe Brain Parietal LobeParietal Lobe
Posterior Parietal Association CortexPosterior Parietal Association Cortex Lesions here if in the dominant hemisphere Lesions here if in the dominant hemisphere
result in apraxia result in apraxia Deficit seems to reflect a lack of Deficit seems to reflect a lack of
understanding how to organize the understanding how to organize the performance of a pattern of movements performance of a pattern of movements
Astereognosia (inability to recognize items by Astereognosia (inability to recognize items by touch) may be present touch) may be present
No loss of tactile or proprioceptive sensation No loss of tactile or proprioceptive sensation
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The BrainThe Brain
Receptive Aphasia Receptive Aphasia Cannot comprehend spoken language, Cannot comprehend spoken language,
May or may not be able to read (alexia), May or may not be able to read (alexia), Characterized by fluent verbalization Characterized by fluent verbalization that lacks meaning, Generally unaware that lacks meaning, Generally unaware of deficitof deficit
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The BrainThe Brain Occipital LobeOccipital Lobe
known as primary visual cortex known as primary visual cortex Retinal surface represented in orderly manner on Retinal surface represented in orderly manner on
surface of the area surface of the area Damage to discrete area will produce scotoma in Damage to discrete area will produce scotoma in
corresponding portion of visual field corresponding portion of visual field Unilateral lesion in results in a contralateral Unilateral lesion in results in a contralateral
homonymous hemianopsia with macular sparing homonymous hemianopsia with macular sparing
Posterior cerebral artery supplies occipital lobe and Posterior cerebral artery supplies occipital lobe and splenium of corpus callosum splenium of corpus callosum
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The BrainThe Brain
Temporal LobeTemporal Lobe Primary Auditory Cortex Primary Auditory Cortex
located on the two transverse gyri of Heschl located on the two transverse gyri of Heschl Cross the superior temporal lobe deep within the Cross the superior temporal lobe deep within the
lateral sulcus lateral sulcus Patients with unilateral damage show little loss of Patients with unilateral damage show little loss of
auditory sensitivity but have some difficulty in auditory sensitivity but have some difficulty in localizing sounds in contralateral field localizing sounds in contralateral field
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The BrainThe Brain CerebellumCerebellum
Derived from the Metencephalon Derived from the Metencephalon Located dorsal to the pons and Located dorsal to the pons and
medulla medulla Fourth ventricle found between Fourth ventricle found between
cerebellum and dorsal aspect of cerebellum and dorsal aspect of pons pons
Involved in fine tuning and Involved in fine tuning and coordination of muscle movements coordination of muscle movements
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The BrainThe Brain
CerebellumCerebellum Midline vermis and two Midline vermis and two
lateral cerebellar lateral cerebellar hemispheres hemispheres
Vermis controls axial and Vermis controls axial and proximal musculature of proximal musculature of limbs limbs
Intermediate part of Intermediate part of hemisphere controls distal hemisphere controls distal musculaturemusculature
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The BrainThe Brain
CerebellumCerebellum Midline vermis and two Midline vermis and two
lateral cerebellar lateral cerebellar hemispheres hemispheres
Lateral part involved in Lateral part involved in motor planning and motor planning and execution execution
Also called the Also called the cerebrocerebellum cerebrocerebellum due to input from due to input from cerebrum cerebrum
Flocculonodular lobe Flocculonodular lobe involved in control of involved in control of balance and eye balance and eye movements movements
Also called the Also called the vestibulocerebellumvestibulocerebellum
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Cerebellar LesionsCerebellar Lesions
Hallmark of cerebellar dysfunction is tremor with Hallmark of cerebellar dysfunction is tremor with intended movement without paralysis or paresis intended movement without paralysis or paresis
Symptoms associated are expressed ipsilaterally Symptoms associated are expressed ipsilaterally Vermal region lesion Vermal region lesion
Difficulty maintaining posture, gait, or balance Difficulty maintaining posture, gait, or balance May be differentiated from those patients with lesion May be differentiated from those patients with lesion
of dorsal columns by presence of a Romberg’s sign of dorsal columns by presence of a Romberg’s sign Cerebellar lesion will have patient sway with eyes open Cerebellar lesion will have patient sway with eyes open
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Cerebellar LesionsCerebellar Lesions Hemisphere lesions Hemisphere lesions
Intention tremor is seen when voluntary movements Intention tremor is seen when voluntary movements performed performed
Dysmetria — inability to stop a movement at the Dysmetria — inability to stop a movement at the proper place proper place
Dysdiadochokinesia — reduced ability to perform Dysdiadochokinesia — reduced ability to perform alternating movements alternating movements
Scanning dysarthria Scanning dysarthria Gaze dysfunction occurs when eyes try to fix on a Gaze dysfunction occurs when eyes try to fix on a
point point Hypotonia — occurs with acute insult Hypotonia — occurs with acute insult
Muscles feel flabby on palpation Muscles feel flabby on palpation Deep tendon reflexes diminished Deep tendon reflexes diminished
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The BrainThe Brain ThalamusThalamus
major sensory relay for ascending tactile, visual, auditory, major sensory relay for ascending tactile, visual, auditory, and gustatory information that goes to neocortexand gustatory information that goes to neocortex
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The BrainThe Brain
HypothalamusHypothalamus
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The BrainThe Brain
Limbic SystemLimbic System Involved in Feeding, Fighting, Feeling, Flight, and sex (5Fs)Involved in Feeding, Fighting, Feeling, Flight, and sex (5Fs)
Consists of cortical and diencephalic structures found on Consists of cortical and diencephalic structures found on the medial aspect of the hemisphere the medial aspect of the hemisphere
Prominent structure — hippocampal formation on medial Prominent structure — hippocampal formation on medial aspect of the temporal lobe aspect of the temporal lobe
Other limbic related structures Other limbic related structures Amygdala — deep in medial part of anterior temporal Amygdala — deep in medial part of anterior temporal
lobe rostral to hippocampus lobe rostral to hippocampus Septal nuclei — medial between anterior horns of lateral Septal nuclei — medial between anterior horns of lateral
ventricle ventricle
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The BrainThe Brain
Basal GangliaBasal Ganglia Initiate and provide gross control over Initiate and provide gross control over
skeletal muscle movements skeletal muscle movements Disorders result in uncontrolled, excessive Disorders result in uncontrolled, excessive
movements or hypokinesiamovements or hypokinesia
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The BrainThe Brain
Basal GangliaBasal Ganglia Major components Major components
Striatum—caudate Striatum—caudate nucleus and putamen nucleus and putamen
External and internal External and internal segments of globus segments of globus pallidus pallidus
Substantia Nigra Substantia Nigra (midbrain) (midbrain)
Subthalamus (ventral to Subthalamus (ventral to thalamus) thalamus)
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Vascular Supply to the HeadVascular Supply to the Head
Supplied by the two Supplied by the two internal carotid internal carotid arteries and the two arteries and the two vertebral arteries vertebral arteries
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Circle of WillisCircle of Willis
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Cerebral Arteries DistributionCerebral Arteries Distribution
Internal carotid arteriesInternal carotid arteries Arises from bifurcation of Arises from bifurcation of
common carotid artery and common carotid artery and enters skull through carotid enters skull through carotid canal canal
Branch of ophthalmic Branch of ophthalmic artery comes off just before artery comes off just before it enters the subarachnoid it enters the subarachnoid space and terminates as space and terminates as middle and anterior middle and anterior cerebral arteries cerebral arteries
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Cerebral Arteries DistributionCerebral Arteries Distribution Middle cerebral arteryMiddle cerebral artery
Supplies bulk of lateral Supplies bulk of lateral surface of hemispheres surface of hemispheres
Supplies the posterior limb Supplies the posterior limb of internal capsule and of internal capsule and basal ganglia basal ganglia
Occlusion results in Occlusion results in spastic spastic paresisparesis of contralateral of contralateral lower face and upper limb lower face and upper limb and and anesthesia anesthesia of of contralateral face and contralateral face and upper limb upper limb
If left middle cerebral artery If left middle cerebral artery branches involved branches involved Wernicke’s or Broca’s Wernicke’s or Broca’s areas may be affected areas may be affected resulting in aphasiaresulting in aphasia
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Cerebral Arteries DistributionCerebral Arteries Distribution Anterior cerebral arteryAnterior cerebral artery
Smaller terminal branch of Smaller terminal branch of internal carotid internal carotid
Supplies the medial Supplies the medial surface of frontal and surface of frontal and parietal lobes parietal lobes
Includes motor and Includes motor and sensory cortical areas for sensory cortical areas for the pelvis and lower limbs the pelvis and lower limbs
Supplies anterior 4/5 of Supplies anterior 4/5 of corpus callosum corpus callosum
Approximately one inch of Approximately one inch of frontal and parietal cortex frontal and parietal cortex
Occlusion will results in Occlusion will results in spastic paresisspastic paresis and and anesthesiaanesthesia of contralateral of contralateral lower limb lower limb
Urinary incontinence may Urinary incontinence may be present if bilateral be present if bilateral damagedamage
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Cerebral Arteries DistributionCerebral Arteries Distribution Posterior cerebral arteryPosterior cerebral artery
Formed by terminal Formed by terminal bifurcation of basilar artery bifurcation of basilar artery
Supplies occipital and Supplies occipital and temporal cortex on inferior temporal cortex on inferior and lateral surfaces of and lateral surfaces of hemisphere hemisphere
Supplies occipital lobe and Supplies occipital lobe and posterior 2/3 of temporal posterior 2/3 of temporal lobe on medial surface of lobe on medial surface of hemisphere hemisphere
Supplies thalamus and Supplies thalamus and subthalamic nucleus subthalamic nucleus
Occlusion - results in Occlusion - results in homonymous hemianopsia homonymous hemianopsia of contralateral visual field of contralateral visual field with macular sparingwith macular sparing
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Dural Venous SinusesDural Venous Sinuses
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Ventricular SystemVentricular System Brain and spinal cord float within a protective bath of CSF Brain and spinal cord float within a protective bath of CSF Produced continuously by choroids plexus Produced continuously by choroids plexus Four ventricles Four ventricles
Two lateral ventricles deep within each cerebral Two lateral ventricles deep within each cerebral hemisphere hemisphere
Third ventricle located in midline within diencephalons Third ventricle located in midline within diencephalons Fourth ventricle located on dorsal surface of pons and Fourth ventricle located on dorsal surface of pons and
upper medulla upper medulla Ventricles connected resulting in flow of CSF Ventricles connected resulting in flow of CSF
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Flow of CSFFlow of CSF
CSF flows from lateral ventricles CSF flows from lateral ventricles → → interventricular foramen of Monro interventricular foramen of Monro → → third third ventricle ventricle → → cerebral aqueduct cerebral aqueduct → → fourth fourth ventricle ventricle → → subarachnoid space either subarachnoid space either throught the foramen of Magendie or throught the foramen of Magendie or foramina Luschkaforamina Luschka
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Cerebrospinal FluidCerebrospinal Fluid Adults produce 90 – 150 mL of total CSF Adults produce 90 – 150 mL of total CSF About 70 % secreted by choroids plexus located in parts About 70 % secreted by choroids plexus located in parts
of the lateral, third, and fourth ventricles, lined by highly of the lateral, third, and fourth ventricles, lined by highly vascularized ependymal cells vascularized ependymal cells
Almost all CSF returns to venous system by draining Almost all CSF returns to venous system by draining through arachnoid granulations into superior sagittal through arachnoid granulations into superior sagittal dural venous sinus dural venous sinus
Concentration of protein is much lower compared to Concentration of protein is much lower compared to serum serum
Few lymphocytes present; presence of PMN’s always Few lymphocytes present; presence of PMN’s always abnormal abnormal
RBCs may be present after traumatic spinal tap or RBCs may be present after traumatic spinal tap or subarachnoid hemorrhage subarachnoid hemorrhage
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CSF AbnormalitiesCSF Abnormalities HydrocephalusHydrocephalus caused by excess volume or pressure of caused by excess volume or pressure of
CSF CSF Communicating hydrocephalusCommunicating hydrocephalus
Caused by oversecretion of CSF without obstruction in Caused by oversecretion of CSF without obstruction in the ventricles or by problems with absorption in the ventricles or by problems with absorption in subarachnoid space subarachnoid space
Noncommunication hydrocephalusNoncommunication hydrocephalus Caused by obstruction of CSF flow inside ventricular Caused by obstruction of CSF flow inside ventricular
system at foramen of Monro, cerebral aqueduct, or system at foramen of Monro, cerebral aqueduct, or fourth ventricle fourth ventricle
Could also be obstruction at foramina Magendie or Could also be obstruction at foramina Magendie or Luschka Luschka
Normal Pressure hydrocephalusNormal Pressure hydrocephalus
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Blood Brain BarrierBlood Brain Barrier
Formed by capillary endothelium connected by Formed by capillary endothelium connected by tight junctions tight junctions
Astrocytes participate in maintenance of BBB Astrocytes participate in maintenance of BBB Numerous long processes with expanded Numerous long processes with expanded
vascular end-feet that attach to walls of vascular end-feet that attach to walls of capillaries capillaries
Water diffuses across BBB readily; glucose must Water diffuses across BBB readily; glucose must be actively transported acrossbe actively transported across
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MeningesMeninges
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Brain StemBrain Stem
Divisible into three Divisible into three continuous parts: continuous parts: midbrain, pons, midbrain, pons, medulla medulla
Home of origins of the Home of origins of the sites or termination of sites or termination of fibers in 9/12 CNs fibers in 9/12 CNs
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Brain StemBrain Stem
Midbrain site of origin for Midbrain site of origin for CN III and CN IV CN III and CN IV
Pons site of entrance or Pons site of entrance or exit exit CN V, CN VI, CN VII, and CN V, CN VI, CN VII, and
CN VIII CN VIII
Medulla site of entrance Medulla site of entrance or exit or exit CN IX, X, and XII CN IX, X, and XII
Useful in diagnosing brain Useful in diagnosing brain stem injury stem injury
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MidbrainMidbrain
Located between pons Located between pons
and diencephalon and diencephalon Cerebral aqueduct Cerebral aqueduct
passes throughpasses through
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PonsPons
Located between medulla Located between medulla and midbrain; cerebellum and midbrain; cerebellum overlies overlies
Fourth ventricle found Fourth ventricle found between dorsal surface between dorsal surface and cerebellum and cerebellum
Ventral surface Ventral surface dominated by fibers dominated by fibers forming a ventral forming a ventral enlargement carrying enlargement carrying pontine fibers to middle pontine fibers to middle cerebellar peduncle (key cerebellar peduncle (key feature of pons)feature of pons)
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PonsPons Aides in relaying Aides in relaying
messages in the brain, messages in the brain, and contains the and contains the pneumotaxic centres that pneumotaxic centres that help regulate respiration. help regulate respiration.
There are two main There are two main domains in the pons for domains in the pons for control of respirationcontrol of respiration apneustic center - lower apneustic center - lower
pons (promote inspiration)pons (promote inspiration) pneumotaxic center - upper pneumotaxic center - upper
pons (inhibiting effect)pons (inhibiting effect)
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PonsPons
Blood to the pons Blood to the pons supplied by a number of supplied by a number of arteries.arteries. Pontine arteriesPontine arteries Anterior inferior cerebellar Anterior inferior cerebellar
artery (AICA)artery (AICA) Superior cerebellarSuperior cerebellar
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MedullaMedulla
Above the spinal cord, Above the spinal cord, below the pons, and below the pons, and anterior to the anterior to the cerebellum.cerebellum.
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MedullaMedulla It controls autonomic It controls autonomic
functions and relays functions and relays nerve signals between nerve signals between the brain and spinal cord.the brain and spinal cord.
The Medulla oblongata is The Medulla oblongata is responsible for controlling responsible for controlling several major autonomic several major autonomic functions of the body:functions of the body: respiration (via dorsal respiration (via dorsal
respiratory group and respiratory group and ventral respiratory group) ventral respiratory group)
blood pressureblood pressure heart rateheart rate reflex arcsreflex arcs vomitingvomiting
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MedullaMedulla Blood to the medulla is Blood to the medulla is
supplied by a number of supplied by a number of arteries.arteries. Anterior spinal artery Anterior spinal artery Posterior inferior cerebellar Posterior inferior cerebellar
artery (PICA)artery (PICA) Direct branches of the Direct branches of the
vertebral arteryvertebral artery
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IV Trochlear
III Oculomotor
VII Facial
VI Abducens
V Trigeminal
CEREBRAL HEMISPHERE
MIDBRAIN
PONS
MEDULLA
CRANIAL NERVESCRANIAL NERVES II Optic
I Olfactory
VIII Acoustic
XII Hypoglossal
XI Accessory
X Vagus
IX Glossopharyngeal
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Cranial NervesCranial Nerves
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Cranial NervesCranial Nerves
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Spinal CordSpinal Cord
The The spinal cordspinal cord lies lies within the spinal within the spinal cavity, consisting of cavity, consisting of the the vertebral columnvertebral column, , the meninges, spinal the meninges, spinal nerves, spinal fluid, nerves, spinal fluid, blood vessels, and a blood vessels, and a cushion of adipose/fat cushion of adipose/fat tissue. tissue.
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Spinal CordSpinal Cord Thirty-one pairsThirty-one pairs of nerves of nerves
connect to the spinal connect to the spinal cord. They have no cord. They have no special names, but are special names, but are numbered according to numbered according to the level of the spinal the level of the spinal column from which they column from which they emerge. There are emerge. There are 8 8 cervicalcervical (C1-C8), (C1-C8), 12 12 thoracicthoracic (T1-T12), (T1-T12), 5 5 lumbarlumbar (L1-L5), (L1-L5), 5 sacral5 sacral (S1-S5), and (S1-S5), and 1 coccygeal1 coccygeal pairs of spinal nerves. pairs of spinal nerves.
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Spinal CordSpinal Cord
The spinal cord has The spinal cord has two general functions:two general functions:
1) It provides the two-1) It provides the two-way conduction way conduction routes to/from routes to/from ((afferent/efferentafferent/efferent) the ) the brainbrain
2) it serves as the reflex 2) it serves as the reflex center for all spinal center for all spinal reflexes. reflexes.
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Spinal Cord and TractsSpinal Cord and Tracts
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Spinal Cord and TractsSpinal Cord and Tracts
Spinothalamic tractSpinothalamic tract, carrying pain and , carrying pain and temperature impulses to the thalamus temperature impulses to the thalamus and the parietal lobe (sensory)and the parietal lobe (sensory)
Dorsal columnsDorsal columns, carrying position and , carrying position and pressure sense to the thalamus and the pressure sense to the thalamus and the parietal lobe (sensory)parietal lobe (sensory)
CorticospinalCorticospinal (or (or pyrimidalpyrimidal) ) tracttract, carrying , carrying impulses to initiate muscle activity from impulses to initiate muscle activity from the frontal lobe. (motor)the frontal lobe. (motor)
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Spinothalamic TractSpinothalamic Tract
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Dorsal ColumnDorsal Column
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Reflex ArcReflex Arc
A reflex is an automatic, i.e."involuntary," A reflex is an automatic, i.e."involuntary," response of the body to some stimulus, response of the body to some stimulus, e.g. pupil dilation, to collect more light, at e.g. pupil dilation, to collect more light, at night. Reflexes have night. Reflexes have afferent afferent (signals (signals toto the CNS) and the CNS) and efferentefferent (signals (signals fromfrom the the CNS) components and may involve one CNS) components and may involve one nerve/synapse (nerve/synapse (monosynaptic reflexmonosynaptic reflex) or ) or multiple synapses (multiple synapses (polysynaptic reflexpolysynaptic reflex). ). The simplest spinal reflex is the The simplest spinal reflex is the tendon tendon reflexreflex, a monosynaptic reflex. , a monosynaptic reflex.
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Reflex ArcReflex Arc
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Peripheral Nervous SystemPeripheral Nervous System
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Spinal NervesSpinal Nerves
All All cervical spinal nervescervical spinal nerves control control movement of the shoulder and arm movement of the shoulder and arm muscles and receive all sensory input from muscles and receive all sensory input from the skin, muscles, bones, and joints. After the skin, muscles, bones, and joints. After leaving the vertebral canal, they merge to leaving the vertebral canal, they merge to form form peripheral nervesperipheral nerves. The merger of . The merger of the spinal nerves in the neck region is the spinal nerves in the neck region is called the called the brachial plexusbrachial plexus. .
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Brachial PlexusBrachial Plexus
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Sensory Innervation of the HandSensory Innervation of the Hand
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Spinal NervesSpinal Nerves
The The thoracic spinal nervesthoracic spinal nerves do not do not recombine into plexuses. The anterior recombine into plexuses. The anterior roots control the muscles of the abdomen roots control the muscles of the abdomen and back; the posterior roots receive and back; the posterior roots receive information from the abdomen, skin, and information from the abdomen, skin, and muscles and joints of the chest and upper muscles and joints of the chest and upper back. back.
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Spinal NervesSpinal Nerves
The The lumbar and sacral nerveslumbar and sacral nerves, like the , like the cervical, do combine after leaving the cervical, do combine after leaving the vertebral canal. This merger, occuring in vertebral canal. This merger, occuring in the pelvis, is called the the pelvis, is called the lumbosacral lumbosacral plexusplexus, which controls the movement of, , which controls the movement of, and receives information from, the lower and receives information from, the lower extremities, bladder, and bowel. extremities, bladder, and bowel.
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Lumbo Sacral PlexusLumbo Sacral Plexus
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Sensory Innervation of the FootSensory Innervation of the Foot
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The EndThe End
Thank youThank you