NEUROPHYSIOLOGY

Slide by Samuel Essel

(HND Science Lab. Tech., BSc. Physician Assistantship, MPhil
Physiology)
 PRESENTATION OUTLINE
1. Function of the Nervous System
2. Organization of the Nervous System
3. Histology / Cells of the Nervous System
4. The Central Nervous System
5. The Peripheral Nervous System
6. The Autonomic Nervous System
7. Special Senses (Taste, Vision, Hearing, Smell); Skin
8. Higher Function of the Nervous System (Learning, Language,
Memory & Emotions)
Functions of the
Nervous System
 Function of the Nervous System
1. Reception of
A. general sensory information (touch, pressure, temperature, pain, vibration)
a) Touch (fine & crude, tactile localization; two-point discrimination)
b) Pressure
c) Temperature (cold & hot)
d) Pain (fast & slow; acute & chronic)
e) Vibration
f) Proprioception
g) Stereognosis
B. receiving and perceiving special sensory information (taste, smell, vision, sounds)
a) Taste
b) Smell
c) Vision
d) Hearing
 Function of the Nervous System
2. Integration of sensory information from different parts of the body and
processing them.
a) Learning
b) Memory
c) Emotions
d) Language
3. Response generation.
• Motor
I. Walking / running / swimming
II. Talking / singing / humming
III. Siting / squatting / skipping
IV. Blinking / winking / nasal flaring
V. Lying down / rolling
VI. Heart beat
VII. Movement or respiratory muscles
VIII. Movement of intestinal tract and glandular secretions
IX. Movements in the urogenital system (bladder contractions, urethral sphincter contraction)
Organization of the
Nervous System
Organization of the Nervous System
Organization of the Nervous System
Organization of the Nervous System
Organization of the Nervous System
Organization of the Nervous System
Histology / Cells of the
Nervous System
 Histology / Cells of the Nervous System
The nervous system is
made of:
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1. Brain cells called -
Neurons
&
2. Supporting cells
called -
Glial Cells:
1. Schwann cells
2. Astrocyte
3. Microglia
4. Ependymal cells
5. Oligodendrocyte
 Histology / Cells of the Nervous System
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Cells of the NS
The nervous system is
made of:
-----------------------------
1. Brain cells called -
Neurons
&
2. Supporting cells
called -
Glial Cells or Neuroglia:
1. Schwann cells
2. Astrocyte
3. Microglia
4. Ependymal cells
5. Oligodendrocyte
 Histology / Cells of the Nervous System – Glial Cells
• Glial cells are also means, “nerve glue”.
• Six types of small cells associated with neurons:
• 4 in CNS
• 2 in PNS
• Most have central cell body and branching processes.
• Perform several functions:
• Supportive scaffolding for neurons.
• Electrical isolation of neurons.
• Neuron health and growth.
 Histology / Cells of the Nervous System – Glial Cells
Astrocyte
• Most abundant and versatile glial cells and are responsible for the formation
and maintenance of the blood-brain barrier (BBB).
• Numerous processes support branching neurons.
• Anchor neurons to capillary blood supply.
• Guide migration of young neurons.
• Facilitate nutrient delivery to neurons.
• (blood > glial cell > neuron)
• Control chemical environment around neurons
• Uptake of K + , neurotransmitters
• Communicate with neurons via:
• Gap junctions
 Histology / Cells of the Nervous System – Glial Cells
Microglia
• These cells are derived from monocytes that migrate from the blood into the
nervous system before birth.
• Small ovoid cells.
• Relatively long “thorny” processes.
• Processes touch nearby neurons.
• Microglial cells are rapidly activated in the CNS in response to injury.
• Migrate toward injured neurons.
• They also present antigens to lymphocytes in response to infections.
• Transform into macrophage.
• Phagocytize microorganisms, debris.
• (Cells of immune system cannot enter the CNS)
 Histology / Cells of the Nervous System – Glial Cells
Ependymal Cells
• Involved in the formation and secretion of CSF
• Lines central cavities of brain (ventricular system) and spinal cord.
• Form permeable barrier between cerebrospinal fluid inside these cavities and tissue
fluid of CNS tissue.
• Shapes range from squamous to columnar.
• Many are ciliated.
• Beating helps circulate cerebrospinal fluid cushioning brain and spinal cord
 Histology / Cells of the Nervous System – Glial Cells
Oligodendrocyte
• Fewer processes than astrocytes.
• Wrap processes tightly around thicker neuron fibers in CNS.
• “ Myelin sheath”
• Insulating covering
 Histology / Cells of the Nervous System – Glial Cells
Satellite cells
• Surround neuron cell bodies within ganglia in the PNS.
• (A ganglion is a collection of nerve cell bodies outside of the CNS).
• Function poorly understood

Schwann cells
• “ Neurolemmocytes”.
• Surround and form myelin sheaths around
larger nerve fibers of PNS.
• Functionally similar to oligodendrocytes.
• Vital to regeneration of peripheral nerve fiber.
 Histology / Cells of the Nervous System – Glial Cells
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 Histology / Cells of the Nervous System – Glial Cells
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Oligodendrocyte
The term oligodendroglia was introduced by Rio Hortega.

Its principal function is to provide support to axons and to

produce the myelin sheath, which insulates axons.

Oligodendrocytes do this by creating the myelin sheath, a

white and shiny fatty substance, which is composed by 80%
of lipid and 20% of protein.

This particular composition confers to the oligodendrocyte’s

capacity to isolate axons from each other and mostly to allow
fast nerve signal conduction.

It takes several oligodendrocytes to fully insulate one axon,

One cell may provide many segments of myelin sheaths.

A single oligodendrocyte can extend its process to 50 axons

and produce myelin sheath of 1 micrometer.
 Histology / Cells of the Nervous System – Glial Cells
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Schwann Cells

Myelinate axons in the PNS.

One schwann cell myelinates one

axon.

Participates in axon regeneration.

 Histology / Cells of the Nervous System – Glial Cells
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 Histology / Cells of the Nervous System – Glial Cells
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 Histology / Cells of the Nervous System – Glial Cells
Ependymal Cells
..
single layer of cuboidal to columnar cells
ciliated & have microvilli function:
1. Line ventricles of brain & central canal
of spinal cord
2. Produce, monitor, & assist in circulation
of cerebrospinal fluid (CSF)
3. Form part of the BBB
 Histology / Cells of the Nervous System – Neurons
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 Histology / Cells of the Nervous System – Neurons
• Neurons are the core components of the nervous system.
• A neuron ( also known as a neuron or nerve cell) is an electrically excitable
cell that processes and transmits information by electrical and chemical
signaling.
• It sends information from peripheral tissues, organs and environment to the
CNS and as well carry information from the CNS to peripheral tissues, organs
and environment.
• Out of the total 37.2 Trillion human body cells, 86 billion of them are nerve
cells (neurons).
 Histology / Cells of the Nervous System – Neurons
• They lack centrioles and hence, are amitotic (except olfactory stem cells).
• the anterior sub-ventricular zone (SVZ) in the forebrain, and the sub-granular zone in
the hippocampus also have neuronal stem cells that no longer undergo mitosis.
• Most cannot divide but damaged neurons in PNS undergo repairs.
• A neuron consists of three main parts the cell body or perikaryon or soma,
dendrites and axons.
• There are different types or classes of neurons.
• Neurons can be classified base on their
• structure : unipolar, bipolar, multi polar
or
• Function : afferent (sensory), efferent (motor) & interneuron (relay)
 Histology / Cells of the Nervous System – Neurons
STRUCTURAL CLASSIFICATION OF NEURONS
• This is based on the number of protoplasmic processes possessed by the
neuron.
• Unipolar : type of neuron in which only one protoplasmic process (neurite)
extends from the cell body. – Found mostly in invertebrate; In humans
mostly found in dorsal root ganglia ; embryonic
• Pseudounipolar : contains an axon that has split into two branches; one
branch runs to the periphery and the other to the spinal cord.
• Bipolar: An axon and a single dendrite on opposite ends of the soma – are
specialized sensory neurons for the transmission of special senses, hence
abundant in sensory pathways for smell, sight, taste, hearing and vestibular
functions
• Multipolar: has several protoplasmic processes. Mostly found in the CNS.
 Histology / Cells of the Nervous System – Neurons
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 Histology / Cells of the Nervous System – Neurons
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 Histology / Cells of the Nervous System – Neurons
FUNCTIONAL CLASSIFICATION OF NEURONS
• This is based on conduction direction in the neuron.
• Afferent neurons: Also called sensory neurons. Convey information from tissues
and organs into the central nervous system (CNS)
• Efferent neurons: Also called as motor neurons. Carry nerve impulses away from
the central nervous system (CNS) to effectors such as muscles or glands.
According to their targets, motor neurons are classified into two broad
categories:
• Somatic motor neurons,
• Somatic motor neurons are further divided in to α motor neuron (innervating extrafusal muscle fibre)
and γ motor neuron (innervating intrafusal muscle fibre). Responsible for reflexes and voluntary control
of skeletal muscles.
• Autonomic / visceral motor neurons: innervate involuntary targets such as smooth
muscles, cardiac muscles and glands. 2 Types: Sympathetic neurons ( “fight or flight”
responses) – emergency situations & Parasympathetic ( “rest & digest activities) – normal
functions.
 Histology / Cells of the Nervous System – Neurons
FUNCTIONAL CLASSIFICATION OF NEURONS
• This is based on conduction direction in the neuron.
• Interneurons:
• lie entirely within the CNS.
• They receive signals from many other neurons and carry out the integrative
function of the nervous system—that is, they process, store, and retrieve
information and “make decisions” that determine how the body responds
to stimuli. About 90% of our neurons are interneurons.
• The word interneuron refers to the fact that they lie between, and
interconnect, the incoming sensory pathways and the outgoing motor
pathways of the CNS.
• Mostly multipolar in structure.
 Histology / Cells of the Nervous System – Neurons
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 Histology / Cells of the Nervous System – Neurons
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 Histology / Cells of the Nervous System – Neurons
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 Histology / Cells of the Nervous System – Neurons
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 Histology / Cells of the Nervous System – Neurons
• A neuron consists of three main parts the cell body or perikaryon or soma,
dendrites and axons.

1. Cell Body
• The cell body, or soma, surrounds the nucleus of the neuron and contains the
endoplasmic reticulum and Golgi apparatus.
• It is responsible for the neuron’s synthesis and processing of proteins.

2. Dendrites
• Dendrites are tapering processes that arise from the cell body.
• They receive information and thus contain receptors for neurotransmitters
that are released from adjacent neurons.
 Histology / Cells of the Nervous System – Neurons
3. Axon
• conducts action potentials away from the cell body.
• Vary in length from a few millimeters to a meter.
• Connected to the cell body by the axon hillock where action potentials are
generated at the initial segment of the axon.
• Can form many branches called axon collaterals.
• Covered in myelin with open spots called nodes of Ranvier.
• A collection/bundle of axons in PNS is called a nerve and in CNS, a tract.
• Transports substances between neuronal cell body and its terminal.
 Histology / Cells of the Nervous System – Neurons
3. Axon Cont’d:
• Transports substances between neuronal cell body and its terminal. -- Axonal
Transport:
• An active process needed to move organelles and proteins from the cell body to axon
terminals
• Fast component moves membranous vesicles.
• Slow components move microfilaments, microtubules, and proteins.
• Anterograde transport – from cell body to dendrites and axon; uses kinesin molecular
motors
• Retrograde transport – from dendrites and axon to the cell body; uses dynein molecular
motors.
- One function of this process is recycling of materials originally
transported from cell body to axon.
- Some viruses take advantage of this transport type in neurons
to gain entry into the CNS.
Histology / Cells of the Nervous
System – Neurons
3. Axon Cont’d:
Virus Entry Routes into the CNS (A) Alpha
herpesviruses (e.g., HSV-1, VZV, and PRV) infect
pseudounipolar sensory neurons of PNS ganglia. CNS
spread is rare and requires anterograde axonal
transport of progeny virions toward the spinal cord. (B)
RABV and poliovirus spread via neuromuscular
junctions (NMJs) from muscles into somatic motor
neurons in the spinal cord. (C) Several viruses may
infect receptor neurons in the nasal olfactory
epithelium. Spread to the CNS requires anterograde
axonal transport along the olfactory nerve into the
brain. (D) Infiltration through the BBB. The BBB is
composed of brain microvascular endothelium cells
(BMVECs) with specialized tight junctions, surrounding
basement membrane, pericytes, astrocytes, and
neurons. Infected leukocytes can traverse this barrier
carrying virus into the brain parenchyma. (E)
Alternatively, virus particles in the bloodstream can
 Histology / Cells of the Nervous System – Neurons
3. Axon Cont’d:

• Regeneration of a cut neuron (axon) in CNS:

• CNS axons are not able to regenerate.
• Damage promote apoptosis of oligodendrocytes.
• Inhibitory proteins in the myelin sheath prevents regeneration.
• Glial scars from astrocytes form that also prevent regeneration.
• Astrocytic proliferation
• inflammation
 Histology / Cells of the Nervous System – Neurons
Axon Cont’d:
• Regeneration of a cut neuron (axon) in PNS:
• When an axon in the PNS is cut, the distal severed part degenerates, and a regeneration
tube is formed by Schwann cells at the proximal end of the cut axon.
• Growth factors are released that stimulate growth of axon sprouts within the tube.
• New axon eventually connects to the undamaged axon or the effector.
• If your nerve is bruised or traumatized but is not cut, it should recover over 6-12
weeks.
• A nerve that is cut will grow at 1mm per day, after about a 4 week period of 'rest'
following your injury.
• When only some of the axons supplying a muscle are damaged, the intact motor
axons produce sprouts that reinnervate the denervated muscle fiber; this is referred
to as collateral sprouting.
• These nerve sprouts originate from the nodes of Ranvier (nodal sprouts) or the
nerve terminals (terminal sprouts) as early as 4 days from the time of injury
 Histology / Cells of the Nervous System – Neurons

Regeneration of
damaged peripheral
nerves (axons)
 Histology / Cells of the Nervous System – Neurons

Regeneration of
damaged peripheral
nerves (axons)
 Histology / Cells of the Nervous System – Neurons

Regeneration of
damaged peripheral
nerves (axons)
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission
• A synapse is the functional connection between a neuron and the cell it is signaling.
• In the CNS, this second cell will be another neuron.
• In the PNS, the second cell will be in a muscle or gland; often called myoneural or
neuromuscular junctions.
• The synapse is composed of 3 parts:
(a) the axon terminal;
(b) the synaptic cleft, the space between the cells and
(c) the membrane of the postsynaptic cell.
• If one neuron is signaling another neuron, the first is called the presynaptic neuron,
and the second is called the postsynaptic neuron.
• A presynaptic neuron can signal the dendrite, cell body, or axon of a second neuron.
• There are axodendritic, axosomatic, and axoaxonic synapses.
• Most synapses are axodendritic and are 1 direction.
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission
• Transmission of impulses along axon can be very fast.
• Up to 300 mph (150 m/s).
• Transmission of a signal across a synapse is slow in comparison.
• Leads to “synaptic delay”.
• ~0.3 to 5.0 milliseconds.
• Rate-limiting step of neural transmission.
• Transmission along multi-synaptic pathways is slower than along pathways with fewer
synapses
• Synapses can be electrical or chemical
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission

A nerve cell in the

brain may have
about 10, 000 to
150, 000 synapses.
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission : Electrical Synapses
• Less common than chemical synapses.
• Electrical synapses occur in smooth muscle and cardiac muscle, between
some neurons of the brain, and between glial cells.
• Cells are joined by gap junctions.
• Cytoplasm of adjacent neurons are connected through protein channels.
• Ions flow directly between neurons.
• Neurons are “electrically coupled”.
• Stimulation causes phosphorylation or dephosphorylation of connexin
proteins to open or close the channels.
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission :

Electrical Synapses
 Histology / Cells of the Nervous System – Neurons
Synaptic
Transmission :

Electrical
Synapses
 Histology / Cells of the Nervous System – Neurons
Synaptic
Transmission :

Comparism of:
Chemical
&
Electrical Synapses
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission : Chemical Synapses
• Most synapses involve the release of a chemical called a neurotransmitter
from the axon’s terminal boutons.
• The synaptic cleft is very small, and the presynaptic and postsynaptic cells are
held close together by cell adhesion molecules (CAMs).
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission : Chemical Synapses
Neurotransmitters
• Both excitatory and inhibitory neurotransmitters are present in the CNS and
the PNS. A given neurotransmitter may be excitatory in some locations and
inhibitory in others.
• Neurotransmitters can be divided into two classes based on size:
• (1) small-molecule neurotransmitters (acetylcholine, amino acids, biogenic amines,
ATP and other purines, nitric oxide, and carbon monoxide), and
• (2) neuropeptides, which are composed of 3 to 40 amino acids.
• Chemical synaptic transmission may be modified by affecting synthesis,
release, or removal of a neurotransmitter or by blocking or stimulating
neurotransmitter receptors.
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission : Chemical Synapses
Neurotransmitters
Criteria that must be fulfilled for a substance to be considered as a
transmitter
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission : Chemical Synapses
Release of Neurotransmitter
• Neurotransmitter is enclosed in synaptic vesicles in the axon
terminal.
• When the action potential reaches the end of the axon, voltage-gated Ca2+
channels open.
• Ca2+ stimulates the fusing of synaptic vesicles to the plasma membrane
and exocytosis of neurotransmitter.
• A greater frequency of action potential results in more stimulation of the
postsynaptic neuron.
 Histology / Cells of the Nervous System – Neurons

Synaptic
Transmission @
Chemical Synapses
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission : Chemical Synapses
Action of the Transmitter Substance on the Postsynaptic Neuron—Function of “Receptor Proteins”
• The membrane of the postsynaptic neuron contains large numbers of receptor proteins, shown in Figure
on next slide. The molecules of these receptors have two important components:
1. a binding component that protrudes outward from the membrane into the synaptic cleft— here it
binds the neurotransmitter coming from the presynaptic terminal—and
2. an intracellular component that passes all the way through the postsynaptic membrane to the
interior of the postsynaptic neuron.
• Receptor activation controls the opening of ion channels in the postsynaptic cell in one of two ways:
1. by gating ion channels directly and allowing passage of specified types of ions through the
membrane, or
2. by activating a “second messenger” that is not an ion channel but instead is a molecule that
protrudes into the cell cytoplasm and activates one or more substances inside the postsynaptic
neuron. These second messengers increase or decrease specific cellular functions.
• Neurotransmitter receptors that directly gate ion channels are often called ionotropic receptors, whereas
those that act through second messenger systems are called metabotropic receptors.
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission : Chemical Synapses
Action of the Transmitter Substance on the Postsynaptic Neuron—Function of
“Receptor Proteins”
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission : Chemical Synapses

Action of the Transmitter Substance

on the Postsynaptic Neuron—
It’s a Function of “Receptor Proteins”
Histology / Cells of the Nervous System – Neurons
 Histology / Cells of the Nervous System – Neurons

METABOTROPIC
RECEPTOR
PATHWAY OF
OPENING /
CLOSSING OF
ION CHANNELS
Histology / Cells of the Nervous System – Neurons
 Histology / Cells of the Nervous System – Neurons

METABOTROPIC
RECEPTOR
PATHWAY OF
OPENING /
CLOSSING OF
ION CHANNELS
Histology / Cells of the Nervous System – Neurons
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission : Chemical Synapses
Action of Neurotransmitter
• Neurotransmitter (ligand) diffuses across the synapse, where it binds to a specific
receptor protein.
• This results in the opening of chemically regulated ion channels (also called ligand-
gated ion channels).
• When ligand-gated ion channels open, the membrane potential changes depending
on which ion channel is open.
• Opening Na+ or Ca2+ channels results in a graded depolarization called an
excitatory postsynaptic potential (EPSP).
• Opening K+ or Cl− channels results in a graded hyperpolarization called
inhibitory postsynaptic potential (IPSP).
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission : Chemical Synapses
Action of Neurotransmitter
• NOTE:
• EPSPs move the membrane potential closer to threshold; may require EPSPs from
several neurons to actually produce an action potential
• IPSPs move the membrane potential farther from threshold. Can counter EPSPs from
other neurons so summation of EPSPs and IPSPs at the initial segment of the axon
(next to the axon hillock) determines whether an action potential occurs.
• Some Common Neurotransmitters
• GABA
• ACH
• Dopamine
• Serotonin
• Epinephrine/Norepinephrine
 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission : Chemical Synapses
Fate of Neurotransmitters after synaptic activities
• Binding of neurotransmitter to its receptor is reversible.
• Permeability affected as long as neurotransmitter is bound to its receptor.
• Neurotransmitters do not persist in the synaptic cleft.
• Degraded by enzymes associated with postsynaptic membrane. E.g. Acetylcholinesterase
• Reuptake by astrocytes or presynaptic terminal.
• Diffusion of neurotransmitters away from synapse

• NB: Organochlorine pesticide inhibits GABA and organophosphate pesticides inhibit

acetylcholinesterase. Pyrethrins and pyrethroids prolong the period of sodium
conductance thereby increasing the length of the depolarizing action potential
 Histology / Cells of the Nervous System – Neurons
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 Histology / Cells of the Nervous System – Neurons
Synaptic Transmission : Site of Neurotransmitter Synthesis
• Amino acid, amine and purine neurotransmitters:
• - synthesized in the axon terminals.
• - enzymes needed for their synthesis is delivered by slow axonal transport.
• Polypeptide neurotransmitters:
• -synthesized in the cell bodies and delivered to the terminal by fast axonal transport.
• Gaseous transmitters, Nitric Oxide (NO):
• - synthesized from oxygen and the amino acid arginine. Not stored in vesicles.
• - diffuses into its target cell rather than a membrane bound receptor and binds to proteins
and nucleic acids.
• - it has a half-life of about 2-30s.
• - For example, NO is synthesized in the endothelial lining of blood vessels and relaxes
smooth muscle cells in the body walls of the vessels upon release.
 Histology / Cells of the Nervous System – Neurons
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 Histology / Cells of the Nervous System – Neurons
Disorders of Synaptic Transmission
• Synaptic transmission is the most vulnerable step in neuronal signaling. It is a
point where things could go wrong, disrupting normal function.
• Nervous disorders such as Parkinson’s disease, schizophrenia and depression
are due to problems with synaptic transmission.
• Caffine, nicotine, alcohol and common drugs affect synaptic transmission.
• Myasthenia gravis is an autoimmune disease where the body fails to recognise
the nAChR as part of the ‘self’ and produces molecules to attack its receptors.
This causes the membrane to withdraw the receptors from the surface and
destroy them inside. The destruction of receptors produces a diminished
excitatory response to ACh released from the nerve terminal and the inability
of the muscle fibres to contract.
Histology / Cells of the Nervous System – Neurons
Histology / Cells of the Nervous System
–. Neurons
Central Nervous System
(CNS)
CENTRAL NERVOUS SYSTEM
 CENTRAL NERVOUS SYSTEM
• The central nervous system consist of:
1. The brain
2. Spinal Cord
• Functions as an integrating and command center
1. Interprets sensory input
2. Dictates motor output
• Three major levels of the central nervous system have specific functional
characteristics:
1. the higher brain or cortical level functions
2. the lower brain or subcortical level functions, and
3. the spinal cord level functions,
 CENTRAL NERVOUS SYSTEM
Functions of the central nervous system :
• Cortical level functions:
1. The cerebral cortex is an extremely large memory storehouse.
• The cortex never functions alone but always in association with lower centers
of the nervous system.
2. Cerebral cortex aids the functions of the lower brain centers to be
precise.
3. Cerebral cortex is essential for most of our thought processes, but it
cannot function by itself.
• it is the lower brain centers, not the cortex, that initiate wakefulness in the
cerebral cortex, thus opening its bank of memories to the thinking machinery
of the brain.
 CENTRAL NERVOUS SYSTEM
Functions of the central nervous system :
• Subcortical level functions:
• Subconscious activities of the body are controlled in the lower areas (subcortex) of
the brain.
• The brain structures that carry these subcortical or subconscious activities are:-
medulla, pons, mesencephalon, hypothalamus, thalamus, cerebellum, and basal
ganglia.
• Example of subcortical (subconscious) functions:
1. Blood pressure control
2. Control of respiration
3. Control of equilibrium (body balancing)
4. Feeding reflexes, such as salivation and licking of the lips in response to the taste of food,
5. Emotional patterns such as anger, excitement, sexual response, reaction to pain, and
reaction to pleasure
CENTRAL NERVOUS SYSTEM
 CENTRAL NERVOUS SYSTEM
Functions of the central nervous system :
• Spinal Cord level functions:
• Acts as a conduit for signals from the periphery of the body to the brain, or in
the opposite direction from the brain back to the body.
• Even after the spinal cord has been cut in the high neck region, many highly
organized spinal cord functions can still occur. These functions include:
1. Walking movements.
2. Reflexes that withdraw portions of the body from painful stimulus or objects.
3. Control of equilibrium (body balancing)
4. Reflexes that stiffen the legs to support the body against gravity.
5. Reflexes that control local blood vessel response; gastrointestinal movements or
urinary excretion
CENTRAL NERVOUS SYSTEM - BRAIN
CENTRAL NERVOUS SYSTEM - BRAIN
 CENTRAL NERVOUS SYSTEM - BRAIN
• The brain constitutes about one- fiftieth of the body weight and lies within the
cranial cavity.
• The average brain weight :
• At age 20, male is 1400 g; * at age 65 male = 1300 g
• At age 20, female is 1300 g. * at age 65 female = 1200 g
• With increasing age, brain weight decreases (Cerebral Atrophy ) by 2.7 g in
males, and by 2.2 g in females per year. Peak loss of 15% at age 90.
• The brain is composed of 4 main parts :
1. Cerebral Hemispheres
2. Diencephalon
3. Brain stem
4. Cerebellum
CENTRAL NERVOUS SYSTEM - BRAIN
CENTRAL NERVOUS SYSTEM - BRAIN
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRUM
• The largest part of the brain that consist of an outer peripheral layer called
cortex (grey matter) and an inner tissue called medulla (white matter).
• The cerebrum is divided into 2 hemispheres (right and left) by a deep groove
known as the longitudinal fissure.
• The 2 cerebral hemispheres are connected by the corpus callosum, allowing
them to communicate and send information to one another.
• The cerebrum has many different functions including memory, cognition,
language, thought, judgement, reasoning, problem solving, decision making,
attention, motor control, and sensory processing.
• The functional units of the cerebral hemispheres (cortex) have been separated
into what are called Brodmann areas, and include areas 1 through 47.
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRUM
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRUM

The outer layer is the gray matter or

cortex.

Deeper is located the white matter, or

medulla, composed of bundles of
nerve fibers, carrying impulses to and
from the cortex

Basal nuclei are gray matter that are

located deep within the white matter.
(they are an exception because white
matter should only contain fibers)

They help the motor cortex in

regulation of voluntary motor
activities
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRUM
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRUM
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRUM
• In order to make the many advanced cognitive functions of the cerebrum
possible, folds are formed in the cerebral cortex to increase its surface area
within the cranium (skull) - a process known as gyrification.
• This process creates a larger cortical surface area within a smaller space, and
greater cognitive functionality is possible as a result.
• The folded structure of the cerebral cortex has peaks called gyri (singular gyrus)
and grooves called sulci (singular sulcus).
• Some of the gyri and sulci are anatomically and/or functionally important as we
will see below.
• The cerebrum is also divided into four major lobes: frontal, parietal, temporal & Occipital
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRUM

The
boundaries
of the lobes
are marked
by deep
sulci
(fissures).
These are
the central,
lateral and
parieto-
occipital
sulci.
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRUM
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRUM
Functions of the cerebrum
1. Frontal Lobe:
• Associated with reasoning, planning, parts of speech, movement, emotions, and problem
solving
2. Parietal Lobe:
• Associated with movement, orientation, recognition, perception of stimuli and memory
3. Occipital Lobe:
• Associated with visual processing and memory
4. Temporal Lobe:
• Associated with perception and recognition of auditory stimuli, memory, and speech
CENTRAL NERVOUS SYSTEM - BRAIN

Originally defined and

numbered into 52
regions by the
German anatomist
Korbinian Brodmann
in the early 1900’s,
the Brodmann
areas of the cerebral
cortex are defined by
its cytoarchitecture
(histological
structure and cellular
organization).
CENTRAL NERVOUS
SYSTEM - BRAIN
Originally defined and
numbered into 52
regions by the
German anatomist
Korbinian Brodmann
in the early 1900’s,
the Brodmann
areas of the cerebral
cortex are defined by
its cytoarchitecture
(histological
structure and cellular
organization).
CENTRAL NERVOUS SYSTEM - BRAIN
CENTRAL NERVOUS SYSTEM - BRAIN
 CENTRAL NERVOUS SYSTEM - BRAIN
DIENCEPHALON
• The diencephalon is located between the 2 cerebral hemispheres and is linked
to them and to the brainstem .
• The major structures of the diencephalon are the
• Thalamus - relay motor and sensory (except smell) signals to & from the cerebral
cortex.
• Hypothalamus - keep your body in a stable state called homeostasis.
• Subthalamus - responsible for sexuality, food and water intake and
maintenance of hydration.
• Epithalamus - connect the limbic system to other parts of the brain.
 CENTRAL
NERVOUS SYSTEM
- BRAIN

DIENCEPHALON
CENTRAL NERVOUS SYSTEM - BRAIN
 CENTRAL NERVOUS SYSTEM - BRAIN
THE BRAINSTEM
• The brainstem has three parts:
1. midbrain, - is traversed by a narrow CSF channel called cerebral aqueduct connecting 3rd & 4th
Ventricles. Visual reflexes (superior colliculi) and auditory relay center (inferior colliculi).
2. Pons – ass. With control of sleep cycles, breathing, connects hindbrain to forebrain, relay fn.
3. medulla oblongata (continues as the spinal cord) .
• It is responsible for basic vital life functions such as
• breathing,
• heartbeat, and
• blood pressure.
• Medulla oblongata directly controls breathing, blood flow, and other essential functions.
• It is connected to the cerebellum with 3 paired peduncles: Superior, middle and inferior .
 CENTRAL NERVOUS SYSTEM - BRAIN
THE BRAINSTEM
• Superior peduncle connects midbrain with cerebellum
• Middle peduncle connects pons with cerebellum
• Inferior peduncle connects medulla oblongata with cerebellum
 CENTRAL NERVOUS SYSTEM - BRAIN
THE BRAINSTEM
• The midbrain:
• Is traversed by a narrow CSF channel called cerebral aqueduct connecting 3 rd & 4th
Ventricles. Visual reflexes (superior colliculi) and auditory relay center (inferior
colliculi).
• The midbrain also contains the
• cerebral peduncles - a pair of structures composed of ascending and descending fiber tracts.
• Red nucleus - maintains connections with the cerebrum and cerebellum and is involved in
motor coordination.
• substantia nigra,
• and other nuclei.
• The midbrain has two systems of dopaminergic (dopamine releasing) neurons that
project to other areas of the brain
The midbrain:
 CENTRAL NERVOUS SYSTEM - BRAIN
THE BRAINSTEM
• The midbrain:
• The midbrain has two systems of dopaminergic (dopamine releasing) neurons that project
to other areas of the brain.
• The nigrostriatal system projects from the substantia nigra to the corpus striatum of the
basal nuclei; this system is required for motor coordination, and it is the degeneration of
these fibers that produces Parkinson’s disease.
• The Mesolimbic system:Other dopaminergic neurons in the ventral tegmental area (VTA)
of the midbrain, adjacent to the substantia nigra, are part of the mesolimbic system that
projects dopaminergic input to the limbic system of the forebrain.
• This system is involved in behavioral reward (reinforcing goal-directed behavior), and has
been implicated in drug addiction and psychiatric disturbances.
• Abused drugs promote the release of dopamine in the nucleus accumbens in the forebrain
(alcohol, amphetamines, cocaine, marijuana, and morphine, nicotine)
 CENTRAL NERVOUS SYSTEM - BRAIN
THE BRAINSTEM
• The midbrain and its
dopaminergic pathways
Defects in any of the 3
pathways may result in
corresponding diseases that
include: parkinsonism,
schizophrenia, drug addiction
negative behaviours, etc..
 CENTRAL NERVOUS SYSTEM - BRAIN
THE BRAINSTEM
• The midbrain and its
dopaminergic pathways
Defects in any of the 3
pathways may result in
corresponding diseases that
include: parkinsonism,
schizophrenia, drug addiction
negative behaviours, etc..
BASAL
GANGLIA
 CENTRAL NERVOUS SYSTEM - BRAIN
.

Dopaminergic circuit
anatomy: The figure illustrates
dopaminergic pathways in the
human brain, with involved
regions and functions. Relevant
glutamate (Glu) and gamma-
aminobutyric acid (GABA)
projections are also illustrated
for comparison. Amyg-
amygdala, Caud -caudate, DA
dopamine, Hipp- hippocampus,
Nacc- nucleus accumbens, Put
putamen, SN- substantia nigra,
VP- ventral pallidum, VTA-
ventral tegmental area. (Original
figure from Treadway and Zald ,
used with permission)
CENTRAL NERVOUS
SYSTEM - BRAIN

THE BRAINSTEM
CENTRAL NERVOUS SYSTEM - BRAIN
 CENTRAL NERVOUS SYSTEM - BRAIN
THE CEREBELLUM
• The cerebellum is situated behind the pons and immediately below the
posterior portion of the cerebrum
• It is ovoid in shape and has two hemispheres, separated by a narrow median
strip called the vermis.
• It has 2 cerebellar hemispheres with convoluted surface.
• It has an outer cortex of gray matter and an inner region of white matter.
• It provides precise coordination for body movements and helps maintain
equilibrium.
• Regulates movement and posture and plays a role in certain kinds of motor
learning.
 CENTRAL NERVOUS SYSTEM - BRAIN
THE CEREBELLUM
There are three main divisions of the cerebellum: the
vestibulocerebellum, the spinocerebellum, and the pontocerebellum.
• The vestibulocerebellum is dominated by vestibular input and controls
balance and eye movements.
• The spinocerebellum is dominated by spinal cord input and controls
synergy of movement.
• The pontocerebellum is dominated by cerebral input, via pontine
nuclei, and controls the planning and initiation of movements.
 CENTRAL NERVOUS SYSTEM - BRAIN
THE CEREBELLUM
Disorders of the Cerebellum
• Cerebellar lesions result in an abnormality of movement called ataxia. Cerebellar ataxia is a
lack of coordination due to errors in rate, range, force, and direction of movement. Ataxia can
be exhibited in one of several ways.
1. There may be a delayed onset of movement or poor execution of the sequence of a movement,
causing the movement to appear uncoordinated.
2. A limb may overshoot its target or stop before reaching its target.
3. Ataxia may be expressed as dysdiadochokinesia, in which a person is unable to perform rapid,
alternating movements.
4. Intention tremors may occur perpendicular to the direction of a voluntary movement, increasing near
the end of the movement. (Intention tremors seen in cerebellar disease differ from the resting tremors
seen in Parkinson disease.)
5. The rebound phenomenon is the inability to stop a movement; for example, if a person with cerebellar
disease flexes his forearm against a resistance, he may be unable to stop the flexion when the
resistance is removed.
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
• The meninges are three connective tissue membranes that lie just external to
the brain and spinal cord
• The CNS is covered by 3 membranes called meninges which are separated by 2
spaces:
• Subdural &
• Subarachnoid
• Meninges of brain are continuous with spinal meninges at foramen magnum.
• From external to internal, the meningeal layers are: Dura mater > Arachnoid >
Pia mater.
CENTRAL NERVOUS SYSTEM - BRAIN
CENTRAL NERVOUS SYSTEM - BRAIN
CENTRAL NERVOUS SYSTEM - BRAIN
CENTRA
L
NERVOU
S
SYSTEM
- BRAIN
CENTRA
L
NERVOU
S
SYSTEM
- BRAIN
CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES

DURA MATER
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
DURA MATER (Hard Mother) – Outermost & Toughest
• It is bilaminar membrane.
• Has two layers :
• outer, periosteal or endosteal
• Inner, investing, dura proper, meningeal proper
• Outer dura is thick, firm membrane covers the bone from inside. It stops at foramina &
blends with periosteum of margins.
• Inner dura is strong fibrous membrane covering the brain & continuous through foramen
magnum, with spinal dura and ends at S2.. It provides tubular sheath for cranial nerves
through foramina of skull & outside skull fuses with epineuria of nerves. The dural root
sheath or sleeve surround anterior or posterior nerve roots as dural sac fuses with
periostium The two layers are firmly adherent except:
• Where these split to enclose venous sinuses (endothelium lined spaces lie either in folds of dura or
between investing layer & endocranium)
• Where inner layer reduplicates to form folds
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
Functions:
Cover and protect the CNS structures
Protect blood vessels and enclose venous sinuses .
Allows cerebrospinal fluid (CSF) to re-enter blood circulation.
Form partitions within the skull.
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
Dura Mater:
• Dural sheath lies loosely in vertebral canal & separated from wall of canal by
extradural space or epidural space which is occupied by internal vertebral venous
plexus embedded in fatty matrix- epidural fat
• The space between dura & arachnoid mater is called subdural space. It contains
capillary layer of fluid.
• The leathery dura mater is by far the strongest of the meninges .
• Where it surrounds the brain it is a double layer membrane.
• The periosteal layer is the superficial and lines the inner surface (periostium) of the
skull .
• The deeper meningeal layer forms the true external covering of the brain.
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
Dura Mater:
• The brain’s dural layers are fused together except in certain areas where they
enclose the blood filled dural sinuses .
• The dural sinuses collect venous blood and direct it into the internal jugular
veins of the neck.
• In several places the meningeal dura mater extends inward to form flat septa
(partitions) that limit movement of the brain within the skull.
• Has five (5) processes: (1)Falx cerebri (2)Tentorium cerebelli (3) Falx cerebelli 4)
Diaphragma sellae (5) Cavum trigeminale
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
Dura Mater:
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
Dura Mater:
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
Dura Mater:
• Blood supply of dura in brain:
• Middle meningeal artery along with
• ICA,
• maxillary artery,
• ascending pharyngeal artery,
• Occipital artery,
• vertebral artery.
• Dura matter receives innervation by general sensory fibers of CN V, X and C1 &
C2 cervical nerves.
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
Dura Mater:
CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES

ARACHNOID MATER
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
Arachnoid Mater (Spiderlike):
• The middle membrane forms a loose brain covering over the surface of the
cerebrum.
• It is separated from the dura mater by a narrow serous cavity, the subdural
space.
• Beneath the arachnoid membrane is the wide subarachnoid space.
• The subarachnoid space is filled with cerebrospinal fluid and contains the
largest blood vessels serving the brain
• Since the arachnoid is fine and elastic, these blood vessels are rather poorly
protected
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
Arachnoid Mater (spiderlike):
Has several processes or extensions:
• Arachnoid villi & granulation are finger like processes which arise from surface
of arachnoid, push dura before them eventually perforating it & project into
venous sinuses convey, CSF to blood stream. These are valvular structures.
Granulations are just aggregation of arachnoid villi clumped together, found in
adults. In old age may erode bone, most numerous in sup. Sagittal sinus.
• Subarachnoid space is crossed by connective tissue - subarachnoid trabeculae.
• Down distal to termination of spinal cord subarachnoid space around filum
terminale becomes roomy forming a pool of CSF. - Lumbar cistern
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
Arachnoid Mater (spiderlike):
Has several processes or extensions:
• Arachnoid villi act as one-way valves for the flow of CSF into venous blood, and
hydrostatic pressure is the main stimulus that causes these valves to open.
• Cerebrospinal fluid is absorbed into the venous blood sinuses through these
valve-like villi
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
Pia Mater (Tender loving mother):
• The pia mater is a delicate connective tissue that is richly invested with tiny
blood vessels.
• It is the only membrane that clings tightly to the brain, following its every
convolution.
• Innermost vascular, thin delicate membrane closely fits the surfaces of CNS.
Blood vessels lie on external surface of pia.
• Meningitis is an inflammation of the meningeal layers that is caused by either a
bacterial or viral infection that can spread to the underlying nerve tissue
• Brain inflammation is called encephalitis
 CENTRAL NERVOUS SYSTEM - BRAIN
THE MENINGES
Pia Mater (Tender mother):
 CENTRAL NERVOUS SYSTEM - BRAIN
THE BLOOD BRAIN BARRIER (BBB)
 CENTRAL NERVOUS SYSTEM - BRAIN
THE BLOOD BRAIN BARRIER (BBB) – Features
• BBB = Barrier between cerebral capillary blood and the CSF.
• Consists of the endothelial cells of the cerebral capillaries and the epithelium of
the choroid plexus.
• Features of BBB
• Tight Junctions = The junctions between endothelial cells in the brain are so
“tight” that few substances can cross between the cells.
• Only a few substances can pass through the endothelial cells: Lipid-soluble
substances (e.g., oxygen and carbon dioxide) can cross the BBB, but water-
soluble substances are excluded.
• The BBB does not restrict nutrient supply to the brain tissue.
 CENTRAL NERVOUS SYSTEM - BRAIN
THE BLOOD BRAIN BARRIER (BBB)
 CENTRAL NERVOUS SYSTEM - BRAIN
THE BLOOD BRAIN BARRIER (BBB) – Conditions That Impairs Integrity
of The BBB
• Conditions increasing permeability of BBB =
infections/inflammation, tumors, irradiations, cerebral ischemia,
malignant hypertension, seizure activity, circulating toxins.
• Impaired BBB increase permeability of substances usually excluded
• e.g. antibiotics, radiolabeled markers, cancer/chemotherapeutic drugs, etc.
• Raised CSF proteins = meningitis, tuberculosis, multiple sclerosis,
Guillain-Barre syndrome.
 CENTRAL NERVOUS SYSTEM - BRAIN
THE BLOOD BRAIN BARRIER (BBB) – Functions
• It maintains a constant environment for neurons in the CNS .
• It protects the brain from endogenous or exogenous toxins.
• It prevents the escape of neurotransmitters from their functional sites
in the CNS into the general circulation.
 CENTRAL NERVOUS SYSTEM - BRAIN
THE VENTRICLES
CENTRAL NERVOUS SYSTEM - BRAIN
THE CSF
 CENTRAL NERVOUS SYSTEM - BRAIN
THE CEREBROSPINAL FLUID
Functions:
• Excretion of waste products of cerebral metabolism –CO2, Lactate, H+, etc.
• Nutrition for neurons as well as creation of optimal chemical environment for
neuronal function.
• Control of ventilation (acid-base status of brain ECF).
• Drugs penetrate the blood-brain barrier to varying degrees.
• –For example, nonionized (lipid-soluble) drugs cross more readily than
ionized (water-soluble) drugs.
 CENTRAL NERVOUS SYSTEM - BRAIN
THE CEREBROSPINAL FLUID
Formation:
The extracellular
compartment of the
brain encompasses
both interstitial fluid
and cerebrospinal
fluid (CSF) that
surrounds the brain
and spinal cord and
fills the brain
ventricles.
 CENTRAL NERVOUS SYSTEM - BRAIN
THE CEREBROSPINAL FLUID
Formation:
• CSF is formed by epithelial cells of choroid plexus
• Choroid plexus in the two lateral ventricles, the third ventricle and the fourth
ventricle
• Choroid plexus is at the CSF end of the barrier between cerebral capillary
blood and CSF (refer to diagram)
• CSF is formed from plasma by selective secretion (not simple filtration) by the
choroid plexus,
• Lipid-soluble substances (C02 and O2) and H20 freely cross the BBB and equilibrate
between blood and CSF.
 CENTRAL NERVOUS SYSTEM - BRAIN
THE CEREBROSPINAL FLUID
Formation:
• Other substances are transported by carriers in the choroid plexus epithelium.
• They may be secreted from blood into the CSF or absorbed from the CSF into
blood.
• Protein and cholesterol are excluded from the CSF because of their large
molecular size.
• About 500 ml of CSF is produced a day in adults
• At steady state, 500 ml of fluid is transferred from CSF to venous system →
general circulation
• CSF composition is different from blood composition(See table on next slide).
 CENTRAL NERVOUS SYSTEM - BRAIN
THE CEREBROSPINAL FLUID
 CENTRAL NERVOUS SYSTEM - BRAIN
THE CEREBROSPINAL FLUID
Circulation:
 CENTRAL
NERVOUS
SYSTEM -
BRAIN
THE CEREBROSPINAL FLUID

Circulation:
 CENTRAL NERVOUS SYSTEM - BRAIN
THE CEREBROSPINAL FLUID
Circulation:
 CENTRAL NERVOUS SYSTEM - BRAIN
THE CEREBROSPINAL FLUID
Circulation:
 CENTRAL NERVOUS SYSTEM - BRAIN
INTRACRANIAL PRESSURE (ICP)
• Intracranial pressure
• In adults, skull is a ‘closed space’
• Contents exert intracranial pressure
• Normal ICP = 5 –12 mmHg)

• Intracranial contents in an average adult

• Brain substance = about 1200 –1600 ml
• Blood : 100 –150 ml
• CSF: 100 –150 ml
• ECF : <75 ML
 CENTRAL NERVOUS SYSTEM - BRAIN

INTRACRANIAL PRESSURE

Intracranial
Volume-Pressure
Relationship
 CENTRAL NERVOUS SYSTEM - BRAIN
INTRACRANIAL PRESSURE (ICP)
Intracranial Volume Pressure Relationship
• Brain in adults is a ‘closed’ compartment
• Horizontal region is a region of compensation
• Increase in intracranial mass volume doesn’t translate to increase in
pressure
• Mechanism:
• A) displacement of CSF into spinal sub-arachnoid space;
• B) increased absorption of CSF;
• C) decreased intracranial blood volume
 CENTRAL NERVOUS SYSTEM - BRAIN
INTRACRANIAL PRESSURE (ICP)

Intracranial Volume Pressure Relationship

• Beyond a given limit, increase in volume translates to increase in intracranial

pressure

• Beyond region of compensation, small increases in volume results in large

increases in ICP .
 CENTRAL NERVOUS SYSTEM - BRAIN
INTRACRANIAL PRESSURE
Causes of Increased Intracranial Pressure (ICP)
1. Increased brain substance –tumour, abscess, hematoma
2. Increased CSF Volume –hydrocephalus, blocked shunt, benign intracranial
hypertension
3. Increased brain extracellular fluid –cerebral oedema
4. Increased blood volume in brain
• Increased cerebral blood flow: hypercapnia, hypoxia, hyperthermia
• Increased cerebral venous volume / decreased drainage : increased thoracic
pressure, venous obstruction in head, head down tilt, coughing.
 CENTRAL NERVOUS SYSTEM - BRAIN
INTRACRANIAL PRESSURE (ICP)
Increased Intracranial Pressure
Cushing’s Reflex
• Increased ICP → Decreased CPP → Decreased CBF
• In an attempt to increase cerebral perfusion, sympathetic NS is stimulated.
• Leads to increased systemic blood pressure
• Reflex decrease in HR
• Cushing’s Triad = Response to Increased ICP
• Hypertension
• Bradycardia
• Irregular respirations :
• Assignment –explain mechanism for irregular respiration.
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
• CBF is about 15% of the total resting cardiac output.
• This is equal to 50–55 ml/100 g brain tissue per minute.

• Grey Vs. White Matter Blood Flow

• Grey matter blood flow equals 70–80 ml/100 g per minute.
• White matter blood flow equals 15–20 ml/100 g per minute
• Grey matter blood flow relative to white matter blood flow = 3–4:1.
• Implication ?

• A fall in cerebral blood flow to less than 10 ml/100 g per minute is associated
with irreversible neuronal damage
• Secondary to failure of the Na-K ATPase pump mechanism
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
According to Hagen-Poiseuille Equation:
• Most important factor affecting flow is vessel radius –exponential
change to the fourth power.
• When radius is halved, resistance increases by a factor of 16 and flow
decreases by a factor of 16
• Next important factor is perfusion pressure = change in pressure
between the two ends of the flow
• Other factors
• Viscosity
• Tube length
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
1. Factors Affecting Cerebral Perfusion Pressure (CPP)
• CPP is the difference between the mean arterial blood pressure
(MAP) and the mean cerebral venous pressure.
• The mean cerebral venous pressure is difficult to measure and
approximates to the more easily measured intracranial pressure (ICP).
• CPP = MAP – ICP
• MAP = DBP + 1/3 pulse pressure
• MAP is usually around 90mmHg.
• ICP is much lower and is normally less than 13mmHg(normal ICP = 5 –12
mmHg)
• CPP is normally about 80mmHg & is affected by any change in MAP or ICP.
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
1. Factors Affecting Cerebral Perfusion Pressure (CPP)
• CPP = MAP – ICP
Factors affecting MAP
• Cardiac output
• Stroke Volume = preload (EDV , venous return), afterload and contractility
• Heart Rate
• Systemic Vascular Resistance
• Hypotension – Decrease in MAP leads to decrease in CPP.
Factors affecting ICP:
• Discussed earlier under ICP
• Increased intracranial pressure → decreased cerebral perfusion pressure
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
• This is regulated by four primary factors
A. Cerebral metabolism
B. Gas Partial pressures (carbon dioxide and oxygen) and Drugs
C. Autoregulation
D. Neuro-humeral factors
• The most important local vasodilator for the cerebral
circulation is CO2
• Other factors include temperature and drugs
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2.Factors Affecting Cerebral Artery Radius
A. Cerebral metabolism
• CBF is primarily determined by metabolic demands of the
brain. Increased demand leads to increased supply.
 CBF increases in hyperthermia, pain/anxiety, epileptic seizures.
Drugs like Ketamine increases CBF.
• Hyperthermia causes cerebral vasodilation and increase in CBF
 CBF decreases in hypothermia and coma. Some anaesthetic
drugs like propofol and thiopentone decreases CBF
• HYPOTHERMIA : Every 1 degree centigrade drop in temperature reduces
cerebral metabolism by about 5-7% and vice versa
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2.Factors Affecting Cerebral Artery Radius
A. Cerebral metabolism
• Local metabolites that cause cerebral vasodilation:
• Hydrogen ions
• Potassium
• Carbon Dioxide
• Adenosine
• Glycolytic intermediates
• Nitric Oxide
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2.Factors Affecting Cerebral Artery Radius
B. Gas Partial Pressures (CO2 & O2)
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
B. Gas Partial Pressures (CO2 & O2)
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
B. Gas Partial Pressures (CO2 & O2)
• The most important extrinsic influences on CBF are respiratory gas tensions particularly
Paco2.
• CBF is directly proportionate to Paco2 between tensions of 20 and 80 mm Hg.
• Blood flow changes approximately 1–2 mL/100 g/min per mm Hg change in Paco2. This
effect is almost immediate and is thought to be secondary to changes in the pH of CSF and
cerebral tissue. Because ions do not readily cross the blood–brain barrier but CO 2 does,
acute changes in Paco2 but not HCO3– affect CBF. Thus, acute metabolic acidosis has little
effect on CBF because hydrogen ions (H+) cannot readily cross the blood–brain barrier. After
24–48 hr, CSF HCO3– concentration adjusts to compensate for the change in Paco2, so that
the effects of hypocapnia and hypercapnia are diminished.
• Marked hyper-ventilation (Paco2< 20 mm Hg) shifts the oxygen– hemoglobin dissociation
curve to the left, and, with changes in CBF, may result in EEG changes suggestive of cerebral
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
B. Gas Partial Pressures (CO2 & O2)
• High CPP increases responsiveness to hyperventilation .
• Hypotension of 50mmHg abolishes the effect of PaCO2 on CBF.
• H+ ions is very polar and cannot cross the blood brain barrier .
• Plasma pH or H+ have little to no effect on CBF.
QUESTION
• Fastest and most efficient way to relax the brain
• –Hyperventilate patient to reduce PaCO2
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
B. Gas Partial Pressures (CO2 & O2)
• High CPP increases responsiveness to hyperventilation .
• Hypotension of 50mmHg abolishes the effect of PaCO2 on CBF.
• H+ ions is very polar and cannot cross the blood brain barrier .
• Plasma pH or H+ have little to no effect on CBF.
QUESTION
• Fastest and most efficient way to relax the brain
• –Hyperventilate patient to reduce PaCO2
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
B. Gas Partial Pressures (CO2 & O2)
• PaO2 increases cerebral blood flow only when it has markedly fallen below 50 mmHg.
• Whereas hyperoxia may be associated with only minimal decreases (–10%) in CBF, severe
hypox-emia (Pao2< 50 mm Hg) greatly increases CBF.
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
B. Drugs affecting Cerebral Vessel Radius
Drugs increasing CBF
• Vasodilators like nitro-glycerine and nitroprusside;
• Ketamine
• Volatile anaesthetic agents
• Suxamethonium
Drugs Decreasing CBF
• IV Anaesthetics like propofol, thiopentone, ethomidate
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
C. Cerebral Autoregulation
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
C. Cerebral Autoregulation
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
C. Cerebral Autoregulation
Mechanisms For Local Regulation of Blood Flow –autoregulation, active
hyperemia and reactive hyperemia
Autoregulation : Myogenic hypothesis
• Autoregulation–blood flow to an organ remains constant over a wide range of
mean arterial pressure
• Heart, brain and kidneys exhibit autoregulation
• Mechanism: Vascular smooth muscles contracts when stretched.
Active and Reactive Hyperemia
• In increased metabolic activity, local metabolites like CO2, H+, K+, lactate, and
adenosine are produced.
• All these have vasodilator actions
CENTRAL NERVOUS
SYSTEM - BRAIN

CEREBRAL BLOOD FLOW

(CBF)
2. Factors Affecting
Cerebral Artery Radius
C. Cerebral
Autoregulation
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
C. Cerebral Autoregulation
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
C. Cerebral Autoregulation
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
C. Cerebral Autoregulation
CENTRAL
NERVOUS
SYSTEM -
BRAIN
CEREBRAL BLOOD FLOW
(CBF)
2. Factors
Affecting
Cerebral Artery
Radius
C. Cerebral
Autoregulat
ion in
Traumatic
Brain Injury
(TBI)
CENTRAL
NERVOUS
SYSTEM -
BRAIN
CEREBRAL BLOOD FLOW
(CBF)
2. Factors
Affecting
Cerebral Artery
Radius
C. Cerebral
Autoregulat
ion in
Traumatic
Brain Injury
(TBI)
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD
FLOW (CBF)
2. Factors
Affecting
Cerebral Artery
Radius
C. Cerebral
Autoregulat
ion in
Traumatic
Brain Injury
(TBI)
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
2. Factors Affecting Cerebral Artery Radius
C. Autonomic Influences
• Intracranial vessels are innervated by the sympathetic
(vasoconstrictive) and parasympathetic (vaso-dilatory)
systems.
• Intense sympathetic stimulation induces vasoconstriction in
these vessels, which can limit CBF.
• Autonomic innervation may also play an important role in
cerebral vasospasm following brain injury and stroke.
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
3. Factors Affecting Blood Viscosity
• The most important determinant of blood viscosity is hematocrit. A decrease
in hematocrit decreases viscosity and can improve CBF; unfortunately, a
reduction in hematocrit also decreases the oxygen-carrying capacity and thus
can potentially impair oxygen delivery.
• Elevated hematocrit, as may be seen with marked polycythemia, increases
blood viscosity and can reduce CBF.
• There is no significant effect of viscosity on CBF when hematocrit (packed cell
volume) is between 30% and 50%.
• Outside this range: – CBF increases with reducing viscosity
CENTRAL
NERVOUS
SYSTEM -
BRAIN
CEREBRAL BLOOD
FLOW (CBF)
 CENTRAL NERVOUS SYSTEM - BRAIN
CEREBRAL BLOOD FLOW (CBF)
CENTRAL NERVOUS SYSTEM – SPINAL CORD
CENTRAL NERVOUS SYSTEM – SPINAL CORD
CENTRAL
NERVOUS SYSTEM
– SPINAL CORD
CENTRAL NERVOUS SYSTEM – SPINAL CORD
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
Grey Matter
• Has a central gray matter that forms an “H” or butterfly, with a central canal in
the middle of the gray commissure.
• This grey matter contains neuronal cell bodies and central terminals of primary
afferents from the periphery.
• Grey matter receives and integrates incoming and outgoing information.
• Has two (2) main projections or horns on each half of spinal cord: dorsal horn,
and anterior / ventral horn.
• The ventral horns contain somatic & visceral motor nuclei, whereas the dorsal
horns contain somatic and autonomic sensory nuclei
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
1. Grey Matter cont’d
Roles of the Dorsal Horn
• A relay station for the transmission of both noxious and innocuous stimuli
• Modulating pain transmission.
• It achieves this via spinal and supraspinal mechanisms.
• Dorsal horn has 7 laminae – lamina I is most dorsal (superficial) and lamina VII
is the most ventral (deepest)
• Spinal cord gray matter is a site where excitatory and inhibitory impulses are
summed
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
Seven (7) Laminae
of dorsal horn and
their functions
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
Seven (7) Laminae
of dorsal horn and
their functions
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter
• Surrounding the central grey matter is a white matter that contains ascending
and descending fibers or tracts.
• Nerve impulse conduction role.
• All the neurons within the descending motor system are classed as upper motor
neurons. Their cell bodies are found in the cerebral cortex or the brain stem,
with their axons remaining within the CNS.
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter
Ascending Tracts
• Sensory signals from the skin, extremities and internal organs are carried via
pathways in the ascending tracts.
• Sensory signals from the skin and extremities are called somatosensations &
those from internal organs are called visceral sensations.
• There are two (2) different somatosensory pathways in the ascending tracts of
the spinal cord: Dorsal Column System & Anterolateral System
• Most of these signals are relayed to the brain. Some activate reflexes which are
controlled by interneurons in the spinal cord and are not addressed by the
brain.
 CENTRAL
NERVOUS SYSTEM
– SPINAL CORD
Ascending Tracts
• The dorsal column system
processes the sensations of
fine touch, pressure, two-
point discrimination,
vibration, and proprioception
(limb position).
• The anterolateral system
processes the sensations of
pain, temperature, and light
touch.
CENTRAL
NERVOUS
SYSTEM –
SPINAL
CORD

Internal Anatomy
2. White Matter
Ascending Tracts
CENTRAL
NERVOUS
SYSTEM –
SPINAL
CORD

Internal Anatomy
2. White Matter
Ascending Tracts
CENTRAL
NERVOUS
SYSTEM –
SPINAL
CORD

Internal Anatomy
2. White Matter
Ascending Tracts
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter
Descending Tracts
• Axons within the descending tracts control the smooth muscles of internal
organs (visceral) and the skeletal muscles of the arms and legs (somatic).
• Neural signals follow specific pathways. In the case of the descending tracts
axons from the brain synapse with cell bodies in the spinal cord which then
send impulses out to the rest of the body.
• Their cells of origin lie in the cerebral cortex and brainstem (upper motor
neurons –UMN).
• UMN control voluntary motor activity; maintain posture & equilibrium; control
muscle tone & reflex activity and generally exert their effect on muscle groups.
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Descending Tracts: Types
• The descending motor tracts can be functionally divided into two major groups
1. Pyramidal tracts
A. Corticospinal tracts
I. Anterior corticospinal tracts
II. Lateral corticospinal tracts
B. Corticobulbar tracts
2. Extrapyramidal tracts.
A. Vestibulospinal
B. Reticulospinal
I. Lateral Reticulospinal
II. Medial Reticulospinal
C. Rubrospinal
D. Tectospinal
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter
Descending Tracts : 1. Pyramidal Tracts
• These tracts originate in the cerebral cortex carrying motor fibres to the spinal
cord and brain stem.
• The pyramidal tracts derive their name from the medullary pyramids of the
medulla oblongata, which they pass through.
• These pathways are responsible for the voluntary control of the musculature of
the body and face.
• Functionally, these tracts can be subdivided into two:
• Corticospinal tracts – supplies the musculature of the body.
• Corticobulbar tracts – supplies the musculature of the head and neck.
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter
Descending Tracts :
Pyramidal Tracts
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter
Descending Tracts : 1. Pyramidal Tracts
• Most important and largest descending tract.
• 1 million fibers (approx.) in human, >90% – small diameter & unmyelinated
(SLOW CONDUCTING PATHWAY).
• Myelination starts in neonate on 10th – 14th day and completes in 2 years.
• NEUROTRANSMITTERS : GLUTAMATE, ASPARTATE.
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter

Descending Tracts : 1. Pyramidal Tracts: Functions:

• Fine, skillful voluntary movement of Distal limb parts (LCST)
• Postural stability of Axial & proximal muscle (ACST).
• Influence on stress reflexes.
• Facilitatory (++) –> alpha & gamma where it ends directly. Inhibitory (–) –> via
Interneurons
• Efferent limb of superficial reflexes (e.g, abdominal, plantar, cremasteric,
corneal etc)
• Useful in sensori-motor coordination.
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter

Descending Tracts : 1. Pyramidal Tracts: Lesions:

• MOTOR DEFICITS OCCUR DUE TO DESCENDING TRACTS. PURE Pyramidal tract
lesions are rare.
• PLANTAR REFLEX – Normal (flexion)/abnormal (extension – positive Babinski
sign) – dysfunction of CST.
• ACUTE Lesion (Stage of shock)–> Paralysis of opposite half, No reflexes,
Emotions are intact. Lasts for 2-3 weeks. (Symptoms include lesions of both PT+
EPT )
• CHRONIC Lesion (Stage of recovery) :
• Refer to next slide
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter Descending Tracts : 1. Pyramidal Tracts: Lesions:
 CENTRAL
NERVOUS
SYSTEM –
SPINAL
CORD
Internal Anatomy
2. White Matter
Descending Tracts :
Pyramidal Tracts:
Course of CST
 CENTRAL
NERVOUS
SYSTEM –
SPINAL
CORD
Internal Anatomy
2. White Matter
Descending Tracts :
Pyramidal Tracts
Course of CST
 CENTRAL
NERVOUS
SYSTEM –
SPINAL
CORD
Internal Anatomy
2. White Matter
Descending Tracts : Lateral Anterior
Corticospinal Corticospinal
Pyramidal Tracts Tract Tract
Course of CST
CENTRAL
NERVOUS
SYSTEM
– SPINAL
CORD
Internal Anatomy
2. White Matter
Descending Tracts :
Pyramidal Tracts
Course of CST
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter
Descending Tracts
Course / pathway for corticospinal tracts (CST):
• Originates in several cortical areas, about half of these axons extend from
neurons in the primary motor cortex, but others originate in the nonprimary
motor areas of the brain as well as in regions of the parietal lobe like the
somatosensory cortex.
• The axons that travel in the CST descend into the brainstem as part of large fiber
bundles called the cerebral peduncles.
• The tract continues down into the medulla where it forms two large collections
of axons known as the pyramids; the pyramids create visible ridges on the
exterior surface of the brainstem.
CENTRAL NERVOUS SYSTEM – SPINAL CORD
Descending Tracts
Course / pathway for corticospinal tracts (CST):
• At the base of the pyramids, approximately 90% of the fibers in the
corticospinal tract decussate, or cross over to the other side of the brainstem, in
a bundle of axons called the pyramidal decussation.
• The fibers that have decussated form the lateral corticospinal tract; they will
enter the spinal cord & terminate in the anterior gray column of all the spinal
cord segments, and thus cause movement, on the side of the body that is
contralateral to the hemisphere of the brain in which they originated.
• The other 10% of the corticospinal tract fibers will not decussate; they will
continue down into the ipsilateral spinal cord; this branch of the corticospinal
tract is known as the anterior (or ventral) corticospinal tract. Most of the axons
of the anterior corticospinal tract will decussate in the spinal cord ( in the
cervical and upper thoracic regions) just before they synapse with lower motor
neuron cell bodies in the anterior gray column of all the spinal cord segments.
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Descending Tracts
Course / pathway for corticospinal tracts (CST):
• The fibers of these two different branches of the corticospinal tract
preferentially stimulate activity in different types of muscles.
• Lateral corticospinal tract primarily controls the movement of muscles in the
limbs
• Anterior corticospinal tract is involved with movement of the muscles of the
trunk, neck, and shoulders.
• Of all corticospinal fibres approximately 20% terminate at thoracic levels, 25%
at lumbosacral levels and 55% at cervical levels. Many of the fibres that
originate from the motor cortex then terminate in the ventral horn of the spinal
cord.
• NB: Corticobulbar tracts control movement of muscles in the head & neck via
the cranial motor nerves.
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Descending Tracts
Course / pathway for corticobulbar tracts :
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter
Descending Tracts : Extrapyramidal Tracts: Introduction
• These tracts originate in the brain stem carrying motor fibres to the spinal cord.
• They are responsible for the involuntary and automatic control of all
musculature, such as muscle tone, balance, posture and locomotion
• There are no synapses within these extrapyramidal descending pathways.
• At the termination of these extrapyramidal descending tracts, the neurons
synapse with a lower motor neuron.
• There are four types of tracts in total.
• The vestibulospinal and reticulospinal tracts do not decussate, providing ipsilateral
innervation.
• The rubrospinal and tectospinal tracts do decussate, and therefore provide contralateral
innervation.
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter
Descending Tracts : Extrapyramidal Tracts
Functions:
• The tectospinal tract is concerned with reflex postural movements in response
to visual stimuli. Those fibers that are associated with the sympathetic neurons
in the lateral gray column are concerned with the pupillodilation reflex in
response to darkness.
• originates in the superior colliculus (tectum or “roof” of the brain stem) and projects to
the cervical spinal cord. It is involved in control of neck muscles.
• The rubrospinal tract acts on both the alpha and gamma motor neurons in the
anterior gray columns. And facilitates the activity of flexor muscles and inhibits
the activity of extensor or antigravity muscles.
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter
Descending Tracts : Extrapyramidal
Functions:
• The reticulospinal tracts may facilitate (pontine – antigravity muscles) or
inhibit (medullary – antigravity muscles) the activity of the alpha and gamma
motor neurons in the anterior gray columns; And may, therefore, facilitate or
inhibit voluntary movement or reflex activity.
• Vestibulospinal tract by acting on the motor neurons in the anterior gray
columns:
• Facilitates the activity of the extensor/antigravity muscles.
• Inhibits the activity of the flexor muscles. And is concerned with the postural
activity associated with balance.
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter
Descending Tracts
Functions:
• Olivospinal tract - May play a role in muscular activity, but there is doubt that it
exists.
• Descending autonomic fibers Are concerned with the control of visceral motor
activity (sympathetic & parasympathetic).
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter
Descending Tracts : Extrapyrimidal
Lesions:
• MUSCLE TONE – Increased (upper limb – Flexion, Lower limb – Extension)
• ABNORMAL POSTURE
• INVOLUNTARY MOVEMENT – tremor
• LOSS OF RIGHTING/POSTURAL REFLEXES
• DEEP REFLEXES – exaggerated, clonus may appear
• CLASP KNIFE RIGIDITY (Lengthening reaction) present
CENTRAL
NERVOUS
SYSTEM –
SPINAL
CORD

Internal Anatomy
2. White Matter
Descending Tracts
CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy 2. White Matter: Descending Motor Tracts
CENTRAL
NERVOUS
SYSTEM –
SPINAL
CORD

Internal Anatomy
2. White Matter
Descending Tracts
CENTRAL NERVOUS SYSTEM – SPINAL CORD

Internal Anatomy
2. White Matter
Descending Tracts
CENTRAL NERVOUS SYSTEM – SPINAL CORD
Internal Anatomy
2. White Matter
Descending Tracts could broadly
be gouped into tracts in the
lateral pathway and tracts in the
medial pathway
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
External Anatomy
• There are 31 pairs of spinal nerves (8 cervical, 12 thoracic, 5 lumbar, 5 sacral,
and 1 coccygeal)
• Bundles of axons called roots connect each nerve to the spinal cord
• The dorsal root is sensory, the ventral root is motor
• Each dorsal root has a “swelling” composed of cell bodies of sensory neurons,
called the dorsal root ganglion
• Nerves to and from the upper limbs form the cervical enlargement (C5 – T1),
nerves to and from the lower limbs form the lumbar enlargement (L2 – S3)
• The spinal cord tapers at its end to form the conus medullaris
• Lumbar, sacral, and coccygeal nerves hang below the conus medullaris to form
the cauda equina (“horse’s tail”)
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
External Anatomy
Regions of Control
• Cervical spinal nerves (C1 to C8) control signals to the back of the head, the
neck and shoulders, the arms and hands, and the diaphragm.
• Thoracic spinal nerves (T1 to T12) control signals to the chest muscles, some
muscles of the back, and parts of the abdomen.
• Lumbar spinal nerves (L1 to L5) control signals to the lower parts of the
abdomen and the back, the buttocks, some parts of the external genital organs,
and parts of the leg.
• Sacral spinal nerves (S1 to S5) control signals to the thighs and lower parts of
the legs, the feet, most of the external genital organs, and the area around the
anus.
CENTRAL
NERVOUS SYSTEM
– SPINAL CORD

External Anatomy
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
External Anatomy
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
External Anatomy
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical Application

A spinal tap (lumbar

puncture) is a
procedure in which a
needle is inserted into
the arachnoid space in
the lumbar region to
withdraw CSF or
administer medication
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical
Application

Spinal Cord
Reflexes
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical Application

A spinal tap (lumbar

puncture) is a
procedure in which a
needle is inserted into
the arachnoid space in
the lumbar region to
withdraw CSF or
administer medication
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical Application
Knee Jerk Reflex:
 Also called the patellar reflex.
 It’s a stretch reflex that tests
intactness of the L2, L3 and L4 spinal
segments of the spinal.
 It is applicable for the detection of
level-specific nerve root involvement
in patients with lumbar
radiculopathy.
Mechanism of Knee Jerk Reflex :
Striking the patellar tendon with a
reflex hammer stretches the muscle
spindle in the quadriceps femoris
muscle; this produces a signal that
synapses directly onto an alpha-motor
neuron at the level of L3 or L4 in the
spinal cord. From there, the motor
neuron conducts an efferent impulse
back to the quadriceps femoris,
triggering contraction.
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical
Application

Spinal Cord
Reflexes:

Stretch Reflex
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical
Application

Spinal Cord
Reflexes:

Stretch Reflex
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical
Application

Spinal Cord
Reflexes:

Stretch Reflex
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical
Application

Spinal Cord
Reflexes:

Crossed
Extensor
Reflex
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical
Application

Spinal Cord
Reflexes:

Crossed
Extensor
Reflex
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical
Application

Spinal Cord
Reflexes:

Crossed
Extensor
Reflex
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical Application : Spinal Cord Reflexes:
Superficial Reflexes
• Plantar Reflex – blunt object stroked along lateral side of the plantar
surface
• Test spinal cord segment (L4 – S2)
• Integrity of corticospinal tracts
• Normal response downward deflection of toes (plantar flexion).
• Abnormal response – Babinski’s sign – toes dorsiflex, smaller toes flare
laterally – this is normal in children
• Abdominal Reflexes - stroke skin on lateral side of abdomen to the
side, above or below the umbilicus
• Normal – umbilicus should move towards stroked side
• Test cord segments (T8 – T12)
• Integrity of corticospinal tracts
 CENTRAL
NERVOUS SYSTEM
– SPINAL CORD
Ascending Tracts
• The dorsal column system
processes the sensations of
fine touch, pressure, two-
point discrimination,
vibration, and proprioception
(limb position).
• The anterolateral system
processes the sensations of
pain, temperature, and light
touch.
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical
Application

Effect of hemisecting
The spinal cord
CENTRAL NERVOUS SYSTEM – SPINAL CORD
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical
Application
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical
Application
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical
Application
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical
Application
 CENTRAL NERVOUS SYSTEM – SPINAL CORD
Clinical
Application
Peripheral Nervous
System
(PNS)
Peripheral Nervous System
 Peripheral Nervous System
• The network of nerves branching out throughout the body from the brain and
spinal cord is called the peripheral nervous system.
• This generally comprises of:
• Sensory Receptors (Stimulus transduction) & Motor Endings (muscle
stimulation)
• Cranial nerves and peripheral nerves (– transmission of sensory or motor
information via action potential)
• Ganglia (relay action potential transmission)
• Provides links to and from the external environment
Peripheral Nervous System
Peripheral Nervous System
Organization of the Peripheral Nervous
System
Organization of the Peripheral Nervous
System
 Peripheral Nervous System - Receptors
• Receptors are transducers that convert various forms of energy / stimulus in the
environment into action potentials in the neurons. They may be a part of the neuron
or a specialized cell that generates action potential in the neurons.
• Activation results in graded potentials that trigger nerve impulses.
• Awareness of stimulus (sensation) and interpretation of the meaning of stimulus
(perception) occur in brain.
• Three ways to classify receptors:
• by type of stimulus,
• body location, and
• structural complexity
• Four (4) conditions of sensation:
• Adequate stimulus
• Adequate receptor (transducer)
• Conduction
• Translation (interpretation)
 Peripheral Nervous System - Receptors
Receptor Classification by Stimulus Type
• Mechanoreceptors – respond to touch, pressure, vibration, stretch,
and itch.
• Thermoreceptors – sensitive to changes in temperature.
• Photoreceptors – respond to light energy (e.g., retina)
• Chemoreceptors – respond to chemicals (e.g., smell, taste, changes in
blood chemistry)
• Nociceptors – sensitive to pain-causing stimuli
 Peripheral Nervous System - Receptors
Receptor Classification by Stimulus Type
Photoreceptors
• are activated by light and are involved in vision.
Chemoreceptors
• are activated by chemicals and are involved in olfaction, taste, and detection of
oxygen and carbon dioxide in the control of breathing.
Thermoreceptors
• are activated by temperature or changes in temperature.
Nociceptors
• are activated by extremes of pressure, temperature, or noxious chemicals.
 Peripheral Nervous System - Receptors
Receptor Classification by Stimulus Type
 Peripheral Nervous System - Receptors
Receptor Classification by Stimulus Type: Mechanoreceptors
 Peripheral Nervous System - Receptors
Receptor Classification by Stimulus Type: Thermoreceptors
The two classes of Thermoreceptors are cold
receptors and warm receptors

When the skin is warmed above 36°C, the

cold receptors become quiescent, and when
the skin is cooled below 36°C, the warm
receptors become quiescent.

At 36°C, both receptors are active.

Transduction of warm temperatures involves

transient receptor potential (TRP) channels
in the family of vanilloid receptors (i.e.,
TRPV). Capsaicin, an ingredient in spicy foods
stimulate this receptor – “hot”.

Transduction of cold temperatures involves a

different TRP channel, TRPM8, which is also
opened by compounds like menthol (which
gives a cold sensation)
 Peripheral Nervous System - Receptors
Receptor Classification by Stimulus Type : Nociceptors
• Nociceptors respond to noxious stimuli that can produce tissue damage. There
are two major classes of nociceptors:
• Mechano-thermal or mechanano-sensitive nociceptors (TRPV or TRPM8 channels) are
supplied by finely myelinated A-delta afferent nerve fibers (20 m/s) and respond to
mechanical stimuli such as sharp, pricking pain.
• Polymodal nociceptors are supplied by unmyelinated C fibers (< 2 m/s) and respond to
high-intensity mechanical or chemical stimuli and hot and cold stimuli.
• Mast cells near the site of injury release histamine, which directly activates
nociceptors.
• Axons of the nociceptors release substances that sensitize the nociceptors to
stimuli that were not previously noxious or painful. This sensitization process,
called hyperalgesia, is the basis for various phenomena including reduced
threshold for pain.
 Peripheral Nervous System - Receptors
Receptor Classification by Stimulus Type : Nociceptors
• Fast pain (e.g., pin prick) is carried on A delta, group II, and group III fibers, has
a rapid onset and offset, and is precisely localized.
• Slow pain (e.g., burn) is carried on C fibers and is characterized as aching,
burning, or throbbing pain that is poorly localized.
• PHANTOM PAIN Activation of a sensory pathway at any point gives rise to the
same sensation that would be produced by stimulation of the receptors in the
body part itself. This phenomenon is the traditional explanation for phantom
pain—for example, pain perceived as originating in the foot by a person whose
leg has been amputated at the knee. Irritation of the severed endings of the aff
erent pathways in the stump can trigger action potentials that, on reaching the
foot region of the somatosensory cortex, are interpreted as pain in the missing
foot.
 Peripheral Nervous System - Receptors
Receptor Classification by Stimulus Type : Nociceptors
• Referred pain is of visceral origin that is misperceived as pain arising from a
somatic location. The pain is “referred” according to the dermatomal rule,
which states that sites on the skin are innervated by nerves arising from the
same spinal cord segments as those innervating the visceral organs. Thus
according to the dermatomal rule, ischemic heart pain (angina) is referred to
the chest and shoulder, gallbladder pain is referred to the abdomen, kidney pain
is referred to the lower back, and so forth.
 Peripheral Nervous System - Receptors

Receptor Classification
by Stimulus Type :
Nociceptors
• Referred pain
 Peripheral Nervous System - Receptors

Receptor Classification
by Stimulus Type :
Nociceptors
• Referred pain
 Peripheral Nervous System - Receptors
Receptor Classification by Location
• Exteroceptors
• Respond to stimuli arising outside the body.
• Found near the body surface.
• Sensitive to touch, pressure, pain, and temperature.
• Include the special sense organs.

• Interoceptors
• Respond to stimuli arising within the body.
• Found in internal viscera and blood vessels.
• Sensitive to chemical changes, stretch, and temperature changes.
• Proprioceptors
• Respond to stretch in skeletal muscles, tendons, joints, ligaments, and connective tissue
coverings of bones and muscles.
• Inform brain of one's direction of limb movements.
 Peripheral Nervous System - Receptors
Receptor Classification by Structural Complexity
• Simple Receptors
• Modified dendritic endings of sensory neurons.
• Found throughout the body and monitor most types of general sensory
information.
• Monitor general sensation which include tactile sensations (touch, pressure,
stretch, vibration), temperature, pain, and muscle sense.
• Include:
• encapsulated nerve endings and
• unencapsulated nerve endings
• Complex Receptors
• Sense organs (special senses - Vision, hearing, equilibrium, smell, and taste)
 Peripheral Nervous System - Receptors
Receptor Classification by Structural Complexity
• Simple Receptors: Unencapsulated nerve endings.
• Abundant in epithelia and connective tissues.
• Most are non-myelinated, small-diameter group C fibers; distal
terminals have knoblike swellings.
• Respond mostly to temperature, pain, or light touch
• Thermoreceptors
• Cold receptors are activated by temps from 10 to 40oC
• Located in superficial dermis.
• Heat receptors are activated from 32 to 48oC located in deeper dermis.
• Outside those temperature ranges, nociceptors are activated and
interpreted as pain
 Peripheral Nervous System - Receptors
Receptor Classification by Structural Complexity
• Simple Receptors: Unencapsulated nerve endings.
• Nociceptors: pain receptors triggered by extreme temperature
changes, pinch, or release of chemicals from damaged tissue.
• Vanilloid receptor: protein in nerve membrane is main player.
• Acts as ion channel that is opened by heat, low pH, chemicals (example: capsaicin
in red peppers).
• Itch receptors in dermis: can be triggered by chemicals such as histamine.
• Tactile (Merkel) discs: function as light touch receptors
• Located in deeper layers of epidermis.
• Hair follicle receptors: free nerve endings that wrap around hair
follicles.
• Act as light touch receptors that detect bending of hairs.
• Example: Allows you to feel a mosquito landing on your skin
 Peripheral Nervous System - Receptors
Receptor Classification by Structural Complexity
• Simple Receptors: Encapsulated nerve endings.
• Almost all are mechanoreceptors whose terminal endings are encased in
connective tissue capsule.
• Vary greatly in shape and include:
• Tactile (Meissner’s) corpuscles: small receptors involved in discriminative touch.
• Found just below skin, mostly in sensitive and hairless areas (fingertips)
• Lamellar (Pacinian) corpuscles: large receptors respond to deep pressure and
vibration when first applied (then turn off).
• Located in deep dermis
• Bulbous corpuscles (Ruffini endings): respond to deep and continuous pressure.
Located in dermis.
• Muscle spindles: spindle-shaped proprioceptors that respond to muscle stretch.
• Tendon organ: proprioceptors located in tendons that detect stretch.
• Joint kinesthetic receptors: proprioceptors that monitor joint position and motion
 Peripheral Nervous System - Receptors
Sensory Transduction By Receptors

• Sensory transduction is the process by which an environmental stimulus (e.g.,

pressure, light, chemicals) activates a receptor and is converted into electrical
energy.

• The conversion typically involves opening or closing of ion channels in the

receptor membrane, which leads to a flow of ions (current flow) across the
membrane. Current flow then leads to a change in membrane potential, called a
receptor potential, which increases or decreases the likelihood that action
potentials will occur.
 Peripheral Nervous System - Receptors
Sensory Transduction By Receptors
• The following series of steps occurs when a stimulus activates a sensory
receptor:
1. The environmental stimulus interacts with the sensory receptor and causes a change in
its properties.
2. These changes cause ion channels in the sensory receptor membrane to open or close,
which results in a change in current flow (receptor potential). NB: Receptor potentials
are graded electronic potentials, whose amplitude correlates with the size of the
stimulus.
3. If the receptor potential is depolarizing, it moves the membrane potential toward the
threshold potential and increases the likelihood that an action potential will occur. If
the receptor potential is hyperpolarizing, it moves the membrane potential away from
the threshold potential, always decreasing the likelihood that action potentials will
occur.
 Peripheral Nervous System - Receptors
Sensory Transduction By Receptors
Mechanoreceptors
• are activated by pressure or changes in pressure. Mechanoreceptors include,
but are not limited to, the
1. Pacinian corpuscles in subcutaneous tissue,
2. Meissner corpuscles in nonhairy skin (touch),
3. Baroreceptors in the carotid sinus (blood pressure), and
4. Hair cells on the organ of Corti (audition) and in the semicircular canals (vestibular
system).
 Peripheral Nervous System - Receptors
Sensory Transduction By Receptors - (transduction of mechanical stimulus)
 Peripheral Nervous System - Receptors
Sensory Transduction By Receptors - (transduction of mechanical stimulus)
 Peripheral Nervous System - Receptors
Sensory Transduction By Receptors
Photoreceptors
• are activated by light and are involved in vision.
Chemoreceptors
• are activated by chemicals and are involved in olfaction, taste, and detection of
oxygen and carbon dioxide in the control of breathing.
Thermoreceptors
• are activated by temperature or changes in temperature. Nociceptors are
activated by extremes of pressure, temperature, or noxious chemicals.
 Peripheral Nervous System - Receptors
Receptive Field
• A receptive field defines an area of the body that when stimulated results in a
change in firing rate of a sensory neuron.
• The change in firing rate can be an increase or a decrease; therefore receptive
fields are described as excitatory (producing an increase in the firing rate of a
sensory neuron) or inhibitory (producing a decrease in the firing rate of a
sensory neuron).
• Receptive fields vary in size (Fig. 3.6 below). The smaller the receptive field, the
more precisely the sensation can be localized or identified.
 Peripheral Nervous System - Receptors
Receptive Field
.
 Peripheral Nervous System - Receptors
Receptive Field
• Receptive fields can be excitatory or inhibitory, with the pattern of
excitatory or inhibitory receptive fields conveying additional
information to the CNS.
• Figure 3.7 above illustrates one such pattern for a second-order
neuron. The receptive field on the skin for this particular neuron has a
central region of excitation, bounded on either side by regions of
inhibition.
• All of the incoming information is processed in relay nuclei of the spinal cord
or brain stem.
• The areas of inhibition contribute to a phenomenon called lateral inhibition
and aid in the precise localization of the stimulus by defining its boundaries
and providing a contrasting border.
 Peripheral Nervous System - Receptors
Receptive Field
• Receptive field depends on the density of receptors in that area of
skin.
• The smaller the receptive field, the greater the density of receptors in
that skin area.
• Smaller receptive fields produce greater acuity or discriminative
ability(e.g. fingertips).
• Two-point discrimination maps out receptive field density.
• Density of receptive fields varies across the body (lips, fingers have
highest density so most sensitive).
 Peripheral Nervous System - Receptors
Receptive Field
 Peripheral Nervous System - Receptors
Receptive Field – Two-point discrimination
 Peripheral Nervous System - Receptors
Receptive Field
 Peripheral Nervous System - Receptors
Receptive Field
 Peripheral Nervous System - Receptors
Receptive Field
 Peripheral Nervous System - Receptors
Sensory Coding
• This involves how the CNS is informed of the type (what?), location (where?),
duration (how long) and intensity (how much?) of a stimulus.
• The CNS is able to distinguish between different sensory information base on
the below properties of a stimulus:
• Type of stimulus (Sensory modality)
• Mechanism: Distinguished by the type of receptor activated and the specific
pathway over which this information is transmitted to a particular area of the
cerebral cortex
• Location of stimulus
• Mechanism: Distinguished by the location of the activated receptive field and the
pathway that is subsequently activated to transmit this information to the area of
the somatosensory cortex representing that particular location. Lateral inhibition.
 Peripheral Nervous System - Receptors
Sensory Coding
• Intensity of stimulus
• Mechanism: Distinguished by the frequency of action potentials initiated in
an activated afferent neuron and the number of receptors (and afferent
neurons) activated and the activation of different types of receptors (Thus a
light touch of the skin may activate only mechanoreceptors, whereas an
intense damaging stimulus to the skin may activate mechanoreceptors and
nociceptors. The intense stimulus would be detected not only as stronger
but also as a different modality).
• Threshold of stimulus
• is the minimum stimulus that can be detected. Threshold is best appreciated
in the context of the receptor potential. If a stimulus is large enough to
produce a depolarizing receptor potential that reaches threshold, it will be
detected. Smaller subthreshold stimuli will not be detected.
 Peripheral Nervous System - Receptors
Sensory Coding
• Duration of stimulus
• is encoded by the duration of firing of sensory neurons. However, during a prolonged
stimulus, receptors “adapt” to the stimulus and change their firing rates. Sensory
neurons may be rapidly adapting or slowly adapting.
• Adaptation is observed when a constant stimulus is applied for a period of time. Initially,
the frequency of action potentials is high, but as time passes, this frequency declines
even though the stimulus continues. The pattern of adaptation differs among different
types of receptors. Some receptors are phasic, meaning they adapt rapidly to the
stimulus (e.g., pacinian corpuscles), and others are tonic, meaning they adapt slowly to
the stimulus (e.g., Merkel cells).
• Phasic receptors are illustrated by the Pacinian corpuscles, which detect rapid changes in the stimulus
or vibrations. These receptors adapt rapidly to a constant stimulus and primarily detect onset and
offset of a stimulus and a changing stimulus.
• Tonic receptors are illustrated by mechanoreceptors (e.g., Merkel receptors) in the skin, which detect
steady pressure. When compared with the Pacinian corpuscles (which detect vibration with their fast
on-off response), tonic mechanoreceptors are designed to encode duration and intensity of stimulus.
 Peripheral Nervous System - Receptors
Sensory Coding
• Duration of stimulus:
Adaptation
 Peripheral Nervous System - Receptors
Sensory Coding
• Neural mapping
Stimulus information
also is encoded in
neural maps formed by
arrays of neurons
receiving information
from different locations
on the body (i.e.,
somatotopic maps),
from different locations
on the
retina (i.e., retinotopic
maps), or from
different
sound frequencies (i.e.,
tonotopic maps).
 Peripheral Nervous System - Receptors
Sensory
Coding
• Neural
mapping
 Peripheral Nervous System - Receptors
Sensory
Coding
• Neural
mapping
 Peripheral Nervous System - Receptors
Sensory
Coding
• Neural
mapping
 Peripheral Nervous System - Receptors
Sensory
Coding
• Neural
mapping

- Sensory
Homonculus
(green strip)
 Peripheral Nervous System - Receptors
Sensory
Coding
• Neural
mapping

Receptors are
organized in
maps by
dermatome
A dermatome is
an area of skin
supplied by the
dorsal (sensory)
root of a spinal
nerve.
 Peripheral Nervous
System - Receptors

Sensory Coding
• Neural
mapping

Receptors are organized in

maps by dermatome
A dermatome is an area of skin
supplied by the dorsal (sensory)
root of a spinal nerve.
 Peripheral Nervous
System - Receptors

Sensory Coding
• Neural
mapping

Receptors are organized in

maps by dermatome
A dermatome is an area of skin
supplied by the dorsal (sensory)
root of a spinal nerve.
 Peripheral Nervous
System - Receptors

Sensory Coding
• Neural
mapping

Receptors are organized in

maps by dermatome
A dermatome is an area of skin
supplied by the dorsal (sensory)
root of a spinal nerve.
 Peripheral Nervous
System - Receptors

Sensory Coding
• Neural
mapping

Receptors are organized in

maps by dermatome
A dermatome is an area of skin
supplied by the dorsal (sensory)
root of a spinal nerve.
 Peripheral Nervous System - Receptors
Sensory
Coding
• Neural
mapping

Receptors are
organized in
maps by
dermatome
A dermatome is
an area of skin
supplied by the
dorsal (sensory)
root of a spinal
nerve.
 Peripheral Nervous System - Receptors
Sensory
Coding
• Neural
mapping

Receptors are
organized in
maps by
dermatome
A dermatome is
an area of skin
supplied by the
dorsal (sensory)
root of a spinal
nerve.
 Peripheral Nervous System - Nerves

SENSORY NEUERONS HAVE BEEN

DISCUSSED EARLER
 Peripheral Nervous System – SENSORY
TRACTS
SENSORY TRACTS / PATHWAYS HAVE
BEEN DISCUSSED EARLER
UNDER CNS
 Peripheral Nervous System – MOTOR
SYSTEMS
Content
1. Primary Motor Cortex (UMN) – Discussed earlier
2. Basanglia (UMN) – Assignment (Parkinson’s Dx & Huntington Dx
3. Motor Tracts (UMN) - Discussed earlier under CNS
4. Motor Neuron / Nerve / AHC (LMN)
5. Neuromuscular Junction - Discussed earlier in muscle physiology
Peripheral Nervous System
 Peripheral Nervous System – MOTOR
SYSTEMS
INTRODUCTION
• Posture and movement depend on a combination of
1. involuntary reflexes coordinated by the spinal cord and
2. voluntary actions controlled by higher brain centers.
3. Involuntary actions controlled by ANS
• A myotome is defined as a group of muscles which is innervated by a single
motor spinal nerve root.
• A motor unit is defined as a single motoneuron and the muscle fibers that it
innervates.
• A dermatome is an area of the skin innervated by the nerves from a single
sensory spinal nerve root.
Peripheral Nervous System
Peripheral Nervous System
 Peripheral Nervous System – MOTOR
SYSTEMS
MOTOR NEURON
• There are two types of motoneurons:
• α Motoneurons innervate extrafusal skeletal muscle fibers. Action potentials in α
motoneurons lead to action potentials in the extrafusal muscle fibers they innervate,
which results in contraction.
• γ Motoneurons innervate specialized intrafusal muscle fibers, a component of the muscle
spindles. The overall function of the muscle spindle is to sense muscle length; the
function of the γ motoneurons innervating them is to adjust the sensitivity of the muscle
spindles (so that they respond appropriately as the extrafusal fibers contract and shorten).
• α Motoneurons and γ motoneurons are coactivated (activated simultaneously)
so that muscle spindles remain sensitive to changes in muscle length even as the
muscle contracts and shortens.
 Peripheral Nervous System – CRANIAL
NERVES
• Twelve (12) pairs of cranial nerves arise from the brain (cerebrum &
brainstem) to serve as peripheral nerves for the head, neck and some
parts of the shoulder.

• They have sensory, motor, or both sensory and motor functions.

• Each nerve is identified by a number (I through XII) and a name.

• Four cranial nerves carry parasympathetic fibers that serve muscles

and glands (CN III, CN VII, CN IX & CN X).
Peripheral Nervous System – CRANIAL
NERVES
Peripheral Nervous System – CRANIAL
NERVES
Peripheral Nervous
System – CRANIAL
NERVES
Peripheral Nervous System – CRANIAL
NERVES
Peripheral Nervous
System – CRANIAL
NERVES
Peripheral Nervous System – CRANIAL
NERVES
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve I: Olfactory

• Arises from the olfactory epithelium.

• Passes through the cribriform plate of the ethmoid bone.

• Fibers run through the olfactory bulb and terminate in the primary olfactory
cortex.

• Functions solely by carrying afferent impulses for the sense of smell.

 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve I: Olfactory
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve II: Optic

• Arises from the retina of the eye.

• Optic nerves pass through the optic canals and converge at the optic
chiasm.

• They continue to the thalamus where they synapse.

• From there, the optic radiation fibers run to the visual cortex.

• Functions solely by carrying afferent impulses for vision.

 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve II: Optic
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve III: Oculomotor

• Fibers extend from the ventral midbrain, pass through the

superior orbital fissure, and go to the extrinsic eye muscles.

• Functions in raising the eyelid, directing the eyeball,

constricting the iris, and controlling lens shape.

• Parasympathetic cell bodies are in the ciliary ganglia.

 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve III: Oculomotor
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve III, IV & VI

Control movements of the

Eyeballs in all directions

 Peripheral Nervous
System – CRANIAL
NERVES

Cranial Nerve III, IV & VI

Control movements of the

Eyeballs in all directions

 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve IV: Trochlear

• Fibers emerge from the dorsal midbrain and enter the orbits
via the superior orbital fissures; innervate the superior
oblique muscle.

• Primarily a motor nerve that directs the eyeball

(depression,Incyclotorsion, abduction).
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve IV: Trochlear
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve IV: Trochlear
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve V: Trigeminal

• Three divisions: ophthalmic (V1), maxillary (V2), and mandibular (V3).

• Fibers run from the face to the pons via the superior orbital fissure
(V1), the foramen rotundum (V2), and the foramen ovale (V3).

• Conveys sensory impulses from various areas of the face (V1) and
(V2), and supplies motor fibers (V3) for mastication.
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve V: Trigeminal
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve VI: Abducens

• Fibers leave the inferior pons and enter the orbit via the
superior orbital fissure.

• Primarily a somatic motor nerve to the lateral rectus muscle.

 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve VI: Abducens
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve VII: Facial

• Fibers leave the pons, travel through the internal acoustic meatus, and
emerge through the stylomastoid foramen to the lateral aspect of the
face.

• Somatic Motor to the muscles of facial expression, and

• Visceral motor to lacrimal and salivary glands.

• Sensory function is taste from the anterior two-thirds of the tongue.

Peripheral Nervous System – CN
Cranial Nerve

VII: Facial
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve VIII: Vestibulocochlear

• Fibers arise from the hearing and equilibrium apparatus of the inner
ear, pass through the internal acoustic meatus, and enter the
brainstem.

• Two divisions – cochlear (hearing) and vestibular (balance).

• A sensory nerve
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve VIII: Vestibulocochlear
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve IX: Glossopharyngeal

• Fibers emerge from the medulla, leave the skull via the jugular foramen, and run
to the throat.

• Nerve IX is a mixed nerve with motor and sensory functions.

• Somatic Motor – innervates part of the tongue and pharynx, and

• Visceral Motor fibers to the parotid & salivary gland.

• Visceral Sensory –taste and general sensory impulses from the tongue and
pharynx.
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve IX: Glossopharyngeal
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve X: Vagus
• The only cranial nerve that extends beyond the head and neck.

• Fibers emerge from the medulla via the jugular foramen.

• The vagus is a mixed nerve.

• Most visceral motor fibers are parasympathetic fibers to the heart, lungs, and
visceral organs.

• Its visceral sensory function is in taste, thorax and abdomen

Peripheral Nervous System
– CRANIAL NERVES

Cranial

Nerve X:

Vagus
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve XI: Accessory

• Formed from a cranial root emerging from the medulla and a spinal
root arising from the superior region of the spinal cord.

• The spinal root passes upward into the cranium via the foramen
magnum.

• The accessory nerve leaves the cranium via the jugular foramen.
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve XI: Accessory
• Primarily a somatic motor nerve
• Supplies fibers to the larynx, pharynx, and soft palate.
• Innervates the trapezius and sternocleidomastoid, which move the head and
neck.
 Peripheral Nervous System – CRANIAL
NERVES
Cranial Nerve XI: Accessory
 Peripheral Nervous System – CRANIAL
NERVES
• Cranial Nerve XII: Hypoglossal

• Fibers arise from the medulla and exit the skull via the hypoglossal
canal.

• Somatic motor innervates the muscles of the tongue, which

contribute to swallowing and speech.
 Peripheral Nervous System – CRANIAL
NERVES
• Cranial Nerve XII: Hypoglossal
 Peripheral Nervous System – NERVES FIBERS
• Nerve fibers are classified according to their axonal diameter,
conduction velocity, and function
• The velocity depends on the size of the fibers and the presence or absence
of myelination.

• Three main types –A, B and C

• The classification A, B and C applies to both sensory and motor fibers
• A type has subtypes: A-alpha, A-beta, A-gamma and A-delta

• In terms of conduction velocity: A > B> C

• A and B are generally myelinated
• In terms of size: A > B> C
Peripheral Nervous System – NERVES FIBERS
Peripheral Nervous System – NERVES FIBERS
Peripheral Nervous System – NERVES FIBERS
Peripheral Nervous System – NERVES FIBERS
Clinical Application –Regional
Anaesthesia
• Smaller and unmyelinated nerves are blocked faster
–Smaller nerves are blocked first
–myelinated nerves are blocked last because they are
resistant to local anaesthetic agents

• Local anesthetics depress transmission in group C fibers

before they affect group A touch fibers
Peripheral Nervous System – Clinical Application
SYMPTOMS OF PNS DISEASE
• Single focal lesions: weakness/numbness/ pain in one limb, often
defined to one part of the limb

• Multiple or diffuse lesions: weakness/ numbness/pain in more than

one limb, usually bilateral and distal
Peripheral Nervous System – Clinical Application
SIGNS OF PNS DISEASE
• Lower motor neuron signs (atrophy, fasciculations)
• Hyporeflexia or areflexia
• Hyperreflexia and spasticity occur with upper motor neuron lesions (CNS)
• Hyporeflexia, fasciculations, atrophy with lower motor neuron lesions (PNS)
• Patch of sensory loss, or stocking-glove sensory loss

• Note UMN signs (spasticity, hyperreflexia, upgoing toe) or “brain”

signs (impaired consciousness, cognition, or language)
Peripheral Nervous System – Clinical Application
WORKUP PNS DISEASE
• Serologies, especially for treatable causes
• Electromyography (EMG) helps localize and characterize lesions of
PNS
• Imaging for some focal lesions, or to exclude CNS mimics (such as
cord lesion or stroke)
• CSF analysis in demyelinating neuropathies, or polyradiculopathy
• Nerve biopsy
NOTE: EMG measures electrical activity in muscles when at rest and in
use. Nerve conduction study (NCS) on the other hand measures how
well and how fast the nerves can send electrical signals.
Peripheral Nervous System – Clinical Application
PNS DISEASE : Amyotrophic lateral sclerosis
• Anterior horn cells (lower motor neurons) and upper motor neurons
degenerate
• Mix of UMN and LMN signs/symptoms
• Weakness, spasticity, multifocal muscle atrophy
• No sensory loss from ALS!
• Loss of speech, swallow, respiration Death in 2-5 years
Peripheral Nervous System – Clinical Application
PNS DISEASE : Radiculopathy
Peripheral Nervous System – Clinical Application
PNS DISEASE : Spinal Nerve Root Disorders (radiculopathies)
• Most common: monoradiculopathy (cervical or lumbosacral)
• Radiating pain, +/- weakness, +/- sensory loss. Reduced reflex for
that root level
• Commonest causes: disk herniation, minor trauma, degenerative
change
• Usually self-limited
• Request for Image if severe, worsening, or concern for cancer,
infection
Peripheral Nervous System – Clinical Application
PNS DISEASE : Plexopathy
Peripheral Nervous System – Clinical Application
PNS DISEASE : Plexopathy
• PNS syndrome in one limb not explained by a single spinal root, or by
a single “named” peripheral nerve
• Causes: trauma or stretch, compression by tumor or hematoma,
radiation, diabetic
• EMG confirms plexopathy
• Image if compressive lesion suspected
Peripheral Nervous System – Clinical Application
PNS DISEASE : Plexopathy
Peripheral Nervous System – Clinical Application
PNS DISEASE : Mononeuropathy
Peripheral Nervous System – Clinical Application
PNS DISEASE : Mononeuropathy
• Weakness, numbness, pain, paresthesias confined to the distribution of
• UE: median nerve, radial n., ulnar n.
• LE: femoral n., sciatic n., peroneal n.

• Most common causes: entrapment, trauma, prolonged limb immobility (e.g.,

surgery)
Peripheral Nervous System – Clinical Application
PNS DISEASE : Some Important Mononeuropathies

• Median mononeuropathy at the wrist (carpal tunnel syndrome)

• Ulnar mononeuropathy at the elbow (cubital tunnel syndrome)

• Radial mononeuropathy (“Saturday night palsy”) wrist and finger

drop

• Peroneal mononeuropathy (e.g., from leg crossing) one cause of

footdrop
Peripheral Nervous System – Clinical Application
PNS DISEASE : Some Important Mononeuropathies
 Peripheral Nervous
System – Clinical
Application
PNS DISEASE : Peripheral Polyneuropathy
Peripheral Nervous System – Clinical Application
PNS DISEASE : “Peripheral Neuropathy”
• Distal symmetric polyneuropathy
• Affects longest sensory/ motor/ autonomic nerves
• Nerves are “dying back”
• Length dependent (“stocking glove”)
• Symmetric loss of pin/ temp / vibration/ proprioception; distal reflex
loss
• Usually chronic. Many possible causes!
Peripheral Nervous System – Clinical Application
PNS DISEASE : “Peripheral Neuropathy” - Symptoms
• Initially, feet numb with paresthesia/ pain
• Symptoms ascend:  legs fingertips
• Distal weakness (feet, or fingers/grip), atrophy,
• Severe sensory loss can cause “steppage gait”, “sensory ataxia”,
imbalance, falls
• Feet prone to injuries, ulcers, deformation (e.g., “Charcot foot”)
• Autonomic: orthostasis, bladder and erectile dysfunction
Peripheral Nervous System – Clinical Application
PNS DISEASE : “Peripheral Neuropathy” - Causes
• Usually toxic or metabolic
• #1 cause: diabetes & impaired glucose tolerance
• B12
• Hematologic (e.g., multiple myeloma) or other immunoglobulin
disorders (check SPEP)
• Drugs: Li, chemotherapy
• Alcoholic neuropathy
• Liver or kidney disease
• HIV and neurosyphilis
• Inflammatory causes: connective tissue disease
Peripheral Nervous System – Clinical Application
PNS DISEASE : “Peripheral Neuropathy” - Workup
• For typical distal symmetric sensory > motor neuropathy: glucose /
a1c, B12, SPEP with ifix

• Need EMG and more if rapid or severe, prominent weakness,

asymmetry, young patient
Peripheral Nervous System – Clinical Application
PNS DISEASE : Myopathy
Autonomic Nervous
System
(ANS)
 Autonomic Nervous System – Introduction
• The autonomic nervous system is an involuntary system that controls and
modulates the functions primarily of visceral organs.
• Each pathway in the autonomic nervous system (ANS) consists of two neurons:
a preganglionic neuron and a postganglionic neuron. (NB: somatic NS consists
of a single motoneuron and the skeletal muscle fibers it innervates).
• The cell body of each preganglionic neuron resides in the central nervous
system.
• The axons of these preganglionic neurons synapse on the cell bodies of
postganglionic neurons in one of several autonomic ganglia located outside
the central nervous system.
 Autonomic Nervous System – Introduction
• The axons of the postganglionic neurons then travel to the periphery, where
they synapse on visceral effector organs such as the heart, bronchioles,
vascular smooth muscle, gastrointestinal tract, bladder, and genitalia.
• All preganglionic neurons of the autonomic nervous system release
acetylcholine.
• Postganglionic neurons release either acetylcholine or norepinephrine or, in
some cases, neuropeptides.
• The ANS has two major divisions: the sympathetic and the parasympathetic,
which often complement each other in the regulation of organ system function.
A third division of the autonomic nervous system, the enteric nervous system,
is located in plexuses of the gastrointestinal tract
 Autonomic
Nervous
System –
Introduction
 Autonomic Nervous System – Introduction
• Preganglionic neurons in the sympathetic division originate in the
thoracolumbar spinal cord.
• Preganglionic neurons in the parasympathetic division originate in the brain
stem and sacral spinal cord.
• The terms adrenergic and cholinergic are used to describe neurons of either
division, according to which neurotransmitter they synthesize and release.
• Adrenergic neurons release norepinephrine; receptors for norepinephrine on
the effector organs are called adrenoreceptors.
• Adrenoreceptors may be activated by norepinephrine, which is released from
adrenergic neurons, or by epinephrine, which is secreted into the circulation by
the adrenal medulla.
• All preganglionic neurons release ACh and therefore are called cholinergic.
 Autonomic
Nervous System –
Introduction
 Autonomic
Nervous System –
Introduction
 Autonomic
Nervous System –
Introduction
 Autonomic Nervous System – Introduction
• The junctions between postganglionic autonomic neurons and their effectors
(target tissues), the neuroeffector junctions, are analogous to the
neuromuscular junctions of the somatic nervous system.
• There are, however, several structural and functional differences with the
neuromuscular junction.
1. Neuromuscular junction has a discrete arrangement, whereby the “effector,” a skeletal
muscle fiber, is innervated by a single motoneuron. In contrast, in the autonomic
nervous system, the postganglionic neurons that innervate target tissues form diffuse,
branching networks. Beads, or varicosities, line these branches and are the sites of
neurotransmitter synthesis, storage, and release. The varicosities are therefore
analogous to the presynaptic nerve terminals of the neuromuscular junction.
2. There is overlap in the branching networks from different postganglionic neurons, such
that target tissues may be innervated by many postganglionic neurons.
3. In the autonomic nervous system, postsynaptic receptors are widely distributed on
the target tissues, and there is no specialized region of receptors analogous to the
motor end plate of skeletal muscle.
 Autonomic Nervous System – SYMPATHETIC
NS
• The overall function of the sympathetic nervous system is to mobilize the body
for activity.
• In the extreme, if a person is exposed to a stressful situation, the sympathetic
nervous system is activated with a response known as “fight or flight,” which
includes :
• increased arterial pressure,
• increased blood flow to active muscles,
• increased metabolic rate,
• increased blood glucose concentration, and
• increased mental activity.
• One category of preganglionic neuron synapses on postganglionic neurons in
paravertebral ganglia (e.g., superior cervical ganglion) of the sympathetic
chain.
 Autonomic Nervous System – SYMPATHETIC
NS
• The other category of preganglionic neuron passes through the sympathetic
chain without synapsing and continues on to synapse in prevertebral ganglia
(celiac, superior mesenteric, and inferior mesenteric) that supply visceral
organs, glands, and the enteric nervous system of the gastrointestinal tract.
• A tumor of the adrenal medulla, or pheochromocytoma, may be located on or
near the adrenal medulla, or at a distant (ectopic) location in the body. Unlike
the normal adrenal medulla, which secretes mainly epinephrine, a
pheochromocytoma secretes mainly norepinephrine, which is explained by the
fact that the tumor is located too far from the adrenal cortex to receive the
cortisol that is required by phenylethanolamine-N-methyltransferase (PNMT).
Autonomic Nervous
System –
SYMPATHETIC NS
 Autonomic Nervous System –
PARASYMPATHETIC NS
• The overall function of the parasympathetic nervous system is restorative, to
conserve energy.
• Figure in the next slide depicts the organization of the parasympathetic nervous
system in relation to the CNS (brain stem and spinal cord), the parasympathetic
ganglia, and the effector organs.
• Preganglionic neurons of the parasympathetic division have their cell bodies in
either the brain stem (midbrain, pons, and medulla) or the sacral spinal cord.
• Preganglionic axons project to a series of ganglia located near or in the
effector organs.
 Autonomic Nervous
System –
PARASYMPATHETI
C NS
 Autonomic Nervous
System – Effects of the
Autonomic Nervous
System on Organ
System Function
 Autonomic Nervous
System –
PARASYMPATHETI
C NS
 Autonomic Nervous
System –
PARASYMPATHETI
C NS
 Autonomic
Nervous System
Autonomic
Nervous
System
Autonomic
Nervous
System
Autonomic
Nervous
System
Autonomic
Nervous
System
SPECIAL
SENSES