Neuro Anatomy PDF

Organization of the Nervous System  Anatomical divisions: 1. Central Nervous System  The brain + the spinal cord  2. The center of integration and control Peripheral Nervous System   The nervous system outside of the brain and spinal cord Consists of:   31 Spinal nerves  Carry info to and fr...

Organization of the Nervous System  Anatomical divisions: 1. Central Nervous System  The brain + the spinal cord  2. The center of integration and control Peripheral Nervous System   The nervous system outside of the brain and spinal cord Consists of:   31 Spinal nerves  Carry info to and from the spinal cord 12 Cranial nerves  Carry info to and from the brain Brain Forebrain: (Prosencephalon) Cerebrum: (Telencephalon) Diencephalon Thalamus Hypothalamus Epithalamus Subthalamus Midbrain: (Mesencephalon) Hindbrain: (Rhombencephalon) Pons Medulla oblingata Cerebellum Peripheral Nervous System   Responsible for communication between the CNS and the rest of the body. Can be divided into:  Sensory Division  Afferent division     Conducts impulses from receptors to the CNS Informs the CNS of the state of the body interior and exterior Sensory nerve fibers can be somatic (from skin, skeletal muscles or joints) or visceral (from organs within the body cavity) Motor Division  Efferent division   Conducts impulses from CNS to effectors (muscles/glands) Motor nerve fibers Peripheral Nervous System  Somatic nervous system 1) Sensory neurons: (somatic sensory neurons) convey information to the CNS from sensory receptors in the skin, skeletal muscles, and joints, and from the receptors for the special senses. 2) Motor neurons: (somatic motor neurons)  VOLUNTARY  conduct impulses from the CNS to skeletal muscles Peripheral Nervous System  Autonomic nervous system 1) Sensory neurons: Autonomic (visceral) sensory neurons convey information to the CNS from autonomic sensory receptors, located primarily in the visceral organs (smooth muscle organs in the thorax, abdomen,and pelvis) 2) Motor neurons: Autonomic motor neurons  INVOLUNTARY (generally)  Conducts impulses from the CNS to smooth muscle, cardiac muscle, and glands. Upper motor neurons in primary motor cortex Somatic motor nuclei of brain stem Skeletal muscle Lower motor neurons Somatic motor nuclei of spinal cord Skeletal muscle In the somatic nervous system (SNS), an upper motor neuron in the CNS controls a lower-motor neuron in the brain stem or spinal cord. The axon of the lower-motor neuron has direct control over skeletal muscle fibers. Stimulation of the lower- motor neuron always has an excitatory effect on the skeletal muscle fibers. Visceral motor nuclei in hypothalamus Preganglionic neuron Visceral effectors Autonomic nuclei in brain stem Ganglionic neurons Autonomic nuclei in spinal cord In the autonomic nervous system (ANS), the axon of a preganglionic neuron in the CNS controls ganglionic neurons in the periphery. Stimulation of the ganglionic neurons may lead to excitation or inhibition of the visceral effector innervated Preganglionic neuron  Axon of 1st (preganglionic) neuron leaves CNS to synapse with the 2nd (ganglionic) neuron  Axon of 2nd (postganglionic) neuron extends to the organ it serves Diagram contrasts somatic (lower) and autonomic: autonomic this dorsal root ganglion is sensory somatic 16 Note: the autonomic ganglion is motor Sensory ganglion Ganglion cells in dorsal root ganglia do not receive synapses 17 External anatomy of Spinal Cord      Runs through the vertebral canal Extends from foramen magnum to second lumbar vertebra Regions  Cervical (8)  Thoracic (12)  Lumbar (5)  Sacral (5)  Coccygeal (1) Gives rise to (31) pairs of spinal nerves  All are mixed nerves Not uniform in diameter  Cervical enlargement: supplies upper limbs  Lumbar enlargement: supplies lower limbs External anatomy of Spinal Cord Flattened slightly anteriorly and posteriorly length of the adult spinal cord ranges from 42 to 45 cm Conus medullaris- tapered inferior end (conical structure) – Ends between L1 and L2 Cauda equina - origin of spinal nerves extending inferiorly from conus medullaris. Meninges  Connective tissue membranes  Dura mater:  Outermost layer; continuous with epineurium of the spinal nerves Dense irregular connective tissue from the level of the foramen magnum to S2 Closed caudal end is anchored to the coccyx by the filum terminale externum     Arachnoid mater:  Thin web arrangement of delicate collagen and some elastic fibers. Adheres to the inner surface of the dura mater  Meninges   Connective tissue membranes Pia mater:  Bound tightly to surface  Thin transparent connective tissue layer that adheres to the surface of the spinal cord and brain  Forms the filum terminale  anchors spinal cord to coccyx  Forms the denticulate ligaments that attach the spinal cord to the arachnoid mater and inner surface of the dura mater Spaces – Epidural: space between the dura mater and the wall of the vertebral canal. Anesthestics injected here Fat-fill – Subdural space: serous fluid – Subarachnoid: between pia and arachnoid Filled with CSF Lumbar puncture supracristal line L3-L4 Spinal cord segment     The segments of the spinal cord are not in line with the corresponded vertebrae and the difference increases as we go downward. The roots increase in length as you go downward. Every spinal nerve emerges from the spinal column through the intervertebral foramen under its corresponding vertebra first 7 cervical nerves pass above their corresponding vertebrae Spinous spinal cord process segment C7 C8 T3 T5 T9 T12 T10 L1-2 T11 L3-4 T12 L5 L1 S1-end Herniated Disc/ ruptured disc/ slipped disc protrusion (leakage) of the gelatinous nucleus pulposus through the anulus fibrosus of IV disc Posterolateral direction: Thinner annulus fibrosus 95% in L4/L5 or L5/S1 somatic sensory nerve (GSA) somatic motor nerve (GSE) spinal nerve skin (dermatome) muscle (myotome) Common lumbar disc problems Disc Root Percentage Motor weakness Sensory changes L3-L4 L4 3-10% Knee extension (Quadriceps femoris Anteriomedial Knee jerk leg (saphenous) L4-L5 L5 40-45% Big toe dorsifelxion (EHL) and TA Hamstring jerk Big toe , anteriolateral leg (Common P) L5-S1 S1 45-50% Foot planter flextion (Gastrocnemius) Lateral border of foot (sural) Important myotomes of lower limb Test L5: by asking the patient to stand on his heels Test S1: by asking the patient to stand on his tiptoes Reflex affected Ankle jerk Major symptoms of disc herniation Low back pain: radiating to the gluteal region, the back of the thigh and back of the leg spinal nerve gives a meningeal branch bring sensation from the dura matter Dura matter is sensitive to stretch Pain is diffused due to overlapping dermatomes Straight Leg Raise Test (SLR) MRI is commonly used to aid in making the diagnosis of a herniated disc 28 Cross Section of Spinal Cord Anterior median fissure: wide groove on the Anterior aspect posterior median sulcus: Narrow groove on the posterior aspect Gray matter: neuron cell bodies, dendrites, axons – Divided into horns - Posterior (dorsal) horn (cell body of sensory N) - Anterior (ventral) horn (cell body of motor N to skeletal M) -Lateral horn (cell body of motor N to cardiac M, smooth M, glands) Cross Section of Spinal Cord l Ascending tracts Mechanoreceptors  Meissner’s corpuscle  Respond to touch, pressure and low frequency vibration (low frequency)  rapidly adapting  Merkel’s disc (Tactile Disc)  Discriminative touch  Slowly adapting  End organ of Ruffini  sensitive to skin stretch  Slowly adapting  Pacinian corpuscles  Vibrations (high frequency)  rapidly adapting Rapidly adapting: signals fade away after stimulus exposure Slow adaptation: signals is transmitted as long as the stimulus is present Adaptation of receptors occurs when a receptor is continuously stimulated. Many receptors become less sensitive with continued stimuli. Rapidly adapting receptors are best at detecting rapidly changing signals, while slowly adapting receptors are capable of detecting a long, continuous signal Thermoreceptors  Free nerve endings  Detect change in temperature  TRP channels Nociceptors  Free nerve endings  Detect damage (pain receptors)  Multimodal Adaptation of receptors occurs when a receptor is continuously stimulated. Many receptors become less sensitive with continued stimuli. Rapidly adapting receptors are best at detecting rapidly changing signals, while slowly adapting receptors are capable of detecting a long, continuous signal 34 Receptive field  Every receptor receives sensation from a certain area of the skin, (receptive field) The greater the density of receptors, the smaller the receptive fields of individual afferent fibers The smaller the receptive field the greater is the acuity or the discriminative touch Labelled line theory  individual receptors preferentially transduce information about an adequate stimulus  individual primary afferent fibres carry information from a single type of receptor Conclusion: pathways carrying sensory information centrally are therefore also specific, forming a "labelled line" regarding a particular stimulus  Note: The adequate stimulus is the amount and type of energy required to stimulate a specific sensory organ  Sensation:  Modality  Locality  Intensity 36 Posterior White Column-Medial Lemniscal Pathway Modality: Discriminative Touch Sensation (include Vibration) and Conscious Proprioception Receptor: Most receptors except free nerve endings Ist Neuron: Dorsal Root Ganglion 2nd Neuron: Dorsal Column Nuclei (Nucleus Gracilis and Cuneatus) ---Internal Arcuate Fiber Lemniscal Decussation ---Medial Lemniscus 3rd Neuron: Thalamus (VPL) Internal Capsule ----- Corona Radiata Termination: Primary Somesthetic Area (S I)