CHAPTER 8

Nervous System

Nervous System Overview

Nervous System
Brain
Spinal cord
Nerves

Functions of nervous system

Regulates and coordinates all body activities
Center of all mental activity, including thought,
learning, and memory
2

Nervous System Divisions

Central Nervous System (CNS)
Brain
Spinal Cord
Processes and stores sensory and motor
information
Controls consciousness

Nervous System Divisions

Peripheral Nervous System (PNS)
12 Pairs of Cranial Nerves
31 Pairs of Spinal Nerves
Transmits sensory and motor impulses back and
forth between CNS and rest of body

Nervous System Divisions

Peripheral Nervous System

Afferent (sensory) nerves
Carry impulses from the body to the central
nervous system

Efferent (motor) nerves

Carry impulses from the central nervous
system to muscles and glands
Cause the target organs to do something in
response to commands
6

Peripheral Nervous System

Somatic Nervous System (SNS)
Provides voluntary control over skeletal
muscle contractions

Autonomic Nervous System (ANS)

Provides involuntary control over smooth
muscle, cardiac muscle, and glandular
activity and secretions in response to the
commands of the central nervous system

Autonomic Nervous System

Sympathetic nerves

Increase heart rate

Constrict blood vessels
Raise blood pressure
Fight-or-flight response

Parasympathetic nerves

Slow heart rate

Increase peristalsis of intestines
Increase glandular secretions
Relax sphincters
8

Cells of the Nervous System

Neuron
Cell body
Contains the nucleus and cytoplasm

Axon
Conducts impulses away from the cell body
Some axons are covered with a myelin sheath

Dendrite
Conducts impulses toward the cell body

Synapse
Space between two nerves which the impulse
must cross
9

Cells of the Nervous System

10

Cells of the Nervous System

Neuroglia
Connective tissue
Support system for neurons

Do not conduct impulses

Protect nervous system through phagocytosis

Types of Neuroglia Cells

Astrocytes
Microglia
Oligodendrocytes
11

Central Nervous System

Brain
Surrounded by bone for protection
Enclosed in cranium

Spinal cord
Surrounded by vertebrae for protection
Surrounded by meninges and cerebrospinal
fluid

12

Meninges
Dura mater
Outermost layer of meninges
Tough, white connective tissue
Epidural space
Located outside of the dura mater
Contains supporting cushion of fat and connective
tissue

Subdural space
Located beneath the dura mater
Cavity is filled with serous fluid
13

Meninges
Arachnoid membrane
Middle layer of the meninges
Resembles a spider web
Subarachnoid space immediately beneath
Contains cerebrospinal fluid

Pia mater
Innermost layer of the meninges
Tightly bound to the surface of the brain
and spinal cord
14

Structures of the Brain

Cerebrum
Largest and uppermost portion of the brain
Controls consciousness, memory,
sensations, emotions, voluntary movements
Cortex = outer surface
Gyri = elevations
Sulci = grooves
Longitudinal fissure divides cerebrum into two
hemispheres
15

Structures of the Brain

Cerebellum
Attached to the brain stem
Maintains muscle tone
Coordinates normal movement and balance

Diencephalon
Located between cerebrum and midbrain
Consists of thalamus, hypothalamus, and
pineal gland
16

Structures of the Brain

Brain Stem
Region between diencephalon and spinal cord
Consists of midbrain, pons, and medulla
oblongata
Serves as pathway for impulses between brain
and spinal cord
Controls respiration, blood pressure, and heart
rate
17

Spinal Cord
Pathway for impulses traveling to and from
brain
Carries 31 pairs of spinal nerves
Affects limbs and lower part of body

18

PATHOLOGICAL CONDITIONS

Nervous System

Alzheimers Disease
Pronounced
(ALTS-high-merz dih-ZEEZ)

Defined
Progressive and extremely debilitating
deterioration of a persons intellectual
functioning

20

Amyotrophic Lateral Sclerosis

(ALS)
Pronounced
(ah-my-oh-TROFF-ik LAT-er-al skleh-ROHsis)

Defined
Severe weakening and wasting of the involved
muscle groups
Usually begins with hands
Progresses to shoulders, upper arms, then legs
21

Anencephaly
Pronounced
(an-en-SEFF-ah-lee)

Defined
Absence of the brain and spinal cord at birth
Condition is incompatible with life

22

Bells Palsy
Pronounced
(BELLZ PAWL-zee)

Defined
Temporary or permanent unilateral weakness
or paralysis of muscles in the face

23

Brain Abscess
Pronounced
(BRAIN AB-sess)

Defined
Accumulation of pus located anywhere in the
brain tissue

24

Carpal Tunnel Syndrome

Pronounced
(CAR-pal TUN-el SIN-drom)

Defined
Pinching or compression of median nerve
within the carpal tunnel
Inflammation and swelling of tendons cause
intermittent or continuous pain

25

Cerebral Concussion
Pronounced
(seh-REE-bral con-KUSH-un)

Defined
Brief interruption of brain function usually with
loss of consciousness lasting for a few
seconds

26

Cerebral Contusion
Pronounced
(seh-REE-bral con-TOO-zhun)

Defined
Small, scattered venous hemorrhages in the
brain
Bruise of the brain tissue
Occurs when brain strikes the inner skull

27

Cerebral Palsy
Pronounced
(seh-REE-bral PAWL-zee)

Defined
Collective term used to describe congenital
brain damage that is permanent but not
progressive
Characterized by the childs lack of control of
voluntary muscles

28

Cerebral Palsy
Spastic
Damage to cortex of the brain
Tense muscles
Very irritable muscle tone

Ataxic
Damage to cerebellum
Affects equilibrium

29

Cerebral Palsy
Athetoid
Damage to basal ganglia
Causes sudden jerking

Rigidity
Causes child to be in continual state of tension

Mixed cerebral palsy

30

Cerebrovascular Accident (CVA)

Pronounced
(seh-REE-broh-VASS-kyoo-lar AK-sih-dent)

Defined
Death of a specific portion of brain tissue
Results from decreased blood flow to that area of
the brain

Also called a stroke

31

Cerebrovascular Accident
Causes
Transient ischemic attacks (TIAs)
Also known as mini strokes

Cerebral thrombosis
Occurs largely in individuals older than 50

Cerebral embolism
Embolus causes an occlusion

Cerebral hemorrhage
Cerebral vessel ruptures
32

Degenerative Disk
Pronounced
(deh-JEN-er-ah-tiv disk)

Defined
Deterioration of the intervertebral disk
Usually due to constant motion and wear on the
disk

33

Encephalitis
Pronounced
(En-seff-ah-LYE-tis)

Defined
Inflammation of the brain or spinal cord
tissue
Virus enters CNS when person experiences viral
disease such as mumps, measles, or through
tick or mosquito bite

34

Epilepsy
Pronounced
(EP-ih-lep-see)

Defined
Syndrome of recurring episodes of excessive
irregular electrical activity of the central
nervous system, called seizures

35

Grand Mal Seizure

Pronounced
(grand MALL SEE-zyoor)

Defined
Epileptic seizure characterized by sudden
loss of consciousness and generalized
involuntary muscular contraction
Vacillates between rigid body extension and an
alternating contracting and relaxing of muscles

36

Petit Mal Seizure

Pronounced
(pet-EE MALL SEE-zyoor)

Defined
Small seizures in which there is a sudden,
temporary loss of consciousness
Lasts only a few seconds
Also known as absence seizures

37

Guillain-Brr Syndrome
Pronounced
(GEE-yon bah-RAY SIN-drom)

Defined
Acute polyneuritis of the peripheral nervous
system

Myelin sheaths on the axons are destroyed

Decreased nerve impulses
Loss of reflex response
Sudden muscle weakness
Usually follows viral gastrointestinal or respiratory
infection
38

Headache (Cephalalgia)
Pronounced
(seff-ah-LAL-jee-ah)

Defined
Pain anywhere within the cranial cavity
varying in intensity from mild to severe
May be chronic or acute
May occur as result of a disease process
May be totally benign

39

Migraine Headache
Pronounced
(MY-grain headache)

Defined
Recurring, pulsating, vascular headache
developing on one side of the head
Characterized by slow onset
May be preceded by an aura during which sensory
disturbance occurs

40

Cluster Headache
Pronounced
(KLUSS-ter headache)

Defined
Headache occurring typically two to three
hours after falling asleep
Described as extreme pain around one eye that
wakens the person from sleep

41

Tension Headache
Pronounced
(TEN-shun headache)

Defined
Headache that occurs from long, endured
contraction of the skeletal muscles around the
face, scalp, upper back, and neck

42

Epidural Hematoma
Pronounced
(eh-pih-DOO-ral hee-mah-TOH-mah)

Defined
Collection of blood located above the dura
mater and just below the skull

43

Subdural Hematoma
Pronounced
(sub-DOO-ral hee-mah-TOH-mah)

Defined
Collection of blood below the dura mater and
above the arachnoid layer of the meninges

44

Herniated Disk
Pronounced
(HER-nee-ay-ted disk)

Defined
Rupture or herniation of the disk center
through the disk wall and into the spinal canal
Causes pressure on the spinal cord or nerve roots

45

Huntingtons Chorea
Pronounced
(HUNT-ing-tonz koh-REE-ah)

Defined
Inherited neurological disease characterized
by rapid, jerky, involuntary movements and
increased dementia
Progressive, degenerative disease

46

Hydrocephalus
Pronounced
(high-droh-SEFF-ah-lus)

Defined
Abnormal increase of cerebrospinal fluid in
the brain that causes the ventricles of the
brain to dilate
Results in increased head circumference in infant
with open fontanel
Congenital disorder
47

Intracranial Tumors
Pronounced
(in-trah-KRAY-nee-al TOO-morz)

Defined
Tumors occurring in any structural region of
the brain
May be malignant or benign
Classified as primary or secondary
Named according to the tissue from which they
originate

48

Primary Intracranial Tumors

Pronounced
(PRIGH-mah-ree in-trah-KRAY-nee-al TOOmorz)

Defined
Tumors that arise from gliomas and the
meninges
Gliomas = malignant glial cells that are a support
for nerve tissue

49

Primary Intracranial Tumors

Glioblastoma multiforme
Most rapidly growing of the gliomas

Astrocytomas
Tend to invade surrounding structures

Ependymomas
Occur more commonly in children and
adolescents
Usually encapsulated and benign
50

Metastatic Intracranial Tumors

(Secondary)
Pronounced
(met-ah-STAT-ik in-trah-KRAY-nee-al TOOmorz)

Defined
Tumors occurring as a result of metastasis
from a primary site such as the lung or breast

51

Meningitis
(Acute Bacterial)
Pronounced
(men-in-JYE-tis ah-KYOOT back-TEE-ree-al)

Defined
Serious bacterial infection of the meninges
Can have residual debilitating effects or even a
fatal outcome
Must be diagnosed and treated promptly with
appropriate antibiotic therapy

52

Multiple Sclerosis (MS)

Pronounced
(MULL-tih-pl SKLEH-roh-sis)

Defined
Degenerative inflammatory disease of the
central nervous system attacking the myelin
sheath in the spinal cord and brain
Leaves area sclerosed (hardened) or scarred

53

Myasthenia Gravis
Pronounced
(my-ass-THEE-nee-ah GRAV-is)

Defined
Chronic progressive neuromuscular disorder
Causes skeletal muscle weakness (without
atrophy) and fatigue
Occurring at different levels of severity

54

Narcolepsy
Pronounced
(NAR-coh-lep-see)

Defined
Rare syndrome of uncontrolled, sudden
attacks of sleep
Main features of narcolepsy are daytime
sleepiness and cataplexy
Sudden loss of muscle tone
55

Neuroblastoma
Pronounced
(noo-roh-blass-TOH-mah)

Defined
Highly malignant tumor of the sympathetic
nervous system
Most commonly occurs in the adrenal medulla with
early metastasis to liver, lungs, lymph nodes, and
bone

56

Parkinsons Disease
Pronounced
(PARK-in-sons dih-ZEEZ)

Defined
Degenerative, slowly progressive deterioration
of nerves in the brain stems motor system,
characterized by a gradual onset of symptoms
Classic Symptoms: stooped posture with body
flexed forward, bowed head, shuffling gait, pillrolling gestures, expressionless mask-like facial
appearance
57

Peripheral Neuritis
Pronounced
(per-IF-er-al noo-RYE-tis)

Defined
Inflammation of one or more peripheral nerves
Effects are dependent upon particular nerve
involved

58

Poliomyelitis
Pronounced
(poh-lee-oh-my-ell-EYE-tis)

Defined
Infectious viral disease that affects the ability
of spinal cord and brain motor neurons to
receive stimulation
Virus enters through the upper respiratory tract
Muscles affected become paralyzed without the
motor nerve stimulation
59

Post Polio Syndrome

Pronounced
(POST POH-lee-oh SIN-drom)

Defined
Progressive weakness occurring at least 30
years after the initial poliomyelitis attack

60

Reyes Syndrome
Pronounced
(RISE SIN-drom)

Defined
Acute brain encephalopathy along with fatty
infiltration of the internal organs that may
follow acute viral infections
Occurs in children under the age of 18; often with a
fatal result
Linked to aspirin administration during a viral
illness
61

Shingles (Herpes Zoster)

Pronounced
(SHING-lz) (HER-peez ZOSS-ter)

Defined
Acute viral infection characterized by
inflammation of the underlying spinal or
cranial nerve pathway producing painful,
vesicular eruptions on the skin along these
nerve pathways
Seen mainly in adults
62

Shingles

Image courtesy of Robert A. Silverman,

M.D., Pediatric Dermatology,
Georgetown University

63

Skull Fracture (Depressed)

Pronounced
(SKULL FRAK-chur, deh-PREST)

Defined
Broken segment of the skull bone thrust into
the brain as a result of a direct force, usually a
blunt object

64

Spina Bifida Cystica

Pronounced
(SPY-nah BIFF-ih-dah SISS-tih-kah)

Defined
Back portion of one or more vertebrae is not
closed normally and a cyst protrudes through
the opening in the back, usually at the level of
the 5th lumbar or 1st sacral vertebrae
Congenital defect of the CNS

65

Meningocele
Pronounced
(men-IN-goh-seel)

Defined
Cystlike sac covered with skin or a thin
membrane protruding through the bony defect
in the vertebrae containing meninges and
CSF

66

Meningomyelocele
Pronounced
(men-in-goh-my-ELL-oh-seel)

Defined
Cystlike sac covered with skin or a thin
membrane protruding through the bony defect
in the vertebrae that contains meninges, CSF,
and spinal cord segments

67

Spina Bifida Occulta

Pronounced
(SPY-nah BIFF-ih-dah oh-KULL-tah)

Defined
Congenital defect of the central nervous
system in which the back portion of one or
more vertebrae is not closed
A dimpling over the area may occur

68

Paraplegia
Pronounced
(pair-ah-PLEE-jee-ah)

Defined
Paralysis of the lower extremities caused by
severe injury to the spinal cord in the thoracic
or lumbar region
Results in loss of sensory and motor control
below the level of the injury
69

Quadriplegia
Pronounced
(kwod-rih-PLEE-jee-ah)

Defined
Paralysis of the trunk, legs, and pelvic organs
with partial or total paralysis in the upper
extremities caused by severe injury to the
spinal cord between the 5th and 8th cervical
vertebrae
The higher the trauma, the more debilitating the
motor and sensory impairments
70

Tay-Sachs Disease
Pronounced
(TAY SACKS dih-ZEEZ)

Defined
Congenital disorder caused by altered lipid
metabolism, resulting from an enzyme
deficiency
Accumulation of this type of lipid occurs in the
brain, leading to progressive neurological
deterioration with both physical and mental
retardation
71

Trigeminal Neuralgia
(Tic Douloureux)
Pronounced
(try-JEM-ih-nal noo-RAL-jee-ah),
(tik DOO-loh-roo)

Defined
Short periods of severe unilateral pain which
radiates along the fifth cranial nerve
(trigeminal nerve)
Heat, chewing, or touching of the affected area
activates the pain
72

DIAGNOSTIC TECHNIQUES,
TREATMENTS, AND
PROCEDURES

Nervous System

Diagnostic Techniques,
Treatments, and Procedures
Babinskis Reflex
Reflex tested by stroking the sole of the foot,
beginning at mid-heel and moving upward
and lateral to the toes.
Positive Babinskis occurs when there is
dorsiflexion of the great toe and fanning of the
other toes

74

Diagnostic Techniques,
Treatments, and Procedures
Brain scan
Nuclear counter scanning of cranial contents
two hours after an intravenous injection of
radioisotopes
Isotopes concentrate in abnormal tissue of brain,
indicating a pathological process

75

Diagnostic Techniques,
Treatments, and Procedures
Cerebral Angiography
Visualization of the cerebral vascular system
via x-ray after injection of a radiopaque
contrast medium into an arterial blood vessel
May use carotid, femoral, or brachial artery

76

Diagnostic Techniques,
Treatments, and Procedures
Cerebrospinal fluid analysis
Laboratory analysis of cerebrospinal fluid
Obtained from a lumbar puncture for the
presence of bacteria, blood, malignant cells,
and amount of protein and glucose present

77

Diagnostic Techniques,
Treatments, and Procedures
CT scan of the brain
Analysis of a three-dimensional view of brain
tissue obtained as X-ray beams pass through
successive horizontal layers of the brain
CT = computerized tomography
Images look down through the top of the head

78

Diagnostic Techniques,
Treatments, and Procedures
Chordotomy
Neurosurgical procedure for pain control
accomplished through a laminectomy
Surgical interference of pathways within the spinal
cord that control pain

79

Diagnostic Techniques,
Treatments, and Procedures
Cisternal puncture
Insertion of a short, beveled spinal needle into
the cisterna magna in order to drain CSF or to
obtain a CSF specimen
Cisterna magna = shallow reservoir of CSF
between the medulla and the cerebellum

80

Diagnostic Techniques,
Treatments, and Procedures
Craniotomy
Surgical procedure that makes an opening
into the skull

Echoencephalography
Measurement of electrical activity produced
by the brain and recorded through electrodes
placed on the scalp

81

Diagnostic Techniques,
Treatments, and Procedures
Electroencephalography (EEG)
Measurement of electrical activity in the brain
and recorded through electrodes
Sleep-deprived EEG
Individual deprived of sleep for 24 hours before test

Ambulatory EEG
Provides prolonged readings of electrical activity of
brain over a 24-hour period of time, while person is
awake or asleep
82

Diagnostic Techniques,
Treatments, and Procedures
Laminectomy
Surgical removal of the bony arches from one
or more vertebrae in order to relieve pressure
from the spinal cord

83

Diagnostic Techniques,
Treatments, and Procedures
Electromyography (EMG)
Process of recording electrical activity of
muscle
Insert small needle into the muscle, deliver
small current that stimulates the muscle

84

Diagnostic Techniques,
Treatments, and Procedures
Lumbar puncture
Insertion of a hollow needle and stylet into
subarachnoid space between third and fourth
lumbar vertebrae below level of the spinal
cord
Performed under strict aseptic technique

85

Diagnostic Techniques,
Treatments, and Procedures
Magnetic Resonance Imaging (MRI)
Noninvasive scanning procedure that provides
visualization of fluid, soft tissue, and bony
structures without the use of radiation
Provides far more preciseness and accuracy than
most diagnostic tools

Not limited to scans of the brain

May also be used to examine the abdomen, chest,
joints, nervous system, pelvis, and spinal column
86

Diagnostic Techniques,
Treatments, and Procedures
Myelography
Introduction of contrast medium into the
lumbar subarachnoid space through a lumbar
puncture in order to visualize the spinal cord
and vertebral canal through x-ray examination

87

Diagnostic Techniques,
Treatments, and Procedures
Neurectomy
Neurosurgical procedure to relieve pain in a
localized or small area by incision of cranial or
peripheral nerves

Pneumoencephalography
Process used to radiographically visualize one
of the ventricles or fluid occupying spaces in
the central nervous system (CNS)
88

Diagnostic Techniques,
Treatments, and Procedures
Polysomnogram (PSG)
Sleep study or sleep test that evaluates
physical factors affecting sleep
Physical activity and level of sleep are monitored
by a technician while the patient sleeps

Useful in evaluating sleep disorders such as

sleep apnea, sleep walking, night terrors,
restless leg syndrome, insomnia, and
narcolepsy
89

Diagnostic Techniques,
Treatments, and Procedures
Positron Emission Tomography (PET
Scan)
Computerized radiographic images of various
body structures produced when radioactive
substances are inhaled or injected

Romberg test
Examination used to evaluate cerebellar
function and balance
90

Diagnostic Techniques,
Treatments, and Procedures
Stereotaxic Neurosurgery
Neurosurgery on a precise location of an area
within the brain that controls specific
function(s)
May involve destruction of brain tissue with various
agents such as heat, cold, and sclerosing or
corrosive fluids

91

Diagnostic Techniques,
Treatments, and Procedures
Sympathectomy
Surgical procedure used to interrupt a portion
of the sympathetic nerve pathway, for the
purpose of relieving chronic pain

Trichotomy
Through a craniotomy, the anterolateral
pathway in the brain stem is surgically
divided in an attempt to relieve pain
92

Diagnostic Techniques,
Treatments, and Procedures
Transcutaneous Electrical Nerve
Stimulation (TENS)
Form of cutaneous stimulation for pain relief
that supplies electrical impulses to the nerve
endings of a nerve close to the pain site

93