SUMMARIES OF PRESENTATIONS 1-5 & CEREBROSPINAL FLUID

GROUP MEMBERS
y TERRENCE ISACCS y LATISA CUDJOE y PATRICEE DOUGLAS y WAVENEY CHARLES y NIKITA BOWMAN y OLVA BESS y OLYNSIE MORRIS y CORESSA HENRY y NIKETA BARKER

(Leader)

The Nervous System is one of the body s organ systems that contains a network of neurones which coordinate actions and transmit signals around the body. It comprises of two parts 1.The Central Nervous System (CNS) 2.The Peripheral Nervous System (PNS)
yThe CNS comprising of the Brain and spinal cord, serves to integrate and coordinate all activities of the body. yThe Brain is divided into three parts , the cerebrum (the seat of consciousness),the cerebellum and the medulla oblongata

spinal cord to the rest of the body, and nerve relay stations called ganglia.

yThe PNS contains nerves that connect the brain and

Ref 2

y The Peripheral nervous system is divided into two

functional parts,
1. The Autonomic nervous system (ANS) which controls

involuntary actions within the body

2. The Somatic Nervous System (SNS) which exerts

control over voluntary actions of the skeletal muscles

Ref 6

Structural & Functional Overview of the Nervous System

Ref

Origin Of The Two Main Divisions Of The Nervous System

y During the 3rd Week of embryological

deveoplment The Central nervous system is formed The neural plate consisting of the neuroectoderm becomes the neural tube, which forms the brain and the spinal cord

y The Peripheral Nervous System (PNS) is formed

from three main sources 1. The Neural crest Cells 2. The Neural Tube 3. Mesoderm Layer

Ref

Reference 2

Cells Of The Nervous System

The Nervous System is made up primarily of two categories of cells 1. The neurones - functional unit of the NS, that transmit nerve impulses. Neurones are made up of the parts,the Dendrites that receive information from on cell and send it to the cell body. The Cell Body which contains the organelles of the cell The Axon that conducts messages away from the cell body 2. The Glia cells or Neuroglia are non neuronal cells that maintain homeostasis, form myelin and provide support and protection for the brain s neurones.
Ref 6

A Typical Neurone

Glia Cells

A typical Neurone

Ref

The Main types of Neurones

Reference 3

Multipolar neuron

Unipolar neuron

Bipolar neuron

Ref 7

Ref

The Divisions of Nerves Found in The Nervous System

Reference 1

y The Nerves that are associated with the nervous system are divided into two categories these are; 1. The Spinal Nerves, which arise from the spinal cord (approximately 31 in all found on either side of the vertebral column). They have both motor and sensory aspects. These nerves provide innervation to areas of the body that are below the neck. 2. The Cranial Nerves, (12 in all), emerge directly from the brain and carry impulses mainly to the head and neck

Ref

THE CENTRAL NERVOUS SYSTEM

EMBRYOLOGY

y The central nervous system (CNS) is formed during

week 3 of development as the neural plate.

y The neural plate: - consists of neuroectoderm - becomes the neural tube - gives rise to the brain and spinal cord.

Ref 22,23

Neurulation
y refers to the formation and closure of the neural tube. y (BMP-4), noggin, chordin, (FGF-8), and (N-CAM)

appear to play a role in neurulation.

Ref 22, 23

The events of neurulation occur as follows:

A. notochord induces the overlying ectoderm to

differentiate into neuroectoderm forming the neural plate.

B. -

The neural plate folds and give rise to the neural tube which: is open at both ends as the anterior and posterior neuropores the anterior and posterior neuropores connect the lumen of the neural tube to the amniotic cavity.
Ref 22,24

1. anterior neuropore: - closes on day 25 - becomes the lamina terminalis - failure to close results in upper neural tube defects (anencephaly). 2. posterior neuropore: - closes two days later (27th) - failure to close results in lower NTDs (spina bifida with myeloschisis).
Ref 22

C. As the neural plate folds, some cells differentiate into neural crest cells. D. The rostral part of the neural tube becomes the adult brain. E. The neural tube caudal to the fourth somite becomes the spinal cord. F. The lumen of the neural tube gives rise to the ventricular system of the brain and central canal of the spinal cord.
Ref 22,24

Spinal Cord formation

The neuroepithelial layer divides rapidly and gives rise to neuroblasts primitive nerve cells. These form:
y the mantle layer: - develops two thickenings on each side - The ventral thickenings basal plates contain ventral motor horn cells - The dorsal ones alar plates contain sensory areas. - which develops into the grey matter of the spinal cord. y -

the marginal layer: The outermost layer of the spinal cord Contains myelinated fibres of the mantle zone This forms the white matter of the spinal cord
Ref 22, 25

Prosencephalon
y Telencephalon - Cerebral hemispheres, caudate, putamen, amygdaloid, claustrum, lamina terminalis, olfactory bulbs, hippocampus. y Diencephalon - Epithalamus, subthalamus, thalamus,

hypothalamus, mamillary bodies, neurohypophysis, pineal gland, globus pallidus, retina, iris, ciliary body, optic nerve (CN II), optic chiasm, optic tract

Ref 22

Rhombencephalon:
y Metencephalon - Pons, cerebellum y Myelencephalon - Medulla

Mesencephalon: y Midbrain

Ref 22

HISTOLOGY
y Consists of the brain and spinal cord y Composed of neurones, glial cells (supporting cells)

and blood vessels y Macroscopically, parts of CNS are made up of:  Grey matter neurone cell bodies  White matter axons of neurones

Ref 3

SPINAL CORD
is composed of grey and white matter: y The grey matter - composed of nerve cell bodies and - in a cross-sectional cut appears as a darker stained "H"-like central area
y The white matter

composed entirely of axonal projections; surrounds the grey matter

Ref 3

Meninges
y The brain and spinal cord are invested by three layers of supporting tissue collectively called the meninges - the outer most dura mater consists of dense connective tissue. - Middle layer the arachnoid made of dense connective tissue. Spaces within the arachnoid are filled with cerebrospinal fluid. - the inner most layer, the pia mater, consists of loose connective tissue on the surface of the brain and lining channels which penetrate the brain carrying the vascular system

Ref 3

Neuroglia
y Are support cells which comprise all the non-neural cells of the CNS. y forms almost half the total mass of the CNS y are highly branched cells that occupy the spaces between neurones; the CNS contains little extracellular material. y They have intimate functional relationships with neurones providing both mechanical and metabolic support.
Ref 3

y Oligodendrocytes - CNS equivalent of the Schwann cells of the PNS

and are responsible for myelination y Astrocytes - highly branched cells that pack the interstices between the neurons, their processes and oligodendrocytes; provide mechanical support as well as mediate the exchange of metabolites between neurons and the vascular system; also form part of the blood-brain barrier and play an important role in repair of CNS tissue after injury or damage by disease
y Microglia - CNS representatives of the monocyte-macrophage system

and have defense and immunological functions

y Ependymal cells - make up a specialized epithelium which lines the

ventricles and spinal canal. Some are ciliated, which facilitates the movement of cerebrospinal fluid.

Ref 3

Cerebellar cortex
y This portion of the brain's gray matter is arranged into three layers: y the superficial molecular layer containing mostly unmyelinated axons and few cell bodies y a deeper layer of large flask-shaped cells called Purkinje cells that send long dendritic projections into the molecular layer y an inner granular layer containing many small cell bodies
Ref 3

Cerebral cortex
y Consists of a convoluted cortex of grey matter overlying the central

medullary mass of white matter, which conveys fibres between different parts of the cortex and to and from other parts of the CNS.

y Starting at the surface of the cortex and moving inward, you can

identify the first three layers of cell bodies: - superficial molecular layer, containing only a few small cell bodies - outer granular layer, containing small round cell bodies - pyramidal cell layer, containing cell bodies triangular in shape.
y In total, the cerebral cortex consists of six layers with the inner most

three represented by an inner granular layer, internal pyramidal layer, and polymorphic cell layer, the innermost layer containing cell bodies of many shapes.

Ref 3

Histological Layers of the Cerebral Cortex

Plexiform Layer Outer Granular Layer Pyramidal Cell Layer

Inner Granular Layer Ganglionic Layer Multiform Cell Layer Ref 3

Choroid Plexus
y The choroid plexus produces the cerebrospinal fluid y It consists of a small tuft of capillaries surrounded by

epithelium which "hangs" in the brain ventricles

y The capillaries are covered by a layer of simple

cuboidal epithelium, the ependymal cells, which also surround the ventricular space and made of ion transporting cells
Ref 3

ANATOMY

The central nervous system consists of the brain

and spinal cord, which are composed of neurones, glial cells and blood vessels. . The brain can be further divided into: 1. The cerebrum 2. The diencephalon 3. The cerebelum 4. The brainstem

Ref 2

The Brain

reasoning, planning, parts of speech, It is the largest portion movement, emotions, and problem solving the mass)

The Cerebrum
of the brain in humans

associated with movement, orientation, recognition, perception of stimuli (accounts for 2/3

occupies the anterior and middle cranial fossae in the skull and    

extending backwards over the tentorium cerebelli Divided into left and right hemispheres by a longitudinal fissure associated with visual and connected by the corpus callosum processing Each cerebral hemisphere is divided into 4 lobes by sulci or fissures: The frontal lobe-most ventral The parietal lobe-dorsal to the frontal The occipital lobe- dorsal to the parietal associated with The temporal lobe- lies inferior to the frontal and parietal (at the perception and temple and ears) recognition of auditory
stimuli, memory, and speech

Ref 2, 11

The Cerebellum
Is the large brain mass lying posterior to the pons and

medulla and inferior to the posterior part of the cerebrum. It lies beneath the tentorium cerebelli in the posterior cranial fossa and is separated from the cerebrum by tentorium cerebelli and the transverse fissure It consists of two lateral hemispheres that are united by a narrow middle part, the vermis.

Ref 2

The Diencephalon
y The Diencephalon - located within the cerebrum

between the cerebral hemispheres, and above the brain stem y Composed of : -the thalmus -the hypothalmus -the subthalmus -the epithalmus

Consists of :

The Brainstem

1.

THE MIDBRAIN
most rostral part of the brainstem, lies at the junction of the middle and posterior cranial fossae Acts as relay station for tracts passing between cerebrum and spinal cord or cerebellum Contains reflex centers for visual, auditory and tactile responses THE PONS the part of the brainstem between the midbrain rostrally and the medulla oblongata caudally; it lies in the anterior part of the posterior cranial fossa. Connects the cerebrum to the medulla and the cerebellum to the rest of the CNS via bundles of axons Also functions in conjunction with centres in the medulla to regulate breathing. THE MEDULLA OBLONGATA is the most caudal subdivision of the brainstem; is continuous with the spinal cord; lies in the posterior cranial fossa. Contains automatic centres for regulating breathing and vasoconstriction (blood pressure) Also contains centres for vomitting, coughing, sneezing, hiccuping, and swallowing. Ref 2,4

2.

3.

ORGANISATION OF THE BRAIN

The Spinal Cord

The spinal cord is the major reflex center and conduction pathway between the body and the brain It extends from the base of the brain through the foramen magnum to the first lumbar vertebra The spinal cord is segmented, with 31 pairs of spinal nerves that contain both sensory (afferent) nerves and motor (efferent) nerves.

Ref 2,12

 Sensory nerves carry

information to the spinal cord from the periphery via dorsal root and cranial nerve ganglia. Motor nerves carry information from the spinal cord to the periphery and include somatic motor nerves and motor nerves of the autonomic nervous system

Ref 13

Physiology Of The Nervous System

y The basic function of the nervous system is to receive

sensory input form both the internal and external environments, process this information and effect an appropriate motor response.

Ref 4

y Comprised of the sensory receptors which receive the sensory information y The information can either cause: I.

Sensory Part Of The Nervous System

immediate reaction from the brain II. memory of the experience can be stored in the brain y The sensory information enters the CNS and is conducted to sensory areas in :
1. 2. 3. 4. 5.

The spinal cord at all levels the reticular substance of the medulla, pons, and mesencephalon of the brain the cerebellum the thalamus areas of the cerebral cortex
Somatosensory axis of the nervous system. Ref 1

The Motor part Of the Nervous System

y The major function of the nervous system is to effect motor control over the body. VOLUNTARY y Signals travel via motor neurones to effectors which carry out the function. Motor functions include:
CONTROL

contraction of appropriate skeletal muscles throughout the body II. contraction of smooth muscle in the internal organs III. secretion of active chemical substances by both exocrine and endocrine glands INVOLUNTARYANS CONTROL y Effectors= muscles and glands
I.
Ref 1

Storage of Information: Memory

y Most sensory information is stored for future use. The process of storage is called memory. y Much of the storage occurs in the cerebral cortex y Memory occurs through the process of facilitation y once these memories have been stored in the nervous system they help to select the important new sensory information and channel it into appropriate memory storage area for future use or into motor areas to cause immediate bodily response

Ref 1

Major Levels Of CNS Function

y There are three major levels of CNS function:

1. The spinal cord level- the cord is capable of carrying out its own motor functions (eg walking movements, reflexes that withdraw portions of the body from painful objects reflexes that control local blood vessels etc.) 2. The subcortical level(lower brain)- the medulla, pons, mesencephalon, hypothalamus, thalamus, cerebellum, and basal ganglia. Most subconscious activities of the body occur at this level.(eg. Control of arterial pressure and respiration by the pons and medulla, control of equilibrium) 3. The cortical level(higher brain)- Cerebral cortex is an extremely large memory storehouse that functions in association with lower centers of the brain.
Ref 1

THE BASIC FUNCTIONAL UNIT OF THE CNS: THE NUERON

y Information is transmitted in the central nervous

system mainly in the form of nerve action potentials, called simply nerve impulses, through a succession of neurons, one after another. y Nerve impulses are transmitted from one neurone to the next via synapses.

Ref 1

SYNAPSES OF THE CNS

Types of Synapses: 1. Chemical Synapses: -most CNS synapses are of this time -in these types of synapses the presynaptic neuron secretes a chemical substance called a neurotransmitter which acts on protein receptors of the postsynaptic neurone to excite the neuron, inhibit it, or modify its sensitivity in some other way. -nerve impulses travel in one direction 2.Electrical Synapses: -in contrast, are characterized by direct open fluid channels that conduct electricity from one cell to the next. -the open fluid channels consist of gap junctions. -signals travel in either direction

Ref

Anatomy of a Synapse

Ref 2

RELEASE OF NEUROTRANSMITTERS
y Impulses arriving at the terminal end of the

presynaptic neuron cause an increase in the membrane s permeability to Ca y Voltage gated Ca ion channels open leading to influx of Ca ions y Ca ions bind to releasing sites causing neurotransmitter release y These neurotransmitters act on the receptor proteins of the post synaptic neuron

Ref 1

ACTION OF NEUROTRANSMITTERS ON THE RECEPTORS

In addition to a binding component the receptors of the postsynaptic neurone have: 1. An ionophore component- either an ion channel or a second messenger system y Ion channels -cation channels: excitatory -anion channels: inhibitory y Second messenger systems unlike ion channels are used to bring about long term neuronal changes y G proteins- common second messenger system
y
Ref 1

y I. II. y
y y y y y y y y

Neurotransmitter substances are divided into two types: Small molecule, Rapidly- acting transmitters Neuropeptide, Slowly-acting transmitters The small molecule transmitters cause the most acute responses of the nervous system. The most important ones are:
Acetylecholine Norepinephrine Dopamine Glycine GABA (gamma-aminobutyric acid) Glutamate Serotonin Nitric oxide

The neuropeptides usually cause more prolonged actions such as longterm changes in numbers of neuronal receptors, long-term opening or closure of certain ion channels etc. Include ACTH, leutinising hormone, ADH, insulin, glucagon, calcitonin etc.

Ref 1

Electrical Events During Neuronal Excitation and Inhibition

y Excitation

An excitatory transmitter increaes membrane pemeability to Na ions y Influx of Na causes depolarisation, changing the resting potential to a less negative excitatory postsynaptic potential y The EPSP rises to a point at which it is capable of initiating an action potential in the postsynaptic neuron y Inhibition y Inhibitory neurotransmitters cause Cl ion channels to oprn causing influx of Cl ions y They cause K ion channels to open causng efflux of these ions y These two actions lead to hyperpolarisation of the membrane- a more negative potential than the resting potential is established ( an Inhibitory Postsynaptic Potential) y The neuron is inhibited
y

Ref 1

SUMMATION
y Spatial Summation y Temporal Summation

Ref 1

THE CRANIAL NERVES

CRANIAL NERVES- EMBRYOLOGY

Twelve pairs of cranial nerves form during the fifth and sixth weeks. y Cranial Neural crest cell migrate from the rhombencephalon

y y

(hind brain) into the pharyngeal arches. The rhombencephalon is divided into eight segments called rhombomeres (R1-R8) Cranial neural crest cells from R1 and R2 migrate into pharyngeal arch 1 (which also receives neural crest cells from the midbrain area). R4 migrate into pharyngeal arch 2. R6 and R7 migrate into pharyngeal arch 3. This pattern is controlled by the expression of the Hoxb gene complex and OTX2.

The cranial nerves are classified into three groups, according to their embryologic origins: y Somatic Efferent Cranial Nerves y Nerves of Pharyngeal Arches y Special Sensory Nerves
Ref 22

CRANIAL NERVES
Olfactory nerve CN I y Olfactory nerve is derived from the nasal (olfactory) placode . CN I is capable of regeneration. y Olfactory neurosensory cells - olfactory epithelium in the superior part of the lateral and septal walls of the nasal cavity. y axons from these cells pass - foramina in the cribriform plate of the ethmoid bone, pierce the dura and arachnoid mater, and y enter the olfactory bulbs in the anterior cranial fossa. y During breathing air molecules attach to the olfactory mucosa and stimulate the olfactory and electrical activity is transduced into the olfactory bulb. y Olfactory bulb cells then transmit electrical activity to other parts of the central nervous system via the olfactory tract.
Ref 20

CRANIAL NERVES

Ref 20

CRANIAL NERVES
CN II. Optic Nerve

is derived from the ganglion cells of the retina (which is a diverticulum of the diencephalon) .

y The optic nerve originates from the bipolar cells of the retina which are connected to the specialized receptors in the retina (rod and cone cells). y The optic nerve passes poster medially through the orbit, runs through the optic canal to the middle cranial fossa and joins the optic chiasm. y Posterior to the optic chiasm the optic nerves are instead called optic tracts. Most fibers in the optic tracts terminate in the lateral geniculate bodies of the thalamus. y Visual information enters the eye in the form of photons of light which are converted to electrical signals in the retina. These signals are carried via the optic nerves, chiasm, and tract to the lateral geniculate nucleus of each thalamus and then to the visual centers of the brain for interpretation.

Ref 20

CRANIAL NERVES

Ref 9

CRANIAL NERVES
Oculomotor nerve (CN III)
y is derived from the basal plate of the rostral midbrain. y Emerges from the midbrain, pierces the dura, runs in the lateral wall of y y

the cavernous sinus. Exits the skull through the superior orbital fissure and enters the orbit. From here it splits into a superior division (which supplies the superior rectus m.) and an inferior division (which supplies the inferior and medial rectus and inferior oblique m. and also carries autonomic fibers to the ciliary ganglion). The somatic motor component of CN III plays a major role in controlling the muscles responsible for the precise movement of the eyes for visual tracking or fixation on an object. The visceral motor component is involved in the pupillary light and accomodation reflexes
Ref 9

CRANIAL NERVES

Ref 9

CRANIAL NERVES
CN IV. Trochlear Nerve y is derived from the basal plate of the caudal midbrain. y emerges from the dorsal surface of the midbrain , winds around the brainstem, pierces the dura and passes anteriorly in the lateral wall of the cavernous sinus. y Exits the cavernous sinus and passes through the superior orbital fissure into the orbit to supply the superior oblique muscle.

Ref 21

CRANIAL NERVES
y CN V. Trigeminal Nerve y The motor division of CN V is derived from the basal plate of the rostral pons. The

sensory division of CN V is derived from the cranial neural crest cells.

y Emerges from the pons by a small motor root and a large sensory root. The ophthalmic

division (V1) is exclusively sensory and exits

y through the superior orbital fissure. The maxillary division (V2) is exclusively sensory

and exits through the foramen rotundum. The and a branchial motor component (SVE).

y mandibular division (V3) exits through the foramen ovale; it has a sensory component y In the sensory innervation:

1.Ophthalamic branch (word root = 'eye') Innervates upper face including conjunctiva, cornea, forehead, eyelid,bridge of nose Maxillary branch (word root = 'upper jaw') Innervates upper jaw, cheeks, nasal cavity Mandibular branch (word root = 'lower jaw') Innervates lower jaw, teeth gums, anterior 2/3 of tongue.
y

Ref 21

CRANIAL NERVES
y The motor component includes innervations of :

1. muscles of mastication, which aid in biting 2. tensor tympani, which adjusts the tension of the eardrum, which allows us to increase our sensitivity to really quiet sounds

Ref 21

CRANIAL NERVES
y CN VI. Abducent Nerve y Abducent nerve (CN VI) is derived from the basal plate of the caudal pons y Exits brainstem at medullopontine junction between the pyramids and pons. It then pierces the dura and passes through the y cavernous sinus. Enters the orbit through the superior orbital fissure and runs anteriorly to supply the lateral rectus muscle. y The function of the abducent nerve is to contract the lateral rectus which results in abduction of the eye. The abducens nerve in humans is solely and somatomotor nerve.

Ref 21

Cranial nerve VII: Facial nerve y Emerges from the brainstem between the pons and medulla and passes through the internal acoustic meatus. y the motor division of this nerve derived from the basal plate of the pons while its sensory division is from the cranial neural crest cells. y Both divisions are innervations of pharyngeal arch 2 derivatives eg. Stapes, stapedius muscle y The facial nerve carries somatic motor innervation to the many muscles for facial expression. y This nerve has five branches: temporal, zygomatic, buccal, mandibular and submandibular(cervical). y The fibers are of 4 types
I. II. III. IV.

Special sensory General sensory Branchiomotor Parasympathetic motor

y It carries sensory information form the face (deep pressure sensation) and taste

information from the anterior two thirds of the tongue. y It arises at the pons in the brainstem and it emerges through openings in the temporal bone and stylomastoid foramen and has many branches. Ref 23, 26 y It is composed of both sensory and motor axons.

Cranial nerve VIII: Vestibulocochlear nerve y Emerges from the internal acoustic meatus y derived from the otic placode. y innervates the hair cell receptors of the inner ear. It carries vestibular information to the brain from the semicircular canals, utricle, and saccule providing the sense of balance and equilibrium. It also carries information from the cochlea providing the sense of hearing. y branches into the Vestibular branch (balance) and the cochlear branch (hearing). The cochlear fibers originate from the spiral ganglion. It is pure sensory nerve fiber.

Ref 5, 23

Cranial nerve IX: Glossopharyngeal nerve y Emerges from the jugular foramen. y Has 2 divisions.
y y

The motor division is derived from the basal plate of the medulla. The sensory division is derived from the cranial neural crest cells.

y It is composed of both sensory and motor axons and originates from the

nucleus ambiguous in the reticular formation of the medulla.

y CN IX mediates the sensory and motor innervation of pharyngeal arch 3 y y y

derivatives. innervates the pharynx (upper part of the throat), the soft palate and the posterior one-third of the tongue. It carries sensory information (touch, temperature, and pressure) from the pharynx and soft palate. It carries taste sensation from the taste buds on the posterior one third of the tongue. It provides somatic motor innervation to the throat muscles involved in swallowing. It provides visceral motor innervation to the salivary glands. This cranial nerve also supplies the carotid sinus and reflex control to the heart.

Ref 23

Cranial nerve X: Vagus nerve . emerges from the jugular foramen. y The motor division of CN X is derived from the basal plate of the medulla. The

y y

y y y y y

sensory division of CN X is derived from the cranial neural crest cells. Mediates the sensory and motor innervation of pharyngeal arches 4 and 6 derivatives. The vagus nerve consists of many rootlets that come off of the brainstem just behind the glossopharyngeal nerve. The branchial motor component originates from the nucleus ambiguous in the reticular formation of the medulla. The visceral component originates from the dorsal motor nucleus of the vagus located in the floor of the fourth ventricle in the rostral medulla and in the central grey matter of the caudal medulla. It is the longest cranial nerve innervating many structures in the throat, thorax and abdominal cavity. It provides sensory information (touch, temperature and pressure) from the external auditory meatus and a portion of the external ear It carries taste sensation from taste buds in the pharynx. It also provides sensory information from the esophagus, respiratory tract, and abdominal viscera (stomach, intestines, liver, etc.). It provides visceral motor innervation to the heart, stomach, intestines, and gallbladder. It is part of the ANS, the parasympathetic branch. Other parasympathetic ganglia include CN III , CN VII and CN IX . Ref 5, 23

Cranial nerve XI: Spinal Accessory nerve y Emerges from the jugular foramen y is derived from the basal plate of the spinal segments C-1 to C-6. y The spinal accessory nerve has two branches. The cranial branch provides somatic motor innervation to some of the muscles in the throat involved in swallowing. This cranial branch is accessory to CN X, originating in the caudal nucleus ambiguous, with the fibers of the cranial root traveling the same extracranial path as the branchial motor component of the vagus nerve. The spinal branch provides somatic motor innervation to the trapezius muscles, providing muscle movement for the upper shoulders head and neck. It is pure motor nerve fiber. Cranial nerve XII: Hypoglossal nerve y Emerges from the hypoglossal canal. y is derived from the basal plate of the medulla. y CN XIII innervates the intrinsic and extrinsic muscles of the tongue. The hypoglossal nerve provides somatic motor innervation to the muscles of the tongue. This pure motor nerve originates from the hypoglossal nucleus located in the tegmentum of the medulla.

Ref 23, 27

Ref 27

THE VENTRICULAR SYSTEM

y The ventricular system of the brain consists of two

lateral ventricles and the midline 3rd and 4th ventricles connected by the cerebral aqueduct y CSF, largely secreted by the choroid plexuses of the ventricles, fills these brain cavities and the subarachnoid space of the brain and spinal cord.

Ref 2,14

 The Lateral Ventricles: - are the largest cavities of the ventricular system; occupy large -

areas of the cerebral hemispheres. Each opens through an interventricular foramen into the 3rd ventricle. The Third Ventricle: a slit-like cavity between the right and the left halves of the diencephalon;continuous posteroinferiorly with the cerebral aqueduct, which connects the 3rd and 4th ventricles The Fourth Ventricle: pyramid-shaped; posterior to the pons and medulla and it extends inferoposteriorly. Inferiorly, it tapers to a narrow channel that continues into the cervical region of the spinal cord as the central canal
Ref 2

SUBARACHNOID CISTERNS
CFS fills the subarachnoid cisterns of the brain. They are:

- The Cerebellomedullary Cistern: largest of the subarachnoid cisterns, located between the cerebellum and the medulla - The Pontocerebellar Cistern : ventral to the pons, continuous inferiorly with the spinal subarachnoid space. - The Interpeduncular Cistern: located in the interpeduncular fossa - The Chiasmatic Cistern: Inferior and anterior to optic chiasm - The Quadrigeminal Cistern : located between the posterior part of the corpus callosum and the superior surface of the cerebellum. - The Ambient Cistern :located on the lateral aspect of the midbrain and continuous posteriorly with the quadrigeminal
Ref 2

CEREBROSPINAL FLUID SECRETION

CSF is secreted (at the rate of 400-500 mL daily) by

choroidal epithelial cells of the choroid plexuses in the ventricles The choroid plexuses : -are vascular structures arising from the walls of each of the four ventricles of the brain -They are invaginated into the roofs of the 3rd and 4th ventricles and on the floors of the bodies and inferior horns of the lateral ventricles
Ref 2

CIRCULATION OF CEREBROSPINAL FLUID from: CSF flows

lateral ventricles ventricle ventricle foramen of Monro fourth third aqueduct of Sylvius foramina of Magendie and Luschka

subarachnoid space over brain and spinal cord reabsorption into venous sinus blood via arachnoid granulations. Ref 2
Ref 2

ABNORMALITIES OF CEREBROSPINAL FLUID

HYDROCEPHALUS y Obstructive Hydrocephalus - Overproduction of CSF, obstruction of CSF flow, or interference with CSF absorption results in excess fluid in the cerebral ventricles and enlargement of the head - The excess CSF dilates the ventricles, thins the cerebral cortex, and separates the bones of the calvaria in infants. - blockage usually occurs in the cerebral aqueduct or an interventricular foramen y Communicating Hydrocephalus - the flow of CSF through the ventricles and into the subarachnoid space is not impaired - movement of CSF from this space into the venous system is partly or completely blocked - blockage may be caused by the congenital absence of arachnoid granulations, or the granulations may be blocked by red blood cells as the result of a subarachnoid hemorrhage
Ref 2

LEAKAGE OF CEREBROSPINAL FLUID y CSF Otorrhea- fractures in the floor of the middle cranial fossa may result in CSF leakage from the external acoustic meatus if the meninges superior to the middle ear are torn and the tympanic membrane is ruptured

y CSF rhinorrhea- fractures in the floor of the anterior cranial fossa may involve the cribriform plate of the ethmoid, resulting in CSF leakage through the nose

Both CSF otorrhea and CSF rhinorrhea may be the primary indications of a cranial base fracture
Ref 2

y The majority of CSF flows into the interpeduncular

and quadrigeminal cisterns. C y CSF also passes into the extensions of the subarachnoid space around the cranial nerves, the most important of which are those surrounding the optic nerves.

Ref 2

NORMAL CHARACTERISTICS OF CFS

Pressure: 70 - 180 mm H20 Appearance: clear, colorless CSF total protein: 15 - 60 mg/100 mL Gamma globulin: 3 - 12% of the total protein CSF glucose: 50 - 80 mg/100 mL (or greater than 2/3 of

blood sugar level) CSF cell count: 0 - 5 white blood cells (all mononuclear), and no red blood cells Chloride: 110 - 125 mEq/L
Ref 2

FUNCTIONS OF CEREBROSPINAL FLUID

y circulation

the cerbrospinal fluid delivers nutrients to the structures of the nervous system y the cerebrospinal fluid removes wastes from the brain and spinal cord, detoxifying the environment of the nervous system y shock absorption y the cerbrospinal fluid protects the brain and spinal cord from trauma brought upon by movement, falls, blows, etc.
y

y The CSF in the subarachnoid space provides the buoyancy that

prevents the weight of the brain from compressing the cranial nerve roots and blood vessels

Ref 2

PERIPHERAL NERVOUS SYSTEM

y The peripheral nervous system(PNS) is the portion on the nervous system which lies outside the CNS and is composed of:

-Nerves that carry sensory messages to CNS and motor commands from CNS to muscles and glands. Nerves are bundles of axons(axons that occur in nerve fibers are called nerve fibers) -ganglia, swellings associated with nerves that contain collections of cell bodies.
Ref 4

PERIPHERAL NERVES
y These nerves include cranial and spinal nerves. y Some nerves contain sensory input(afferent) fibers, while some contain motor output(efferent) fibers. y Some cranial nerves, however, contain both sensory and motor fibers(mixed nerves) y The afferent fibers have sensory receptors which detect internal and external stimuli(which is sent to the CNS and interpreted) y The motor fibers conduct impulses to the effectors(muscles and glands) which respond to the stimuli detected by the sensory receptors. y In the PNS, cranial nerves take impulses to and from the brain, and the spinal nerve take impulses to and from the spinal cord.

Ref 4

Ref 19

ORIGIN OF THE PERIPHERAL NERVOUS SYSTEM

y The CNS is formed in week three of development as

the neural plate. The neural plate(consisting of neuroectoderm) becomes the neural tube. This gives rise to the brain and spinal cord. y The PNS is derived from 3 sources: -neural crest cells -neural tube(gives rise to all preganglionic autonomic fibers and all fibers that innervate skeletal muscles. -mesoderm(gives rise to the dura mater and connective tissue investments of peripheral nerve fibers(endoneurium, perineurium, epineurium)
Ref 22

ORIGIN OF THE SYMPATHETIC NERVOUS SYSTEM

y The sympathetic nervous system originates from the

basal plate of the neural tube and neural crest cells y The basal plate gives rise to the preganglionic sympathetic neurons y The neural crest cells give rise to postganglionic sympathetic neurons within the sympathetic chain ganglia

Ref 22

ORIGIN OF THE PARASYMPATHETIC NERVOUS SYSTEM

y The parasympathetic nervous system originates from the basal plate of the neural tube and neural crest cells. y The basal plate gives rise to preganglionic parasympthetic nervous system within the nuclei of the midbrain, pons, medulla and spinal cord at S2 to S4. y The neural crest cells give rise to postganglionic parasympathetic neurons within the ciliary ganglion, pterygopalatine ganglion, submandibular ganglion, otic ganglion, enteric ganglia of the gut and abdominal/pelvic cavity parasympathetic ganglia

Ref 22

RECEPTORS OF THE PERIPHERAL NERVOUS SYSTEM

There are many types of receptors in the PNS and these can be grouped according to : 1.Modality-this is the type of stimulus the receptor receives y Mechanoreceptors y Thermoreceptors y Noicereceptors y Chemoreceptors y Photoreceptors 2.Location y Exteroceptors y Interoceptors y Proprioceptors
Ref 19

SENSORY NERVE ENDINGS

y The sensory nerve endings which contain the sensory

receptors that detect stimuli are of two types: -unencapsulated nerve endings(free nerve endings) -encapsulated nerve endings

Ref 19

FREE NERVE ENDINGS- These are responsible for detecting pain and temperature and are of two types: -hair follicle receptors(located in and around hair follicles) -Merkel discs(basal layer of epidermis) ENCAPSULATED NERVE ENDINGS-These consist of one or more end fibers of sensory neurons and are enclosed in connective tissue. y There are three types: -Meissner s corpuscles(nipples, eyelids, external genitalia, fingertips) -Pacinian corpuscles(subcutaneous:tendons, ligaments, joint capsules) -Ruffini s corpuscles(deep in the dermis, hypodermis, joint capsules)

Ref 19

y The motor fibers leading to effectors cause response by

muscles and glands via secreting neurotransmitters at neuromuscular junctions. y They also secrete these neurotransmitters at varicosities at smooth muscle and glands.

Ref 19

DIVISIONS OF THE PNS

PNS

Autonomic Nervous System

Somatic Nervous System

Ref 4

SOMATIC NERVOUS SYSTEM

y The somatic nervous system includes nerves that take sensory information from external sensory receptors to the CNS and motor commands from the CNS to the skeletal muscles. y Some actions in the somatic nervous system are due to reflexes, which are automatic responses to a stimulus. The reflex occurs quickly without having to think about it. y Other actions are voluntary and these always originate in the cerebral cortex, as when we decide to move a limb. y This system serves the skin, skeletal muscles and tendons.

Ref 4

AUTONOMIC NERVOUS SYSTEM

y The autonomic nervous system regulates the activity of the smooth muscle, cardiac muscle and the gands. There is no conscious control in this system. It is divided into: -the sympathetic nervous system -the parasympathetic nervous system These systems both function automatically and involuntarily, innervate all internal organs and for each signal, utilise two neurons that synapse at a ganglion.
Ref 4

y The first neuron has a cell body within the CNS and its axon is called the preganglionic fiber. The second neuron has a cell body within the ganglion and its axon is called the postganglionic fiber. y However, in the sympathetic nervous system, the preganglionic fiber is shorter than the postganglionic fiber. y This is the opposite in the parasympathetic nervous system: the preganglionic fiber is longer than the postganglionic fiber.
Ref 4

y Reflex actions, such as those that regulate blood

pressure(degree of stretch in blood vessel walls) and breathing rate(abnormal CO2 and O2 levels) are very important to the maintenance of homeostasis. y The reflexes begin when sensory neurons in contact with the internal organs send messages to the CNS. Motor neurons within the autonomic system effect the response

Ref 4

SYMPATHETIC NERVOUS SYSTEM

y This system, characterised by flight or fight responses, is important during emergency situations. y Accelerated heart rate, bronchial dilation(active muscles require ready supply of glucose and oxygen), inhibtion of digestive tract are all actions promoted by the sympathetic nervous system. y The neurotransmitted primarily released is norepinephrine(noradrenaline).
Ref 4

PARASYMPATHETIC NERVOUS SYSTEM

y This division inludes a few cranial nerves( eg the vagus nerve) as well as fibers that arise from the sacral portion of the spinal cord. y Hence, the parasympathetic nervous system is often referred to as the craniosacral portion of the autonomic nervous system. y This system is sometimes termed the housekeeper division and promotes all the internal responses associated with rest and digest. y Acetylcholine is the main neurotransmitter released by the parasympathetic nervous system y It promotes contraction of pupils, food digestion and retardation of heartbeat.
Ref 4

Ref

The Somatic Efferent Division of the PNS : Innervation of Skeletal Muscles

MECHANISM OF MUSCLE CONTRACTION

y Begins with a stimulus. y The sensory neurone converts this stimulus to an electrical

impulse after which it becomes depolarised providing that the stimulus is great enough for the neuron to meet the threshold value. This information is then relayed to the motor neuron by a relay neuron. This motor neuron is associated directly with the muscle a the neuromuscular junction. When the action potential reaches the terminal bouton of the neuromuscular junction its simulates the opening of gated Ca2+ channels which facilitates the movement of Ca2+ into the terminal bouton. y This influx of Ca2+ allows or the binding of synaptic vesicles containing ACETYLCHOLINE (a neurotransmitter) to the membrane of the bouton. Hence the contents of the vesicles are released into the synaptic clef.
Ref 18

Mechanism of Muscle Contraction

y Acetylcholine then binds to the receptors on the secondary synaptic cleft( or sub-neural space). y The binding of acetylcholine to the synaptic clef facilitates the relaying of information to the post synaptic membrane. y When enough acetylcholine becomes bound to receptors in the sub-neural space depolarization of the post synaptic membrane occurs. y Hence a wave of depolarization spreads throughout the muscle fibres by means of the TRANVERSE TUBULE SYSTEM which eventually cause contraction of skeletal muscle.

Ref 18

NEUROMUSCULAR JUNCTION

Ref17

CRANIAL NERVES
y There are 12 crainal nerves total, numbered I through XII. y Cranial nerves I and II attach to the forebrain y All others attach to the brain stem y Primarily serve head and neck structures y However the vagus nerve (X) extends into the abdomen

Ref 17

CRANIAL NERVES

Ref17

SPINAL NERVES
 They are named from the point of issue from the

spinal cord.
 8 pairs of cervical nerves (C1-C8)  12 pairs of thoracic nerves (T1-T12)  5 pairs of lumbar nerves (L1-L5)  5 pairs of sacral nerves (S1-S5)  1 pair of coccygeal nerves (Co1)

Ref 19

PERIPHERAL NERVES AND FUNCTIONS

Ref

Ref 19

DISORDERS OF THE PNS

y Your peripheral nerves are the ones outside your brain and spinal y

y y y y y y

cord There are more than 100 kinds of peripheral nerve disorders. They can affect one nerve or many nerves. Some are the result of other diseases, like diabetic nerve problems. Others, like Guillain-Barre syndrome, happen after a virus infection. Still others are from nerve compression, like carpal tunnel syndrome or thoracic outlet syndrome. In some cases, like complex regional pain syndrome, the problem begins after an injury. Some people are born with peripheral nerve disorders. Symptoms often start gradually, and then get worse. They include Numbness Pain Burning or tingling Muscle weakness Sensitivity to touch

Ref 18

y Shingles ( caused by herpes zoster)

REF. 2

y is a painful, blistering skin rash. y caused by the varicella-zoster virus, the same virus that causes

chickenpox. y Symptoms manifest years after one would have had chickenpox.

y Guillian Barre Syndrome REF. 2 y An autoimmune disorder. y Occurs with viral infections such as HIV, herpes simplex and mononucleosis. y Results n damage to myelinated nerve fibres. y Myasthenia Gravis REF. 2 y An autoimmune neuromuscular disorder. y The body s antibodies invade the neuromuscular junctions and block the acetylcholine receptors preventing the binding of it. y Results in disruption of nerve impulse transmitting.

Ref 16,19

THE AUTONOMIC NERVOUS SYSTEM

The glands, smooth muscle, and cardiac muscle of the body (the viscera ) respond to a second network of motor neurons called the autonomic nervous system (ANS). This system plays a major role in controlling the body s internal environment and thus, homeostasis. The ANS affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of the pupils, micturition (urination), and sexual arousal. It is composed of two elements usually acting antagonistically (in opposition to each other):y the parasympathetic nervous system y the sympathetic nervous system
Ref

THE AUTONOMIC NERVOUS SYSTEM

The parasympathetic nervous system (PSNS) consists of a network of:y long efferent axons that make synaptic contact with ganglia in the immediate vicinity of an organ and y short efferent neurons extending from the ganglia to a organ.

The sympathetic nervous system (SNS) is composed of a network of:y Short efferent CNS axons that extend to ganglia located near the spine and y Long efferent neurons extending from the ganglia directly to each target organ.
Ref1

THE AUTONOMIC NERVOUS SYSTEM

y Autonomic nerve impulses cross two synapses in travelling from the CNS

out of its target organ. (unlike the somatic nervous system)

y The first synapse is in the ganglion and the second synapse is between the

autonomic neuron s axon and the target organ.

Ref1

COMPARISON OF SNS & PSNS PATHWAYS

THE AUTONOMIC NERVOUS SYSTEM

y The neurotransmitter in the ganglion is acethylcholine for both sympathetic and parasympathetic nerves. However, the neurotransmitter between the terminal autonomic neuron axon and the target organ is different in the PSNS and SNS. y In the parasympathetic system the neurotransmitter at the terminal synapse is acetylcholine, just as it is in the ganglion. y Whereas in the sympathetic system the neurotransmitter at the terminal synapse is either adrenaline (epinephrine) or noradrenaline (norepinephrine), both of which have an effect opposite to that of acethylcholine.
Ref1

THE AUTONOMIC NERVOUS SYSTEM

y Most glands (except the adrenal gland), smooth muscles, and cardiac muscle controlled by the ANS have inputs from both the sympathetic and parasympathetic systems. y The CNS controls activity in each case by varying the ratio of the two signals. y With regard to function, the ANS is usually divided into sensory (afferent) and motor (efferent) subsystems. Within these systems, however, there are inhibitory and excitatory synapses between neurons.
Ref1

THE AUTONOMIC NERVOUS SYSTEM

y An organ receiving nerves from both

components of the ANS will be subject to the effects of the two opposing neurotransmitters. If the sympathetic nerve ending excites a particular organ, the parasympathetic synapse usually inhibits it.

y For example, the sympathetic system speeds up

the heart and inhibits gastrointestinal motility and secretion, inhibiting digestion, whereas the parasympathetic system slows up the heart rate and increases gastrointestinal activity.
Ref1

y Sympathetic and parasympathetic divisions typically function in

opposition to each other. This natural opposition is better understood as complementary in nature rather than antagonistic. We can think of the sympathetic division as the accelerator and the parasympathetic division as the brake. The sympathetic division typically functions in actions that require quick responses. The parasympathetic division functions with actions that do not require immediate reaction.
y The afferent fibers of the ANS, which transmit sensory information

from the internal organs of the body back to the central nervous system, are not divided into parasympathetic and sympathetic fibers as the efferent fibers are. Instead, autonomic sensory information is conducted by general visceral afferent fibers. Ref1

TYPICAL ACTIONS OF THE AUTONOMIC NERVOUS SYSTEM

Ref1

Sympathetic Nervous System

y The sympathetic nervous system (SNS) is one of the two parts of the autonomic nervous system. Its general action is to mobilize the body's resources under stress; to induce the fight-or-flight response. It is, however, constantly active at a basal level to maintain homeostasis. This response is also known as sympatho-adrenal response of the body. y The SNS aids in the control of most of the body's internal organs. Additionally, it is thought that the SNS counteracts the parasympathetic system, which generally works to promote maintenance of the body at rest.
Ref1

Sympathetic Nervous System

y The SNS is activated by any stimulus over an individual s

threshold (and the threshold can vary enormously), including feelings, and by noise, light, drugs and chemicals (e.g. caffeine). y In response to the stimulus an immediate anticipatory state is generated by the release of adrenaline. This causes the heart to beat more quickly and strongly, increases blood supply to the muscles, raises blood pressure, dilates the bronchii and increases the breathing rate, raises the blood sugar level for increased energy, speeds up mental activity, increases tension in the muscles, dilates pupils and increases sweating. y Non-emergency functions, such as digestion are lessened or suspended. the fight or flight to describe the function of the rapid mobilisation of resources.

Ref1

Organization
y Sympathetic nerves originate inside the vertebral column,

toward the middle of the spinal cord in the intermediolateral cell column (or lateral horn), beginning at the first thoracic segment of the spinal cord and are thought to extend to the second or third lumbar segments. Because its cells begin in the thoracic and lumbar regions of the spinal cord, the SNS is said to have a thoraco-lumbar outflow. Axons of these nerves leave the spinal cord through the anterior rootlet/root. They pass near the spinal (sensory) ganglion, where they enter the anterior rami of the spinal nerves. out through white rami connectors (so called from the shiny white sheaths of myelin around each axon) that connect to either the paravertebral (which lie near the vertebral column) or prevertebral (which lie near the aortic bifurcation) ganglia extending alongside the spinal column.
Ref1

y However, unlike somatic innervation, they quickly separate

y To reach target organs and glands, the axons

must travel long distances in the body, and, to accomplish this, many axons relay their message to a second cell through synaptic transmission. The ends of the axons link across a space, the synapse, to the dendrites of the second cell.
y The first cell (the pre-synaptic cell) sends a

neurotransmitter across the synaptic cleft where it activates the second cell (the postsynaptic cell). The message is then carried to the final destination.
Ref1

y There are two kinds of neurons involved in the transmission of any

signal through the sympathetic system; pre- and post- ganglionic. The shorter preganglionic neurons originate from the thoracolumbar region of the spinal cord (levels T1 - L2, specifically) and travel to a ganglion, often one of the paravertebral ganglia, where they synapse with a postganglionic neuron. From there, the long postganglionic neurons extend across most of the body. In the SNS and other components of the peripheral nervous system, these synapses are made at sites called ganglia. The cell that sends its fiber is called a preganglionic cell, while the cell whose fiber leaves the ganglion is called a postganglionic cell.

The ganglia include not just the sympathetic trunks but also the cervical ganglia (superior, middle and inferior), which sends sympathetic nerve fibers to the head and thorax organs, and the celiac and mesenteric ganglia (which send sympathetic fibers to the gut). Ref1

y Presynaptic nerves' axons terminate in either the paravertebral

ganglia or prevertebral ganglia. This can occur through one of four methods:

y 1. The nerve enters the paravertebral ganglion at the level of its

originating spinal nerve, and then ascends to a more superior paravertebral ganglion, where it synapses with the postsynaptic cell. y 2. The nerve enters the paravertebral ganglion at the level of its originating spinal nerve and synapses with the postsynaptic cell at that level. y 3. The nerve enters the paravertebral ganglion at the level of its originating spinal nerve, and then descends to a more inferior paravertebral ganglion, where it synapses with the postsynaptic cell. y 4. The nerve enters the paravertebral ganglion at the level of its originating spinal nerve and then descends to a prevertebral ganglion, where it synapses with the postsynaptic cell.

Ref1

y Messages travel through the SNS in a bidirectional flow. Efferent

messages can trigger changes in different parts of the body simultaneously. For example, the sympathetic nervous system can accelerate heart rate; widen bronchial passages; decrease motility (movement) of the large intestine; constrict blood vessels; increase peristalsis in the esophagus; cause pupillary dilation, piloerection (goose bumps) and perspiration (sweating); and raise blood pressure. Afferent messages carry sensations such as heat, cold, or pain.
y The first synapse (in the sympathetic chain) is mediated by

nicotinic receptors physiologically activated by acetylcholine, and the target synapse is mediated by adrenergic receptors physiologically activated by either noradrenaline (norepinephrine) or adrenaline (epinephrine).

Ref1

y An exception is with sweat glands, which receive sympathetic

innervation but have muscarinic acetylcholine receptors, which are normally characteristic of the parasympathetic nervous system.
y Another exception is the adrenal medulla, which develops in

tandem with the sympathetic nervous system, and acts as a modified sympathetic ganglion: synapses occur between preand post- ganglionic neurons within it, but the post ganglionic neurons do not leave the medulla; instead they directly release norepinephrine and epinephrine into the blood.

Ref1

Ref1

When large portions of the sympathetic nervous system discharge at the same time, that is a mass discharge, this increases in many ways the ability of the body to perform vigorous muscle exercises. Some of these ways are:
y Increased arterial pressure y Increased blood flow to active muscles concurrent with

y y y y y y

decreased blood flow to organs such as the gastrointestinal tract and the kidneys that are not needed for rapid motor activity Increased rates of cellular metabolism throughout the body Increased blood glucose concentration Increased glycolysis in the liver and in muscle Increased muscle strength Increased mental activity Increased rate of blood coagulation
Ref1

y The sum of these effects permits a person to perform far more

strenuous physical activity than would otherwise be possible. Because either mental or physical stress can excite the sympathetic system, it is frequently said that the purpose of the sympathetic system is to provide extra activation of the body in states of stress: this is called the sympathetic stress response.

y The sympathetic system is especially strongly activated in

many emotional states. For instance, in the state of rage, which is elicited to a great extent by stimulating the hypothalamus, signals are transmitted downward through the reticular formation of the brain stem and into the spinal cord to cause massive sympathetic discharge; most aforementioned sympathetic events ensue immediately. This is called the sympathetic alarm reaction.

Ref1

PHARMACOLOGY OF THE SYMPATHETIC NERVOUS SYSTEM

Effect of drugs: Many drugs increase or decrease the effects of

normal neurotransmission. y Agonists: mimic the effects of a transmitter at receptors, due to structural similarities y Antagonists: bind the receptor but do not activate it, preventing the transmission of any signal via the receptor Drug action enhances or reduces the amount of tone. y The relationship between noradrenergic and cholinergic tone in an organ may change. For example, noradrenergic tone may become stronger than cholinergic tone, causing the heart to beat faster. Examples.............. y Isoprenaline (agonist at b-adrenoceptors): Acts on b2-adrenoceptors in the heart in the same way as noradrenaline. The drug has a similar effect to increasing the tone of the sympathetic nervous system, causing tachycardia y Atropine (antagonist at muscarinic acetylcholine receptors) Prevents acetylcholine from binding to its receptors. The drug has a similar effect to decreasing the tone of the parasympathetic nervous system, causing tachycardia. Ref

Presynaptic neurons synthesize and package their neurotransmitter in vesicles for release (by exocytosis) at the synapse and often have "reuptake" transporters that reclaim the transmitter back into the cell when it has done its job. Postsynaptic neurons display receptors to which the neurotransmitter binds. All of this machinery provides many targets for alteration by exogenous chemicals; that is, psychoactive chemicals introduced into the body. These drugs fall into several distinct families. (stimulants, sedatives, local anesthetics, opiates, anti-depressants, etc.) Stimulants The most widely used stimulants are: y caffeine (in coffee, tea, and cola beverages) y nicotine (in cigarettes) y amphetamines y cocaine All of these drugs mimic the stimulation provided by the sympathetic nervous system. Ref

Nicotine binds to a subset of acetylcholine (ACh) receptors. ACh is a neurotransmitter at synapses early in the pathways of sympathetic stimulation. Although a weak drug in one sense, nicotine is strongly addictive. The use of chewing gum and skin patches containing nicotine is designed to satisfy the craving for nicotine while avoiding the serious health effects of other ingredients in cigarette smoke. Amphetamines and cocaine bind to thus blocking transporters used for the reuptake of dopamine (and noradrenaline) into presynaptic neurons. This causes the level of dopamine to rise in the synapses. High levels of dopamine in an area of the brain called the nucleus accumbens appear to mediate the pleasurable effects associated with these (as well as other) psychoactive drugs. Some amphetamines:

y y

The chief medical uses for amphetamines and amphetamine-like drugs areto help people lose weight (because they suppress appetite); to help children with attention deficit/hyperactivity disorder (ADHD) to perform better in school. At first glance, this second use seems counterproductive. This controversial procedure seems to work by increasing the alertness of the child so that it can focus its energies more effectively on the tasks in front of it.

Ref

Fen-Phen y Fen-Phen refers to a mixture of two amphetamine-like drugs: fenfluramine and phentermine y These were prescribed for losing weight. Because of reports of occasional very serious side effects, the mixture is no longer available and fenfluramine has been removed from the U.S. market. Cocaine y Cocaine has been used for thousands of years by certain tribes in the Andes of South America. Cocaine and some of its relatives have legitimate medical uses as local anesthetics (e.g., lidocaine). However, the widespread recreational use of cocaine has created serious social problems.

y Immunity to cocaine addiction? In order to achieve its effects, cocaine must cross the so-called bloodbrain barrier. If antibodies are bound to the cocaine molecule, it cannot cross. This has raised the possibility of immunizing people against cocaine. It works in mice.
Ref

Drugs That Act on Adrenergic Effector Organs:

Sympathomimetic Drugs y Intravenous injection of norepinephrine causes the same effects throughout the body as sympathetic stimulation. Therefore, norepinephrine is called a sympathomimetic or adrenergic drug. Epinephrine and methoxamine are also sympathomimetic drugs, and there are many others. They differ from one another in the degree to which they stimulate different sympathetic effector organs and in their duration of action.
y Norepinephrine and epinephrine have actions as short as 1

to 2 minutes, whereas the actions of some other commonly used sympathomimetic drugs last for 30 minutes to 2 hours.
Ref

Important drugs that stimulate specific adrenergic receptors but not others are:
y phenylephrine (alpha receptors) y isoproterenol (beta receptors)

Ref

Drugs That Block Adrenergic Activity

Adrenergic activity can be blocked at several points in the stimulatory process, as follows:
y

1. The synthesis and storage of norepinephrine in the sympathetic nerve endings can be prevented. The best known drug that causes this effect is reserpine. 2. Release of norepinephrine from the sympathetic endings can be blocked. This is caused by guanethidine. 3. The sympathetic alpha receptors can be blocked. Two drugs that cause this effect are: phenoxybenzamine and phentolamine. 4. The sympathetic beta receptors can be blocked. A drug that blocks beta1 and beta 2 receptors is propranolol. One that blocks mainly beta1receptors is metoprolol. 5. Sympathetic activity can be blocked by drugs that block transmission of nerve impulses through the autonomic ganglia. An important drug for blockade of both sympathetic and parasympathetic transmission through the ganglia is hexamethonium.

Ref

PHYSIOLOGIC ANATOMY OF THE PARASYMPATHETIC NERVOUS SYSTEM

demonstrates parasympathetic fibers leave the central nervous system through cranial nerves III, VII, IX, and X; additional parasympathetic fibers leave the lowermost part of the spinal cord through the second and third sacral spinal nerves and occasionally the first and fourth sacral nerves. y About 75 per cent of all parasympathetic nerve fibers are in the vagus nerves (cranial nerve X), passing to the entire thoracic and abdominal regions of the body. yThe vagus nerves supply parasympathetic nerves to the heart, lungs, esophagus, stomach, entire small intestine, proximal half of the colon, liver, gallbladder, pancreas, kidneys, and upper portions of the ureters. y Parasympathetic fibers in the third cranial nerve go to the pupillary sphincter and ciliary muscle of the eye. Fibers from the seventh cranial nerve pass to the lacrimal, nasal, and submandibular glands. yFibers from the ninth cranial nerve go to the parotid gland. The sacral parasympathetic fibers are in the pelvic nerves, which pass through the spinal nerve sacral plexus on each side of the cord at the S-2 and S-3 levels. yThese fibers then distribute to the descending colon, rectum, urinary bladder, and lower portions of the ureters. Also, this sacral group of parasympathetic supplies nerve signals to the external genitalia to cause erection. Ref 1
yFrom the diagrammatic representation of the Autonomic nervous System above

BASIC CHARACTERICS OF THE PARASYMPATHETIC NERVOUS SYSTEM

PARASYMPATHETIC NERVOUS SYSTEM

y The parasympathetic system specifically is responsible for

stimulation of "rest-and-digest" activities that occur when the body is at rest, including (SLUDD): salivation, lacrimation (tears), urination, digestion and defecation. It s also involve in sexual arousal.

Ref

CHOLINERGIC AND ADRENERGIC FIBERS SECRETION OF ACETYLCHOLINE OR NOREPINEPHRINE

y Parasympathetic nerve fibers secrete mainly one or the other of two synaptic transmitter

substances, acetylcholine or norepinephrine.

y Those fibers that secrete acetylcholine are said to be cholinergic. y Those that secrete norepinephrine are said to be adrenergic, a term derived from

adrenalin, which is an alternate name for epinephrine.

y All preganglionic neurons are cholinergic. y Either all or most of the postganglionic neurons of the parasympathetic nervous system

are cholinergic.
y The terminal nerve endings of the parasympathetic system all or virtually all secrete

acetylcholine.
y Therefore, acetylcholine is called a parasympathetic transmitter.

Ref 1

Synthesis of Acetylcholine, Its Destruction After Secretion, and Its Duration of Action.
y Acetylcholine is synthesized in the terminal endings and varicosities of the cholinergic

nerve fibers where it is stored in vesicles in highly concentrated form until it is released.
y Acetyl-CoA + Choline (Acetylcholine acetyltransferase) gives acetylcholine. y When acetylcholine is secreted into a tissue by a cholinergic nerve ending, it persists in

the tissue for a few seconds while it performs its nerve signal transmitter function.
y Then it is split into an acetate ion and choline, catalyzed by the enzyme

acetylcholinesterase that is bound with collagen and glycosaminoglycans in the local connective tissue.
y This is the same mechanism for acetylcholine signal transmission and subsequent

acetylcholine destruction that occurs at the neuromuscular junctions of skeletal nerve fibers.
y The choline that is formed is then transported back into the terminal nerve ending,

where it is used again and again for synthesis of new acetylcholine.

Ref 1

STRUCTURE OF ACETYLCHOLINE

Ref 1

RECEPTORS ON THE EFFECTOR ORGANS

y Before an acetylcholine at an autonomic nerve ending can stimulate an effector organ, it

must first bind with specific receptors on the effector cells.

y The receptor is on the outside of the cell membrane, bound as a prosthetic group to a

protein molecule that penetrates all the way through the cell membrane.
y When the transmitter substance binds with the receptor, this causes a conformational

change in the structure of the protein molecule.

y In turn, the altered protein molecule excites or inhibits the cell, most often by (1)

causing a change in cell membrane permeability to one or more ions or (2) activating or inactivating an enzyme attached to the other end of the receptor protein where it protrudes into the interior of the cell.

Ref

TWO PRINCIPAL TYPES OF ACETYLCHOLINE RECEPTORS MUSCARINIC AND NICOTINIC RECEPTORS

y Acetylcholine activates mainly two types of receptors.

y They are called muscarinic and nicotinic receptors. The reason for these

names is that muscarine, a poison from toadstools, activates only muscarinic receptors and will not activate nicotinic receptors, whereas nicotine activates only nicotinic receptors; acetylcholine activates both of them.

y Muscarinic receptors are found on all effector cells that are stimulated by

the postganglionic cholinergic neurons of either the parasympathetic nervous system or the sympathetic system.

y Nicotinic receptors are found in the autonomic ganglia at the synapses

between the preganglionic and postganglionic neurons of both the sympathetic and parasympathetic systems. Ref 1

STIMULATION OF DISCRETE ORGANS AND MASS STIMULATION IN OTHER INSTANCES BY THE PARASYMPATHETIC SYSTEMS

PARASYMPATHETIC CONTROLS OF BODY ORGANS

1.

The eyes- when bright light is shone into the eyes, the messages is transmitted to the midbrain giving rise to an appropriate stimulus which travels through the parasympathetic fibers to the oculomotor(third cranial nerve), to the pupils which results in the autonomic contraction of the pupillary muscles, constricting the aperture, thus reducing the amount of light reaching the sensory cells of the retina. The stomach- stimuli of entry of food into the stomach are conveyed by afferent fibers of the vagus nerve to the command station where messages are conveyed through efferent fibers of the vagus nerve back to the stomach. As a result there is secretion of gastric juices and peristaltic contraction to mix food. These food is conveyed to the small intestine where it follows the same parasympathetic nervous pathway. Bladder and rectum- emptying the bladder and rectum is not entirely autonomic but is subjected to parasympathetic impulses that are voluntary controlled. The filling of the urinary bladder stimulates stretch sensitive receptors in its wall whence the message is conveyed to the midbrain where the stimulus to blood contraction and opening of sphincter is voluntary initiated for the discharge of urine.

2.

3.

Ref 1

y Abdominal muscles-the complex requirement for giving birth are initiated by

stimuli in the dilatation of the cervix and involuntary control of the uterine musculature with delivery of the fetus assisted by voluntary contraction of the abdominal muscles.

Ref 1

Autonomic Reflexes Many visceral functions of the body are regulated by autonomic reflexes.

CARDIOVASCULAR AUTONOMIC REFLEXES

ySeveral reflexes in the cardiovascular system help to

control especially the arterial blood pressure and the heart rate. y One of these is the baroreceptor reflex, Baroreceptors are located in the walls of several major arteries, including especially the internal carotid arteries and the arch of the aorta. y When these become stretched by high pressure, signals are transmitted to the brain stem, where they inhibit the sympathetic impulses to the heart and blood vessels and excite the parasympathetics; this allows the arterial pressure to fall back toward normal. Ref 1

Gastrointestinal Autonomic Reflexes:

yThe uppermost part of the gastrointestinal tract and the rectum are

controlled principally by autonomic reflexes. For instance, the smell of appetizing food or the presence of food in the mouth initiates signals from the nose and mouth to the vagal, glossopharyngeal, and salivatory nuclei of the brain stem. These in turn transmit signals through the parasympathetic nerves to the secretory glands of the mouth and stomach, causing secretion of digestive juices sometimes even before food enters the mouth.
yWhen fecal matter fills the rectum at the other end of the alimentary canal,

sensory impulses initiated by stretching the rectum are sent to the sacral portion of the spinal cord, and a reflex signal is transmitted back through the sacral parasympathetics to the distal parts of the colon; these result in strong peristaltic contractions that cause defecation.

Ref1

OTHER AUTONOMIC REFLEXES

y Emptying of the urinary bladder is controlled in the same way as

emptying the rectum; stretching of the bladder sends impulses to the sacral cord, and this in turn causes reflex contraction of the bladder and relaxation of the urinary sphincters, thereby promoting micturition.

y Also important are the sexual reflexes, which are initiated both by

psychic stimuli from the brain and by stimuli from the sexual organs. Impulses from these sources converge on the sacral cord and, in the male, result first in erection, mainly a parasympathetic function, and then ejaculation, partially a sympathetic function. regulation of pancreatic secretion, gallbladder emptying, kidney excretion of urine, sweating, blood glucose concentration, and many other visceral functions.

y Other autonomic control functions include reflex contributions to the

Ref 1

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Medical Physiology, 11th Clinically Oriented Anatomy Wheather s Functional Histology Madder, Sylvia S.,(2006),Inquiry Into Life, McGraw-Hill Board review Physiology 3rd Edition Lynda S Costanzo, PHD http://www2.estrellamountain.edu/faculty/farabee/biobk/biobooknerv.htm l#The Neuron How the body works- A comprehensive illustrated Enclopedia of Anatomy DR. Peter Abrams http://www.chop.edu/healthinfo/acute-spinal-cord-injury.html http://www.meddean.luc.edu/lumen/MedEd/grossanatomy/h_n/c/cn1/mai nframe.htm http://www.cerebromente.org.br/n02/fundamentos/circulation_i.htm http://www.le.ac.uk/pa/teach/va/anatomy/case3/frmst3.html http://www.chop.edu/healthinfo/acute-spinal-cord-injury.html http://www.southtexascollege.edu/nilsson/4_GB_LectureNotes_f/4_GB_16_ AnimS_Ho_J_Spr2003.html

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