Neuro Anatomy Neuro Assessment
Neuro Anatomy Neuro Assessment
Neuro Anatomy Neuro Assessment
Nursing
Overview of the Anatomy
and Physiology of the
NERVOUS
SYSTEM
NERVOUS
SYSTEM
CENTRAL PERIPHERAL
⮚organ system that contains a network
of specialized cells called neurons.
⮚Controller of various processes
Nervous system
Anatomic & Physiologic Overview
• 2 major parts: CNS & PNS
• FUNCTIONS
⮚Sensory input
⮚Processing & interpreting
⮚Motor output
• Composition: 2 principal types of cells
(conducting and supportive cells)
Cells of the Nervous System
1. Neuron
(Neurone,
Nerve cell)
⮚ Dendrites- threadlike structures that
conveys incoming electrochemical
messages toward the cell body.
⮚ Axon- long projections that
generates impulses away from the
cell body.
⮚ Cell body- center of neuron; nucleus
⮚Synapses- fundamental property of
neurons that is used to communicate
with other cells
⮚Myelin Sheath- whitish, fatty
material (covers long nerve fibers);
- has waxy appearance (protects &
insulates the fibers & increases the rate
of nerve impulses)
⮚Schwann cells- myelinate the axon
⮚Nodes of Ranvier- gaps or
indentations between myelin sheath
NEUROTRANSMITTERS
- chemicals made by neurons
Action: to potentiate, terminate, or
modulate a specific action and can
either excite or inhibit the target cell’s
activity
How: By communicating messages from
one neuron to a specific target tissue
Types of Neurotransmitters:
1. Amines group- contains molecules of
carbon, hydrogen, and nitrogen
a. Acetylcholine- most widely used
neurotransmitter
b. Norepinephrine- major
neurotransmitter of the sympathetic
nervous system
c. Dopamine- involved in the movement
of muscles, and it controls the secretion of
the pituitary hormone prolactin
c. Serotonin-helps control mood and
sleep; inhibits pain pathways
2. Amino Acid group- organic compound
containing both an amino group (NH2) and a
carboxylic acid group (COOH)
a. Glycine
b. Glutamic and aspartic acids
c. Gamma-amino butyric acid (GABA)
Glutamic acid and GABA- most abundant
neurotransmitters within the central nervous
system especially in the cerebral cortex
(largely responsible for such higher brain
functions as thought and interpreting
sensations)
3. Peptide group- contains at least 2,
and sometimes as many as 100
amino acids
a. Substance P- influences the
sensation of pain
2. Supporting cells- Neuroglia or
Glial cells/ non- neuronal cells
⮚Not able to transmit impulses
⮚50x ˃ neurons=40% of the brain’s bulk
⮚Types:
a. astroglia/ astrocytes- supply nutrients to
neurons; help maintain neurons’ electrical
potential; form part of the blood- brain
barrier
b. Ependymal cells- help produce CSF
c. Microglia- phagocytic cells that ingest
and digest microorganisms and waste
products from injured neurons
d. Oligodendroglia- supports and
electrically insulate CNS axons by forming
protective myelin sheaths
Central Nervous System
• Brain & the
spinal cord.
• Surrounded by
bone-skull and
vertebrae.
• Fluid and tissue
insulate the brain
and spinal cord.
THE BRAIN • Part of CNS
contained within
the cranium
• mass of soft,
spongy pinkish gray
nerve tissue.
• accounts for
approx. 2% of the
TBW
Main regions of the brain:
❖CEREBRUM ❖CEREBELLUM
❖DIENCEPHALON ❖BRAIN STEM
CEREBRUM
- Largest & most prominent part
- Governs higher mental processes
- Consists of the R&L hemisphere
separated by the great longitudinal
fissure
- Joined at the lower portion of the
fissure by the corpus callosum
• GYRI or GYRUS - convolutions
• SULCI or SULCUS - shallow grooves
• FISSURES- deeper groves
• Cerebral cortex
Layers of the Cerebrum:
• gray matter (muscle
control, sensory
perception, memory,
emotions, and
speech)
• white matter
• Divisions/ Lobes of Cerebral Hemispheres
1. Frontal- largest lobe
Functions: (1) concentration, abstract thought,
information storage or memory and motor
function; (2) contains Broca’s area; and (3)
responsible for an individual’s affect,
judgment, personality and inhibitions
2. Parietal- primary sensory cortex
Functions: (1) analyzes sensory
information, and relays the
interpretation of the information to the
thalamus and other areas; (2) essential
for an individuals awareness of the
body in space
3. Temporal- contains the auditory
receptive areas, interpretive area
that provides integration of
somatization, visual, and auditory
areas, Wernicke’s area,
proprioception (sense of position of
self)
4. Occipital- the posterior lobe
responsible for visual interpretation
DIENCEPHALON
STRUCTURES:
1. THALAMUS- relay station for all sensory impulses,
memory, and pain impulses
2. HYPOTHALAMUS- located anterior & inferior to the
thalamus.
- Contains nuclei very important in maintaining
homeostasis
- Regulation of visceral activities
- Regulates the pituitary secretion of hormones
3. EPITHALAMUS – located superior and posterior to
thalamus
- Involved in emotional and visceral response to odor
and contains the PINEAL BODY
BRAIN STEM
• STRUCTURES
1. MIDBRAIN - connects the pons & the
cerebellum with the cerebral hemispheres.
- acts as master coordinator for all the
messages going in & out of the brain to the
spinal cord.
2. PONS - helps regulate breathing, contains the
respiratory center.
3. MEDULLA OBLONGATA - most inferior part of
the brainstem
- contain centers that control HR, BP,
sneezing, coughing, breathing, swallowing &
vomiting
CEREBELLUM
- posterior to the midbrain & pons, &
below the occipital lobe.
- Literally means “little brain”
- Responsible for balance,
coordination and muscle tone
Structures Protecting the Brain
1. Skull- bony structure that
protects the brain from
injury
Major bones: frontal,
temporal, parietal and
occipital
Suture Lines: Coronal,
Sagittal, lambdoidal, and
squamosal
2. Meninges - fibrous connective tissue that
covers the brain and spinal cord; provides
protection, support and nourishment to the
brain and spinal cord
Layers:
a. Dura mater- outermost; covers the brain and
the spinal cord; tough, inelastic, fibrous, and
gray
Epidural space- potential space between the
dura matter and skull in the cranium, and
between periosteum and dura in the
vertebral column
b. Arachnoid Matter- middle
membrane; white; contains the
choroid plexus
- has unique fingerlike projections,
arachnoid villi
c. Pia mater- innermost membrane;
thin, transparent layer that hugs the
brain closely
Cerebrospinal fluid
- clear & colorless fluid
- Acts as protective
cushion
- produced at rate of
about 500ml/day
- laboratory analysis:
clear color, normal
specific gravity of
1.007, protein count,
minimal WBC count,
glucose, & some
electrolytes, no RBC
Spinal Cord
• runs along the dorsal side of
the body; links the brain to
the rest of the body.
• Carries sensory information
to & motor information
from the brain.
• encased in a series of bony
vertebrae that comprise the
vertebral column.
• 45cm/18” long & about the
thickness of a finger
• Surrounded by meninges
• Gray matter- inner
core; consists mostly
of cell bodies and
dendrites.
• White matter- made
up of fiber bundles;
ascending and
descending
• Vertebral column
consists of 7 cervical,
12 thoracic, 5 lumbar
vertebrae,
sacrum(fused mass of
5 vertebrae); coccyx
Vertebral Column
Spinal cord as H- structure
- Lower portion is broader than upper portion and
corresponds to the anterior horn
a. Anterior Horn- contains cells with fibers that
form the anterior (motor) root end; essential
for the voluntary and reflex activity of the
muscles they innervate
b. Posterior Horn - contains cells with fibers that
enter over the posterior (sensory) root end and
thus as a relay station in the sensory/ reflex
pathway
Peripheral Nervous System
• 2 Principal Subdivisions
1. Sensory or afferent division- carry information
from the outside world; sensory receptors are
located in the different parts of the body; i.e.
somatic sensory fibers, visceral sensory fibers
Reaction to light
Brisk
Sluggish (Meningitis, Subarachnoid Hematoma)
Non-Reactive
Comparison of pupils
Isocoria-equal size in pupils
Anisocoria- unequal size in pupils
AVPU SCALE – quick and easy method
Awake
✔ Alert and oriented to person, place and time
✔ Acting reasonably to stimuli
✔ Patient is aware of you approaching him/her
Verbal Stimulation (responds to)
✔ Responds to voice
✔ Unawake but will respond by speaking/moaning,
facial expressions, limb movement, eyelid blinking
Pain Stimulation (responds to)
Patient will only respond to painful stimuli such as:
✔ Suborbital pressure
✔ Pinching the fleshy part near the axilla
✔ Trapezium squeeze
✔ Shaking the shoulders
✔ Earlobe pinch
✔ Nail pinch
Unresponsive
✔ Unawake, no response to verbal and pain stimuli
ALTERED LEVEL OF CONSCIOUSNESS
• An altered level of consciousness (LOC) is apparent in the patient who is
not oriented, does not follow commands, or needs persistent stimuli to
achieve a state of alertness. LOC is gauged on a continuum, with a normal
state of alertness and full cognition (consciousness) on one end and coma
on the other end.
• Coma is a clinical state of unarousable unresponsiveness in which there
are no purposeful responses to internal or external stimuli, although
nonpurposeful responses to painful stimuli and brain stem reflexes may
be present. The usual duration of coma is 2 to 4 weeks.
• Akinetic mutism is a state of unresponsiveness to the environment in
which the patient makes no voluntary movement.
• Persistent vegetative state is a condition in which the unresponsive
patient resumes sleep–wake cycles after coma but is devoid of cognitive
or affective mental function.
• Locked-in syndrome results from a lesion affecting the pons and results in
paralysis and the inability to speak, but vertical eye movements and lid
elevation remain intact and are used to indicate responsiveness. The level
of responsiveness and consciousness is the most important indicator of
the patient’s condition.