NEUROLOGY

EMERITA C. MENDOZA, R.N.,

M.D.
 PRINCIPAL DIVISIONS:
1. Central Nervous System
(CNS)
a. brain & the spinal cord
 serves as control
mechanism for the entire
organism
2. Peripheral Nervous
System (PNS)
a. 12 cranial nerves (CN)
b. 31 spinal nerves
c. autonomic nerves
a. sympathetic
b. parasympathetic
 Glial cells & Neuron
 Nervous tissue is
composed of two
main cell types:
Neurons transmit
nerve messages.
Glial cells direct
contact with
neurons and often
surround them.
 The Neuron
 functional unit
 dendrites – receive neural
msgs
& transmit towards cell
body
 axon – transmits neural
msgs
away from cell body
 cell body – contains nucleus,
mitochondria, & other
organelles
 myelin & cellular sheath
produced by Schwann
 Axons are wrapped in a myelin sheath
formed from the plasma membranes of
specialized glial cells known as (
Schwann cells). -supportive, nutritive, and
service facilities for neurons.
 Node of Ranvier, gap between Schwann
cells, points along the neuron for
generating a signal.
Signals jumping from node to node travel
hundreds of times faster than signals
traveling along the surface of the axon.
This allows your brain to communicate
with your toes in a few thousandths of a
second.
 TYPES OF NEURONS
 Sensory neurons typically have a long
dendrite
and short axon, carry messages from
sensory receptors 
central nervous system.

 Motor neurons have a long axon and short

dendrites, transmit messages from
central nervous system muscles (or to
glands).
 Nerves & Ganglia
 nerve – a large bundle
of axons wrapped in
CT
 tracts or pathways –
bundle of axons within
the CNS
 ganglia – aggregation
of nerve cell bodies
w/in the PNS
 nuclei – collection of
cell bodies w/in the
CNS
 Neural circuits
 NEURAL CIRCUITS- neurons organized into
sequences
-arranged so that the axon of one
neuron in the circuit forms junctions with
the dendrites of the next neuron in the
circuit.
synapse - junction between two neurons.
synaptic cleft -separates synapse by a
tiny gap (less than one-millionth of an
inch)
 presynaptic neuron -ends at a specific
synapse
 Synapses
 The junction between a nerve cell
and another cell is called a synapse.
Messages travel within the neuron as
an electrical action potential. The
space between two cells is known as
the synaptic cleft. To cross the
synaptic cleft requires the actions of
neurotransmitters. Neurotransmitters
are stored in small synaptic vessicles
clustered at the tip of the axon.
 Reflex Action
 simplest example of a neural
response
predictable, automatic response to
stimuli
 4 processes:

-reception of the stimuli,

- transmission of information,
-integration (interpretation &
determination of appropriate
 CNS: the BRAIN
 complex organ that
allows us to think,
move, feel, see,
hear, taste, and
smell.
 It controls our
body, receives
information,
analyzes
information, and
stores information
(our memories).
 BRAIN
 average human
brain weighs about
3 pounds (1300-
1400 g).
 At birth, the human
brain weighs less
than a pound
(0.78-0.88 pounds
or 350-400 g).
 The human brain
reaches its full size
at about 6 years of
age.
 The brain consists of
gray matter (40%)
and white matter
(60%) contained
within the skull.
 Brain cells include
neurons and glial
cells.
 4 MAJOR PARTS: the
cerebrum, the
diencephalon, the
cerebellum, and the
brain stem.
 BRAIN
 2% of the body's weight,
it uses 20% of the
oxygen supply
 gets 20% of the blood
flow.
 Blood vessels (arteries,
capillaries, and veins)
supply the brain with
oxygen and nourishment,
and take away wastes.
 If brain cells do not get
oxygen for 3 to 5
minutes, they begin to
die.
 Cerebrospinal fluid (CSF)
 Medulla
 Formally known as medulla
oblongata
 Most inferior portion of the brain
stem continuous with the spinal
cord; 4th ventricle is continuous
with the central canal
 80% of the pyramidal fibers cross
or decussate to the other side (so R
side of the brain controls
movement of the left side of the
 Vital reflex centers within the
medulla:
 Cardiac centers – control heart rate
 Vasomotor centers – control blood
pressure
 Respiratory centers – regulate breathing

 Centers for vomiting, sneezing,

coughing, & swallowing
 Centers for reflexes mediated by CNs IX-
XII
 The Pons
 A bulge on the anterior (ventral)
surface of the brain stem, just above
the medulla
 Acts as a bridge/link connecting
various parts of the brain
 Contains one of the respiratory
centers & centers for reflexes
mediated by the CNs V-VII
 The Midbrain
 Also known as mesencephalon
 Extends from the pons to the
diencephalon
 I the cerebral aqueduct,
connects the 3rd & 4th ventricle
 Consists of 4 rounded bodies,
the corpora quadrigemina:
 Paired upper bodies: serve
as visual reflex centers for
head & eyeball movements

 Paired lower bodies: serve

as relay centers for auditory
information
 The Diencephalon
 Part of the brain between the
cerebrum & the midbrain
 Its cavity is the 3rd ventricle
 Contains the following important
structures:
1. Thalamus
2. Hypothalamus
3. Pineal body (an endocrine gland)
 The Thalamus
 Consists of two oval masses, one on each
side of the 3rd ventricle
 Afferent neurons coming from all sense
organs (except olfactory) & motor neurons
synapse with nuclei found within the
thalamus  cerebrum
 A person becomes vaguely aware of
sensory impulses when they reach the
thalamus
 The thalamus also helps one associate
feelings of pleasantness or unpleasantness
with sensory impulses
 The Hypothalamus
 Lies inferior to the thalamus, forms
the floor & part of the lateral walls of
the 3rd ventricle
 Optic chiasma – crossing part of each
optic nerve
 Infundibulum – a stalk of tissue that
connects the pituitary gland to the
hypothalamus
 Mechanisms of the hypothalamus
that maintain homeostasis:
1. Connects the cerebral cortex & the
lower autonomic centers.
2. Link bet the nervous & endocrine
systems.
3. Helps maintain fluid balance. ( ADH &
presence of thirst center)
4. Body temperature is regulated.
5. The appetite & satiety centers within
regulate food intake.
6. Influences sexual behavior & the
affective (emotional) aspects of
 The Cerebellum
 2nd largest part of the brain w/c consists
of 2 hemispheres & a connecting
portion, the vermis
 responsible for coordination of muscle
movements
 functions:
1. helps make muscular movement smooth
instead of jerky & trembling
2. helps maintain muscle tone & posture
3. impulses from the vestibular apparatus are
continuously delivered to the cerebellum to
help maintain equilibrium
 The Cerebrum
 seat of consciousness
 the largest & most prominent part of
the brain
 governor of all higher mental
processes: interprets sensation,
controls motor activities, & serves as
center of intellect, reason, memory,
language, and consciousness
 convolutions or gyri & grooves: sulci
or fissures
Basic structure of
Cerebrum
 The cerebrum, the largest part of the
human brain, is divided into left and
right hemispheres connected to each
other by the corpus callosum. The
hemispheres are covered by a thin
layer of gray matter known as the
cerebral cortex, the most recently
evolved region of the vertebrate
brain.
 The cortex in each hemisphere of the
cerebrum is between 1 and 4 mm
thick. Fissures & sulci divide the
cortex into six lobes: occipital,
temporal, parietal, frontal, central
(insula), and limbic.
 No region of the brain functions
alone, although major functions of
various parts of the lobes have been
determined
 The occipital lobe (back of the head)
receives and processes visual
information.
 The temporal lobe receives auditory
signals, processing language and the
meaning of words.
 The parietal lobe is associated with the
sensory cortex and processes information
about touch, taste, pressure, pain, and
heat and cold.
 The frontal lobe conducts three functions:
1. motor activity and integration of muscle
activity
2. speech
3. thought processes
 The limbic lobe is thought to be a link bet
emotional & cognitive (thought)
Associated structures:
 Just anterior to the central fissure lies the
precentral gyrus of the frontal lobe.
Because voluntary movements of skeletal
muscles are controlled from this area, it is
known as the motor cortex or primary
motor area. One part of the premotor
area, known as Broca's speech area, is
concerned with directing the formation of
words.
 The parietal lobe has a primary sensory
area, the postcentral gyrus, that
receives information from the sensory
receptors in the skin and joints.
 Homunculus
(Motor/Sensory)
 It is the literal
representation of connected
parts of the human body on
the surface of the brain. The
surface of the postcentral
gyrus provides the literal
somatosensory homunculus,
while the surface of the
precentral gyrus provides
the literal motor
homunculus. Please note
that the sensory
homunculus is almost a
mirror image of the motor
 White Matter of the
Cerebrum
 The white matter of
the cerebrum is
composed of
myelinated fibers.
These connect the
cortical areas with one
another and with
other parts of the
nervous system. A
large band of white
matter, the corpus
callosum, connects
the right and left
hemispheres The
 Limbic system
 limbic system
 emotional responses,
autonomic responses,
subconscious motor
and sensory drives)
sexual behavior,
biological rhythms,
and motivation,
including feelings of
pleasure and
punishment. Certain
structures of the
cerebrum and
diencephalon make up
the limbic system
 CNS: The Spinal Cord
 2 main functions:
 controls many reflex activities of the
body
 transmits information back & forth
from peripheral nerves to the brain via
its ascending & descending tracts
 it emerges from the base of the
brain at the level of the foramen
magnum & extends caudally to L2
vertebra (average length 45 cms/17
in)
 Cervical & Lumbar
enlargements – supply
UE & LE respectively
 at caudal end: tip is
known as the conus
medullaris  extends
as the filum terminale
w/c attaches to the
coccyx
 SC ends as the cauda
equina (horse’s tail) a
fan of nerve fibers
found below L2
vertebra of the spinal
column; carries all the
nerves that affect the
 Cross section of Spinal
Cord
 A cross section of the
spinal cord reveals an
inner section of gray
matter (containing
cell bodies and
dendrites of peripheral
nerves) and an outer
region of white
matter (containing
the nerve fiber tracts
with myelin sheaths)
conducting impulses
to and from the brain.
 MENINGES
 connective tissue membranes covering
the CNS (in conjunction with CSF)
 outermost: dura mater – tough, white
fibrous CT
 subdural space – potential space
 middle: arachnoid – thin, delicate,
cobweb-like membrane
 subarachnoid space – filled with CSF &
blood vessels
 innermost: pia mater – thin, vascular
membrane tightly bound to the brain
 Cerebrospinal Fluid
 shock-absorbing CSF fills the ventricles,
brain cavities, and the subarachnoid
spaces
 produced by clusters of capillaries, the
choroid plexuses which project from the
pia mater into the ventricles
 circulates through the ventricles 
through small apertures into the
subarachnoid space  reabsorbed into
the blood through arachnoid granulations
 Peripheral Nervous
System
 made up of the sense organs, the
sensory neurons, & the nerves that
link the CNS with the effectors
 2 systems:
 somatic system – responsible for body
balance in relation to outside world
 autonomic system – responsible for
internal body balance
Comparison of Efferent Components of Somatic and Autonomic Nervous Systems

Somatic System Autonomic System

Structures Skeletal (voluntary) Smooth (involuntary) muscle, cardiac muscle, glands

Innervated muscle

Effect on Effector Excitatory Excitatory or inhibitory

General Role Adjustments to Adjustments within internal environment

external environment (homeostasis)

Number of Neurons One Two

from CNS to
Effector

Ganglia Outside None Chain ganglia, collateral ganglia, or terminal ganglia

CNS (near effector)

Neurotransmitter Acetylcholine Acetylcholine; norepinephrine by sympathetic

postganglionic neurons

Effect of Nerve Paralysis and Effector remains functional but is not able to respond
Destruction on atrophy to changing needs of body.
Effector
Comparison of Sympathetic and Parasympathetic Actions on Selected Effectors

Sympathetic Action Parasympathetic Action

Effector
Heart Increases rate and strength of Decreases rate; no direct effect on
contraction strength of contraction
Bronchial tubes Dilates Constricts
Iris of eye Dilates (pupil becomes larger) Constricts (pupil becomes smaller)
Sex organs Constricts blood vessels; ejaculation Dilates blood vessels; erection
Blood vessels Generally constricts No innervation for many
Sweat glands Stimulates No innervation
Intestine Inhibits motility Stimulates motility and secretion
Liver Stimulates glycogen breakdown No effect
metabolism
Adipose tissue Stimulates free fatty acid release No effect
from fat cells
Adrenal medulla Stimulates secretion of epinephrine No effect
and norepinephrine
Salivary glands Stimulates thick, viscous secretion Stimulates profuse, water
secretion