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Anatomy5.

7b

January17,2012
Dr.Esguerra

The Peripheral Nervous System

OUTLINE
I.FunctionalComponentsofPeripheralNerves
II.SpinalCord,Roots&Nerves
III.StructureofSpinalNerves
IV.SegmentalInnervation
V.CranialNerves
VI.BrainstemRuleof4

Objectives:PleaserefertoAnatomy5.7a

ItalicizedtextweredirectlyliftedfromtherecordingofDr.Esguerras
lecture
Text in Times New Roman were lifted from our references

I.FUNCTIONALCOMPONENTSOFPERIPHERALNERVES

Olfactoryandgustatoryreceptors
Musclesofbranchiomericorigintheonesthatare

derivedfrombranchialarches(msofmastication,facial
ms,larynx,pharynx,etc.)

Table1.2Sensory/Motor+Somatic/Visceral

SOMATIC
(SomaticNervous
System)

SENSORY
(Afferents)

SOMATICSENSORY
GeneralSomatic
Afferent(GSA)

MOTOR
(Efferents)

SOMATICMOTOR
GeneralSomatic
Efferent(GSE)

Peripheral nerves is a collective term for the cranial and spinal

nerves

Eachparticlenervefibercanbedistinguishedto3setsof

functions:

o Afferent(Sensory)vs.Efferent(Motor)

Sensory(Afferent)Nerve
CNS:(Pseudo)Unipolarneuronsconductingimpulses
fromsensoryorganstotheCNS
Bundles of nerve fibers of the posterior root that carry
nervous impulses to the central nervous system
The cell bodies of these nerve fibers are situated in a
swelling on the posterior root called the posterior root
ganglion
Motor(Efferent)
CNS:Multipolarneuronsconductingimpulsesfromthe
CNStoeffectororgansmusclesandglands
Arises from the anterior root of the spinal cord
Consists of bundles of nerve fibers carrying nerve impulses
away from the central nervous system

o Somaticvs.Visceral

Note:
GVEonlyAUTONOMIC
GVAvisceralreflexes

Table1.3SummariesofFunctionalComponents

Somatic
General
Visceral

Table1.1SomaticvsVisceral

ATTRIBUTE

Embryological
OriginofTissue

Examplesof
AdultTissue
Perception

SOMATICSYSTEM
Body
Wall:Somatic

(Parietal)Mesoderm

(Dermatome,
Myotome)
Dermsofskin,
skeletalmuscle,
connectivetissues
Conscious,
Voluntary

VISCERALSYSTEM

OrgansSplanchnic

(Visceral)
Mesoderm,
Endoderm

Glands,Cardiac
muscles,smooth
muscles
Unconscious,
Involuntary

o Generalvs.Special

General:Allfunctionsofspinalnervesandsomecranial
nerveswithsimilarfunctions
Special:Thosewithspecializedfunctions(e.g.Somecranial
nerves
Specialsenseorganoftheeyeandtheear

Somatic
Special
Visceral

Afferent(GSA)(CN
V,VII,IX,X)
Efferent(GSE)(CN
III,IV,VI,XII)
Afferent(GVA)(CN
VII,IX,X)
Efferent(GVE)(CN
III,VII,IX,X)
Afferent(SSA)(CNII,
VII)
Afferent(SVA)(CNI,
VII,IX,X)
Efferent(SVE)(CNV,
VII,IX,XI)

Note:
GSAandGSEsomaticnervoussystem
GVAandGVEANS
Thereisnospecialsomaticefferent

II.SPINALCORD,ROOTS&NERVES
Spinal nerve roots pass from the spinal cord to the level of their
respective intervertebral foramina, where they unite to form a
spinal nerve
Spinalnerveisformedwiththejoiningofthetworootscoming
outofthespinalcorddorsalandventralroots
Mixture of motor and sensory fibers
Anterior Ramus Larger; supply the muscles and skin over the
anterolateral body wall and all the muscles and skin of the limbs.
Posterior Ramus Smaller; supply the muscles and skin of the
back

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VISCERAL
(AutonomicNervous
System)
VISCERALSENSORY
GeneralVisceral
Afferent(GVA)
(ex.Distentionof
bowels,bloodpresse)
VISCERALMOTOR
GeneralVisceral
Efferent(GVE)
(ex.Promotesmotility
orsecretionof
glands.)

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Gangliaconnectedtothespinalcordbytworami(dorsaland
ventral)communicantes,May be divided into sensory ganglia of
spinal nerves (posterior root ganglia) and cranial nerves and
autonomic ganglia.
o 3Cervical
o 1011Thoracic
o 4Lumbar
o 4Sacral
o 1Coccygeal
14WhiteRamiCommunicantes(T1L2)moredistalthan
theGrayramus
31GrayRamiCommunicantes

o Disruptionofsensoryneurons(dorsalramus):backparesthesia
(buttheventralramusisintact)
o Disruptionofmotorneurons(dorsalramus):Paralysisofdeep
backmuscles

IV.SEGMENTALINNERVATION
Peripheralnerves:multiplespinalnervesfromdifferentcord
levels
Plexusformation:mixingofnervesfromdifferentcordlevelsby
unionanddivisionofbundles

III.STRUCTUREOFSPINALNERVES
SomaticPathways
o MixedSpinalNerve
o SomaticSensations
Touch,pain,temperature,pressure
Proprioception:joints,muscles
SomaticMotorActivity:InnervateSkeletalMuscle
GSAfiberintheDORSALroot
GSEfiberintheVENTRALroot

DorsalandVentralRami
o TerritoryofDorsalRami:Everythingelsebutthehead(whichis
innervatedbytheventralrami)

Figure5.1Schematicdemarcationofdermatomes

Figure3.1Sectionsthroughthethoracicregionofthespinalcordshowing
examplesofnervefibersenteringorleavingthecentralnervoussystem;
ascendinganddescendingnervefibers(tractsorpathways)arealsoshown.

IMPACTOFLESIONS
o Disruptionofsensory(afferent)neurons:Paresthesia(lossof
sensation)
o Disruptionofmotor(efferent)neurons:Paralysis(problemin
theroots)
o Disruptionofbothsensoryandmotorneurons:Paresthesia&
Paraylsis

DERMATOMES
o Singlespinalnerve
o Cutaneous(skin)sensoryterritoryofasinglespinalnerve
o Dermatomemaps
Basedonclinicalfindingsofdeficitsincutaneoussensation
onecanlocalizedtheareaofpain
Diagnosticaids:localizationoflesionstocordlevels
Limitstospecificityduetooverlapofdermatomes
Doesnotcoincidewiththeactualperipheralnervebecause
oftheplexustheyhave
MYOTOMES
o Massofmuscleinnervatedbyasinglespinalnerve
o NOTbylocationbutbydistribution
o Myotomemaps
Particularfunctionsarelinkedtomuscleinnervatedby
particularcordlevels
Example:C5lesion

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Weaknessinflexionofelbow&shoulder
Weaknessinabduction&lateralrotationofshoulder

o SVAvisceralsensationoftasteandsmell
o SSAsomaticsensationsofvision,hearingandequilibrium

o Distributionofasinglespinalrootthroughoutaplexus
o MyotomereturntotheC5lesionexample
Abduction:supraspinatus&deltoid
LateralRotation:infraspinatus&teresminor
Fexion:bicepsbrachii&brachalis

V.CRANIALNERVES
12CranialNerves
o Olfactory(I)
o Optic(II)
o Oculomotor(III)
o Trochlear(IV)
o Trigeminal(V)
o Abducens(VI)
o Facial(VII)
o Vestibulocochlear(VIII)
o Glossopharyngeal(IX)
o Vagus(X)
o SpinalAccessory(XI)
o Hypoglossal(XII)
TheyhaveallfunctionalcomponentsplusSPECIALfunctions

Figure 5.1 Different stages in the development of the spinal cord showing the
neural crest cells, which will form the first afferent neurons in the sensory
pathway

Table5.1.FunctionalComponentsofCranialNerves

Table5.2CranialNervesaccordingtofunction

SENSORY
(Afferents)

MOTOR
(Efferents)

SOMATIC
SOMATICSENSORY
GeneralSomatic
Afferent(GSA)
VISION&HEARING
SpecialSomatic
Afferent(SSA)
SOMATICMOTOR
GeneralSomatic
Efferent(GSE)
NoSpecialSomatic
Efferent(SSE)

VISCERAL
VISCERALSENSORY
GeneralVisceral
Afferent(GVA)
SMELL&TASTE
SpecialVisceral
Afferent(SVA)
VISCERALMOTOR
GeneralVisceral
Efferent(GVE)
BRANCHIOMERIC
SpecialVisceral
Efferent(SVE)

PositionsofFunctionalComponentsinDevelopingNeuralTube
o Embryologically,thecutofneuraltubeisattheareaofthe
basalandalarplate,dividedbythesulcuslimitans
Basalplateanteriorthickening
Alarplateposteriorthickening
o Developmentofspinalcordhasnomovement,alarplatebasal
ofourdorsalhorn;basalplatebaseoftheventralhorn
o Howeverthereisalateralrotationofthealarplateinthe
brainstem,thereforeitismorelateralhereandtheareaofthe
basalplateisventral
o Efferentnucleibasal;afferentalarplatebecomeslateral
o GSEnucleimostmedial
o GSAnucleimostlateralwithanexceptionintheSSAdueto
hearing.
Allspinalnervesandsomecranialnerves
o GSAconscioussensation
o GVAvisceralsensation
o GVEautonomicnervefibers
o GSEvoluntarymotortoskeletalmusclesderivedfrom
myotomesorsomites
SomeCranialnerves
o SVEvoluntarymotorskeletalmusclesderivedfrom
branchiomeres

Sensory(CNI,II,VIII)

Olfactory
Optic
Vestibulocochlear

Motor(CNIII,IV,
VI,XI,XII)
Oculomotor
Trochlear
Abducens
SpinalAccessory
Hypoglossal

Mixed(CNV,VII,
IX,X)
Trigeminal
Facial
Glossopharyngeal
Vagus

I.OLFACTORYNERVE(CNI)
FunctionalComponents:SVA
Runfromthenasalmucosatotheolfactorybulbtherearemany
olfactorynerves
Extendthruthecribriformplateopeninginthecraniumwhere
thenervepasses
Lesiontothesenervesorcribriformplatefracturemayyield
anosmia(lossofsmell)
CNISchemanucleiarecalledmitralandtuftedcellslocatedin
theolfactorybulbtoreachtherhinencephalon(entorhinalarea)
o Note:Tuftedcellsandgranularcellsaresmallernervecells
whichsynapsewiththemitralcells

II.OPTICNERVE(CNII)
FunctionalComponents:SSA
Beginattheretina(axonsoftheganglion),runthroughtheoptic
canaltotheopticchiasmcrossoverandcontinueastheoptic
tractandsynapseinthelateralgeniculatebody(thalamus)
o Nucleusofopticn.=lateralgeniculatebody
Opticnervedamageyieldsblindnessintheeyeservedbythe
nerve
Optictractdamageyieldspartialvisuallossofbotheyesbecause
ofthesharedfibercomingfrombothsides
Visualdefects:Anopsias/hemianopsia
Note: CN I and CN II are those nerves wherein their nuclei is not
located at the brainstem.

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III.OCULOMOTOR(CNIII)
EyeMover
FunctionalComponents:GSE,GVE(duetoinnervationsofthePNS)
(+GSA)
o Nocranialnerveispurelymotor
Originateattheventralmidbrain
Exitskullthroughsuperiororbitalfissure
Synapseon:
o Extraocularmuscles
Superioroblique,inferior,medialandsuperiorrecti(GSE)
o Parasympatheicinnervationtoirisconstrictormuscleandciliary
muscle(GVE)
AnycranialnervewithaPNSorANShasGVEfunction
SympatheticisallInthethoracicolumbarpartevenifitisin
thehead
Disorderscanresultineyeparalysis:Diplopia(doublevision)or
Ptosis(innervatesthelevatorpalpebraems)
CNIIINucleuslocatedatrostralmidbrain
o EdingerWestphalNucleus(GVE)for iris constrictor and ciliary
ms
Consists of preganglionic parasympathetic fibers and
terminate in the ciliary ganglion
Found posterior of oculomotor nucleus
o OculomotorNucleus(GSE)movementofEOMexceptfor
superiorobliqueandlateralrectus
Itsverymuchmedialinthepositionofthebrainstem;close
toyourventricularsystem
Found in anterior part of gray matter surrounding the cerebral
aqueduct of the midbrain
Lies at the level of superior colliculus

IV.TROCHLEARNERVE(CNIV)
Controlsthesuperiorobliquemusclewhichdepressestheeyevia
pullingonthesuperiorobliquetendonwhichloopsovera
ligamentouspulleyknownastheTrochlea
Originatesonthedorsalmidbrainexitskullthroughthesuperior
orbitalfissureandsynapsesonthesuperioroblique
FunctionalComponents:GSE(+GSAforproprioception)
CNIVNucleus
o TrochlearNucleus(GSE)
o Found inferior to the oculomotor nucleus at the level of inferior
colliculus

V.TRIGEMINALNERVE(CNV)
FunctionalComponents:GSA,SVE
Biggestcranialnerve
ArisesfromventrolateralponswithTrigeminal(Gasserian)
ganglionandeventuallysplitsinto3divisions
o Ophthalmic(V1)Superiororbitalfissure;goestoforehead;
purelysensory
o Maxillary(V2)Foramenrotundum;goestocheek;purely
sensory
o Mandibular(V3)Foramenovale;mixedsensoryandmotor
Sensoryinfo(touch,temperature,painandpositionsense)from
face
Motortomusclesofmastication(branchiomeric)
CNVNuclei
o Mesencephalic(midbrain)nucleus(GSA)
Forproprioception
Lateralpartofgraymatteraroundcerebralaqueductat
caudalpons
o Motornucleus(SVE)
Medialtosensorynucleus

Atrostralpons
Innervatethemuscleofmastication,tensorvelipalatiniand
othermuscles.
o Mainsensorynucleus(GSA)
Fortouchandtemperature
Lateraltomotornucleusatrostralpons
Continuousbelowwiththespinalnucleus
o Spinalnucleus(GSA)
Extendsinferiorlythroughwholelengthofmedullaandinto
partofthespinalcordasfarasC2segment

VI.ABDUCENSNERVE(CNVI)
FunctionalComponents:GSE(+GSA)
Innervatesthelateralrectus(extraocular)muscle
Arisesfromlowerventralponspassesthroughthesuperiororbital
fissuretoinnervatelateralrectus
CNVInucleus
o Abducensnucleus(GSE)
Notes:
Allnervesthatinnervatetheextraocularmusclesexitthrough
thesuperiororbitalfissure.
NoCNispurelymotorsincetherewillalwaysbeasensory
componentthatwillactforproprioception.

VII.FACIALNERVE(CNVII)
FunctionalComponents:SVE,GVE,SVA,GVA,GSA
Originatesatthelowerpons(Cerebellopontineangle)withtwo
nerveroots(Nervusintermediusandfacialmotor)
Exittointernalacousticmeatus
Motortomusclesoffacialexpression(branchiomeric):(SVE)
ParasympatheticmotorimpulsestoLacrimalGlandand
Submandibular,Sublingual&SalivaryGlands(GVE)
Sensoryinformationfromtastebudsonanterior2/3ofthe
tongue(SVA)
Sensationoverskinwithinearcanal(GSA)
Deepnasalandoralcavitiesviageniculateganglion(GVA)
Pterygopalatineandsubmandibularganglion
CNVIINuclei
o FacialMotorNucleus(SVE)
Deepinthereticularformationatcaudalpons
o SuperiorSalivatoryNucleus(GVE)
FoundposterolateralofthemotornucleusofCNVII
Forsublingualandsubmaxillaryglandrespectively
o Lacrimatorynucleus(GVE)
Parasympatheticsecretomotornervesupplytothelacrimal
gland
o SolitaryNucleus(SVA,GVA)
Rostralpart:Taste
Caudalpart:Visceralafferent
o SpinalNucleusofCNV(GSA)
Forsensationofearcanal
Note:
Superiorsalivatory,solitary,andspinalnucleusof
cranialVarethecomponentsfornervusintermedius.

VIII.VESTIBULOCOCHLEARNERVE(CNVIII)
FunctionalComponents:SSA(Forhearingandbalance)
Originatesatthepons(Cerebellopontineangle)closelyassociated
withCNVII
ExitthroughInternalAcousticmeatustoinnervatetheinnerear
2Divisions
o Vestibular

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Afferentfibersfromequilibriumreceptorsininnerear
Balance
o Cochlear
Afferentfibersfromcochleaintheinnerear
Hearing
CNVIIINuclei
o VestibularNuclei(SSA)
Superior,Lateral,Medial,Descending(SpinalorInferior)
o CochlearNuclei(SSA)
Atpontomedullaryjunctionincaudalpons
Dorsal(Posterior),Ventral(Anterior)

IX.GLOSSOPHARYNGEALNERVE(CNIX)
FunctionalComponents:SVA,GVE,SVE,GVA,GSA
Fibersemergefromlateralmedullaatthepost.olivarysulcus
closelyassociatedwithCNX
Existsskullthroughjugularforamen
Withtwosensoryganglia(SuperiorandInferior)andone
parasympatheticganglion(Otic)fortheparotidgland
MotorFunctions:
o Motorfiberstostylopharyngeusmuscle(branchiomeric):(SVE)
o Parasympatheticfiberstoparotidsalivaryglands(GVE)
SensoryFunctions:
o TasteandgeneralsensationfromPharynxandposterior1/3of
tongue(SVA)
o GeneralVisceralAfferent(GVA)informationfrom
chemoreceptorsonthelevelofO2,CO2andNintheblood(ex.
carotidbody),informationfrombaroreceptorsonBP(ex.
carotidsinus)
o Sensationofposterior1/3oftongue(GVA)
o Sensationonskinofexternalauditorycanal(GSA)

X.VAGUSNERVE(CNX)
FunctionalComponents:GVE,SVE,GVA,SVA,GSA
Onlycranialnervetoextendbeyondheadandneck
FibersemergefromlateralmedullainferiortoCNIXandleavethe
skullthroughjugularforamenandcoursedownwardsintothe
thoraxandabdomen
Hastwosensoryganglia(SuperiorandInferior)
MotorFunctions:
o Parasympatheticefferentstotheheart,lungsandabdominal
organsuptothelevelofthedistalonethirdofthetransverse
colon(GVE)
o Motorfiberstopalatalpharyngealandlaryngealmuscles
(branchiomeric)SVE
SensoryFunctions:
o Generalvisceralinputfromthoracicandabdominalorgans
fromchemoreceptorsinmajorbloodvessels(GVA)
o Fromtastebudsinposteriorpharynx(SVA)
o Generalsensationfromskininearcanal(GSA)
Ex.Earandcottonbudsgagreflex
CNIX&XNuclei
o Nucleusambiguus(SVE)msofbranchiomericorigin(pharynx,
larynx,etc.;motornucleus
o Dorsalmotornucleus(GVE)forvagus;parasympathetictoGI
tract
o Inferiorsalivatorynucleus(GVE)forparotidglandof
glossopharyngeal(parasympatheticnuclei)
o Solitarynucleus(SVA,GVA)taste,pharynx,andGIT
o SpinalnucleusofCNV(GSA)skinandexternalcanalofear
XI.SPINALACCESSORYNERVE(CNXI)

Formedbytheunionofacranialrootandaspinalroot
o CRarisesfromlateralmedulla(postolivarysulcus),whilethe
spinalrootarisesfromcervicalspinalcord
o SRpassesthrutheforamenmagnumandjoinswithCRtoform
theaccessorynerve;Theythenleavetheskullviathejugular
foramenandthenseparatesintocranialandspinaldivision
Cranialdivisionthenseparatesandjoinsvagusandinnervates
musclesofthelarynx,pharynxandsoftpalate
Spinaldivisioninnervatesthesternocleidomastoidandtrapezius
muscles
CNXINuclei
o NucleusAmbiguus(SVE);Motor(CranialRoot)
o AccessoryNucleus(GSE);SpinalRoot

XII.HYPOGLOSSALNERVE(CNXII)
FunctionalComponents:GSE(becausethetongueisconsidered
skeletal)(+GSA)
Arisefromtheventralmedulla(Preolivarysulcus)andexitthe
skullviathehypoglossalcanalandinnervatethetongue
Innervatetheintrinsicandextrinsicmusclesofthetongue
o Swallowing,speech,foodmanipulation
CNXIINucleus
o HypoglossalNucleus(GSE)expectedinthemidline
o WitheminenceaboveHypoglossaltrigone
o Exitviapreolivarysulcus
Note:
Sensoryafferentarelateralandefferentoncearethethemedial
oneseperatedbythesulcuslimitans
AllnucleiareinthebrainstemexceptCN1(olfactorybulb)andCN
2(lateralgeniculatebody)

**PleaserefertoappendixAfortableonCranialNerveSensory
Nuclei

VI.BRAINSTEMRULEOF4
4medialstructuresstartingwithM(mediallylocated)
o Motor(Corticospinal)pathway
o MedialLeminiscus
o MedialLongitudinalFasciculus
o MotorNuclei&Nerves
4side(lateral)structuresstartingwithS
o Spinocerebellarpathway
o Spinothalamicpathway
o SensoryCNVnuclei
o Sympatheticpathway
4CNinMedulla(CN912),4CNinPons(CN58),4CNabovePons
(CN14)
4Motornucleiinmedialbrainstemdivideequallyinto12(except
1&2):3,4,6,12

FunctionalComponents:SVE,GSE(+GSA)dependsonthepart
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CRANIALNERVESAPPENDIX

CN
CNROOT

FUNCTIONAL
COMPONENT
(Major)

NUCLEUS

LOCATION

Olfactory

SVA

Mitralandtuftedcells

Olfactorybulb

II
V

Optic
Trigeminal

SSA
GSA

LateralGeniculateBody
MesencephalicofV

Thalamus
Midbrain
PonsCervical
SpinalCord
PonsMedulla

VII

NervusIntermedus

SVA

MainSensoryand
SpinalofV
Solitary

VIII

Vestibular
Cochlear
Glossopharyngeal

GSA
SSA
SSA
GSA
GVA

SpinalofV
Vestibular
Cochlear
SpinalofV
Solitary(caudal)

PonsMedulla
PonsMedulla
Medulla
Ponsmedulla
Medulla

SVA

Solitary(rostral)

Pons

GSA

SpinalofV

PonsMedulla

GVA

Solitary(caudal)

Medulla

IX

Vagus

III

Oculomotor

SVA
GSE

Solitary(rostral)
Oculomotor

Pons
Midbrain

IV
V

Trochlear
Trigeminal

GVE
GSE
SVE

EdingerWestphal
Trochlear
MotorofV

Midbrain
Midbrain
Pons

VI

Abducens

GSE

Abducens

Pons

DISTRIBUTION

SmellOlfactory
Epithelium
VisionRetina
Jointandmuscle
receptorsofface
Skinandmucous
membranesofhead
TasteAnterior2/3of
tongue
Skinexternalear
BalanceLabyrinth
HearingOrganofCorti
Skinexternalear
Mucousmembraneof
Pharynx,Carotid
Body/Sands,Middleear
TastePosterior1/3of
tongue
Skinexternalear
meninges
Mucousmembraneof
larynx,trachea,andGIT;
Aorticreceptors
Tasteoropharynx
Mostextraocularms.
LevatorPalpebraems.
Irisconstrictor;Ciliaryms
SuperiorObliquems
JawmsTensor,Tympani
Tensor,VeliPalatin,
AnteriorBellyofDigastric
LateralRectusms.

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