THE NERVOUS SYSTEM The human nervous system is a remarkable structure for the body s ability to interact with

the environment and for the regulation of activities involving internal organs. The nervous system literally drives the other systems of the body. It is a network composed of complex structures that transmits signals- both electrically and chemically- between the body s many organs and tissues and the brain. Structurally, the nervous system is divided in the Central Nervous System (CNS) consists of the brain and spinal cord, enclosed within the protective cranial vault and vertebrate. And the Peripheral Nervous System (PNS) is composed of cranial nerves and spinal nerves. Peripheral nerve pathways are differentiated into afferent pathways (ascending pathways), which carry sensory impulse toward the CNS, and efferent pathways (descending pathways), which innervate skeletal muscle or effector organs by transmitting motor impulses away from the CNS. The peripheral nervous system can be divided into the somatic nervous system that consists of pathways that regulate voluntary motor control in example, spinal muscles. The autonomic nervous system is involved with regulation of the body s internal environment (viscera) through involuntary control of organ systems. The ANS is further divided into sympathetic and parasympathetic divisions. Organs innervated by specific components of the nervous system are called effector organs.

CELLS OF THE NERVOUS SYSTEM Two basic types of cells constitute nervous tissue: neurons and supporting cells. The neuron is the primary cell of the nervous system, whereas cells such as neuroglial cells (in the CNS) and the Schwann cells (in the PNS) provide structural support and nutrition for the neurons. Neuron Neurons detect environmental changes and initiate bodily response to maintain a dynamic steady state. Among the cellular constituents of neurons are microtubules, microfilaments and neurofibrils (thought to be involved in transport of cellular products), and the Nissl substances (involved in protein synthesis. A neuron has three components: (1) a cell body (soma) and the thin processes of the cell, (2) the dendrites and (3) the axons. Most cell bodies are located at the CNS; those in the PNS usually found in groups called ganglia (or plexuses). The dendrites are extensions that carry nerve impulses toward the cell body. The dendratic zone receives a stimulus and continues further conduction. Axons are long, conductive projections from the cell body that carry nerve impulses away from the cell body. A typical neuron has only one axon, which may be covered with a segmented layer of lipid material called myelin, an insulating substance. The entire membrane is referred to as the myelin sheath. The myelin sheaths are interrupted at regular intervals by the nodes of Ranvier. Axons branch

extensively at the nodes of Ranvier. Myelin acts as insulator that allows ions to flow between segments rather than along the entire length of the membrane, yielding the increased velocity. This mechanism is referred to as salutatory conduction. Conduction velocities depend not only on the myelin coating but also on the diameter of the axon. Larger axons transmit impulses at a faster rate. Neurons are structurally classified on the basis of the number of processes (projections), extending from the cell body. There are four basic types of cell configuration: (1) unipolar, (2) pseudounipolar, (3) bipolar, and (4) multipolar. Unipolar neurons have only one process that branches shortly after leaving the cell body. Pseudounipolar also have one process: the dendratic portion of each of those neurons extends away from the CNS and the axon portion projects into the CNS. Bipolar neurons have two distinct processes arising from the cell body. Multipolar neurons are the most common and have a multiple processes capable of extensive branching. Functionally, there are three types of neuron; (1) sensory (afferent, mostly pseudounipolar), (2) associational (interneurons, multipolar) and (3) motor (efferent, multipolar). Sensory neurons carry impulses from the peripheral sensory receptors to the CNS. Associational neurons (interneurons) transmit impulses from neuron to neuron- that is, sensory to motor neurons. They are located solely within the CNS. Motor neurons transmit impulses away from the CNS to an effector. In skeletal muscle the processes form a neuromuscular (myoneural) junction. Neuroglia and Schwann Cells Neuroglia ( nerve glue ) are the general classification of cells that support the neurons of the CNS. They comprise approximately half of the total brain and spinal cord volume and are 5 to 10 times more numerous than neurons. Astrocytes, for example, fill the spaces between neurons and surround blood vessels in the CNS; oligodendroglia (oligodendrocytes) deposit myelin within the CNS. Oligodendroglia are the CNS counterpart of the Schwann cells. Ependymal cells line the cerebrospinal fluid (CSF) filled cavities of the CNS. Microglia removes debris (phagocytosis) in the CNS.

THE NERVE IMPULSE Neurons generate and conduct electrical and chemical impulses by selectively changing the electrical potential of the plasma membrane and influencing other nearby neurons by releasing chemicals (neurotransmitters). Synapses Neurons are not physically continuous with one another. The region between adjacent neurons is called synapse. The neurons that conduct a nerve impulse are named according to whether they relay impulses toward (presynaptic neurons) or away (postsynaptic neurons) the synapse.

Neurotransmitters More than 30 substances are thought to be neurotransmitters, including norepnephrine, acetylcholine, dopamine, histamine and serotonin. Man of these transmitters has more than one function. Some neurotransmitters are amino acids such as glutamic acid and aspartic acid. Small chains of amino acids such as enkephalins and endorphins also function as neurotransmitters. Because the neurotransmitter is normally stored on one side of the synaptic cleft and the receptor sites are on the other side, chemical synapses operate in one direction.

THE CENTRAL NERVOUS SYSTEM The Brain The human brain enables a person to reason, function intellectually, express personality and mood and interact with the environment. The pinkish gray organ weighs approximately 3 pounds and receives 15% to 20% of the total cardiac output. The three major divisions of the brain are (1) the forebrain, (2) the midbrain, which includes the corpora quadrigemina and the cerebral peduncles; and the hindbrain, which includes the cerebellum, pons, and the medulla. The midbrain, medulla and pons makes up the brain stem, which connects with the hemispheres of the brain, cerebellum and spinal cord. A collection of nerve cell bodies (nuclei) within the brain stem makes up the reticular formation. The reticular formation is a large network of connected tissue that contains portions of vital reflexes such as controlling cardiovascular function and respiration. It is essential for maintaining wakefulness and therefore is referred to as the reticular activating system. Forebrain Telencephalon The telencephalon consists of the cerebrum, the limbic system and some basal ganglia. The surface of the cerebrum is covered with convolutions called gyri which greatly increases the cortical surface area and the number of neurons. Grooves between adjacent gyri are termed as sulci; deeper grooves are called fissures. The cerebral cortex contains the cell bodies of neurons (gray matter). White matter lies beneath the cerebral cortex and is composed of myelinated nerve fibers. The two cerebral hemispheres are separated by the longitudinal fissure. The surface of each hemisphere is divided into lobes named after the region of the skull under which each lies. The frontal lobes posterior margin is on the central sulcus (fissure of Rolando), and it boarders inferiorly on the lateral sulcus (sylvian fissure, lateral fissure). The prefrontal area is responsible for goal- oriented behavior, short termed or recall memory, the elaboration of thought and the inhibition of limbic areas of the CNS. The pre-motor area (Brodmann area 6) is involved in programming motor movements. The area contains the cell bodies that form part of the basal ganglia system (extrapyramidal system- efferent pathways outside pyramids of the medulla oblongata).

Lying directly beneath the longitudinal fissure is a mass of white matter pathways called the corpus callosum (transverse or commissural fibers). This structure connects the two cerebral hemispheres and is essential in coordinating activities between hemispheres. Inside the cerebrum are numerous tracts and nuclei. The major cerebral nuclei are called basal ganglia and include the corpus striatum and amygdale. The corpus striatum consists of the lentiform nucleus (lens- shaped), the putamen and the globus pallidus, and the ram horn-shaped caudate nucleus. The internal capsule is a thick white matter region in which afferent and efferent pathways, to and from the cerebral cortex; pass through the central of cerebral hemispheres. Functionally, basal ganglia include, in addition to the corpus striatum, the subthalamic nucleus of the diencephalon and the substancia nigra of the mesencephalon. The basal ganglia system is believed to exert a fine tuning effect on motor movements. The limbic system is a group of structures surrounding the corpus callosum that mediate emotion through connections in the prefrontal cortex. Its effects are believed to be involved in primitive behavioral responses, visceral reaction to emotion, feeding behaviors, biologic rhythm and the sense of smell. Diencephalon The diencephalon, surrounded by the cerebrum, has four divisions; epithalamus, thalamus, hypothalamus and the subthalamus. The epithalamus serves as a roof of the third ventricle and composes the most superior portion of the diencephalon. Its connections and functions are closely associated with those of the limbic system. The thalamus borders and surrounds the third ventricle. It is a major integrating center for afferent impulses to the cerebral cortex. The thalamus serves also as a relay center for information from the basal ganglia and the cerebellum to the appropriate motor areas. The hypothalamus forms the base of the diencephalon. The hypothalamus functions as (1) maintain a constant internal environment, (2) implement behavioral patterns. Integrative centers control autonomic nervous system function, regulate body temperature and endocrine function, and regulate emotional expressions. The subthalamus flanks the hypothalamus laterally. It serves as an important basal ganglia center for most neural pathways. Midbrain The midbrain (mesencephalon) is composed of three structures: the corpora quadrigemina (tectum) (composed of the superior and inferior colliculi), the tegmentum (containing the red nucleus and substantia nigra), and the basis pedunculi. (The tegmentum and the basis pedunculi are called collectively as the cerebral peduncles.)

The superior colliculi are involved with voluntary and involuntary visual motor movements. The inferior colliculi accomplish similar motor activities but involve movements affecting the auditory system. The red nucleus receives ascending sensory information from the cerebellum and projects a minor motor pathway to the cervical spinal cord. The last portion of the basal ganglia is the substantia nigra, which synthesizes dopamine, a neurotransmitter and precursor of norepinephrine. The basis pedunculi are made up of efferent fibers of the corticospinal, corticobulbar and a corticopontocerebellar tract. Other notable structures of this region are the nuclei of the third and fourth cranial nerves. The cerebral aqueduct (aqueduct of Sylvius), which carries cerebrospinal fluid, also transverses this structure. Hindbrain Metencephalon The major structures of the metencephalon are the cerebellum and the pons. The cerebellum is composed of gray and white matter and its cortical surface is convoluted like the surfaces of the cerebrum. It is also is divided by a central fissure into two lobes connected by the vermis. The cerebellum is responsible for reflexive, involuntary fine-tuning of motor control and maintaining balance and posture through extensive neural connections with the medulla through the superior cerebellar peduncle. The two hemispheres are connected to the pons by the middle cerebellar peduncle. These connections allow extensive sampling of visual, vestibular and proproceptive data from other regions of the CNS and periphery. The pons (bridge) is easily recognized by its bulging appearance below the midbrain and above the medulla. Primarily it transmits information from the cerebellum to the brainstem and between the two cerebellar hemispheres. The nuclei of the fifth through the eighth cranial nerves are located in this structure. Myelencephalon The myelencephalon usually is called the medulla oblongata and forms the lowest portion of the brain stem. Reflex activities, such as heart rate, respiration, blood pressure, coughing, sneezing, swallowing and vomiting, are controlled in this area. The nuclei of cranial IX through XII also located in this area. A major portion of the descending motor pathways cross the other side or decussate, at the medulla. These pathways, together with other areas of decussation in the CNS are the basis for the phenomenon of contralateral control.

The Spinal Cord The spinal cord is the portion of the CNs that lies within the vertebral canal and is surrounded and protected by the vertebral column. The spinal cord has many functions, which include a long nerve cable that connects the brain and body, somatic and autonomic reflexes, motor pattern, control centers and sensory and motor modulations. It continues from the medulla oblongata and ends at the level of first and second lumbar vertebra in adults. The end of the spinal cord, conus medullaris, is cone shaped. Spinal nerves continue from the end of the spinal cord and form a nerve bundle called the cauda equina. The filament anchor from the conus medullaris to the coccyx is the filum terminale. Grossly, the spinal cord is divided into vertebral sections (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal) that correspond to the paired nerves. The central canal lies in the center of this region and extends through the spinal cord from its origin in the fourth ventricle. The gray matter of the spinal cord is divided into three regions and displays specific functions and characteristics. These regions include the posterior horn or dorsal horn. At the tip of the posterior horn is substantia gelatinosa, a structure involved in pain transmission. The lateral horn contains cell bodies involved with the CNS. The anterior horn or ventral horn contains the nerve cell bodies for efferent pathways that leave the spinal cord by way of spinal nerves. Upper motor neurons are completely contained within the CNS. Their primary roles are controlling fine motor movements and influencing/ modifying the spinal reflex arcs and circuits. Lower motor neurons directly influence muscles. Their cell bodies lie in the gray matter of the brain stem and spinal cord, but their processes extend out of CNS and into the PNS.

Motor Pathways The four clinically relevant motor pathways are the lateral, corticospinal, corticobulbar, and the vestibulospinal tracts. The corticospinal and corticobulbar pathways are essentially the same tract and consist of a two- neuron chain. The corticobulbar tract synapses on motor cranial nuclei within the brain stem. The lateral corticospinal tract axons leave the tract to go to specific interneurons or motor neurons in the anterior horn. These tracts are involved in precise motor movements. The reticulospinal tract modulates motor movement by inhibiting and exciting spinal activity. The vestibulospinal tract arises from a vestibular nucleus in the pons and causes the extensor muscles of the body to rapidly contract, most dramatically witnessed when a person starts to fall backwards. Sensory Pathways The three clinically important spinal afferent pathways are the posterior (dorsal) column, anterior spinothalamic tract, and the lateral spinothalamic tract. The posterior column carries body fine touch, two- point discrimination and proprioceptive information. The primary afferent neuron is the sensory neuron but it sends its axons ipsilaterally up the spinal cord to a specific part of posterior column nuclei in the medulla oblongata. The anterior and lateral spinothalamic tracts are responsible

for vague touch and pain and temperatures respectively. These modalities are referred to as protopathic. These tracts also form a three- neuron chain. However, the primary afferent neurons synapse in the posterior horn of the spinal cord, not just at the level they enter the intervertebral foramen but in a number of spinal segments above and below their point of entry. This is one example of divergence. The second order of neurons in the posterior horn crosses to the contralateral side in the spinal cord and ascends to the same thalamic nucleus as the posterior column pathway and continues on with the posterior column pathway to posterior gyrus.