Anatomy of the Central and Peripheral Nervous System: An Introduction

Tony H, MD Neurology Department dr.Kariadi General Hospital

ANATOMICAL ORGANIZATION of the NERVOUS SYSTEM

Nervous System

CNS
BRAIN

PNS
CRANIAL NERVES SPINAL NERVES

ANS
SYMPATHETIC

SPINAL CORD

PARASYMPATHETIC

Anatomy of Nervous System

CNS-central nervous system Brain Spinal Cord PNS-peripheral nervous system Cranial nerves I XII Spinal nerves C1-S5 ANS-autonomic nervous system Sympathetic Parasympathetic

Central Nervous System (CNS)

Unpaired, bilaterally symmetrical structures extending along the longitudinal axis of the midsagittal plane of the body. Structures arising directly from the neural tube. Includes:
Brain Spinal cord

CNS: Level of Functioning

Spinal Cord: Lowest functioning level of CNS Automatic motor responses and reflexes Brain stem and subcortex (cerebellum and diencephalon): Second functional level Blood pressure, respirations, equilibrium, and primitive emotions Cortex: Highest level Cognition, memory, thinking, abstraction

Peripheral Nervous System

(PNS) Made up of transmission pathways carrying information between the CNS and external/internal environments. Afferent (sensory) pathways:
Carry information to the CNS.

Efferent (motor) pathways:

Carry information from the CNS.

Peripheral Nervous System

Includes:
Cranial nerves (12 pairs) Spinal nerves (31 pairs)

Also includes sensory receptors in skin and wall of gut tube as well as in tendons and skeletal muscles. Also includes motor end plates between motor neurons and skeletal muscle fibers.

Autonomic Nervous System

May be considered a subdivision of the PNS. Entirely motor. Innervates smooth muscle and glands (viscera)

ANS Subdivisions
Sympathetic system
(fight or flight) Also called thoracolumbar

Parasympathetic system
(feed and breed) Also called craniosacral

Cells of Nervous System

Two cell types: Neuroglia:
5-10 times more numerous than neurons Provide support, nourishment, protection to neurons Mitotic: CAN replicate if damaged

Neurons:
Primary functional unit of the nervous system Nonmitotic: cannot replicate

BRAIN

Brain
telencephalon (hemispheres) diencephalon (thalamus etc) mesencephalon (tegmentum, crus cerebri) metencephalon (pons, cerebellum) myelencephalon (medulla oblongata)

Cerebrum

Dominance of a Cerebral Hemisphere

90% have left hemispheric dominance right handed Some left handed people are left dominant Each hemisphere receives sensory information from and controls skeletal muscles of __________________ side of body Hemispheres communicate with each other, but each hemisphere specializes in certain activities: Left side: language, analysis, problem solving, reading, writing, verbal communication Right side: perception of environment, music, art, nonverbal communication and perception of spiritual environment

Frontal Lobe
Concentration, abstract thought Affect, personality, inhibitions Information storage, memory Motor function Voluntary motor control Betz cells/ pyramidal cells Specific arrangement to body parts Voluntary eye movement control Motor control of speech in dominant hemisphere Motor control of involuntary activities Respiration, BP, GI activity

Parietal Lobe
General sensation Primary sensory cortex: arranged in correlation to motor strip
Perception of touch, position, pressure, vibration

Spatial perception and interrelationships Interprets sensory perceptions and sends information to thalamus and cortex

Temporal Lobe
Primary auditory receptive area Interpretive area: At junction of temporal, parietal and frontal lobes Visual, auditory and olfactory perception and memory, learning, emotional affect

Occipital Lobe
Visual perception Visual association Some visual reflexes and involuntary eye movements (smooth tracking of objects)

Basal Ganglia (basal nuclei)

Several masses of subcortical nuclei located deep in cerebral hemispheres, just above thalamus Like brakes in a car control of movement
Controls and facilitates learned and automatic movements Fine motor control, particularly of hands and lower extremities

Diencephalon: Thalamus
Egg shaped masses of gray matter lying ventro medially in hemispheres Major relay center for sensory and other afferent input to cortex
Divided into groups of nuclei responsible for various functions Plays a role in conscious pain awareness, consciousness, focusing attention, emotions, among other vital functions

Helps control primitive responses

Diencephalon: Hypothalamus
Located below thalamus Regulates autonomic functions Controls:
Temperature: monitors blood temp and sends afferent impulses to sweat glands, muscles, etc Water metabolism Hypophyseal secretion Visceral and somatic activities: BP, HR, peristalsis, etc Visible physical emotional expression (blushing, clammy hands)

Internal Capsule
Part of white matter of cerebrum The point at which fibers coming from various portions of the cortex converge at brain stem and enter thalamus-hypothalamus region Crucial anatomical area

Limbic System
Located lateral to hypothalamus; forms border around brain stem Made up of several structures: Hippocampus, fornix, mammillary body, amigdala Controls biological rhythms, sexual behavior, emotions of fear and rage Helps balance extremes in emotion Essential for normal memory (hippocampus)

Reticular Formation
Nuclei from brainstem and portions of diencephalon Motor and sensory neurons providing information about muscle activity Continuous input to support body against gravity Vasomotor and respiratory control

Reticular Activating System: RAS

Nuclei in spinal cord, brain stem, thalamus and hypothalamus Control sleep-wakefulness cycle, consciousness, focused attention Stimulation of brain stem portion will cause wakefulness Stimulation of thalamic portion adds cognition and cerebral cortical activity

Brainstem
Midbrain: nuclei for pupillary reflexes, eye movements; auditory reflexes Pons: Respiratory center, 4th ventricle, reticular formation, nuclei of several cranial nerves Medulla: rate and strength of heartbeat; rate and strength of respirations; sneezing, sucking, coughing, gagging, swallowing, vomiting, blood vessel diameter

Cerebellum, Brain Stem

C71.2

C71.7

C71.6

Cerebellum
Located in posterior cranial fossa Coordinates muscular activity so movements are fluid
Position sense Coordinates agonist and antagonist muscles

Maintains muscle tone and equilibrium

Fine movement Balance

Protective Structures
Cranium: portion of skull covering brain Composed of 8 bones Lobes named for bones they lie under Meninges Three layers of tissue Provide protection, support, and nourishment to brain and spinal cord

Dura Mater (Hard mother)

Outermost layer 2 layers of inelastic membrane space between bone and dura is potential space called epidural SPACE
Falx cerebri: between the two hemispheres Tentorium cerebelli: between cerebrum and cerebellum Falx cerebelli: between lobes of cerebellum Diaphragm sella: over the sella tursica (pituitary)

Arachnoid Mater
Thin, delicate, elastic layer, covers entire brain Houses blood vessels of different sizes Space between dura and arachnoid called subdural SPACE

Pia Mater
______________________________________________________________________________________________________________________________________________________________

Covers entire surface of brain, follows surface folds Space that separates arachnoid and pia called subarachnoid SPACE CSF flow

Ventricular System
4 fluid filled cavities within brain; connect with each other and cord
2 lateral ventricles Cerebral hemispheres Third ventricle Walls made up of thalamus and hypothalamus Fourth ventricle Lies between cerebellum and medulla and pons

Ventricular System

Cerebrospinal Fluid (CSF)

Clear, colorless fluid found within brain Surrounds brain and spinal cord Functions: Cushions brain Allows fluid shifts from cranial cavity to spinal cavity Carries nutrients Produced by choroid plexus: specialized structure in ventricles Approximately 400 500 ml/day Reabsorbed at same rate by arachnoid villi Approximately 150 ml in ventricular / subarachnoid system Provides valuable diagnostic information

Flow of CSF
Low pressure system: 9-14 mmHG Choroid plexus lateral ventricles Foramen of Monro Third Ventricle Aqueduct of Sylvius Fourth Ventricle several foramen subarachnoid space circulates around brain and spinal cord reabsorbed into venous circulation through the arachnoid villi protrusions of arachnoid primarily in the sagittal sinus

Cerebral Blood Flow

Anteriorly: internal carotid arteries Divide into anterior and middle cerebral arteries Anterior 3/5 cerebrum Posteriorly: vertebral arteries join to form BASILAR artery Divides at midbrain to form posterior cerebral arteries Posterior 2/5 of cerebrum; cerebellum and brainstem

Cerebral Arteries
Anterior Cerebral Artery
Supplies anterior portion of brain; frontal lobes Areas affected control thought, personality, motor movement especially of leg

Middle Cerebral Artery

Largest branch off internal carotid Areas affected: sensory and motor for face, throat, hand and arm Dominant hemisphere: motor speech; receptive speech Most often occluded in stroke!!

Circle of Willis
Internal carotids branch
2 anterior cerebral arteries joined to each other by anterior communicating artery 2 posterior communicating arteries

2 posterior cerebral arteries

Cerebral Venous Drainage

Does NOT parallel its arterial supply
Cerebellar and brain stem venous drainage DOES parallel Cerebral veins drain into dural sinuses: formed between dural layers (superior sagittal sinus; transverse sinus) drain into internal jugular veins Decreased venous outflow can INCREASE intracranial pressure

Blood Brain Barrier

Structure of CNS capillaries different Junctions between endothelial cells very tight Solutes and water must pass through endothelial cells, NOT junctions Astrocytes form transport system Oxygen, glucose, other nutrients allowed to enter, waste products removed Excludes water soluble and ionized; large molecules (most antibiotics) Affects penetration of pharmaceutical substances Altered by trauma, cerebral edema, cerebral hypoxemia

Pineal and Pituitary Glands

Cranial Nerves

Spinal Cord

Spinal Cord

Runs through the vertebral canal Extends from foramen magnum to second lumbar vertebra Regions
Cervical Thoracic Lumbar Sacral Coccygeal

Gives rise to 31 pairs of spinal nerves

All are mixed nerves

Not uniform in diameter Cervical enlargement: supplies upper limbs Lumbar enlargement: supplies lower limbs Conus medullaris- tapered inferior end
Ends between L1 and L2

Cauda equina - origin of spinal nerves extending inferiorly from conus medullaris.

 Connective tissue membranes

Meninges

Dura mater: outermost layer; continuous with epineurium of the spinal nerves Arachnoid mater: thin and wispy Pia mater: bound tightly to surface
Forms the filum terminale
anchors spinal cord to coccyx

Forms the denticulate ligaments that attach the spinal cord to the dura

Spaces
Epidural: external to the dura
Anesthestics injected here Fat-fill

Subdural space: serous fluid Subarachnoid: between pia and arachnoid

Filled with CSF

Cross Section of Spinal Cord

Anterior median fissure and posterior median sulcus

deep clefts partially separating left and right halves

Gray matter: neuron cell bodies, dendrites, axons Divided into horns Posterior (dorsal) horn Anterior (ventral) horn Lateral horn White matter Myelinated axons Divided into three columns (funiculi)
Ventral Dorsal lateral

Each of these divided into sensory or motor tracts

Cross section of Spinal Cord

Commissures: connections between left and right halves Gray with central canal in the center White Roots Spinal nerves arise as rootlets then combine to form dorsal and ventral roots Dorsal and ventral roots merge laterally and form the spinal nerve

Organization of Spinal Cord Gray Matter

Recall, it is divided into horns
Dorsal, lateral (only in thoracic region), and ventral

Dorsal half sensory roots and ganglia Ventral half motor roots Based on the type of neurons/cell bodies located in each horn, it is specialized further into 4 regions
Somatic sensory (SS) - axons of somatic sensory neurons Visceral sensory (VS) - neurons of visceral sensory neur. Visceral motor (VM) - cell bodies of visceral motor neurons Somatic motor (SM) - cell bodies of somatic motor neurons

Gray Matter: Organization

Figure 12.31

White Matter in the Spinal Cord

Divided into three funiculi (columns) posterior, lateral, and anterior
Columns contain 3 different types of fibers (Ascend., Descend., Trans.)

Fibers run in three directions

Ascending fibers - compose the sensory tracts Descending fibers - compose the motor tracts Commissural (transverse) fibers - connect opposite sides of cord

White Matter Fiber Tract Generalizations

Pathways decussate (most) Most consist of a chain of two or three neurons Most exhibit somatotopy (precise spatial relationships) All pathways are paired
one on each side of the spinal cord

White Matter: Pathway Generalizations

Descending (Motor) Pathways

Descending tracts deliver motor instructions from the brain to the spinal cord Divided into two groups
Pyramidal, or corticospinal, tracts Indirect pathways, essentially all others

Motor pathways involve two neurons

Upper motor neuron (UMN) Lower motor neuron (LMN)
aka anterior horn motor neuron (also, final common pathway)

Pyramidal (Corticospinal) Tracts

Originate in the precentral gyrus of brain (aka, primary motor area)
I.e., cell body of the UMN located in precentral gyrus

Pyramidal neuron is the UMN

Its axon forms the corticospinal tract

UMN synapses in the anterior horn with LMN

Some UMN decussate in pyramids = Lateral corticospinal tracts Others decussate at other levels of s.c. = Anterior corticospinal tracts

LMN (anterior horn motor neurons)

Exits spinal cord via anterior root Activates skeletal muscles

Regulates fast and fine (skilled) movements

Corticospinal tracts
1. 2. 3. 4. Location of UMN cell body in cerebral cortex Decussation of UMN axon in pyramids or at level of exit of LMN Synapse of UMN and LMN occurs in anterior horn of s.c. LMN axon exits via anterior root

Extrapyramidal Motor Tracts

Includes all motor pathways not part of the pyramidal system Upper motor neuron (UMN) originates in nuclei deep in cerebrum (not in cerebral cortex) UMN does not pass through the pyramids! LMN is an anterior horn motor neuron This system includes
Rubrospinal Vestibulospinal Reticulospinal Tectospinal tracts

Regulate:
Axial muscles that maintain balance and posture Muscles controlling coarse movements of the proximal portions of limbs Head, neck, and eye movement

Extrapyramidal Tract

Note: 1. UMN cell body location 2. UMN axon decussates in pons 3. Synapse between UMN and LMN occurs in anterior horn of sc 3. LMN exits via ventral root 4. LMN axon stimulates skeletal muscle

Extrapyramidal (Multineuronal) Pathways

Reticulospinal tracts originates at reticular formation of brain; maintain balance Rubrospinal tracts originate in red nucleus of midbrain; control flexor muscles Tectospinal tracts - originate in superior colliculi and mediate head and eye movements towards visual targets (flash of light)

Main Ascending Pathways

The central processes of first-order neurons branch diffusely as they enter the spinal cord and medulla Some branches take part in spinal cord reflexes Others synapse with second-order neurons in the cord and medullary nuclei

Three Ascending Pathways

The nonspecific and specific ascending pathways send impulses to the sensory cortex
These pathways are responsible for discriminative touch (2 pt. discrimination) and conscious proprioception (body position sense).

The spinocerebellar tracts send impulses to the cerebellum and do not contribute to sensory perception

Nonspecific Ascending Pathway

Include the lateral and anterior spinothalamic tracts Lateral: transmits impulses concerned with pain and temp. to opposite side of brain Anterior: transmits impulses concerned with crude touch and pressure to opposite side of brain 1st order neuron: sensory neuron 2nd order neuron: interneurons of dorsal horn; synapse with 3rd order neuron in thalamus 3rd order neuron: carry impulse from thalamus to postcentral gyrus

Specific and Posterior Spinocerebellar Tracts

Dorsal Column Tract 1. AKA Medial lemniscal pathway 2. Fibers run only in dorsal column 3. Transmit impulses from receptors in skin and joints 4. Detect discriminative touch and body position sense =proprioception 1st O.N.- a sensory neuron synapses with 2nd O.N. in nucleus gracilis and nucleus cuneatus of medulla 2nd O.N.- an interneuron decussate and ascend to thalamus where it synapses with 3rd O.N. 3rd-order (thalamic neurons) transmits impulse to somatosensory cortex (postcentral gyrus) Spinocerebellar Tract Transmit info. about trunk and lower limb muscles and tendons to cerebellum No conscious sensation

Spinal Cord Trauma and Disorders

Severe damage to ventral root results in flaccid paralysis (limp and unresponsive) Skeletal muscles cannot move either voluntarily or involuntarily Without stimulation, muscles atrophy. When only UMN of primary motor cortex is damaged spastic paralysis occurs - muscles affected by persistent spasms and exaggerated tendon reflexes Muscles remain healthy longer but their movements are no longer subject to voluntary control. Muscles commonly become permanently shortened. Transection (cross sectioning) at any level results in total motor and sensory loss in body regions inferior to site of damage. If injury in cervical region, all four limbs affected (quadriplegia) If injury between T1 and L1, only lower limbs affected (paraplegia)

Spinal Cord Trauma and Disorders

Spinal shock - transient period of functional loss that follows the injury

Results in immediate depression of all reflex activity caudal to lesion. Bowel and bladder reflexes stop, blood pressure falls, and all muscles (somatic and visceral) below the injury are paralyzed and insensitive. Neural function usually returns within a few hours following injury If function does not resume within 48 hrs, paralysis is permanent.
Amyotrophic Lateral Sclerosis (aka, Lou Gehrigs disease)

Progressive destruction of anterior horn motor neurons and fibers of the pyramidal tracts Lose ability to speak, swallow, breathe. Death within 5 yrs Cause unknown (90%); others have high glutamate levels
Poliomyelitis

Virus destroys anterior horn motor neurons Victims die from paralysis of respiratory muscles Virus enters body in feces-contaminated water (public swimming pools)

CNS Anatomy

Cerebrum

Cerebellum, Brain Stem

C71.2

C71.7

C71.6

Ventricular System

Pineal and Pituitary Glands

Cranial Nerves

Meninges

Tentorium

Image source: A Primer of Brain Tumors, ABTA

Spinal Cord C72.0