Chapter 11 The Autonomic Nervous System and Its Central Control 219

Sympathetic Projections of Projections of Parasympathetic

nervous system sympathetic parasympathetic nervous system
nervous system nervous system

Ciliary Oculomotor (III)

Eye ganglion nerve

Lacrimal and Submandibular and Midbrain

salivary glands otic ganglion
Pons
Facial (VII) nerve,
Superior Medulla
C1 Glossopharyngeal
cervical (IX) nerve
ganglion Lung
Cervical
Middle Heart
C8 cervical
T1 ganglion
Stomach
Stellate Liver Vagus (X)
ganglion Pancreas nerve
Greater Celiac Large
Blood vessels splanchnic ganglion Thoracic
intestine
Sweat glands nerve
Smooth muscle
Lesser
T12 splanchnic Small intestine
L1 nerve
Lumbar
L5 L3 Rectum Splanchnic
Adrenal nerve
S1
medulla
Sacral
Superior Interior Bladder
S5 mesenteric mesenteric
ganglion ganglion

Reproductive
organs
Paravertebral
chain
ganglia

Figure 11-1. Schematic showing the sympathetic and parasympathetic pathways.

Sympathetic pathways are shown in red and parasympathetic pathways in blue. Preganglionics are
shown in darker shades and postganglionics in lighter shades.

11-1). Thus, paravertebral and prevertebral ganglia
are located at some distance from their target organs.
In contrast, parasympathetic postganglionic neurons
are found in ganglia, which lie near or actually in the
walls of the target organs.
Control of the sympathetic and parasympathetic
nervous systems of many organs has often been
described as antagonistic. This description is not
entirely correct. It is more appropriate to consider
these two parts of the autonomic control system
as working in a coordinated mannersometimes
acting reciprocally and sometimes synergistically
to regulate visceral function. Furthermore, not all
visceral structures are innervated by both systems.
For example, the smooth muscles and glands in
the skin and most of the blood vessels in the body
receive sympathetic innervation exclusively; only a
small fraction of the blood vessels have parasympa-
thetic innervation. The parasympathetic nervous
system does not innervate the body wall, only struc-
tures in the head and in the thoracic, abdominal, and
pelvic cavities.
The Sympathetic Nervous System
Sympathetic preganglionic neurons are concentrated
in the intermediolateral cell column (lateral horn) in
the thoracic and upper lumbar segments of the spinal
cord (Fig. 11-2). Some neurons may also be found in
the C8 segment. In addition to the intermediolateral
cell column, groups of sympathetic preganglionic
neurons are found in other locations, including the
lateral funiculus, the intermediate gray matter, and the
gray matter dorsal to the central canal.
The axons of preganglionic neurons are often small
myelinated nerve fibers known as B fibers (see Table
5-1). However, some are unmyelinated C fibers. They
leave the spinal cord in the ventral root and enter the
paravertebral ganglion at the same segmental level
through a white communicating ramus. White rami are
found only from T1 to L2. The preganglionic axon may
synapse on postganglionic neurons in this ganglion;
may travel rostrally or caudally within the sympathetic
trunk and give off collaterals to the ganglia that it
passes; or may pass through the ganglion, exit the
sympathetic trunk, and enter a splanchnic nerve to