Basic Concepts in Neuro

1. Autonomic nervous system

2. Sensory system
3. Motor system
4. Important brain areas

General overview of nervous system

NERVOUS
SYSTEM

PHERIPHRAL CENTRAL
NERVOUS NERVOUS
SYSTEM SYSTEM

SENSORY PNS MOTOR PNS Brain Spinal cord

Autonomic i.e.
Somatic i.e. involuntary
Special senses General senses
skeletal muscles

Somatic senses
Visceral senses
Eg skin
Like dull pain
locomotion
 Further dissection of central nervous system

CNS

White matter Gray matter

Cortex( gray Nuclie( gray

Commissural matter inside brain
TRACTS Association Fibers matter on surface
fibers surrounded by
of brain)
white matters)

Concepts in Autonomic Nervous System

1. Origin:

● Sympathetic: Thoraco-Lumbar outflow i.e T1-L2

● Parasympathetic: 3, 7, 9, 10 and S2, S3, S4
cranial nerve 3, 7, 9, and 10 and S2, S3, S4 →So called cranio-sacral outflow

2. Neurons:-
● Preganglionic neuron will secret Ach and its receptor must be nicotinic receptor
● Same rule applies to the neuron supplying skeletal muscle i.e Ach – Nicotinic
receptor
● POst ganglionic neuron will have its own neurotransmitter and receptor
according to Autonomic nervous system subtype of symp and parasymp
Receptors:

Parasympathetic

M1 M2 M3
● Brain ● Heart ● all other
● Stomach mucosa organ
 Sympathetic Receptors

α1 α2 (Inhibitory) β1 β2 (Inhibitory)
●Blood vessels → ● Pre- Synaptic ● Heart – inc its ● Lung – dilation
Constriction neuron terminals activity of
● Platelet ● Kidney – inc airways
●Eye … Radial ●pancreas renin ● Gl-Muscles and
muscle, iris ● Fats – inc lipid bladder
→ contraction break down – relaxation
● Blood vessel in
skeletal
muscle – dilation


3 Main Action of Para-System

⧫Dec heart Activity

⧫increases smooth muscle Contraction e.g G-I Muscle, urinary bladder etc
⧫inc every single secretions e.g lacrimation, salivation, urination etc

Note that … the actions of sympathetic nervous system are just opposite to these

Important Autonomic Centers

Mid Brain - Pons – Medulla – vasomotor

For micturition Pnemotaxic centers centers e.g swallowing
apneustic centers sneezing resp centers
etc.

Sensory System

we will discuss sensory system with following main areas

Sensory Receptors Sensory Fibers Pathways (ascending

pathways
Sensory Receptors

●Pacinian → vibration (rapidly adopting)

●Meisner → soft touch , 2-point discrimination velocity

● Merckle → Deep static touch & position sense

● Raffini→ Pressure

● Krause → Cold

● Free nerve endings → Pain (Slowly adapting)

Important fibers in peripheral nervous system Fibers

A- Fibers B- Fibers C- Fibers

Autonomic Slow Pain
nervous (un-
system myelinated)
A- A- A-γ A-δ(Delta)
α(alpha) β(beta) (gamma) ⧫ Fast pain
⧫ motor ⧫ ⧫ Motor and
neurons Touch neuron to temperatur
(extra- and muscle e
fusal) Pressur spindles
⧫ fastest e (intrafusal)
fiber Esp on
tips ie
fingerti
ps
 Fibers in central nervous system

Commissural fibers → Association fibers these Projection fibers , these

Structures that connects are mainly horizontal are mainly vertical fibers,
hemisphere fibers , association fibers & these → connect the
→ connects different cerebral cortex to the
for example parts of the same lower brain region
hemisphere
⧫.corpus callosum for example For example
⧫Anterior commissure ⧫Internal capsule.
⧫.posterior commissures ⧫Fornex connects the
Note that … Boards parts of limbic association In these examples internal
frequently asks about area capsule is Boards favorite
corpus callosum ⧫Cingulum &
⧫Short association fibers
connect regains of gray
matter in same
hemisphere

Ascending Pathways and important concepts.

1. Concepts of 1st , 2nd and 3rd order neuron

2. Concept of spinothalamic and dorsal column pathway

While descending pathways only have 2 number i.ei. UMH & LMN

Neurons:

● First order neuron lies in sensory ganglion also called dorsal not
ganglion, that carries sensations from sensory receptors and then enters into
spinal cord.

● Second order neuron – in spinal cord or brainstem,, it crosses midline, while for
spinothalamic, it crosses in spinal cord.

● 3rd order neuron – lies in thalamus and carries sensations to cerebral cortex.
Note That: thalamus contains

● Ventral posterior-lateral nucleus – that receives fibers from spinothalamic and

dorsal column systems.

● Ventral-posterio-medial nucleus – that receive, fibers from face via ventral

tegmental tract.

Mnemonic is:
o M for medial i.e. V-P medial
o M for makeup i.e. appeared to face.

Sensations:
⧫ Pain and temperature. Note that anterior spinothalamic carries crude pressure
sensations.
Spinothalamic tract is also called anterio-lateral system, as the fibers are ascending
up in anterior and lateral parts of spinal cord.
Lesions:
⧫ Any lesion of this pathway results in loss of contra-lateral pain and temp 1 – 2
segments below the point of lesion
For example: If the lesion is at right T3 then loss will be at left T5 (opposite and 2
segments below)

Dorsal Column Medial Luminiscal System

Sensations:
Dorsal column carries fine sensation like vibration, proprioception etc.

Neuronal Pathway:
⧫ First order neuron: lies in dorsal root ganglion, and after entering into
spinal cord, it ascend up ipsilaterally and ends-up in nucleus gracillus and
cuneatus of brainstem
⧫ Second order neuron: crosses midline in brainstem and form internal arcuate
fibers, and ascends up to thalamus as medial lemniscus.
⧫ Third order neuron: ascends up to cerebral cortex

Note that dorsal column has 2 pathways in it:

1. Fasciculus Gracilis – fibers from lower limb and memorized as “Legs are
graceful)
2. Fasciculus cuneatus – fibers from upper limb
Lesions: any lesion of this pathway results in loss of ipsilateral vibration
/position/proprioception at the level of lesion.
For example: lesion of dorsal column system at right T3 means loss of sensations,
at right T3 level on same side.

Motor System
Three important concepts in motor system

Types of muscle sensors Types of muscle fibers Descending pathways

 Muscle Sensors

Muscle spindles Golgi Tendon Organs

●Detects change in muscle length e.g.
stretch
on muscle
●If there is stretching of muscle it will
activate
muscle spindles, and muscle will
contract to dec its length
●Think about its action as opposite to
muscle spindle i.e. muscle contraction
increase
firing from golgi tenden organ, and as a
result
muscle has to relax
While in case of spindles, stretch would
cause the spindle to fire more and result
is
contraction

MUSCLE SPINDLES;
IN nutshell
⧫ Stretch on muscle inc firing from muscle spindles
⧫ On other hand contraction of muscle, dec firing from muccle spindle

Summary: Stretch → spindles stimulation → contraction

ie
stretch on muscle Inc firing from spindles Result in muscle contraction
EXAMPLE … KNEE JERK

GOLGI TENDON ORGANS;

GTO wants the muscles in relaxed state i.e. it relives it tension

⧫ Muscle in tension – inc firing of GTO

⧫ Muscle relaxation – dec its firing
 Muscle Fibers

Intra-Fusal Fibers Extra Fusal Fibers

●Smaller than extrafusal ● Make bulk of
fibers muscle
● Unite to form muscle ● Supplied by α-motor neurons
spindle
●Innervated by Gamma
motor neurons; which
are at its ends.
●These fibers has 2

Subtypes

Nuclear Chain Nuclear bag fibers

Fibers
⧫ Detects static ⧫Detects dynamic
chain fast change in
in muscle length muscle length
Functions of Alpha and Gamma motor Neuron
⧫ Alpha motor neuron, innervate. extrafusal fibers, - resulting in force generation
during contraction.

⧫ Gamma motor neurons innervate the end, of intrafusal fibers (muscle spindles)

Note That: Both alpha and gamma motor neurons are co-activated alpha-motor
neurons, are for contraction while gamma motor neurons adjust the sensitivity of
muscle spindles in response to contraction.

Descending Pathways

Neurons: Motor system consist of 2 types of neurons

1. Upper motoneuron
2. Lower motoneurons

UMN – neuron from higher centers

&
Lesion of UMN – everything goes up i.g up going planters exaggerated
reflexes spastic paralysis etc.

LMN – neuron from anterior horn of spinal cord

&
lesions of LMN: everything go down e.g. down going planters, down
reflexes flaccid paralysis etc.
 Descending Pathways:

1. Cortico-Spinal Tract:
● Upper neuron from cortex
● Lower neuron from anterior horn of spinal cord

● UMN cross midline in medulla i.e. Decussation

Lesion of UMN→contra-lateral problem

Lesion of LMN→IPSi-Lateral problem

2. Cortico-Nuclear/Bulbar:-
●Upper neuron from cortex
● Lower neuron in brainstem (e.g CN nuclei) and cranial nerves are lower
motoneurons
Lesion of UMN – supra balder palsy
Lesion of LMN – bulbar palsy

3. Rubro-Spinal:
● From red nucleus to spinal cord supplies flexor muscles i.e. helps in sitting

4. Vestibulo-Spinal:
● Supplies extensors and Helps in standing

Muscle Reflexes

Muslce Stretch Reflex Golgi Tendon Reflex Flexor Withdrawl Reflex

1. Muscle Stretch:

⧫Stimulus: stretching muscle

⧫Number of = one i.e. Mono-synaptic …. Afferent fibers – I1 (sensory)

⧫ Response: Contraction

⧫ Pathway
2. Golgi Tendon Reflex:
(Inverse of the muscle-stretch reflex i.e. a contracted muscle is relaxed)

⧫ Stimulus = muscle contraction

⧫ Num of synapsis= 2 i.e. Bi-synaptic

⧫Afferent fiber = Ib (remember for Bi-Synaptic its Ib and for minoscymaptic Ia)
(sensory)

⧫ Response: Relaxation of muscle

⧫ Pathway:

3. Flexor Withdrawal Reflex:

⧫Stimulus: Pain

⧫Num of snapsis: Polysynaptic

⧫Afferent: II, III, IV, (2, 3, 4) as I2 and Ib are already used by stretch and golgi
tendon reflexes

⧫Response: Ipsilateral flexion & contralateral extension

⧫Pathway:
 Thalamic Nuclei (Relay Station)

Only impotant one are discussed

1. VPL: sensations from limbs
2. VPM: Sensations from Face
3. Lateral Geniculate body: Visual reflexes i.e. L for Light
4.Medial geniculate body: Auditory reflexes, i.e M for music

Note That: Lesion of thalamus produces thalamic pain syndrome i.e. Normal
stimulus i.e. soft touch provokes pain.

Hypothalamic Nuclei

1. Anterior Nuclei: parasympathetic center →for cooling of the body [AC= Ant –
Cooling]

2. Posterior Nuclei: sympathetic center → for healing the body up

3. Arcuate nucleus: produces GnRh and its lesion causes (kalman syndrome)

4. Supra-optic nucleus: ADH Production

5. Supra-Chaismatic: for circadian Rhythms

 Basal Ganglia

● Lentiform nucleus →putamen + Globu palldus

●Neostriatum also called striatum → putamen+ caudate
● Corpus striatum → putamen + globus pallidus + caudate

Pathways

Indirect pathway (Inhibitory) Direct Pathway (Excitatory)

D2-receptors
⧫pathway → cortical inputs stimulate
the striatum, releasing GABA that
disinhibits Sub thalamic nuclei
via GP-Externa inhibition, and STN
stimulates GP-interna to inhibit the
thalamus
i.e. end result on thalamus is inhibitory
D1- Receptor
⧫Pathway →cortical inputs stimulate the
striatum, stimulating the release of
GABA, which
Inhibits GABA release from the Globus
pallidus interna,
disinhibiting the thalamus.
ie the end result is excitatory on
thalamus

⧫Lesion → Site
●Chorea → Caudate
●Athetosis → Globus Pallidus
●Hemi ballismas → Sub Thalamus
●Parkinson → substantic niagra (Damage, to direct pathway)
●Huntingtool → neostriatum (Damage to Gaba neuron)

Heat exhaustion vs heat stroke

Heat Stroke Heat Exhaustion

⧫Core temp is inc ⧫Core temp will not be high
⧫ Less sweating ⧫ Excessive sweating – lead to
fluid loss – fall in BP fainting