NERVOUS SYSTEM

ANATOMY DEPARTEMENT - MEDICAL FACULTY OF HASANUDDIN UNIVERSITY

dr. Fadiyah Ulfah Khalid
NERVOUS SYSTEM

š Network of neurons whose main feature is to generate, modulate

and transmit information between all the different parts of
the human body.
š This property enables many important functions of the nervous
system, such as regulation of vital body functions
(heartbeat, breathing, digestion), sensation and body movements.
NERVOUS TISSUE

Nervous tissue is divided into 2 major cell types:

š Neurons
š Neuroglial cells (the neuroglia) à only functions as a supporting cell
(does not deliver stimuli)
NEURONS

š The structural and functional cells in the nervous system

š Respond to a nervous stimulus and conduct the stimulus along the length of the
cell
š A neuron’s cell body is called the perikaryon, or soma
š Cell bodies are classified by their location:
š Ganglion: a collection of nerve cell bodies located in the peripheral nervous system
(e.g., dorsal root ganglion, trigeminal ganglion, ciliary ganglion)
š Nucleus: a collection of nerve cell bodies located in the central nervous system (e.g.,
Edinger-Westphal nucleus, chief sensory nucleus of cranial nerve [CN] V, motor
nucleus of CN VII)
NEURONS

š Neurons have 2 types of processes that extend from the nerve cell
body:
š Dendrite: process that carries nerve impulses toward the nerve cell body;
neurons may have multiple dendrites
š Axon: process that carries nerve impulses away from the nerve cell body;
neurons can have only 1 axon
NEURONS

dendrites
cell
axon with
body
myelin sheath

Schwann
cell
synapses
Moore’s COA5 2006
• 3 major types of neurons:
• Unipolar: has only 1 process from the cell body (sensory neurons)
• Bipolar: has 2 processes from the cell body: 1 dendrite and 1 axon (sensory neurons;
located only in the retina, olfactory epithelium, and the vestibular and cochlear
ganglia)
• Multipolar: has 3 or more processes from the cell body: 2 or more dendrites and 1 axon
(motor neurons and interneurons)
There are two types of neurons, named according to whether they send an
electrical signal towards or away from the CNS;
• Efferent neurons (motor or descending) send neural impulses from the CNS to
the peripheral tissues, instructing them how to function.
• Afferent neurons (sensory or ascending) conduct impulses from the peripheral
tissues to the CNS. These impulses contain sensory information, describing the
tissue's environment.

š The site where an axon connects to another cell to

pass the neural impulse is called a synapse.
š The synapse doesn't connect to the next cell directly.
Instead, the impulse triggers the release of chemicals
called neurotransmitters from the very end of an axon.
 segm en t of 1 axon
• Satellite cells: located in th e p erip h eral n ervou s system ; su rrou n d th e n erve
cell bod ies of gan glia

NEUROGLIA
Ventricle

Microglial
Ependyma cell

The supporting nervous tissue for neurons, although Tanycyte

neuroglial cells also have assistive roles in neuron

function. Neuroglial cells have only 1 type of process
š Classification: Neuron
Oligodendrocyte

š Astrocytes: located in the central nervous system; help keep

neurons in place, provide nutritional support, regulate the
extracellular matrix, form part of the blood-brain barrier
š Oligodendrocytes: located in the central nervous system;
responsible for axon myelination in the central nervous system; 1 Axon

oligodendrocyte can myelinate 1 segment of multiple axons Astrocyte

Astrocyte foot process

š Microglial cells: located in the central nervous system; Perivascular

responsible for phagocytosis to remove waste Pia mater Capillary
pericyte

š Schwann cells: located in the peripheral nervous system;

responsible for axon myelination in the peripheral nervous
system; 1 Schwann cell can myelinate 1 segment of 1 axon
š Satellite cells: located in the peripheral nervous system;
surround the nerve cell bodies of ganglia
Figu re 3-2

BASIC NEUROANATO MY AND CRANIAL NERVES

WHITE & GRAY MATTER

š The white color of myelinated axons is distinguished from the gray colored
neuronal bodies and dendrites.
š Based on this, nervous tissue is divided into white matter and gray matter, both of
which has a specific distribution;
š White matter (Substantia Alba) comprises the outermost layer of the spinal
cord and the inner part of the brain. (Axon +Dendrit → Fasciculus/Tractus)
š Gray matter (Substantia Grisea) is located in the central part of the spinal
cord, outermost layer of the brain (cerebral cortex), and in several subcortical
nuclei of the brain deep to the cerebral cortex. (Badan Sel Neuron →
Nucleus)
CENTRAL NERVOUS SYSTEM

š Consists of:
š Brain (Encephalon) à cerebrum, diencephalon, truncus cerebri and
cerebellum. Found within skull (cavum cranii)
š Spinal cord (Medulla Spinalis) à found within vertebral column (canalis
vertebralis).
š Covered by ”MENINX” that filled with LIQUOR CEREBROSPINALIS
(LCS).
š The structure of the CNS is formed by:
š Substantia grisea/ Grey Matter (neuron cell body à nucleus)
š Substantia alba/ White matter (axon+ dendrite à fasciculus/ tractus)
 MENINX

š Membrane that encloses the

entire CNS structure for
protection.
š Consist of 3 layers:
1. DURAMATER: The outermost layer,
solid, thick and hard. Consists of 2 layers.

2. ARACHNOIDMATER
3. PIAMATER The innermost layer, clear,
thin
CEREBRUM

š The surface of the cerebral cortex of the brain is divided by:

š Gyri (singular gyrus): the elevations of brain tissue on the surface
š Sulci (singular sulcus): the grooves or fissures located between the gyri
š There are 3 large sulci that help divide the cerebral hemispheres into 4 of its lobes:
š Central sulcus (of Rolando): divides frontal lobe from parietal lobe
š Lateral sulcus (of Sylvius): divides the frontal and parietal lobes from the temporal lobe
š Parieto-occipital sulcus: divides the parietal lobe from the occipital lobe
 Precentral gyrus
Precentral sulcus Central sulcus
Postcentral gyrus
Superior frontal gyrus Superior parietal lobule
Intraparietal sulcus
Inferior parietal
Middle frontal gyrus lobule
Angular gyrus

Inferior frontal gyrus

Frontal pole O ccipital pole

Anterior ramus
Lateral (sylvian) fissure Ascending ramus Inferior temporal gyrus
Posterior ramus
Temporal pole
Superior temporal gyrus

Parietal lobe
 Temporal pole
Superior temporal gyrus

Parietal lobe sensory perceptions related to Parietal lobe

pain, temperature, touch and
pressure, spatial orientation
and perception , sensory aspect
of language (Wernicke’s area)Frontal lobe
Occipi

Frontal lobe
motor movement, motor Occipital lobe Temporal lobe
aspect of speech (Broca’s vision
area), reasoning,
emotions, personality, and
problem solving
Temporal lobe auditory perceptions, learning, and memory

Centr
Circular sulcus of insula

Short gyri
associated with visceral functions including taste Insula Limen
Long gyrus

Figu re 3-3
 DIENCEPHALON

major relay center of

the somatosensory
system and parts of the Auditory & visual
motor system function

Olfactory function

controls the autonomic

nervous system and
endocrine system

Motoric function
BRAIN STEM (TRUNCI CEREBRI)

q Consist of (from caudal to cranial):

1. MEDULLA OBLONGATA (MO)
2. PONS
3. MESENCEPHALON (MES)
q From Truncus Cerebri, there are 10 Nn.
Craniales (drom 12 Nn. Craniales)that in/
out
1. MO à IX, X, XI, XII
2. PONS à V, VI, VII, VIII
3. MES à III, IV
CEREBELLUM

š Part of the motor system

š Receives sensory input of all forms that use the
deep cerebellar nuclei
š Associated with:
š Equilibrium
š Posture
š Tone of axial muscles
š Gait
• Eq u ilibriu m
• Postu re
• Ton e of axial m u scles
• Gait

Corpus callosum
Interthalamic adhesion
Cuneus
Thalamus
Pineal gland
Hypothalamic sulcus
Lingual gyrus
O ptic chiasm
AP
Pituitary gland
Cerebellum
(anterior and posterior)
Medulla oblongata
Midbrain
Pons

Figu re 3-4

BASIC NEUROANATO MY AND CRANIAL NERVES 69

MEDULLA SPINALIS
C1
1st cervical n.
Cervical enlargement
C7

(SPINAL CORD)
8th cervical n.
T1
1st thoracic n.
Spinal dura mater
Filaments of
nerve root

š Begins at the caudal end of the medulla and

ends at vertebral level L1–2, tapering into the
conus medullaris
š Has 2 enlargements associated with the limbs
à intumescentia T12
Lumbosacral enlargement
12th thoracic n.
š Cervical—associated with the upper limb and L1

found between the spinal cord at levels C4 to 1st lumbar n.

Conus medullaris
T1 Cauda equina
L5
5th lumbar n.
š Lumbosacral—associated with the lower limb S1
1st sacral n.
and found between the spinal cord at levels L1 Filum terminale
to S2 5th sacral n.
Coccygeal n.
Coccyx

Figu re 3-5
q MS SEGMENT
o Consist of 31 MS segment (8 Cervicalis, 12 Thoracalis, 5 Lumbalis, 5
Sacralis, dan 1 Coccygeus)
o From every MS segment à there are Radix ant + post à N. Spinalis

q At Cornu Ant à in RADIX ANTERIOR N. Spinalis (Motoris)

q At Cornu Post à out RADIX POSTERIOR N.Spinalis (Sensoris)

q At Thoracalis, Lumbalis, Sacralis MS segment, there is additional

cornu à CORNU LATERALIS as autonomic nervous system center
o Thoracalis + Lumbalis segment à Sympathis
o Sacralis segment à Parasymphatis
 white matter gray matter (cell bodies)
(axons) • dorsal (posterior) horn ventral
• ventral (anterior) horn dorsal rootlets
rootlets
meninges
pia •
arachnoid •
dura • dorsal root
(spinal) ganglion

subarachnoid
space
(CSF)

• dura
• arachnoid
• pia spinal nerve
ventral root meninges • dorsal primary ramus
• ventral primary ramus
PERIPHERAL NERVOUS SYSTEM

š Consists of:
š Cranial nerves—12 pairs
š Spinal nerves—31 pairs

š Can be subdivided into:

š Somatic nervous system—voluntary system associated with afferent (sensory)
and efferent (motor) fibers
š Autonomic nervous system—involuntary system associated with homeostasis
of the body
SOMATIC NERVOUS SYSTEM

š The voluntary component of the peripheral nervous system.

š It consists of all the fibers within cranial and spinal nerves that enable us to
perform voluntary body movements (efferent nerves) and feel sensation from the
skin, muscles and joints (afferent nerves).
š Somatic sensation relates to touch, pressure, vibration, pain, temperature, stretch
and position sense from these three types of structures.
AUTONOMIC
NERVOUS SYSTEM

š The involuntary part of the

peripheral nervous system.
š Further divided into
the sympathetic
(SANS), parasympathetic (PANS)
systems, it is comprised exclusively
of visceral motor fibers.
š The SANS and PANS do not
oppose each other but rather,
they complement each other to
maintain homeostasis.
 SYMPATHETIC
š Sometimes called the “thoraco-lumbar” division
š Short preganglionic neurons; long postganglionic
neurons; ganglia are called the chain ganglia
š Preganglionic neurons secrete Ach onto nicotinic
receptors
š Postganglionic neurons secrete NE on to a or b
receptors
š Target tissues are smooth muscle, cardiac muscle,
endocrine glands, brown fat
PARASYMPATHETIC
• Sometimes called the ”cranio-sacral” division
• Long preganglionic neurons; short postganglionic
neurons (often in the target organ)
• Preganglionic neurons secrete Ach on to nicotinic
receptors
• Postganglionic neurons secrete Ach on to
muscarinic receptors
• Target tissues are smooth muscle, cardiac muscle,
exocrine glands, brown fat
Nn. CRANIALES

š Peripheral nerves that leave the brain or brainstem.

š The cranial nerves customarily are subdivided into 12 pairs:
o N. I = N. OLFACTORIUS à inferior Lobus Frontalis
o N. II = N. OPTICUS à inferior Lobus Frontalis
o N. III = N. OCULOMOTORIS à MES
o N. IV = N. TROCHLEARIS à MES
o N. V = N. TRIGEMINUS à PONS
o N. VI = N. ABDUCENS à between PONS-MO
o N. VII = N. FACIALIS à between PONS-MO
o N. VIII = N. OCTAVUS à between PONS-MO
o N. IX = N. GLOSSOPHARYNGEUS à MO
o N. X = N. VAGUS à MO
o N. XI = N. ACCESSORIUS à MO
o N. XII = N. HYPOGLOSSUS à MO
 Spinal nerve fibers
Efferent (motor) fibers
Afferent (sensory) fibers

CN III
Oculomotor
Ciliary muscle, sphincter
CN I CN II pupillae, and all external eye ic
alm
Olfactory Optic muscles except those below hth
Eye Op
Nasal cavity
CN IV y
Trochlear illar
ax
Superior oblique muscle M
CN V ar Motor—muscles of
bul
Trigeminal ndi mastication: tensor
Ma
CN VI Sensory—face, tympani, tensor
Abducens sinuses, teeth, orbit veli palatini,
Lateral rectus and oral cavities, mylohyoid,
muscle dura mater anterior belly
of digastric

CN VII Intermediate nerve

Facial Motor—submandibular,
Muscles of face, sublingual, lacrimal glands
stapedius, posterior Taste—anterior 2⁄3 of
belly of digastric, tongue, sensory soft palate
stylohyoid, occipitalis,
auricularis muscles

CN VIII
Vestibulocochlear
Cochlear Vestibular

CN IX
Glossopharyngeal
Taste—posterior 1⁄3 of tongue
Sensory—tonsil, pharynx, middle ear
Motor—stylopharyngeus,
parotid gland

CN X
Vagus
Motor—heart, lungs, palate, pharynx,
larynx, trachea, bronchi, GI tract
CN XI Sensory—heart, lungs, trachea,
CN XII Accessory bronchi, larynx, pharynx,
Hypoglossal Sternocleidomastoid, GI tract, external ear
Tongue trapezius muscles
muscles

Infrahyoid
muscles
(C1, 2, 3
fibers)
 Ciliary ganglion
Lacrimal gland
• The maxillary division (V2), Lacrimal n.

being a branch o the trigeminal Nasociliary n. Zygomaticotemporal n.

n., is sensory in function Frontal n.

Zygomaticofacial n.
O phthalmic n. (V1 )
• N. Alveolaris superior Trigeminal
(semilunar) ganglion External nasal branch
posterior of anterior ethmoidal n.
supplies the maxillary sinus and the Trigeminal n. (V)
maxillary molars Meningeal branch

Foramen rotundum
• N. alveolaris superior
media Foramen ovale Infraorbital n.

supplies the maxillary sinus; the Mandibular n. (V3 ) Anterior superior

premolars, mesiobuccal root of the 1st alveolar n.
Maxillary nerve (V2 )
molar; and the gingiva and mucosa Nasal branch
alongside the same teeth. Zygomatic n.
Mucous membrane
of maxillary sinus
Nerve (vidian) of pterygoid canal
• N. alveolaris superior Middle superior alveolar n.
Pterygopalatine ganglion Dental and gingival branches
anterior
Greater and lesser palatine nn. Superior dental plexus
supplies the maxillary sinus; maxillary
central incisor, lateral incisor, and canine Infraorbital nerve entering
Ganglionic branches to pterygopalatine ganglion
infraorbital canal
teeth; and the gingiva and mucosa
alongside the same teeth Posterior superior alveolar n.
 Zygomaticotemporal n. (V2 )
Deep temporal nn. (V3 )
Masseteric n. (V3 )
Mandibular n. (V3 )
Nerve to medial pterygoid and
tensor veli palatini mm. (V3 ) (cut)
• Mandibular division (V3) is the Zygomaticofacial n. (V2 )
largest of the 3 divisions of the Maxillary n. (V2 )
trigeminal n. Has motor and Infraorbital n. (V2 )
Pterygopalatine ganglion
sensory functions
Auriculotemporal
Nerve to lateral
n. (V3 )
pterygoid m. (V3 ) (cut)
• N. Alveolar inferior Middle meningeal a.
Innervates all mandibular teeth (via Superficial temporal
inferior alveolar and incisive nn.), a. (cut)
Buccal n. (V3 )
Facial n. (VII) (cut)
periodontal ligaments (via inferior Chorda tympani n. (VII)
Maxillary a.
alveolar and incisive nn.), and the gingiva Lingual n. (V3 ) Inferior alveolar n. (V3 )
from the premolars anteriorly to the
midline (via the mental n.) Medial pterygoid m. (cut) Nerve to mylohyoid (V3 )
(lateral pterygoid removed)
Submandibular ganglion
Mental n. (V3 ) Internal carotid a.

Figu re 3-22

BASIC NEUROANATO MY AND CRANIAL NERVES 9

 trapezius weakness in
C4 (distal to SCM
innervation) shoulder elevation
C5 and arm abduction
Clinical presentation above horizontal
Trapezius m. varies with location
of damage.
Sternocleidomastoid m. (SCM)

Comparison of clinical findings in CN-XI and long thoracic nerve damage Lesion proximal Weakness Weakness turning
Spinal accessory nerve to sternocleido- of SCM head to opposite
Spinal accessory n.
C1 mastoid (SCM) side
(CN-XI) innervation
C2
Trapezius m.
Drooping of
Spinal
Scapula C3 Lesion in posterior shoulder and mid-
accessory n. Weakness of scapular winging;
Upper triangle of neck
trapezius weakness in
trapezius C4 (distal to SCM
atrophy innervation) shoulder elevation
C5 and arm abduction
Spinal accessory above horizontal
nerve palsy Clinical presentation
Trapezius m. varies with location
of damage.

Drooping
of scapula
Comparison of clinical findings in CN-XI and long thoracic nerve damage
Spinal accessory nerve
Atrophy of the trapezius
demonstrates loss of the Spinal accessory n.
contour of the neck and (CN-XI)
prominence of the Trapezius m.
rhomboids as well as
drooping of the scapula.
Scapula
Upper
trapezius
Figu re 3-31 atrophy

Spinal accessory
nerve palsy
 Sites of lesions affecting
hypoglossal n. (CN-XII)
Motor
cortex

Lesion

Subtle weakness of tongue may be tested by asking

patient to press tongue against cheek (shown)
or against a tongue depressor.
CN-XII

Lesion Nucleus Lesions of

CN-XII
nucleus of
CN-XII or n.
proper result
CN-XII in ipsilateral
deficit.
Patient with
right-sided
CN-XII lesion

Atrophy If hypoglossal nerve is affected on one side, the tongue often deviates
toward the side of the lesion on protrusion (due to imbalance of
genioglossus contraction).

When hypoglossal nerve or its nucleus

Fasciculation is damaged, atrophy and fasciculation with
of the tongue are noted on evaluation. E. Ha tton
 CERVICAL PLEXUS Nerves and Vessels of Neck (continued)
See also Plate 140
2

Accessory nerve (CN XI)

S
• Formed by C1 to C4 ventral rami Cervical plexus: schema
Hypoglossal nerve (CN XII) Great auricular nerve

• Ansa cervicalis (M): Ventral rami of C1 to C3 - (S = gray ramus communicans

C1
Lesser occipital nerve
from superior cervical ganglion)
infrahyoid muscles To rectus capitis lateralis,
longus capitis, and rectus
• N. occipitalis minor (S): ventral ramus of C2 - skin To geniohyoid muscle S C2 capitis anterior muscles
To thyrohyoid muscle
of the neck and the scalp posterosuperior to the clavicle
• N. auricularis major (S): ventral rami C2 and C3 -
S
skin over the parotid gland, the posterior aspect of the C3
auricle, and an area of skin extending from the angle of Transverse cervical nerve
To omohyoid muscle (superior belly)
the mandible of the mastoid process S To longus capitis and
C4
• N. cervical transversus (S): ventral rami C2 and Ansa cervicalis
Superior root longus colli muscles
Inferior root
C3 - skin covering the anterior triangle of the neck
• N. supraclavicularis (S): ventral rami C3 and C4 - To sternothyroid muscle
To sternohyoid muscle
skin over the neck and over the shoulder To omohyoid muscle (inferior belly)
• N. phrenicus (M): ventral rami of C3 to C5 - Supraclavicular nerves
To scalenus and levator
scapulae muscles
diaphragm, mediastinal pleura, pericardium of the heart Phrenic nerve

Right anterior view

TERIMA KASIH
Departemen Anatomi Fakultas Kedokteran Universitas Hasanuddin