ANATOMY

• Central Nervous System (CNS)-

– comprising the brain and the spinal cord; enclosed in a bone and wrapped in protective
coverings (meninges) and fluid-filled spaces
• Peripheral Nervous System (PNS)-
– formed by the 12 cranial and 31 spinal nerves

PHYSIOLOGY
• Somatic Nervous System-
– voluntary control; this innervates the structures of the body wall (skin, muscles and
mucus membranes)
• Autonomic Nervous System-
– involuntary control; it controls the activities of smooth muscles, glands, internal organs
and blood vessels

AUTONOMIC NERVOUS SYSTEM (ANS)

• Sympathetic (“Fight and flight response”)
– prepares the body for emergency
• Parasympathetic (“rest and digest”)
– aims to conserve and restore energy

NEURONS
• the primary functional and anatomic unit of the nervous system
• composed of nerve cell body and nerve cell fibers.
• They are excitable, meaning, they respond to stimuli by generating electrical impulses

PARTS OF NEURON
A. NERVE CELL BODY
• Also known as soma or perikaryon

1. Nucleus-stores the gene elements; in mature neurons, chromosomes no longer duplicate, and its
only function is for gene expression. The chromosomes are also not arranged as compact
structures but exist in dispersed uncoiled state making the nucleus pale
2. Nucleolus-concerned with ribonucleic acid (RNA) synthesis. Its main function is for protein
synthesis as to maintain the protein level in the cytoplasm
3. Nuclear pores-passage for newly formed ribosomes from the nucleus to the cytoplasm
4. Nissl Substances-ER + ribosomes or simply the rough endoplasmic reticulum; responsible for
synthesizing protein which flows along the axons and dendrites; replaces proteins that are
broken down during cellular activity
**fatigue and neuronal damage cause the Nissl bodies to move and become concentrated at the
periphery of the cytoplasm. This phenomenon which gives the impression that the Nissl bodies
disappeared is called CHROMATOLYSIS.

B. NERVE CELL FIBERS

1. Dendrites- branching process that receives stimuli; thinner, shorter and more plentiful than
axons
2. Axon- generates or propagates action potential away from the cell body
3. Axon Hillock- junction of axon and cell body

C.CLASSIFICATION OF NEURONS

• Multipolar
– usually has one axon and multiple dendrites
 • Bipolar
– possesses one axon and one dendrite
• Unipolar
– a neuron with a single axon that bifurcates or divides after a short distance from the cell
body

D.IMPULSE
• Message generated by neurons

TYPES
1. Afferent Impulse
– from sensory neurons to the higher centers of the brain
2. Efferent impulse
– initiated from the higher centers of the brain to the effector organs via motor
neurons
***INTERNEURONS

E. SYNAPSE
• communication between two neurons or between a neuron and a target structure
• Synapse may be:
– Axodendritic
– Axosomatic
– Axoaxonic
Type of Synapse
• Chemical
– uses a chemical, a neurotransmitter, passes across the narrow space between the cells
and becomes attached to a protein molecule called receptor.
– chemicals used by neurons to communicate with other neurons or other cells

EXCITATORY
a. Glutamate
– produced by cortex and thalamus; main excitatory neurotransmitter of the cortex or
CNS in general
b. Acetylcholine (Ach)
– found in both PNS and CNS
INHIBITORY
c. Dopamine
– main inhibitory neurotransmitter of the striatum/substantia nigra
d. GABA
– main inhibitory neurotransmitter of the cortex or CNS

• Electrical
– uses gap junctions that extend from the cytoplasm of presynaptic neuron the cytoplasm
of the postsynaptic neuron
– there are no neurotransmitters or any form of chemicals.
– ionic current flow from one neuron to the other with a minimum delay.
– bidirectional

ACTION POTENTIAL
• series of electrical events that occur when an impulse is propagated

STAGES
1. Resting
– before the action potential occurs
2. Depolarization
– voltage sensitive sodium ions open
3. Repolarization
– voltage sensitive potassium ions open in response to depolarization
– re-establishes the normal negative resting membrane potential

NEUROGLIA
• aka Satellite cells/ glue cells
• non excitable cells that surround neurons

Types of Neuroglia
• Schwann cells and Oligodendrocytes
– produces myelin sheath
– **Schwann cells-produce myelin sheath in PNS
– **Oligodendrocytes-produce myelin sheath in CNS
• Ependymal cells
– lining of cavities of the brain and spinal cord
• Microglia
– active during inflammations and are phagocytic
• Astrocytes
– star-shaped, most abundant and they brace neurons or provide supporting framework.

CEREBRUM
• largest subdivision of the human brain
• memory, interpretation and processing of information
(generally for consciousness or conscious behavior)
• initiates correct response to a situation
• contains gray and white maters

Protective Coverings
1.Skull
– bony rigid structure; protects the brain and
sense organs. It also serves as attachment for muscles and ligaments
2. Meninges and spaces
– 2nd protective layer and coverings; 3 layers of connective tissues.
– They are continuous with the meninges of the spinal cord
3. Meninges and Spaces
a. Dura mater
– outermost layer/pachymeninx
– contains the venous dural sinuses which drains deoxygenated
blood from the brain.
– It also covers the cranial nerves
b. Subdural space
– a protective space between the dura and arachnoid maters
c. Arachnoid mater
– it's a Greek word which means "spider“
– thin, transparent and avascular.
– It closely covers the brain but does NOT follow the convolutions/folds of the brain
d. Subarachnoid space
– protective space between the arachnoid and pia
– contains the CSF and the main blood vessels/arteries

e. Pia mater
– innermost layer
 – highly vascular connective tissue
– follows the convolutions of the gyri, sulci and fissures
– no potential or actual space in between the pia and brain
– The pia mater together with the ependymal cells forms the choroid plexus which
produces CSF

3. Cerebrospinal Fluid
– produced by the choroid plexus
– clear, colorless, odorless solution
– also contains small amounts of protein, glucose and ions such as sodium, potassium and
chloride.
**usual volume is 100-150mL with a rate of production of 500mL/day

Functions of CSF
• shock absorber
• conveys nutrients to the CNS
• removes by-product of metabolism (as there are no lymphatic system in CNS)

Pathway of CNS
• choroid plexus → lateral ventricle → Foramen of Monro →
third ventricle → cerebral aqueduct of Sylvius → Fourth
ventricle → Foramen of Magendie and Luschka → subarachnoid
space → arachnoid villi

HYDROCEPHALUS
• accumulation of fluid in the brain

4. Blood-brain Barrier
– helps maintain the normal function of the brain as it
keeps harmful substances from entering the brain.
5. External Features

1. Fissure
- deep grooves
- Medial Longitudinal Fissure- sagittal fissure that separates the
two cerebral hemispheres

2. Gyrus
- folds that increase the surface area of the brain

3. Sulcus
- gaps/lines that separates gyri
• Central Rolandic-separates frontal and parietal lobes
• Lateral Sylvian- separates parietal and temporal lobes

LOBES OF CEREBRUM

1. Frontal- thinking lobe, motor lobe

2. Parietal
3. Temporal
4. Occipital
**Insular Lobe
-no distinct function; aka Island of Reil, lie deep within the
lateral sulcus and can only be seen by spreading the lips of the lateral
sulcus
**Limbic Lobe
– concerned with emotions and memory; oldest lobe phylogenetically
– PARTS: parahippocampal gyrus, uncus, cingulate gyrus, hippocampus, amygdaloid
nucleus

A. LIMBIC LOBE

• Uncus
– interpretation of olfactory sensation; lesion will result to either anosmia or hyposmia
• Hippocampus
– short term memory; lesion will result in anterograde amnesia
• Amygdaloid nucleus
– emotion and sexual drive; lesion will result to Kluver Bucy or hypersexual behavior

B. Generalized Functions
1. Motor
– voluntary movements
2. Sensory
– provides conscious awareness of a sensation
3. Association
– act mainly to integrate diverse information to come up with purposeful actions

1. Dominant
– usually the left hemisphere (90%OTT)
– right cerebral dominant people are usually males
– concerned with analytical (math concepts) and logical thinking
– language and speech
– more intellectual hemisphere
– production of skilled movements

2. Non-dominant
– emotional side of the brain
– processes abstract concepts and non-verbal ideas
– appreciation of arts and music
– concerned with personal space, intuition and emotion
–
3.BASAL GANGLIA
• related to the cognition and fine tuning of movement (amplitude, speed and direction)
• mass of gray mater deep within the cerebral hemispheres
• The term is debatable because these masses are nuclei (CNS) rather than ganglia (PNS).

Parts of Basal Ganglia

1. Caudate nucleus
– afferent limb of basal ganglia
2. Putamen
– one of the main entrance of impulses to the basal ganglia
– lesion on this area results in dystonia
3.Globus Pallidus
– one of the efferent limb of the basal ganglia together with subthalamic nucleus
– lesion of the globus pallidus 2° to deposition of bilirubin results in athetosis
4. Subthalamus
– located in the diencephalon
– lesion on this area results in hemiballismus
5. Substantia nigra
– located in midbrain
CEREBELLUM
• synchronizes/coordinates motor function in order to execute a smooth sequence of movements
necessary for skilled actions
• it maintains/controls muscle tone, proper posture and equilibrium.

• has no direct pathway or connections to the lower motor neurons but it exerts control via the
cerebrum, brainstem and spinal cord.
• controls movements on the SAME side of the body.

Lobes of Cerebellum

1. Anterior Lobe (paleocerebellum /spinocerebellum)

• involved with maintenance of posture

2. Flocculonodular Lobe (archicerebellum)

• involved with balance or equilibrium

3. Posterior Lobe (neocerebellum)

• involved with fine movements and coordination

DIENCEPHALON
COMPONENTS:
1. Thalamus
• major relay center of all sensory stimulus EXCEPT olfaction
• contains the geniculate bodies on the posterior portion of the thalamus
• lesion on thalamus results in contralateral sensory loss
**cochlear nuclei → medial geniculate body → Brodmann's area 41 (primary auditory area)
• lesion on medial geniculate body leads to deafness
**optic tract → lateral geniculate body → Brodmann's area 17 (primary visual area)
• lesion on lateral geniculate body leads to blindness
2. Hypothalamus
• controls body's homeostasis
• also controls emotion, behavior, endocrine function (oxytocin and vasopressin) and circadian
rhythm (sleep/wake cycle)
THERMOREGULATION
**Anterior hypothalamic center regulates loss of heat (sweating, vasodilation, panting)
**Posterior hypothalamic center: regulates conservation of heat (vasoconstriction, shivering,
piloerection)
• REGULATION OF FOOD AND WATER INTAKE
**Lateral- Hunger and Thirst center; lesion to this area results in anorexia
**Ventromedial- Satiety center; inhibits food and water intake; lesion to this area results in bulimia /
hyperphagia
3. Epithalamus
• contains the pineal gland which secretes melatonin (rise at darkness and falls at day)
**Melatonin- regulates sleep/wake cycle
4. Subthalamus
• controls muscular/motor activities through its connection with the basal ganglia

BRAINSTEM
1. Channel for tracts from spinal cord to higher centers in the brain
2. Contains important reflex centers
3. Contains important nuclei of cranial nerves III through XII.

Three Main Structures

• MIDBRAIN
• PONS
• MEDULLA

MIDBRAIN
• region between the pons and diencephalon
• contains the corpora quadrigemina (superior colliculi and inferior colliculi)

Corpora Quadrigemina
• SUPERIOR COLLICULI
• Contains neurons that receive visual input and serve ocular reflexes
• INFERIOR COLLICULI
• Receives input from both ears
• Involved in auditory reflexes and in determining the side on which a
sound originates

PONS
• anterior to the cerebellum
• connects the medulla oblongata to the midbrain
• LARGEST

MEDULLA
• connects with the pons superiorly and spinal cord inferiorly
• junction of medulla and spinal cord corresponds approximately to the level of the foramen
magnum
Control of Breathing
• Pons - controls the rate and rhythm of breathing
 • Medulla
• Dorsal - rhythm generator of breathing
• Ventral - force expiration

Reticular Formation
• The reticular activating system is the name given to part of the brain believed to be the CENTER
OF AROUSAL AND MOTIVATION.
• The activity of this system is crucial for maintaining the state of consciousness.
• It is involved with the CIRCADIAN RHYTHM (24-hour cycle in the physiological processes of living
beings; biological clock)

Substantia Nigra
• Plays a key role in motor control
• Degeneration of substantia nigra occurs in Parkinson’s disease
SPINAL CORD
• The cord is normally 42-45cm. long and ends at the L1-L2 vertebral level
• In children, the conus medullaris ends at the level of L2 or L3
Segments
• Cervical (8) • Sacral (5)
• Thoracic (12) • Coccygeal (1)
• Lumbar (5)

Parts
• Conus Medullaris
• tapered distal end of the spinal cord (L1/L2)
• Filum Terminale
• extends from the tip of the conus to the distal dural sac of the first coccygeal vertebra
• Cauda Equina
• collection of nerve roots below the conus medullaris
• Central Canal
• filled with CSF and lined with ependymal cells

Blood Supply
Cranial Nerves
• There are 12 pairs of cranial nerves included in the peripheral
nervous system (PNS)
• CN III to XII originate in the brainstem
• Cranial nerves are nerves that emerge directly from the brain in
contrast to spinal nerves which emerge from segments of the
spinal cord.
• In terms of function, cranial nerves could be grouped as sensory,
motor or mixed
• Sensory: CN I, II, VIII
• Mixed: CN X, IX, VII, V  (1975)
• Motor: III, IV, VI, XI, XII
• * With parasympathetic function: CN X, IX, VII, III (1973)

CN I- Olfactory (Sensory) CN VI- Abducens (Motor) CN X- Vagus (Mixed)

CN II- Optic (Sensory) CN VII- Facial (Mixed) CN XI- Spinal Accessory
CN III- Oculomotor (Motor) CN VIII- Auditory (Sensory) (Motor)
CN IV- Trochlear (Motor) CN IX- Glossopharyngeal CN XII- Hypoglossal (Motor)
CN V- Trigeminal (Mixed) (Mixed)

CN I: Olfactory Nerve synapsing on the thalamus. The

• reaches the cerebral cortex without olfactory cortex sends nerve fibers to
 many other centers within the brain to
establish connections for emotional
and autonomic responses to olfactory
sensation
CN II: Optic Nerve
• Enters the undersurface of the
medial (middle) frontal part of the
cerebral hemispheres
• It carries visual impulses from the
retina to the brain.
• TESTS:
• Visual Acuity test
• Visual Field test
CN III: Oculomotor Nerve
• innervates levator palpebrae superioris
(opening of eye for 80%); Mueller's
muscle opens the eye 20% (C7-T1)
• lesion on CN III leads to ptosis or
drooping of the eyelids;
• innervates all the extraocular ms.
except the superior oblique and the
lateral rectus
• when there's lesion on CN III, the eyes
cannot be moved upward, downward
and inward and at rest the eyes look
laterally and downward (external
strabismus). The patient also has
double vision (diplopia).
• also innervates the pupillary muscles
namely the sphicter pupillae and the
ciliary muscles necessary for pupillary
constriction/dilation
• TEST: Pupillary light reflex: CN II
(sensory part) and CN III (motor part)
• direct: the eye lighted should constrict
• consensual: the eye opposite to the
side lighted should constrict
CN IV: Trochlear Nerve
• the slenderest nerve and the only
nerve exiting at the dorsal brainstem
and immediately decussates with the
nerve at the opposite side
• This nerve innervates superior oblique
and assists in turning the eyeball
downward and medially
CN VI: Abducens Nerve
• arises from the anterior (front portion)
pons and supplies one muscle that
moves the eye (lateral rectus)
• responsible for turning the eyes
laterally. The longest nerve
intracranially.
CN V: Trigeminal Nerve
• the largest cranial nerve
• SENSORY: carries sensation from the
inside of the mouth, teeth, and skin of
the face
• MOTOR: supplies the muscles of the
jaw /chewing muscles
• NUCLEI:
• Main sensory nucleus and spinal
nucleus- light touch and pressure
• Motor nucleus- motor aspects
• Mesencephalic nucleus-
proprioception
• Semilunar or Trigeminal nucleus- pain
and temperature sense
CN VII: Facial Nerve
• SENSORY: anterior 2/3 of the tongue
• MOTOR: facial muscles (muscles of
expression)
CN VIII: Auditory Nerve
• Enters the side of the pons and
consists of two parts: the cochlear
nerve which carries hearing and the
vestibular nerve which transmits
impulses from the semicircular canals
which affect balance.
• Lesion in outer and middle ear-
conductive
• Lesion in inner ear or nerve-
sensorineural
CN XI: Accessory Nerve
• innervates trapezius and SCM
• contains cranial and spinal roots; they
join together as they pass the jugular
foramen
• C2C3-SCM
• C3C4-trapezius
CN XII: Hypoglossal Nerve
• innervates all the intrinsic muscles of
the tongue and in addition, the
styloglossus, hyoglossus and
genioglossus
**palatoglossus is innervated by the pharyngeal plexus