Chapter 35

Neurons: impulse-conducting cells that facilitate communication within the nervous system
Neuroglial cells: specialized cells that support and protect the neurons.

Neuroglial Cells
Astrocytes
 attach to blood vessels, neurons, and the pia mater,
 restrict substances from entering the neurons
 conduction of impulses and are known to clear cellular debris.
Ependymal cells
 Assist in the production of cerebrospinal fluid (CSF)
 protect the brain from foreign materials
Microglial cells
 phagocytic
Oligodendrocytes
 form myelin sheaths that increase the speed
Schwann cells form myelin sheaths that cover axons in the PNS.

Neurons
 afferent or sensory
 efferent or motor
 interneurons: located in CNS, make decisions about body respond to stimuli

Tissues in the CNS

 Grey matter
o Cell bodies, dendrites, axon terminals
o Synapse = cell to cell communication
 White matter
o Neuronal axons covered with myelin sheath
o White because of the color of myelin

Neurotransmitters
 Excitatory
o Acetylcholine
o Glutamate
o Norepinephrine
 Inhibitory
o Dopamine
o Serotonin
o GABA

Central Nervous System

Brain
 Largest portion of the brain
 Primary white matter (myelin)
  Divided into right and hemisphere by longitudinal fissure
 Four lobes
o Frontal: personality
o Parietal: sensory and perception
o Temporal: speech
o Occipital: vision
 Also contain:
o Thalamus
 Center of sensory impulses
 Filter all info traveling to the cortex
 Pain, temperature, touch
 Regulate motor control
o Basal ganglia
 Inhibitory signals
 Work with cerebellum to achieve coordinated movement
 Problems means movements disorders as Parkinson
o Hypothalamus
 Regulate ANS
 Excitatory signals
 Regulate metabolism, stress, growth, sleep, memory
o Limbic system
 Role is memory and emotions
 When stimulated produce sensation of pleasure or reward

Brainstem
 10/12 CN originated in the brainstem
o Except olfactory and optic
 Three areas
o Medulla Oblongata
 Receive all impulses from brain to SC
 Respiratory and cardiac center
 Control HR, BP, rhythm, vomiting, sneezing, coughing
 4 CN originate here: IX, X, XI, XII
o Pons:
 4 CN originate here: V, VI, VII, VIII
o Midbrain
 2 CN originate here: III, IV
Cerebellum
 Coordination of muscle activities, balance, equilibrium
 Non motor functions: speech, sensing and emotions

Arterial circulation
 r/l vertebral arteries
o joint to form vertebrobasilar arteries
 r/l internal carotid arteries
 o supply primary cerebrum
o divide into
 anterior cerebral artery
 middle cerebral artery (MCA): 90% of strokes occur here
Circle of Willis: where internal carotid arteries and vertebrobasilar arteries join together. If blood
flow is compromised can cause ischemia

Venous Blood flow: occurs through sinuses

Spinal cord
 carries info from brain to the rest of the body
 grey and white matter
 dorsal root: carry impulses into SC
 ventral root: carry impulses out SC
 some pathways undergo decussation: right side of brain controlling left and viceversa
o if occur, destination is on the oppositive side of the body = contrateral
o if the origin is on the same side of the body = ipsilateral
 spinal tracts
o Names: first part indicated origin, second part indicates termination
 spinothalamic: starts at the spine and ends at the thalamus
o Responsible for sensation, touch, vibration

Meninges
 Dura
 Arachnoid
 Pia matter
Spaces
 Epidural space: between the skull and dura matter
o If middle meningeal artery is damaged, hemorrhage occur = epidural bleed
 Rapid accumulation and onset neuro symptoms
 Subdural space: between the inner dura matter and arachnoid layer
o Bleed = venous origin
 Blood accumulates slowly, slow manifestations
 Subarachnoid space: flows CSF

CSF
 Circulates through the ventricles of the brain and into subarachnoid space
 Produced in the choroid plexus at the lateral ventricles
o The 3 to 4
o From there to the SC
 Constantly reabsorbed = only 125 ml at any one time
o Hydrocephalus: when CSF does not drain adequately = ventricles enlarged w
fluid

Blood brain barrier prevents substances such as antibodies, toxins from entering to the brain
Dermatome: area supply by specific spinal nerve. Can be used to determined wheter a sensory
nerve root is damage or injured

Sympathetic nervous system

 Thoracolumbar system: from thorax or lumbar to SP
 Neurotransmitter: norepinephrine
 Fibers: adrenergic
 Receptors: adrenergic receptors
o Two types
 Alpha: excitatory
 vasoconstriction
 Increases BP
 Pupillary dilation
 Betha: inhibitory and excitatory
 Increases HR
 Increases cardiac contractility
 Bronchodilatation: enhances blood flow
 Urinary sphincter contraction
 Both: decreases GI motility

Parasympathetic
 Craniosacral system: from brainstem or sacral to SP
 Neurotransmitter: acetylcholine
 Fibers: cholinergic
 Receptors: muscarinic and nicotinic
o Muscarinic: inhibitory and excitatory
o Nicotinic: excitatory
Effects:
 Pupillary constriction
 Decreases HR
 Decreases cardiac contractility
 Vasodilation
 Bronchoconstriction
 Decreases GI motility
Urinary sphincter relaxation
ASSESSMENT
History
 Regular medical care
 Medical history
 Family medical history
 Allergies
 Meds
 Social history
 Chief complaint

Physical
Level of consciousness: orientation to time, person and place
 Categories:
o Conscious: awake
o Lethargic: sleepiness, delayed
o Stuporous: minimal movements w/o stimulus
o Coma: unresponsive
 Assessed using Glasgow coma scale
o Eye opening, motor response, verbal response
 Eliciting a response
o 1. Call the pte by name
o 2. Raise voice
o 3. Shake patient
o 4. Apply painful stimuli: nailbed pressure
o 5. Sternal rub
Cognitive Function:
 Mini Mental Status Examination
o Orientation
o Attention: count backwards by seven
o Memory
o Max: 30
o Below 20 means cognitive impairment
Cranial Nerve Assessment
 Assess the 12 CN
Motor assessment:
 Assess muscle mass, tone and strength
 Patient is asked to grasp hand and squeeze
 Biceps and triceps: grasping the wrist. Ask the patient to pull toward you and push
away
 Quadriceps: lift the legs against resistance
 Plantar flexion
 Dorsiflexion: toes to the nose
Pronator drift: extends hands, palms upward, close eyes. If one arm is weak, then starts to
drift downward. This is positive pronator drift meaning UPPER MOTOR neuron disease
Sensory System:
 Assess if the pte is able to identify temperature, pain, vibration
 Patient is instructed to close eyes
 Patient distinguishes between dull and sharp
 Proprioception: ability to recognized position with eyes closed
 Cortical sensory interpretation is a function of the parietal lobe
o Stereognosis
o Two-point discrimination
o Graphesthesia
 Abnormalities
 Anesthesia: absence sensation
 Hypoesthesia: decrease sense
 Hyperesthesia: increase sensitivity to touch
 Paresthesia: Abnormal feeling of needles and pins
 Analgesia: lack of pain sensation
Cerebellar Assessment
 Evaluates balance