THE CENTRAL NERVOUS SYSTEM AND

THE PERIPHERAL NERVOUS SYSTEM: EFFERENT DIVISION

Diah Ayu Aguspa Dita, S.Kep., Ns., M.Biomed

Department of Medical Physiology
Faculty of Medicine and Health Sciences
Universitas Bengkulu
LEARNING OBJECTIVES
• The central nervous system
• Overview of the central nervous system
• Cerebral cortex
• Basal nuclei, thalamus, and hypothalamus
• Cerebellum
• Brain stem
• Spinal cord
• The peripheral nervous system
• Autonomic nervous system
• Somatic nervous system
• Neuromuscular junction
THE CENTRAL NERVOUS SYSTEM
THE THREE FUNCTIONAL CLASSES OF NEURONS
PROTECTION AND NOURISHMENT OF THE BRAIN
• Major features help protect the CNS from injury:
• the cranium (skull) à encases the brain
• the vertebral column à surrounds the spinal cord
• the meninges à protective and nourishing membranes
• the cerebrospinal fluid (CSF)
• blood–brain barrier à limits access of blood-borne materials into the
vulnerable brain tissue
THE MENINGES
• The meningeal membrane
• Wrap, protect, and nourish the central nervous
system
• From the outermost to the innermost layer
• The dura mater
• Tough, inelastic covering that consists of two
layers
• The arachnoid mater
• Delicate, richly vascularized layer with a
“cobwebby” appearance
• The pia mater
• Most fragile, highly vascular and closely adheres
to the surfaces of the brain and spinal cord
THE CEREBROSPINAL FLUID (CSF)
• Surrounds and cushions the brain and spinal cord
• The function:
• A shock-absorbing fluid to prevent the brain from bumping against the interior of the
hard skull
• The exchange of materials between the neural cells and the interstitial fluid
surrounding the brain
• Composition of CSF
• Lower in K+
• Slightly higher in Na+
• Almost no proteins normally present in the CSF
THE CEREBROSPINAL FLUID (CSF)
• CSF volume of about 125 to 150 ml is replaced more than three times a day
• Secretion from:
• Choroid plexuses in the four ventricles, mainly in the two lateral ventricles (2/3 or
more)
• The ependymal surfaces of all the ventricles
• The arachnoidal membranes
• Comes from the brain through the perivascular spaces that surround the blood
vessels passing through the brain
THE CEREBROSPINAL FLUID (CSF)
THE CEREBROSPINAL FLUID (CSF)
• Secretion by the choroid plexus
• Depends mainly on active transport of sodium ions through the epithelial
cells lining the outside of the plexus
• The positive charges of sodium ions in turn pull along large amounts of
negatively charged chloride ions
• The two ions increase the quantity of osmotically active sodium chloride in
the cerebrospinal fluid
• Causes almost immediate osmosis of water through the membrane
• Providing the fluid of the secretion
THE CEREBROSPINAL FLUID (CSF)
• Cont…
• Transport processes move:
• Small amounts of glucose into the cerebrospinal fluid
• Both potassium and bicarbonate ions out of the cerebrospinal fluid into the
capillaries
• The resulting characteristics of the cerebrospinal fluid become the following:
• Osmotic pressure, approximately equal to that of plasma
• Sodium ion concentration, also approximately equal to that of plasma
• Chloride ion, about 15% greater than in plasma
• Potassium ion, approximately 40% less
• Glucose, about 30% less
THE CEREBROSPINAL FLUID (CSF)
• Absorption of cerebrospinal fluid through the arachnoidal villi
• The endothelial cells covering the villi have vesicular passages directly
through the bodies of the cells large enough to allow relatively free flow of:
• Cerebrospinal fluid
• Dissolved protein molecules
• Even particles as large as red and white blood cells into the venous blood
THE CEREBROSPINAL FLUID (CSF)
• Cerebrospinal fluid pressure
• The normal pressure in the cerebrospinal fluid system when one is lying in a horizontal
position averages 130 mm of water (10 mm hg)
• Regulation of cerebrospinal fluid pressure by the arachnoidal villi
• The arachnoidal villi function like valves
• Allow cerebrospinal fluid and its contents to flow readily into the blood of the
venous sinuses
• Not allowing blood to flow backward in the opposite direction
• Cerebrospinal fluid to begin to flow into the blood à cerebrospinal fluid pressure is
about 1.5 mmHg greater than the pressure of the blood in the venous sinuses
• If the cerebrospinal fluid pressure rises still higher à the valves open more widely
THE CEREBROSPINAL FLUID (CSF)
• High cerebrospinal fluid pressure in pathological conditions of the brain
• Brain tumor
• Elevates the cerebrospinal fluid pressure by decreasing reabsorption of the
cerebrospinal fluid back into the blood
• As a result, the cerebrospinal fluid pressure can rise to as much as 500 mm of water
(37 mm hg) or about four times normal
• Hemorrhage or infection occurs in the cranial vault
• Large numbers of red and/or white blood cells suddenly appear in the cerebrospinal
fluid
• Cause serious blockage of the small absorption channels through the arachnoidal
villi
• Also sometimes elevates the cerebrospinal fluid pressure to 400 to 600 mm of water
(about four times normal)
THE CEREBROSPINAL FLUID (CSF)
• Cont..
• Hydrocephalus
• Some babies are born with high cerebrospinal fluid pressure
• Caused by abnormally high resistance to fluid reabsorption through the arachnoidal
villi
• Resulting either from too few arachnoidal villi or from villi with abnormal absorptive
properties
• Divided into:
• Communicating hydrocephalus à fluid flows readily from the ventricular system
into the subarachnoid space
• Noncommunicating hydrocephalus à fluid flow out of one or more of the
ventricles is blocked
THE CEREBROSPINAL FLUID (CSF)
• Cont..
• Hydrocephalus
• Some babies are born with high cerebrospinal fluid pressure
• Caused by abnormally high resistance to fluid reabsorption through the
arachnoidal villi
• Resulting either from too few arachnoidal villi or from villi with abnormal
absorptive properties
• Divided into:
• Communicating hydrocephalus
• Noncommunicating hydrocephalus
THE CEREBROSPINAL FLUID (CSF)
• Cont..
• Hydrocephalus
• Communicating hydrocephalus
• Fluid flows readily from the ventricular system into the subarachnoid space
• Caused by a block in the aqueduct of sylvius
• Resulting from atresia (closure) before birth in many babies or from
blockage by a brain tumor at any age.

• Noncommunicating hydrocephalus
• Fluid flow out of one or more of the ventricles is blocked
• Caused by blockage of fluid flow in the subarachnoid spaces around the basal
regions of the brain or by blockage of the arachnoidal villi
BLOOD–BRAIN BARRIER
• Regulates exchanges between the blood and brain
• Minimizes the possibility that potentially harmful blood-borne substances might reach the
central neural tissue
• The brain depends on a constant blood supply
• The brain normally uses only glucose
• Resting conditions, the brain
• 20% of the O2 and 50% of the glucose
• The brain receives 15% of the blood pumped out by the heart
• Brain damage
• O2 supply for more than 4 to 5 minutes
• Glucose supply is cut off for more than 10 to 15 minutes
BLOOD–BRAIN BARRIER
• Highly permeable àwater, CO2, O2, and most lipid- soluble substances such as alcohol
and anesthetics
• Slightly permeable à electrolytes such as sodium, chloride, and potassium
• Impermeable à plasma proteins and most non–lipid-soluble large organic molecules

• Impossible to achieve effective concentrations of therapeutic drugs

• Such as protein antibodies and non–lipid-soluble drugs, in the cerebrospinal fluid or
parenchyma of the brain
• The cause of the low permeability of blood–brain barriers
• The endothelial cells of the brain tissue capillaries are joined to one another à tight
junctions
CEREBROVASCULAR SYSTEM
REGULATION OF CEREBRAL BLOOD FLOW
• Normal blood flow through the brain
• Averages 50 to 65 ml/100 g of brain tissue/min (adult person)
• 750 to 900 ml/min (for the entire brain)
• Receives 15% of the resting cardiac output
REGULATION OF CEREBRAL BLOOD FLOW
• Cerebral blood flow is related to the tissue metabolism
• Several metabolic factors are believed to contribute to cerebral blood flow
regulation:
• CO2 concentration
• Hydrogen ion (H+) concentration
• O2 concentration
• Substances released from astrocytes
REGULATION OF CEREBRAL BLOOD FLOW
• CO2 AND HYDROGEN ION (H+) CONCENTRATION
• Increase cerebral blood flow
• Increased H+ concentration à depresses neuronal activity
• CO2 is believed to increase cerebral blood flow by combining first with water in the body fluids à
form carbonic acid à form H+ à vasodilation of the cerebral vessels à carries H+, CO2, and other
acid-forming substances away from the brain tissues
• Loss of CO2 à removes carbonic acid from the tissuesà reduces the H+ concentration back
toward normal
• This mechanism helps maintain a constant H+ concentration in the cerebral fluids and thereby
helps to maintain a normal, constant level of neuronal activity
• Substances include lactic acid, pyruvic acid, and any other acidic à increase H+ concentration
• This mechanism helps maintain a constant H+ concentration in the cerebral fluids and thereby
helps to maintain a normal, constant level of neuronal activity
REGULATION OF CEREBRAL BLOOD FLOW
REGULATION OF CEREBRAL BLOOD FLOW
• OXYGEN DEFICIENCY AS A REGULATOR OF CEREBRAL BLOOD FLOW
• Almost exactly 3.5 (±0.2) ml of O2/100 g of brain tissue/min
• The partial pressure of O2 (PO2) is 35–40 mm Hg
• The O2 deficiency à vasodilation à the brain blood flow and transport of O2 to
the cerebral tissues to near normal
• This local blood flow regulatory mechanism is almost exactly the same in the
brain as in coronary blood vessels, in skeletal muscle, and in most other
circulatory areas of the body
REGULATION OF CEREBRAL BLOOD FLOW
• Substances released from astrocytes regulate cerebral blood flow
• Astrocytes are star- shaped non-neuronal cells
• Support and protect neurons
• Provide nutrition
• Astrocytes have numerous projections that make contact with neurons and the
surrounding blood vessels
• Providing a potential mechanism for neurovascular communication
REGULATION OF CEREBRAL BLOOD FLOW
• Cont..
• Gray matter astrocytes (protoplasmic astrocytes) extend fine processes that cover most synapses and large
foot processes that are closely apposed to the vascular wall
• Experimental studies have shown that electrical stimulation of excitatory glutaminergic neurons
• increased intracellular calcium ion concentration in astrocyte foot processes
• vasodilation of nearby arterioles
• Studies have suggested that the vasodilation is mediated by several vasoactive metabolites released
from astrocytes
• nitric oxide
• metabolites of arachidonic acid
• potassium ions
• Adenosine
• other substances generated by astrocytes
• à in response to stimulation of adjacent excitatory neurons have all been suggested to be
important in mediating local vasodilation
FUNCTIONAL MAGNETIC RESONANCE IMAGING (fMRI)
• Assessment for Blood flow and neural activity in different regions of the brain
• Based on the observation that oxygen-rich hemoglobin (oxyhemoglobin) and oxygen-
poor hemoglobin (deoxyhemoglobin) in the blood behave differently in a magnetic
field
• Deoxyhemoglobin is a paramagnetic molecule (i.e., attracted by an externally
applied magnetic field)
• The presence of deoxyhemoglobin in a blood vessel à measurable difference of
the magnetic resonance (MR) proton signal of the vessel and its surrounding
tissue
• Oxyhemoglobin is diamagnetic (i.e., repelled by a magnetic field)
FUNCTIONAL MAGNETIC RESONANCE IMAGING (fMRI)
• THE BLOOD OXYGEN LEVEL–DEPENDENT (BOLD) signals obtained from fMRI
• depend on the total amount of deoxyhemoglobin in the specific three-dimensional
space (voxel) of brain tissue being assessed
• influenced by the rate of blood flow, volume of blood, and rate of O2
consumption in the specific voxel of brain tissue
• BOLD fMRI provides only an indirect estimate of regional blood flow
• It can also be used to produce maps showing which parts of the brain are
activated in a particular mental process
FUNCTIONAL MAGNETIC RESONANCE IMAGING (fMRI)
• ARTERIAL SPIN LABELING (ASL)
• provide a more quantitative assessment of regional blood flow.
• works by manipulating the MR signal of arterial blood before it is delivered to
different areas of the brain
• By subtracting two images in which the arterial blood is manipulated differently, the
static proton signal in the rest of the tissue subtracts out, leaving only the signal
arising from the delivered arterial blood

• ASL and BOLD imaging can be used together simultaneously to provide a probe of
regional brain blood flow and neuronal function
STROKE
• Blockage of some small arteries in the brain
• Caused by arteriosclerotic plaques that occur in one or more of the feeder arteries to the brain
• The plaques can activate the clotting mechanism of the blood à a blood clot to occur à block
blood flow in the artery à leading to acute loss of brain function in a localized area
• High blood pressure makes one of the blood vessels burst à hemorrhage à compressing the
local brain tissue and further compromising its functions
STROKE
• The neurological effects of a stroke are determined by the brain area affected
• One of the most common types of stroke is blockage of the middle cerebral artery
• Supplies the midportion of one brain hemisphere
• For example, if the middle cerebral artery is blocked on the left side of the brain
• The person is likely to lose function in wernicke’s speech comprehension area in
the left cerebral hemisphere
• Also becomes unable to speak words because of loss of broca’s motor area for
word formation
• Loss of function of neural motor control areas of the left hemisphere can create
spastic paralysis of most muscles on the opposite side of the body
STROKE
• Blockage of a posterior cerebral artery
• Cause infarction of the occipital pole of the hemisphere on the same side as the
blockage
• Causes loss of vision in both eyes in the half of the retina on the same side as the
stroke lesion

• Strokes that involve the blood supply to the midbrain

• Effect can block nerve conduction in major pathways between the brain and spinal
cord à causing both sensory and motor abnormalities
TRY TO LEARN
• Aneurism?

• Migraine?

• Exytotoxicity after stroke?

OVERVIEW OF THE CENTRAL NERVOUS SYSTEM
• The CNS consists of the brain and spinal cord
• The function of the brain:
1. subconsciously regulate your internal environment by neural means
2. experience emotions
3. voluntarily control your movements
4. perceive (be consciously aware of) your body and your surroundings
5. engage in other higher cognitive processes such as thought and memory
OVERVIEW OF THE CENTRAL NERVOUS SYSTEM
• The parts of the brain
1. Brain stem
2. Cerebellum
3. Forebrain
a. Diencephalon
1) Hypothalamus
2) Thalamus
b. Cerebrum
1) Basal nuclei
2) Cerebral cortex
THE CENTRAL NERVOUS SYSTEM
CEREBRAL CORTEX Layers of the cerebral cortex
• Layer I is mostly glial cells and axons that run
laterally
• Layers II through VI contain different
proportions of two main classes of cortical
neurons
• pyramidal cells
• which are shaped like upside down
pyramids and are the major output
neurons
• stellate cells
• which are shaped like stars
• Stellate cells primarily receive input to
the cortex and process local
information
CEREBRAL CORTEX
(1) voluntary motor activity
(2) speaking ability Receiving and processing sensory input
(3) elaboration of thought

Carry out initial processing of

visual input

Auditory (sound) sensation

CEREBRAL CORTEX
SOMATOTOPIC MAPS OF THE SOMATOSENSORY CORTEX AND PRIMARY MOTOR CORTEX
• Sensory homunculus
• the distribution of sensory input to the
somatosensory cortex from different parts of
the body.
• The distorted graphic representation of the
body parts indicates the relative proportion of
the somatosensory cortex devoted to reception
of sensory input from each area
• Motor homunculus
• the distribution of motor output from the
primary motor cortex to different parts of the
body
• The distorted graphic representation of the
body parts indicates the relative proportion of
the primary motor cortex devoted to controlling
skeletal muscles in each area
BASAL NUCLEI
• The basal nuclei (basal ganglia) play an important inhibitory role in motor control
• Inhibiting muscle tone throughout the body
• Selecting and maintaining purposeful motor activity while suppressing useless or unwanted
patterns of movement
• Helping monitor and coordinate slow, sustained contractions, especially those related to
posture and support

• How?
• By modifying ongoing activity in motor pathways
THALAMUS
• Serves as a “relay station” for preliminary processing of sensory input
• Plays an important role in motor control by positively reinforcing voluntary motor
behavior initiated by the cortex
THALAMUS AND HYPOTHALAMUS
HYPOTHALAMUS
• The hypothalamus is a collection of specific nuclei and associated fibers that lie beneath the thalamus.
• Integrating center for many important homeostatic functions
• Important link between the autonomic nervous system and the endocrine system
• The function:
• Controls body temperature
• Controls thirst and urine output
• Controls food intake
• Controls anterior pituitary hormone secretion
• Produces posterior pituitary hormones
• Controls uterine contractions and milk ejection
• Serves as a major autonomic nervous system coordinating center, which in turn affects all smooth
muscle, cardiac muscle, and exocrine glands
• Plays a role in emotional and behavioral patterns
• Participates in the sleep–wake cycle
LOCATION OF THE THALAMUS, HYPOTHALAMUS, AND CEREBELLUM IN SAGITTAL SECTION
CEREBELLUM
• The cerebellum is a highly folded, baseball-sized part of the brain
• lies underneath the occipital lobe of the cortex
• attached to the back of the upper portion of the brain stem
• important in balance and in planning and executing voluntary movement
CEREBELLUM
• The cerebellum consists of three functionally distinct parts
• The vestibulocerebellum
• Important for maintaining balance and controls eye movements
• The spinocerebellum
• Enhances muscle tone and coordinates skilled, voluntary movements
• Important in ensuring the accurate timing of various muscle contractions to
coordinate movements involving multiple joints
• The cerebrocerebellum
• Planning and initiating voluntary activity by providing input to the cortical motor
areas
• The region that stores procedural memories
CEREBELLUM
BRAIN STEM
• The brain stem consists
• Medulla
• Pons
• Midbrain
• Vital link between the spinal cord and higher brain regions
• The functions of the brain stem:
• Most of the 12 pairs of cranial nerves arise from the brain stem
• Collected within the brain stem are neuronal clusters or centers that control heart and blood
vessel function, respiration, and many digestive activities
• Helps regulate muscle reflexes involved in equilibrium and posture
• A widespread network of interconnected neurons called the reticular formation runs
throughout the entire brain stem and into the thalamus
• Network receives and integrates all incoming sensory synaptic input
CRANIAL NERVES
SPINAL CORD
• The spinal cord is a long, slender cylinder of nerve tissue
• It is about 45 cm (18 in.) long and 1 to 1.5 cm wide (about the width of your finger)
• Two primary functions:
• Serving as a link for transmission of information between the brain and rest of the
body
• Integrating reflex activity between afferent input and efferent output without
involving the brain
SPINAL CORD
SPINAL NERVES

• The 31 pairs of spinal nerves are named

according to the region of the vertebral
column from which they emerge
• Spinal nerve roots must descend along the
cord before emerging from the vertebral
column at the corresponding intervertebral
space, especially those beyond the level of
the first lumbar vertebra (L1)
• Collectively these rootlets are called the
cauda equina, literally “horse’s tail”

SPINAL CORD
Spinal nerves connect with each side of the spinal cord
by a dorsal root and a ventral root
The gray matter
• Forms an inner butterfly-shaped region
surrounded by the outer white matter
• The cord gray matter consists:
• Primarily of neuronal cell bodies
and their dendrites
• Glial cells
The white matter
• Organized into tracts, which are
bundles of nerve fibers (axons of long
interneurons) with a similar function
• The bundles are grouped into columns
that extend the length of the cord. Each
of these tracts begins or ends within a
particular area of the brain, and each
transmits a specific type of information
SPINAL CORD
• The central canal
• filled with CSF
• Each half of the gray matter is divided:
• dorsal (posterior) horn
• ventral (anterior) horn
• lateral horn
SPINAL CORD Ascending tracts transmit to Descending tracts that
the brain signals derived relay messages from the
from afferent input brain to efferent neurons
SPINAL CORD

The ventral spinocerebellar tract

The ventral corticospinal tract
NEURAL REFLEX
NEURAL REFLEX
REFLEX ARC
• A reflex is any response that occurs automatically without conscious effort
• Reflex arc is the neural pathway involved in accomplishing reflex activity
• Basic components:
1. Sensory receptor
2. Afferent pathway
3. Integrating center
4. Efferent pathway
5. Effector organ
• Pathways for unconscious responsiveness digress from the typical reflex arc in two general
ways:
1. Responses at least partly mediated by hormones
2. Local responses that do not involve either nerves or hormones
REFLEX CATEGORIES
• Spinal or cranial reflexes
• Depending on the CNS level at which the reflex is integrated
• Spinal reflexes à withdrawal reflex, micturition reflex
• Cranial reflexes à the pupillary constriction reflex
• Innate or conditioned reflexes
• Depending on whether the reflex is inborn or learned
• Innate (or simple or basic) reflexes à withdrawal reflex, micturition reflex, the
pupillary constriction reflex
• Conditioned (or acquired) reflexes à increased secretion of saliva on smelling a
favorite food being prepared
REFLEX CATEGORIES
• Somatic or autonomic reflexes
• Depending on which efferent division of the peripheral nervous system and which
effector organs are involved
• Somatic reflexes à withdrawal reflex
• Autonomic (or visceral) reflexes à the micturition, pupillary constriction, and
salivary reflexes, baroreceptor
• Monosynaptic or polysynaptic reflexes
• Depending on how many synapses are in the reflex arc
• Monosynaptic (“one synapse”) reflexes à the stretch reflex
• Polysynaptic (“many synapses”) reflexes
THE PERIPHERAL NERVOUS SYSTEM:
EFFERENT DIVISION
AUTONOMIC NERVOUS SYSTEM
AUTONOMIC NERVOUS SYSTEM
THE SYMPATHETIC NERVOUS SYSTEMS THE PARASYMPATHETIC NERVOUS SYSTEMS
• Sympathetic nerve fibers originate in the lateral • Originates in the brain and sacral region of the
horn of the thoracic (chest) and lumbar spinal cord
(abdominal) regions (thoracolumbar region) of the
spinal cord • Parasympathetic preganglionic fibers
• Long cholinergic preganglionic fibers
• Sympathetic preganglionic fibers
• Arise from the cranial (brain) and sacral (lower
• Very short short cholinergic preganglionic spinal cord) areas of the CNS)
fibers
• Parasympathetic postganglionic fibers
• Located along either side of the spinal cord
• Short cholinergic postganglionic fibers
• Sympathetic postganglionic fibers
• End on the cells of an organ itself
• Long adrenergic postganglionic fibers
• Originate in the ganglion chain and end on
the effector organs
AUTONOMIC NERVOUS SYSTEM
• Sympathetic and parasympathetic postganglionic
fibers typically both innervate the same effector
organs
• The adrenal medulla is a modified sympathetic
ganglion, which releases E and NE into the blood
• Nicotinic cholinergic receptors respond to ACh
released by all autonomic preganglionic fibers
• Muscarinic cholinergic receptors respond to ACh
released by parasympathetic postganglionic fibers
• ⍺1, ⍺2, β1, and β2 adrenergic receptors are variably
located at the autonomic effectors and
differentially respond to NE released by
sympathetic postganglionic fibers and to E released
by the adrenal medulla
AUTONOMIC NERVOUS SYSTEM
• Sympathetic and parasympathetic preganglionic fibers release the same
neurotransmitter, acetylcholine (ACh)
• Parasympathetic postganglionic fibers (cholinergic fibers) release ACh
• released from the terminals of all motor neurons supplying skeletal muscle
• serves as a neurotransmitter in the CNS
• Sympathetic postganglionic fibers (adrenergic fibers) release noradrenaline or
norepinephrine (NE)
• released from the adrenal medulla as a hormone as well
• serves as a neurotransmitter in the CNS
 Fight or flight Rest and digest

AUTONOMIC NERVOUS SYSTEM

AUTONOMIC NERVOUS SYSTEM
AUTONOMIC NERVOUS SYSTEM
AUTONOMIC NERVOUS SYSTEM
AUTONOMIC NERVOUS SYSTEM
AUTONOMIC NERVOUS SYSTEM
SOMATIC NERVOUS SYSTEM
• Motor neurons
• axons constitute the somatic nervous system
• supply skeletal muscles
• Motor-neuron axon terminals release ACh
• Motor neurons are considered the final common pathway
• The somatic system is under voluntary control
SOMATIC NERVOUS SYSTEM
NEUROMUSCULAR JUNCTION
• Motor neurons and skeletal muscle fibers are chemically linked at neuromuscular
junctions
• ACh is the neuromuscular junction neurotransmitter
NEUROMUSCULAR JUNCTION
• The cell body of a motor neuron
originates in the ventral horn of the
spinal cord
• The axon (somatic efferent fiber) exits
through the ventral root and travels
through a spinal nerve to the skeletal
muscle it innervates
• When the axon reaches a skeletal
muscle, it divides into many axon
terminals, each of which forms a
neuromuscular junction with a single
muscle cell (muscle fiber)
• The axon terminal within a
neuromuscular junction further divides
into ne branches, each of which ends in
an enlarged terminal button
NEUROMUSCULAR JUNCTION
REFERENCES
• Bear MF, Connors BW, Paradiso, MA. Neurotransmitter system. 3rd ed. Neuroscience: Exploring the Brain.
USA: Lippincott Williams & Wilins; 2007
• Ganong WF. Review of Medical Physiology. 23th ed.New York: McGraw-Hill Medical; 2010.
• Kandel ER, Schwartz JH, Jessell TM, Siegelbaum SA, Hudspeth AJ. Principles of neural science. 5th ed. New
York: McGraw Hill: 2013
• Purves D, Augustine GJ, Fitzpatrick D, Hall WC, LaMantia A, Mooney RD, et al. Neuroscience. 6th ed.
Massachusetts: Oxford University Press; 2018.
• Sherwood L. Human physiology: from cell to system. 9th ed. Boston: Cengange learning; 2016.
THANK YOU
Reach me at:
diahayuaguspadita@unib.ac.id