NEURODIAGNOSIS

INTRO TO THE PERIPHERAL

NERVOUS SYSTEM

DR. PREEYA CHAUHAN

 Peripheral Nervous System
• Nerves that branch
off the CNS

• Peripheral nerves
– Two types:
• Cranial nerves
• Spinal nerves
 PNS: Cranial Nerves

I. Olfactory nerves
– Carry smell information to the brain for interpretation

II. Optic nerves

– Carry visual information to the brain for interpretation

III. Oculomotor nerves

– Found within the muscles that move the eyeball,
eyelid, and iris

IV. Trochlear nerves

– Act in the muscles that move the eyeball (SO)
 PNS: Cranial Nerves (cont.)
V. Trigeminal nerves
– Carry sensory information from the surface
of the eye, the scalp, facial skin, the lining of
the gums, and the palate to the brain for
interpretation
– Also found within the muscles needed for
chewing
VI. Abducens nerves
– Act in the muscle that move the eyeball (LR)
 PNS: Cranial Nerves (cont.)
VII. Facial nerves
– Found in the muscles of facial expression
as well as in the salivary and tear glands
– Also carry sensory information from the
tongue
VIII. Vestibulocochlear nerves
– Carry hearing and equilibrium information
from the inner ear to the brain for
interpretation
 PNS: Cranial Nerves (cont.)
IX. Glossopharyngeal nerves
– Carry sensory information from the throat
and tongue to the brain for interpretation
– Also act in the muscles of the throat
X. Vagus nerves
– Carry sensory information from the thoracic
and abdominal organs to the brain for
interpretation
– Also found within the muscles in the throat,
stomach, intestines, and heart
 PNS: Cranial Nerves (cont.)

XI. Accessory nerves

– Found within the muscles of the throat,
neck, back, and voice box
• SCM
• Upper Trapezius

XII. Hypoglossal nerves

– Found within the muscles of the tongue
 PNS: Spinal Nerves
• Peripheral nerves originating from the
spinal cord

• 31 pairs of spinal nerves

– 8 pairs of cervical nerves (C1 through C8)
– 12 pairs of thoracic nerves (T1 through
T12)
– 5 pairs of lumbar nerves (L1 through L5)
– 5 pairs of sacral nerves (S1 through S5)
– 1 pair of coccygeal nerves (C0)
 PNS: Spinal Nerves (cont.)
• Dermatome
– Skin segment innervated by spinal nerve
– C1 is not associated with a dermatome

• Ventral root
– Axons of motor neurons only

• Dorsal root
– Axons of sensory neurons only
– Dorsal root ganglion
• Contains cell bodies of sensory neurons
 PNS: Spinal Nerves (cont.)
• Main portions of spinal nerves fuse to form
nerve plexuses
– Cervical – supply skin and muscles of neck
• Phrenic nerve originates from this plexus
– Controls diaphragm
– Brachial – control muscles in the arms
– Lumbosacral – lower abdomen, external
genitalia, buttocks, thighs, legs, and feet
• Sciatic nerve originates from this plexus
– Controls muscles of legs
 PNS: Somatic Nervous System

• Nerves that connect the CNS to skin and skeletal

muscle
• “Voluntary” nervous system
– Controls skeletal muscles, which are under voluntary
control
 PNS: Autonomic Nervous System

• Nerves that connect the CNS to organs and other

structures
• “Involuntary” nervous system
• Motor neurons located in ganglia
– Neuron cell bodies outside the CNS
PNS: Autonomic Nervous System (cont.)
• Sympathetic division
– “Fight or flight” – Prepares body for stressful
or emergency situations
– Neurons release neurotransmitter
norepinephrine
• Increases heart and breathing rates
• Slows down muscles of the stomach and intestines
• Dilates pupils
• Constricts blood vessels – increases blood
pressure
PNS: Autonomic Nervous System (cont.)
• Parasympathetic division
– Prepares body for rest and digesting
– Controls most of the body’s organs
– Releases acetylcholine
• Slows heart and breathing rates
• Constricts pupils
• Activates muscles of stomach and intestine
– No communication with blood vessels

• Sympathetic and parasympathetic

divisions are antagonistic
Basic Structural Components of
the PNS
• Sensory receptors – pick up stimuli from
inside or outside the body
• Motor endings – axon terminals of motor
neurons
– Innervate effectors (muscle fibers and glands)
• Nerves and ganglia
– Nerves – bundles of peripheral axons
– Ganglia – clusters of peripheral neuronal cell
bodies
Basic Anatomical Scheme of the
PNS in the Region of a Spinal
Nerve
 Peripheral Sensory Receptors
• Structures that pick up sensory stimuli
– Initiate signals in sensory axons
• Two main categories of sensory receptors
– Free nerve endings of sensory neurons
• Monitor general sensory information
– Complete receptor cells – specialized
epithelial cells or small neurons
• Monitor most types of special sensory information
 Peripheral Sensory Receptors
• Sensory receptors also classified
according to:
– Location
– Type of stimulus detected
– Structure
 Classification by Location
• Exteroceptors – sensitive to stimuli
arising from outside the body
– Located at or near body surfaces
– Include receptors for touch, pressure, pain,
and temperature
• Interoceptors – (visceroceptors) receive
stimuli from internal viscera
– Monitor a variety of stimuli
• Proprioceptors – monitor degree of
stretch
– Located in musculoskeletal organs
 Classification by Stimulus
Detected
• Mechanoreceptors – respond to
mechanical forces
• Thermoreceptors – respond to
temperature changes
• Chemoreceptors – respond to chemicals
in solution
• Photoreceptors – respond to light –
located in the eye
• Nociceptors – respond to harmful stimuli
that result in pain
 Classification by Structure
• General sensory receptors
– Widely distributed
– Nerve endings of sensory neurons monitor:
• Touch, pressure, vibration, stretch
• Pain, temperature, proprioception
• Divided into two groups
• Free nerve endings
• Encapsulated nerve endings
 Free Nerve Endings
• Abundant in epithelia and underlying
connective tissue
• Respond to pain and temperature
• Monitor affective senses
• Two specialized types of free nerve
endings
– Merkel discs – lie in the epidermis
• Slowly adapting receptors for light touch
– Hair follicle receptors – wrap around hair
follicles
• Rapidly adapting receptors
 Encapsulated Nerve Endings
• Consist of one or more end fibers of
sensory neurons
• Enclosed in connective tissue
• Mechanoreceptors
• Include four main types
 Encapsulated Nerve Endings
• Meissner’s corpuscles
– Spiraling nerve ending surrounded by
Schwann cells
– Occur in the dermal papillae
– Rapidly adapting receptors for discriminative
touch
– Occur in sensitive, hairless areas of the skin
Meissner’s Corpuscles
 Encapsulated Nerve Endings
• Pacinian corpuscles
– Single nerve ending surrounded by layers
of flattened Schwann cells
– Occur in the hypodermis
– Sensitive to deep pressure – rapidly
adapting receptors
• Ruffini’s corpuscles
– Located in the dermis and respond to
pressure
– Monitor continuous pressure on the skin –
adapt slowly
Pacinian Corpuscles and
Ruffini’s Corpuscles
 Encapsulated Nerve Endings
• Proprioceptors
– Monitor stretch in locomotory organs
– Three types of proprioceptors
 Three Types of Proprioceptors
• Muscle spindles – measure the changing
length of a muscle
– Imbedded in the perimysium between muscle
fascicles
• Golgi tendon organs – located near the
muscle-tendon junction
– Monitor tension within tendons
• Joint kinesthetic receptors
– Sensory nerve endings within the joint
capsules
Proprioceptors
Structure of Proprioceptors
 Neurologic Testing

• Typical neurologic examination

– State of consciousness
– Reflex activity
– Speech patterns
– Motor patterns
 Neurologic Testing: Diagnostic
Procedures
• Lumbar puncture
• Computerized
• Magnetic resonance tomography (CT)
imaging (MRI) scan

• Positron emission • Electroencephalogra

tomography (PET) m (EEG)
scan
• X-ray
• Cerebral angiography
Neurologic Testing: Reflex Testing
• Areflexia
– Absence of a reflex

• Hyporeflexia
– Decreased reflex

• Hyperreflexia
– Stronger-than-normal reflex
 Neurologic Testing: Reflex Testing
• Biceps reflex
– Absence indicates spinal cord damage in the
cervical region

• Knee reflex
– Absence may indicate damage to lumbar or
femoral nerves

• Abdominal reflexes
– Used to evaluate damage to thoracic spinal
nerves
 Common Diseases and
Disorders
Disease/Disorder Description
Alzheimer’s Progressive, degenerative
disease disease of the brain
Amyotrophic Lou Gehrig’s disease
lateral sclerosis Degeneration of neurons in the
(ALS) spinal cord and brain
Bell’s palsy Weak or paralyzed facial
muscles
 Common Diseases and
Disorders (cont.)
Disease/Disorder Description
Brain tumors and Abnormal growths
cancers Can be primary or secondary
tumors
Most common – gliomas
Epilepsy and Occurs as a result of bursts of
seizures electrical signals that disrupt
normal brain functioning
Guillain-Barré Body’s immune system attacks
Syndrome the PNS
 Common Diseases and
Disorders (cont.)
Disease/Disorder Description
Headaches
Tension Episodic or chronic
Migraines With aura/without aura
Cluster Form of migraines; occurs in groups
Meningitis Inflammation of meninges
Multiple sclerosis Chronic disease of CNS
(MS) Myelin is destroyed
 Common Diseases and
Disorders (cont.)
Disease/Disorder Description
Neuralgias Disorders causing nerve pain
Parkinson’s Progressive and degenerative
disease motor system disorder
Sciatica Damage to sciatic nerve
Stroke Brain cells die because of an
inadequate blood flow; “brain
attack”
 In Summary
• Functions of the nervous system
– Detecting and interpreting sensory information
– Making decision about that information
– Responding to and carrying out motor functions
• Neurons are responsible for functions
• Divisions
– CNS – brain and spinal cord
– PNS – cranial and spinal nerves
 Homework
• Make definitions for unknown terms
– i.e. dermatomes are skin segment innervated
by spinal nerves