NEUROANATOMY
astroglia/ astrocytes- supply
(Neurological Nursing)
Anatomic & Physiologic Overview
of the Nervous System
NERVOUS SYSTEM
 2 major parts: CNS & PNS
 FUNCTIONS: - Sensory input; processing
& interpreting; and motor output
 Composition: 2 principal types of cells
(conducting and supportive cells)
1. Neuron (Neurone, Nerve cell)– has 3
main parts
 Dendrites- threadlike structures
that conveys incoming
electrochemical messages toward
the cell body.
 Axon- long projections that
generates impulses away from the
cell body.
 Cell body- center of neuron;
nucleus
 Synapses- fundamental
property of neurons that is
used to communicate with
other cells
 Myelin- whitish, fatty material
(covers long nerve fibers); has
waxy appearance (protects &
insulates the fibers & increases
the rate of nerve impulses)
 Schwann cells- myelinates the
axon
 Myelin sheath- a tight coil of
wrapped membranes created
after the Schwann cells
 Nodes of Ranvier- gaps or
indentations between myelin
sheath
- Neurons produce chemical
substances known as
NEUROTRANSMITTERS
NEUROTRANSMITTERS
Action: to potentiate, terminate, or
modulate a specific action and can
either excite or inhibit the target
cell’s activity
How: By communicating messages
from one neuron to a specific target
tissue
2. Supporting cells- Neuroglia or Glial
cells/ non- neuronal cells
- Not able to transmit impulses
- 50x ˃ neurons=40% of the brain’s bulk
Types:
A.
nutrients to neurons; help
maintain neurons’ electrical
potential; form part of the
blood- brain barrier
B. Ependymal cells- help produce
CSF
C. Microglia- phagocytic cells that
ingest and digest
microorganisms and waste
products from injured neurons
D. oligodendoglia- supports and
electrically insulate CNS axons
by forming protective myelin
sheaths
CENTRAL NERVOUS SYSTEM
- Brain & the spinal cord.
- Surrounded by bone-skull and
vertebrae.
- Fluid and tissue insulate the brain and
spinal cord.
- During embryonic development, the
brain first forms as a tube, the anterior
end of which enlarges into three hollow
swellings that form the brain, and the
posterior of which develops into the
spinal cord.
Brain
- Part of CNS contained within the
cranium
- mass of soft, spongy pinkish gray nerve
tissue.
- accounts for approx. 2% of the TBW
- Main regions of the brain: CEREBRUM ,
BRAIN STEM, & CEREBELLUM
A. CEREBRUM
- Largest & most prominent part
- Governs higher mental processes
- Consists of the R&L hemisphere
separated by the great longitudinal
fissure
- Joined at the lower portion of the
fissure by the corpus callosum
- Associated structures:
 GYRI or GYRUS- convolutions
 SULCI or SULCUS- shallow
grooves
 FISSURES- deeper groves
 Cerebral cortex
a. gray matter (muscle
control, sensory perception,
memory, emotions, and
speech)
b. white matter
 - Divisions/ Lobes of Cerebral
Hemispheres
1. Frontal- largest lobe
- Functions: (1) concentration,
abstract thought, information
storage or memory and motor
function; (2) contains Broca’s area;
and (3) responsible for an
individual’s affect, judgment,
personality and inhibitions
2. Parietal- primary sensory cortex
- Functions: (1) analyzes sensory
information, and relays the
interpretation of the information to
the thalamus and other areas; (2)
essential for an individual
awareness of the body in space
3. Temporal- contains the auditory
receptive areas, interpretive area that
provides integration of somatization,
visual, and auditory areas
4. Occipital- the posterior lobe
responsible for visual interpretation
- Right vs. Left Hemisphere
B. DIENCEPHALON
STRUCTURES:
1. Thalamus- relay station for all sensory
impulses, memory, and pain impulses
2. Hypothalamus- located anterior &
inferior to the thalamus.
- Regulation of visceral activities
- Center for many drives & emotion
- Regulates the pituitary secretion of
hormones
C. BRAIN STEM
STRUCTURES
1. Midbrain- connects the pons & the
cerebellum with the cerebral
hemispheres.
- acts as master coordinator for all
the messages going in & out of the
brain to the spinal cord.
2. Pons- helps regulate breathing, contains
the respiratory center.
3. Medulla oblongata- most inferior part
of the brainstem
- contain centers that control HR, BP,
sneezing, coughing, breathing,
swallowing & vomiting
D. CEREBELLUM
- posterior to the midbrain & pons, &
below the occipital lobe.
- Function: integrates sensory
information
Structures Protecting the Brain
1. Skull- bony structure that protects the brain
from injury
- Major bones: frontal, temporal, parietal
and occipital
- Suture Lines: Coronal, Sagittal,
lamboidal, and squamosal
2. Meninges- fibrous connective tissue that
covers the brain and spinal cord; provides
protection, support and nourishment to the
brain and spinal cord
Layers:
a. Dura matter- outermost; covers the
brain and the spinal cord; tough,
inelastic, fibrous, and gray
- Epidural space- potential space
between the dura matter and skull
in the cranium, and between
periosteum and dura in the
vertebral column
b. Arachnoid- middle membrane; white;
contains the choriod plexus
- has unique fingerlike projections,
arachnoid villi
c. Pia mater- innermost membrane; thin,
transparent layer that hugs the brain
closely
3. Cerebrospinal fluid
- clear & colorless fluid
- Acts as protective cushion
- produced at rate of about 500ml/day
- laboratory analysis: clear color, normal
specific gravity of 1.007, protein count,
minimal WBC count, no RBC, glucose, &
some electrolytes
Spinal Cord
- runs along the dorsal side of the body;
links the brain to the rest of the body.
- Carries sensory information to & motor
information from the brain.
- encased in a series of bony vertebrae
that comprise the vertebral column.
- 45cm/18” long & about the thickness of
a finger
- Surrounded by meninges
a. Gray matter- inner core; consists
mostly of cell bodies and dendrites.
b. White matter- made up of fiber
bundles; ascending and descending
- Vertebral column consists of 7 cervical,
12 thoracic, 5 lumbar vertebrae,
sacrum(fused mass of 5 vertebrae);
coccyx
PERIPHERAL NERVOUS SYSTEM
2 Principal Subdivisions NEUROLOGIC ASSESSMENT
1. Sensory or afferent division- carry
information from the outside A. Cranial Nerve Assessment
world;sensory receptors are located in
the different parts of the body; i.e. I Identify common odors
somatic sensory fibers, visceral sensory II Snellen Chart and peripheral vision
fibers checks
2. Motor or efferent division- transmit III Check for pupil constriction
impulses from the brain & spinal cord IV Check for accommodation and
to the muscles; i.e. voluntary nervous convergence as the object is
system, ANS brought near the eyes;
V Check for strength of lid closure
Interconnections between Central and Identify location of the stimulus;
Peripheral Nervous System: Check ability to feel light, dull and
 Cranial nerves; carry impulses to and sharp sensation on the face;
from the brain. Check jaw strength,
- 12 pairs of cranial nerves emerge from VI Check corneal reflex
the lower surface of the brain VII Check for symmetry of facial
expressions and muscle strength;
Identify sweet, sour and salty
 Spinal nerves; carry impulses to and tastes
from the spinal cord. VIII Weber and Rinne test for hearing
- 31 pairs of spinal nerves arising from loss;
the spinal cord & passing out through Romberg’s test for balance
the vertebrae IX Identify sweet, sour and salty
- 8 cervical, 12 thoracic, 5 lumbar, 5 tastes;
sacral & 1 coccygeal Check gag and swallowing reflex
***these nerves serve as the communication
X Ask the client to say “Ah” - uvula
lines of the body***
should rise midline;
Check ability to swallow
SOMATIC NERVOUS SYSTEM
XI Have the client shrug shoulders
- Fibers which connects the CNS with the
against resistance;
structures of the body
Turn the head to one side against
the resistance of the hand
AUTONOMIC NERVOUS SYSTEM
XII Have the client stick out tongue –
- operates without conscious control
observe for deviations/tremors;
- regulates the activities of internal
Check for the strength of tongue
organs
movement as it presses against
- Maintenance & restoration of internal
tongue blade
homeostasis is largely the responsibility
of the ANS
- regulated by centers in the spinal cord,
brain stem & hypothalamus.
2 major divisions:
 SNS; predominantly excitatory responses
(fight or flight response)
Effects: bronchioles dilate, hearts contractions
are stronger & faster, arteries to heart &
voluntary muscles dilate, peripheral BV
constrict, inc. RR
 PNS; predominant during quiet,
nonstressful conditions
**Each of these subsystems operates in the
reverse of the other (antagonism).
 B. Glasgow Coma Scale
Score
C. Level of Consciousness
Level 1  Highest level of consciousness
characterized by appropriate responses to
internal and external stimuli
 Conscious, alert, fully-awake
 Patient oriented to person, place and time
Level 2  Listless, lethargic, somnolent and
obtunded
 Client can be aroused from sleep but when
stimulation ceases, tends to fall asleep
again
Level 3  Stuporous
 Response can only be evoked from a
strong and continuous stimuli
 The patient elicits poor response (i.e.,
reflex withdrawal)
Level 4  Semi-coma - no spontaneous movement
but patient may demonstrate reflex
activities like coughing, swallowing and
vomiting
 Incontinence
Level 5  Coma/Deep Coma – absence of
involuntary responses to any stimuli
 Reflexes are absent
 Pupils may be constricted/dilated and does
not react to light
D. PUPILLARY EXAM – changes can indicate
abnormal intracranial pressure (ICP)
Normal findings: PERRLA (Pupil, Equal,
Round and Reactive to Light and
Accommodation
- Sizes: Pinpoint (miotic), Dilated (mydriatic),
Normal size: 2-6mm
- Shapes:
o Ovoid – may indicate IICP
o Keyhole: patients with
iridectomy
o Irregular – traumatic orbital
injury
- Reaction to light
o Brisk
o Sluggish (Meningitis,
Subarachnoid Hematoma)
o Non-Reactive
- Comparison of pupils
o Isocuria
o Anisocuria
1. AVPU SCALE – quick and easy method
Awake
- Alert and oriented to person, place
and time
- Acting reasonably to stimuli
- Patient is aware of you approaching
him/her
Verbal Stimulation (responds to)
- Responds to voice
- Unawake but will respond by
speaking/moaning, facial
expressions, limb movement, eyelid
blinking
Pain Stimulation (responds to)
- Patient will only respond to painful
stimuli such as:
o Suborbital pressure
o Pinching the fleshy part near
the axilla
o Trapezium squeeze
o Shaking the shoulders
o Earlobe pinch
o Nail pinch
Unresponsive
- Unawake, no response to verbal and
pain stimuli
 EXAMINING THE REFLEXES;
 Reflexes are involuntary contractions of
muscles or muscle groups in response
to a stimulus.
 Classified as deep tendon, superficial or
pathologic
 Assesses the intactness of the spinal
reflex arc at various spinal cord levels.
The limb should be relaxed while
applying a short and snappy blow with a
reflex hammer. Hold the hammer
loosely in a relaxed manner, making a
wrist action. Allow the hammer to
bounce.
 Patellar, Achilles, triceps, biceps
• Reflex responses:
 0 no response
1+ diminished, low normal
2+ average, normal
3+ brisker than normal
4+ very brisk, hyperactive

Oculocephalic Reflex or Doll’s Eye

Phenomenon
• Done by holding the person’s eyelids
open and rotating the head from side
to side.
• The reflex is present if the eyes move in
the opposite direction of the head
movements.

Oculovestibular Reflex or Caloric ice Water

Test

• a test that uses differences in

temperature to diagnose damage to
the ear or brainstem.
Cold water = FAST phase of nystagmus to the
side Opposite from the cold water filled ear
Warm water = FAST phase of nystagmus to
the Same side as the warm water filled ear