The nervous system is the body's command center, made up of the brain, spinal cord, and nerves.

It
sends electrical signals between the brain and the rest of the body, telling it to breathe, move, speak,
and see. The nervous system also regulates thoughts and memory, and plays a role in things like blushing
and blinking

The nervous system has three main parts:

Central nervous system (CNS)

Made up of the brain and spinal cord, the CNS receives, processes, and responds to sensory information.
The brain controls how we think, learn, move, and feel. The spinal cord carries messages between the
brain and the nerves throughout the body.

Peripheral nervous system (PNS)

A network of nerves that runs throughout the head, neck, and body. The PNS carries messages to and
from the CNS, and carries out commands from the brain to the body.

Autonomic nervous system

A component of the PNS that regulates involuntary processes like heart rate, blood pressure, respiration,
digestion, and sexual arousal. The autonomic nervous system is involved in the fight-or-flight response.

Central Nervous System

Central Nervous System (CNS) is often called the central processing unit of the body. It consists of the
brain and the spinal cord.

Brain

The brain is one of the important, largest and central organ of the human nervous system. It is the
control unit of the nervous system, which helps us in discovering new things, remembering and
understanding, making decisions, and a lot more. It is enclosed within the skull, which provides frontal,
lateral and dorsal protection. The human brain is composed of three major parts:

Forebrain: The anterior part of the brain, consists of Cerebrum, Hypothalamus and Thalamus.

Midbrain: The smaller and central part of the brainstem, consists of Tectum and Tegmentum.

Hindbrain: The central region of the brain, composed of Cerebellum, Medulla and Pons.
Also read: Human Brain

Spinal Cord

The spinal cord is a cylindrical bundle of nerve fibers and associated tissues enclosed within the spine
and connect all parts of the body to the brain. It begins in continuation with the medulla and extends
downwards. It is enclosed in a bony cage called vertebral column and surrounded by membranes called
meninges. The spinal cord is concerned with spinal reflex actions and the conduction of nerve impulses
to and from the brain.

Peripheral Nervous System

Peripheral Nervous System (PNS) is the lateral part of the nervous system that develops from the central
nervous system which connects different parts of the body with the CNS. We carry out both voluntary
and involuntary actions with the help of peripheral nerves.

Also refer: Peripheral Nervous System

PNS includes two types of nerve fibers:

Afferent nerve fibers – These are responsible for transmitting messages from tissues and organs to the
CNS.

Efferent nerve-fibers – These are responsible for conveying messages from CNS to the corresponding
peripheral organ.

Classification of the peripheral nervous system:

Somatic neural system (SNS): It is the neural system that controls the voluntary actions in the body by
transmitting impulses from CNS to skeletal muscle cells. It consists of the somatic nerves.

Autonomic neural system (ANS): The autonomic neural system is involved in involuntary actions like
regulation of physiological functions (digestion, respiration, salivation, etc.). It is a self-regulating system
which conveys the impulses from the CNS to the smooth muscles and involuntary organs (heart, bladder
and pupil). The autonomic neural system can be further divided into:

Sympathetic nervous system

Parasympathetic nervous system

Neuron

Neuron

A Neuron is a structured and functional unit of the nervous system and unlike other cells, neurons are
irregular in shape and able to conduct electrochemical signals. The different parts of a neuron are
discussed below.

Dendrite stretches out from the cell body of a neuron, and it is the shortest fibre in the cell body.

Axon is the longest thread on the cell body of a neuron and has an insulating and protective sheath of
myelin around it.

Cell body consists of cytoplasm and nucleus.

Synapse is the microscopic gap between a pair of adjacent neurons over which nerve impulses pass,
when moving from one neuron to the other.

Explore more: Placebo Effect

Nerves

Nerves are thread-like structures that emerge from the brain and spinal cord. It is responsible for
carrying messages to all the parts of the body. There are three types of nerves. Some of these neurons
can fire signals at speeds of over 119 m/s or above 428 km/h.

Sensory nerves send messages from all the senses to the brain.

Motor nerves carry messages from the brain to all the muscles.

Mixed nerves carry both sensory and motor nerves.

Also read: Nerves

Cranial nerves begin from the brain as these nerves carry impulses to start from the central nervous
system. Certain cranial nerves belong to the group of mixed nerves while certain ones fall under sensory
nerves. Spinal nerves originate from the spinal cord. All the spinal nerves carry impulses to and from the
central nervous system and these are part of mixed nerves. The above nervous system diagram depicts
the various nerves arising from various parts of the body.
Learn more in detail about the Human Nervous System with diagrams or any other related topics by
referring to the nervous system notes provided at BYJU’S website. Download BYJU’S app for further
reference.

Frequently Asked Questions

Q1

What are the two divisions of the nervous system?

The human nervous system controls all activities of the body in a quicker fashion. It can be divided into
the central nervous system and peripheral nervous system. The central nervous system includes spinal
cord and brain and the peripheral covers the nerves branching from spinal cord and brain.

Q2

What are nerves and neurons?

Nerves are thread-like structures that emerge from the spinal cord and brain. These nerves are actual
projections of neurons. A neuron is a basic structural and functional unit of a nervous system that
conducts electrochemical signals.

Q3

What are cranial nerves?

The nerves that extend throughout the body on both sides and emerges directly from the brain stem and
brain are called cranial nerves. They carry information from the brain to other parts, primarily to the
neck and head.

Function

What does the nervous system do?

Your nervous system’s main function is to send messages from various parts of your body to your brain,
and from your brain back out to your body to tell your body what to do. These messages regulate your:

Thoughts, memory, learning and feelings.

Movements (balance and coordination).

Senses (how your brain interprets what you see, hear, taste, touch and feel).

Wound healing.
Sleep.

Heartbeat and breathing patterns.

Response to stressful situations, including sweat production.

Digestion.

Body processes, such as puberty and aging.

How does the nervous system work?

Your nervous system uses nerve cells called neurons to send signals, or messages, all over your body.
These electrical signals travel among your brain, skin, organs, glands and muscles.

The messages help you move your limbs and feel sensations, like pain. Your eyes, ears, tongue, nose and
the nerves all over your body take in information about your environment. Then, nerves carry that data
to and from your brain.

There are different types of neurons. Each type of neuron has a different job:

Motor neurons take signals from your brain and spinal cord to your muscles. They help you move. They
also assist with breathing, swallowing and speaking.

Sensory neurons take information from your senses (what you see, touch, taste, etc.) to your brain.

Interneurons communicate between motor and sensory neurons. These neurons regulate your
movement in response to sensory information (like moving away from a hot surface) and play a role in
how you learn, think and remember.

Anatomy

What are the parts of the nervous system?

The nervous system has two main parts:

Central nervous system (CNS): Your brain and spinal cord make up your CNS. Your brain reads signals
from your nerves to regulate how you think, move and feel.

Peripheral nervous system (PNS): Your PNS is made up of a network of nerves. The nerves branch out
from your spinal cord. This system relays information from your brain and spinal cord to your organs,
arms, legs, fingers and toes.

There are two parts to your peripheral nervous system:

The somatic nervous system guides your voluntary movements.

The autonomic nervous system regulates the activities you do without thinking about them (involuntary
movements).

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What does the nervous system look like?

Nerve cells (neurons) are the basis of your nervous system. There are 100 billion neurons in your brain.
These cells connect throughout your entire body.

Imagine your nervous system as a tree. Your central nervous system is the trunk of the tree that contains
your brain and spinal cord. The tree branches are your peripheral nervous system (nerves). The branches
extend from the truck (brain and spinal cord) to reach all parts of your body.

Conditions and Disorders

What are common conditions or disorders that affect the nervous system?

There are many conditions that affect your nervous system. Some of the most common include:

Alzheimer’s disease.

Cancer.

Cerebral palsy.

Epilepsy.

Huntington’s disease.

Infection (meningitis).

Parkinson’s disease.

Stroke.

Traumatic brain injury.

What are common signs or symptoms of nervous system conditions?

Signs and symptoms of nervous system conditions vary by type but may include:

Movement and coordination changes.

Memory loss.

Pain, numbness or a pins and needles feeling.

Behavioral and mood changes.

Difficulty with thinking and reasoning.

Seizures.

Some conditions, like a stroke, are medical emergencies that need treatment quickly. If you notice the
following symptoms, contact 911 or your local emergency services number:

Muscle weakness or paralysis in one side of your body.

Sudden vision loss.

Slurred speech.

Confusion.

What tests check the health of your nervous system?

A healthcare provider may use one of the following tests to check the health of your nervous system:

Computed tomography (CT) scan.

Electrocardiogram (ECG or EKG).

Electroencephalogram (EEG).

Lumbar puncture (spinal tap).

Magnetic resonance imaging (MRI) scans.

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How are conditions that affect the nervous system treated?

A healthcare provider will review your symptoms to diagnose and treat any conditions that affect your
nervous system. Treatment varies for each condition. So, your healthcare provider will take into
consideration several factors, like your age and general health, to create your treatment plan. This plan
may include:

Taking medications.

Having surgery.
Participating in counseling for mental and emotional support.

Receiving supportive care (to keep you comfortable).

Care

How do I keep my nervous system healthy?

You can keep your nervous system healthy by:

Seeing a healthcare provider regularly.

Maintaining good health (like eating balanced foods).

Avoiding harmful substances (like not smoking tobacco).

Wearing protective gear or equipment (a helmet) when playing sports or participating in certain
activities.

Managing any underlying health conditions.

When should I call a healthcare provider?

Contact a healthcare provider right away if you notice sudden changes to your health like:

Muscle weakness.

Vision problems or severe headaches.

Slurred speech.

Numbness, tingling or loss of sensation in your arms or legs.

Tremors or tics (random muscle movements).

Changes in behavior or memory.

Problems with coordination or moving your muscles.

If you or a loved one shows signs of a stroke or seizure, contact 911 or your local emergency services
number.

A note from Cleveland Clinic

Your nervous system is the command center for your entire body. It helps you think, learn, move and
remember. This vast network of nerves connects to all of your organs, muscles and glands. It needs care
to keep working. Sometimes, unexpected events can affect your nervous system, like an infection, injury
or underlying condition. A healthcare provider can help you stay healthy so your nervous system has all it
needs to function as expected.
The nervous system has two main parts:

The central nervous system is made up of the brain and spinal cord.

The peripheral nervous system is made up of nerves that branch off from the spinal cord and extend to
all parts of the body.

The nervous system transmits signals between the brain and the rest of the body, including internal
organs. In this way, the nervous system’s activity controls the ability to move, breathe, see, think, and
more.1

The basic unit of the nervous system is a nerve cell, or neuron. The human brain contains about 100
billion neurons. A neuron has a cell body, which includes the cell nucleus, and special extensions called
axons (pronounced AK-sonz) and dendrites (pronounced DEN-drahytz). Bundles of axons, called nerves,
are found throughout the body. Axons and dendrites allow neurons to communicate, even across long
distances.

Different types of neurons control or perform different activities. For instance, motor neurons transmit
messages from the brain to the muscles to generate movement. Sensory neurons detect light, sound,
odor, taste, pressure, and heat and send messages about those things to the brain. Other parts of the
nervous system control involuntary processes. These include keeping a regular heartbeat, releasing
hormones like adrenaline, opening the pupil in response to light, and regulating the digestive system.

When a neuron sends a message to another neuron, it sends an electrical signal down the length of its
axon. At the end of the axon, the electrical signal changes to a chemical signal. The axon then releases
the chemical signal with chemical messengers called neurotransmitters (pronounced noor-oh-TRANS-
mit-erz) into the synapse (pronounced SIN-aps)—the space between the end of an axon and the tip of a
dendrite from another neuron. The neurotransmitters move the signal through the synapse to the
neighboring dendrite, which converts the chemical signal back into an electrical signal. The electrical
signal then travels through the neuron and goes through the same conversion processes as it moves to
neighboring neurons.

The nervous system also includes non-neuron cells, called glia (pronounced GLEE-uh). Glia perform many
important functions that keep the nervous system working properly. For example, glia:

Help support and hold neurons in place

Protect neurons

Create insulation called myelin, which helps move nerve impulses

Repair neurons and help restore neuron function

Trim out dead neurons

Regulate neurotransmitters

The brain is made up of many networks of communicating neurons and glia. These networks allow
different parts of the brain to “talk” to each other and work together to control body functions,
emotions, thinking, behavior, and other activities

The nervous system subdivides into the central nervous system and the peripheral nervous system. The
central nervous system is the brain and spinal cord, while the peripheral nervous system consists of
everything else. The central nervous system's responsibilities include receiving, processing, and
responding to sensory information.

The brain is an organ of nervous tissue that is responsible for responses, sensation, movement,
emotions, communication, thought processing, and memory. Protection for the human brain comes
from the skull, meninges, and cerebrospinal fluids. The nervous tissue is extremely delicate and can
suffer damage by the smallest amount of force. In addition, it has a blood-brain barrier preventing the
brain from any harmful substance that could be floating in the blood.

The spinal cord is a vital aspect of the CNS found within the vertebral column. The purpose of the spinal
cord is to send motor commands from the brain to the peripheral body as well as to relay sensory
information from the sensory organs to the brain. Spinal cord protection is by bone, meninges, and
cerebrospinal fluids.

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Structure and Function

The brain is broken up into two hemispheres, the left, and the right. While they are in constant
communication, the left and right hemisphere are responsible for different behaviors, known as brain
lateralization. The left hemisphere is more dominant with language, logic, and math abilities. The right
hemisphere is more creative, being dominant in artistic and musical situations, and intuition.

Cerebral cortex: The cerebral cortex is the outermost layer that surrounds the brain. It is composed of
gray matter and filled with billions of neurons used to conduct high-level executive functions. The cortex
divides into four lobes; frontal, parietal, occipital, and temporal by different sulci.[1] The frontal lobe,
located anteriorly to the central sulcus, is responsible for voluntary motor function, problem-solving,
attention, memory, and language. Located in the frontal lobe are the motor cortex and the Broca area.
The motor cortex allows for the precise voluntary movements of our skeletal muscles, while the Broca
area controls motor functions responsible for producing language. The parietal lobe is separated from
the occipital lobe by the parieto-occipital sulcus and is behind the central sulcus. It is responsible for
processing sensory information and contains the somatosensory cortex. Neurons in the parietal lobe
receive information from sensory and proprioceptors throughout the body, process the can, and form an
understanding about what is being touched based on previous knowledge. The occipital lobe, known as
the visual processing center, contains the visual cortex. Similar to the parietal lobe, the occipital lobe
receives information from the retina and then uses past visual experiences to interpret and recognize the
stimuli. Lastly, the temporal lobe processes auditory stimuli through the auditory cortex.
Mechanoreceptors located in the hair cells lining the cochlea are activated by sound energy, which in
turn sends impulses to the auditory cortex. The impulse is processed and stored based on previous
experiences. The Wernicke area is in the temporal lobe and functions in speech comprehension.

Basal nuclei: The basal nuclei, also known as basal ganglia, is located deep within the cerebral white
matter and is composed of the caudate nucleus, putamen, and globus pallidus. These structures form
the pallidum and striatum. The basal ganglia are responsible for muscle movements and coordination.[2]

Thalamus: The thalamus is the relay center of the brain. It receives afferent impulses from sensory
receptors located throughout the body and processes the information for distribution to the appropriate
cortical area. It is also responsible for regulating consciousness and sleep.

Hypothalamus: While the hypothalamus is one of the smallest parts of the brain, it is vital to maintaining
homeostasis. The hypothalamus connects the central nervous system to the endocrine system. It is
responsible for heart rate, blood pressure, appetite, thirst, temperature, and the release of various
hormones. The hypothalamus also communicates with the pituitary gland to release or inhibit
antidiuretic hormone, corticotropin-releasing hormone, gonadotropin-releasing hormone, growth
hormone-releasing hormone, prolactin inhibiting hormone, thyroid releasing hormone, and oxytocin.[3]

Pons: Found in the brainstem, the pons connects the medulla oblongata and the thalamus. It is
composed of tracts responsible for relaying impulses from the motor cortex to the cerebellum, medulla,
and thalamus.

Medulla oblongata: The medulla oblongata is at the bottom of the brain stem, where the spinal cord
meets the foramen magnum of the skull. It is responsible for autonomic functions, some of which are
crucial for survival. The medulla oblongata monitors the bodies respiratory system using
chemoreceptors. These receptors are able to detect changes in blood chemistry. For example, if the
blood is too acidic, the medulla oblongata will increase the respiratory rate allowing for more oxygen to
reach the blood.[4] It is also a cardiovascular and vasomotor center. The medulla oblongata can regulate
the body's blood pressure, pulse, and cardiac contractions based on the body’s needs. Lastly, it controls
reflexes like vomiting, swallowing, coughing, and sneezing.

Cerebellum: The cerebellum, also known as the little brain, is responsible for smooth, coordinated
voluntary movements. It subdivides into three lobes: the anterior, posterior, and flocculonodular lobes.
The cerebellum contains a cerebellar circuit, using Purkinje cells and cerebellar peduncles to
communicate to other parts of the brain. The superior cerebellar peduncle is composed of white matter
that connects the cerebellum to the midbrain and allows for coordination in the arms and legs. The
inferior cerebellar peduncle connects the medulla and cerebellum using proprioceptors to maintain
balance and posture. Lastly, the middle cerebellar peduncle is used as a one-way communication
method from the pons to the cerebellum. It is mostly composed of afferent fibers that alert the
cerebellum about voluntary motor actions. The cerebellum is in constant communication with the
cerebral cortex, taking higher-level instructions about the brain’s intentions, processing them through
the cerebellar cortex, then sending messages to the cerebral motor cortex to make voluntary muscle
contractions. These contractions are calculated to determine the force, direction, and momentum
necessary to ensure each contraction is smooth and coordinated.

Limbic System: The limbic system is composed of the piriform cortex, hippocampus, septal nuclei,
amygdala, nucleus accumbens, hypothalamus, and anterior nuclei of the thalamus.[5] The fornix and
fiber tracts connect the limbic system parts allowing them to control emotion, memory, and motivation.
The piriform cortex is part of the olfactory system and is in the cortical area of the limbic system. The
hypothalamus receives most of the limbic output, which explains psychosomatic illnesses, where
emotional stressors cause somatic symptoms. For example, a patient who is currently having financial
struggles might present to his primary care physician with hypertension and tachycardia. The septal
nuclei, amygdala, and nucleus accumbens are found in the subcortical areas and are responsible for
pleasure, emotional processing, and addiction, respectively.

Reticular formation: Reticular formation is an extensive network of pathways containing neurons that
begins in the brainstem and travels from the top of the midbrain to the medulla oblongata. These
pathways have projecting reticular neurons that affect the cerebral cortex, cerebellum, thalamus,
hypothalamus, and spinal cord. The reticular formation controls the body's level of consciousness
through the reticular activation system, also known as RAS. Sensory axons, found in visual, auditory, and
sensory impulses, activate RAS neurons in the brain stem. These neurons then relay information to the
thalamus and cerebrum. Continuous stimulation of the RAS neurons causes the cerebrum to stay in an
aroused state; this gives the feeling of alertness. However, RAS can filter out repetitive, weak stimuli; this
prevents the brain from responding to unimportant information, as well as being sensory overloaded.

Spinal cord: The spinal cord proper extends from the foramen magnum of the skull to the first or second
lumbar vertebrae. It creates a two-way pathway between the brain and the body and divides into four
regions - cervical, thoracic, lumbar, and sacral. These regions are then broken down into 31 segments
with 31 pairs of spinal nerves. There are 8 cervical nerves, 12 thoracic nerves, 5 lumbar nerves, 5 sacral
nerves, and 1 coccygeal nerve. Each nerve exits the vertebral column passing through the intervertebral
foramina and to its designated location in the body.

Due to cervical and lumbar enlargements, the spinal cord differs in width throughout its structure. The
cervical enlargement occurs at C3 to T1, and the lumbar enlargement is at L1 to S2. The white matter is
present on the outside of the spinal cord, with gray matter located in its core and cerebrospinal fluid in
the central canal. The gray commissure, the dorsal, lateral, and ventral horns are all composed of gray
matter. The gray commissure surrounds the central canal. The dorsal horns are made of interneurons,
while the ventral horns are somatic motor neurons. Afferent neurons in the dorsal roots carry impulses
from the body’s sensory receptors to the spinal cord, where the information begins to be processed. The
ventral horns contain efferent motor neurons, which control the body's periphery. The axons of motor
neurons are found in the body's skeletal and smooth muscle to regulate both involuntary and voluntary
reflexes.

The spinal cord ends in a cone-shaped structure called conus medullaris and is supported to the end of
the coccyx by the filum terminale. Ligaments are found throughout the spinal column, securing the
spinal cord from top to bottom.

Ascending pathway to the brain: Sensory information travels from the body to the spinal cord before
reaching the brain. This information ascends upwards using first, second, and third-order neurons. First-
order neurons receive impulses from skin and proprioceptors and send them to the spinal cord. They
then synapse with second-order neurons. Second-order neurons live in the dorsal horn and send
impulses to the thalamus and cerebellum. Lastly, third-order neurons pick up these impulses in the
thalamus and relay it to the somatosensory portion of the cerebrum. Somatosensory sensations are
pressure, pain, temperature, and the body's senses.

Descending pathway: Descending tracts send motor signals from the brain to lower motor neurons.
These efferents neurons then produce muscle movement.[6]

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Embryology

The adult brain and spinal cord begin to form during week 3 of embryological development. The
ectoderm begins to thicken, forming the neural plate. The neutral place then folds inwards, creating the
neural groove. Neural folds that migrate laterally flank the neural groove. The neural groove then
develops into the neural tube, which forms the CNS structures.
The neural tube gets separated into an anterior and posterior end. The anterior end forms the primary
brain vesicles, prosencephalon (forebrain), mesencephalon (midbrain), and rhombencephalon
(hindbrain), while the posterior end becomes the spinal cord. The primary brain vesicles continue to
differentiate, creating secondary brain vesicles. The forebrain separates to form the telencephalon and
diencephalon, and the hindbrain splits to form the metencephalon and the myelencephalon (spinal
brain).[7] The midbrain does not divide and stays the mesencephalon. The development of the
secondary brain vesicles produces the adult brain structures

Telencephalon to cerebrum

Diencephalon to hypothalamus, thalamus, retina

Mesencephalon to the brain stem (midbrain)

Metencephalon to the brain stem (pons), cerebellum

Myelencephalon to the brain stem (medulla oblongata)

The central part of the neural tube forms continuous, hollow cavities known as ventricles. During month
6 of gestation, the cerebral cortex changes from a smooth to wrinkled, convoluted appearance; this is
due to the continued growth of the cerebral hemispheres. The elevated parts of the ridges are gyri, while
the grooves have the name sulci. The convolutions allow for the increased surface area of the brain to fit
within the skull. Throughout the brain, there are areas of white and gray matter. The gray matter
contains neuronal cell bodies, dendrites, glia, and unmyelinated neurons. Contrary, white matter is
composed of myelinated axons.[7]

The spinal cord, formed from the caudal portion of the neural tube, is composed of both gray and white
matter. At 6 weeks of gestation, the gray matter begins to aggregate, forming the dorsal alar plate and
ventral basal plate. Interneurons form from the alar plate, while motor neurons form from the basal
plate. Dorsal root ganglia, which brings information from the periphery to the spinal cord, arise for the
neural crest cells.

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Blood Supply and Lymphatics

Due to the importance and delicate nature of the central nervous system, the body closely monitors the
blood traveling to and from it. The cardiovascular system ensures continuous, oxygenated blood as a
drop-in oxygenation level can be detrimental. The common carotid arteries branch off of the aorta,
which carries oxygen-rich blood from the heart for distribution. The common carotid further branches
into right and left internal and external carotid arteries, which supply the cranium with blood. Vertebral
arteries begin in the neck and branch as they enter into the skull through the foramen magnum. They
supply the anterior portion of the spinal cord. The vertebral arteries then merge into the basilar artery.
The basilar artery is responsible for delivering blood to the brainstem and cerebellum. The circle of Willis
ensures that blood will continue to circulate even if one of the arteries is not working appropriately. The
internal carotid and vertebral arteries compose the circle of Willis.[8] After being used in the CNS, blood
then travels back to the lungs for oxygenation. Multiple dural venous sinuses do this:

Superior sagittal sinus

The confluence of sinuses

Transverse sinuses

Sigmoid sinuses

Jugular veins

Carotid arteries

Superior vena cava

Lungs

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Surgical Considerations

Anesthesia is a controlled state of temporary loss of sensation that allows the performance of painful
medical procedures that would otherwise be unfeasible. There are many types of anesthesia, such as
general, sedation, and local. However, they are all used to disrupt the cellular and intracellular
communication in the central and peripheral nervous system.

General anesthesia involves the use of an analgesic, paralytic, and amnesia, which all work together to
render the patient unconscious. Under general anesthesia, the activity of the central nervous system
undergoes complete suppression, and there is a total loss of sensation. Neuromuscular blockers are
used, requiring intubation and subsequent mechanical ventilation. Depolarizing neuromuscular blockers,
such as succinylcholine, binds to the postsynaptic cholinergic receptors causing depolarization. However,
the removal of succinylcholine from the receptors is much slower, which inhibits the binding of
acetylcholine and therefore, prevents future depolarizations. Non-depolarizing neuromuscular blockers,
like vecuronium, act as an acetylcholine inhibitor blocking the postsynaptic cholinergic receptors.
However, when these neuromuscular blockers bind, they do not change the permeability of the ion
channels.[9]

During regional anesthesia, the anesthesiologist numbs only the portion of the body that is the target of
the operation. Spinal and epidurals are used as a local anesthetic medication and get injected into the
vertebral canal. Spinal anesthesia targets the spinal fluid, while the epidural injection is into the epidural
space.
As with any surgical procedures, there is always a risk when going under anesthesia. Conditions that
increase the risk of having a complication are obesity, diabetes, hypertension, and any disease process of
the respiratory and cardiovascular system.[10]

Neurosurgeons have received training in the diagnosis and treatment of patients with injuries or
diseases affecting the central nervous system. They provide operative management of neurological
disorders, such as tumors, stroke, head, and spinal injuries, chronic pain, etc. Any surgical procedures
have risks, especially when dealing with delicate nervous tissue in the brain and spinal cord.
Complications of brain surgery, including bleeding in the brain, speech, memory, coordination issues,
stroke, brain swelling, and possible coma.

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Clinical Significance

Wernicke aphasia: Wernicke aphasia occurs most commonly as a result of a hemorrhagic or ischemic
stroke. Strokes that occur in the left middle cerebral artery prevent oxygenated blood from reaching the
Wernicke area. In Wernicke aphasia, a person can speak clearly and produce speech. However, their
speech has no meaning. They have difficulty understanding language.

Broca aphasia: Broca aphasia, also known as expressive aphasia, is caused by a stroke, brain tumor, or
brain trauma. When a stroke occurs in the Broca area, oxygen is cut off to that part of the brain. The
hypoxia causes irreversible damage. During Broca aphasia, the person has difficulty producing speech.
They can comprehend and know what they want to say; however, they are unable to form the words to
communicate the message.[11]

Traumatic brain injuries: Traumatic brain injuries (TBI) occur when there is a disruption to normal brain
activity, which can occur during a sports injury, a car accident, by a penetrating object, or even a blunt
object. TBI symptoms can vary depending on the severity of the injury. For example, a concussion can
cause temporary dizziness or loss of consciousness, while a contusion causes lasting neurological
damage. Contusions to the brain stem resulting in a coma. TBI can cause subdural or subarachnoid
hemorrhage and cerebral edema. When the brain sustains a trauma, the blood vessels in the brain
break. The blood begins to pool, increasing the intracranial pressure, and compressing the brain tissue.
As the brain pushes through the skull onto the spinal cord, autonomic nervous system functions are lost.

Cerebrovascular Accidents: Cerebrovascular accidents, also known as strokes, occur when the brain is
not able to get oxygenated blood. The lack of oxygen causes hypoxia, and tissues in the brain start to die.
Commonly, strokes are caused by a blood clot that has traveled from one location in the body to the
cerebral artery in the brain. Dependent on where the clot lands, determine the symptoms of the stroke.
For example, some people may experience left-sided paralysis, while others might have slurred speech.
Transient ischemic attacks are considered small strokes as their symptoms are more temporary. In any
CVA, time is crucial. If necessary, doctors can administer tissue plasminogen activator which breaks down
the clot or can surgically remove it. The severity of symptoms directly correlates to how long the brain’s
oxygen supply has been cut off.

Alzheimer's disease: Alzheimer's disease (AD) is a common type of dementia in which one’s brain cells
and neural connections begin to degenerate and die. This condition presents with loss of memory and
cognitive decline. Alzheimer's is progressive, with symptoms worsening over time.[12] Scientists have
found aggregations of beta-amyloid plaques and neurofibrillary tangles made of tau within the neurons
in AD patients. These plaques and tangles result in the death of brain cells and form because of the
misfolding of proteins within them. AD patients have a decrease in neural activity in the parietal cortex,
hippocampus, and basal forebrain.

Parkinson's disease: Parkinson's disease is a nervous system disorder that results in the deterioration of
dopamine-releasing neurons in the substantia nigra.[13] The drop-in dopamine levels create tremors,
unsteady movements, and loss of balance. Parkinson's disease is progressive as it usually starts as a
tremor in one hand. Many patients exhibit a pill-rolling movement in their hand, bradykinesia, stiffness,
and a mask life face as symptoms progress. A Parkinson's disease diagnosis results from looking at the
patient’s symptoms, medical history, and a neurological and physical exam. While no cure exists for the
disease, the severity of the symptoms can be controlled. Levodopa can pass through the blood-brain and
undergo conversion into dopamine for CNS use. Deep brain stimulation is a surgical option that can stop
the abnormal brain activity and thus control the tremors. However, deep brain stimulation does not keep
the disease from progressing.

Huntington disease: Huntington disease is a hereditary, progressive brain disorder that is caused by a
mutation in the huntingtin gene, HTT. The CAG segment in the HTT gene normally repeats up to 35
times. However, in someone with Huntington’s disease, the CAG segment is repeated up to 120 times.
This large CAG segment causes the huntingtin protein to accumulate in the brain cells, which eventually
leads to cell death. Initially, Huntington disease causes chorea, involuntary jerking, and hand-flapping
movements. As the disease progresses, cognitive decline occurs. Fatally follows within 15 years of
diagnosis.

Spinal cord traumas: Symptoms of spinal cord injuries is dependent on where the injury occurs. If
damage to the sensory tracts occurs, the sensation can be affected. However, if the ventral roots or
ventral horns are damaged, paralysis occurs. Flaccid paralysis is when nerve impulses do not reach the
intended muscles. Without stimulation, the muscles are unable to contract. Spastic paralysis is when the
motor neurons undergo irregular stimulation, causing involuntary contraction. Paraplegia, paralysis of
the lower limbs, occurs when the spinal cord gets cut between T1 and L1. Quadriplegia, paralysis of all
limbs, is a result of an injury in the cervical region.

Poliomyelitis: Poliomyelitis is an inflammation of the spinal cord due to the virus, Polio. Poliovirus
spreads from human to human or through infected food and water. It demolishes the neurons in the
ventral horn of the spinal cord leading to paralysis. The infection of the poliovirus is preventable through
the administration of the vaccine.[14]

Amyotrophic Lateral Sclerosis: Amyotrophic lateral sclerosis, known also as ALS and Lou Gehrig disease,
destroys motor neurons that control voluntary and involuntary movements like breathing, speaking, and
swallowing. The cause of ALS is not known, and unfortunately, there is no cure. Scientists believe that
cell death is related to the excess amount of extracellular glutamate in ALS patients. Riluzole, which can
disrupt the formation of glutamate, is used to slow down the progression and reduce the painful
symptoms of ALS.

Multiple sclerosis: Multiple sclerosis is an autoimmune disease, in which the body attacks the myelin
proteins of the central nervous system, disrupting the communication between the brain and the body.
MS has a high prevalence in young adults and presents as pain, weakness, vision loss, and loss in
coordination. The severity of symptoms varies from patient to patient. Medication is used to suppress
the body’s immune system and can help control the adverse effects of this disease.