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Home , Ciliary ganglion, Ganglion impar, Middle cervical ganglion, Ramus communicans

The sympathetic and the parasympathetic

Zsuzsanna Tóth, PhD Institute of Anatomy, and Embryology Semmelweis University The role of the

Claude Bernard • „milieu intérieur” concept; every organism lives in its internal environment that is constant and independent form the external environment Walter Bradford Cannon homeostasis; • an extension of the “milieu interieur” concept • consistence in an open system requires mechanisms that act to maintain that consistency • steady-state conditions require that any tendency toward change automatically meets with factors that resist that change • regulating systems that determine the homeostatic state :

o autonomic nervous system ( sympathetic, parasympathetic, enteral)

o endocrine system General structure of the autonomic nervous system

craniosacral thoracolumbar Anatomy Neurotransmittersof the gut autonomic nervous system.

symp. gangl pregangl. fiber pregangl. postgangl. fiber fiber (PoR)

PoR enteral

PoR PoR

smooth muscle smooth muscle

Kuratani S Development 2009;136:1585-1589 Sympathetic activation: Fight or flight reaction

• energy mobilization • preparation for escape, or fight vasoconstriction • generalized

Parasympathetic activation:

adrenal • energy saving and restoring • „rest and digest” system • more localized

vasoconstriction

Paravertebral ganglia and the sympathetic chains

pars cervicalis superius ganglion medium cervicale stellatum

pars vertebrae • from the base of the skull to the caudal end thoracalis thoracalis of the • paravertebral ganglia (ganglia trunci sympathici) • rami interganglionares

pars vertebrae • the two chains fuses at the abdominalis lumbalis

sacrum pars pelvina foramen sacralia anteriora ganglion impar Anatomy of the cervical part of the

superior cervical ganglion • behind the seath of the carotid, fusiform ggl. cervicale superius • IML T1-3 vegetative motoneurons- preganglionic fibers truncus symp. pars cephalica a. vertebralis in the fossa scalenotrachealis ggl. cervicale medium ansa subclavia a. vertebralis • connects the middle cervical and the stellate ansa subclavia ganglia • a loop of the trunk around the subclavian artery a. subclavia

ggl. cervicale inferius • lies superior to the of the first rib ggl. stellatum T1 ganglion • trunci symp. formed by the fusion of the inferior cervical ganglion and the first thoracic ganglion (80%) Sympathetic efferents

divergence , IML paravertebral ganglia T1-L2(3) (sympathetic chain) preganglionic : postganglionic ≈ 1:30

prevertebral ganglia

target organ

target organ

target organ

adrenal medulla Rami communicantes

white rami communicantes: • distal radix dorsalis • myelinated, ganglion spinale (DRG) • preganglionic fibers and ramus dorsalis nervus spinalis visceral afferents • only at T1-L2 spinal IML ramus ventralis • run longitudinal within the nervus spinalis trunk visceral efferents gray rami communicantes: radix ventralis • proximal griseus • non-myelinated, postgangionic fibers ramus communicans • postganglionic fibers albus • each spinal nerves has one preganglionic and afferent fibers visceral afferents visceral afferents: ganglion • with sympathetic efferents via viscera trunci sympathici the r.c. albus, • with parasympathetic efferents • terminate in the DRG Parietal sympathetic efferents

IML paravertebral ganglia T1-L2(3) (sympathetic chain)

head, body, limbs: vasomotor, sudomotor, piloerrector, innervation Sympathetic innervation of the skin pathway: • IML→preganglionic fiber, spinal → white ramus→ paravertebral ganglion → postganglionic fiber, grey ramus→ → skin functions: • vasomotor, sudomotor, piloerrector –vasoconstriction, perspiration, goose bumps

intermediolateral Paravertebral Spinal nerve Target area cell column (IML) ganglion ggl. cerv. superius nn. C1-4 (cervical plexus) head, neck

T1-7 ggl. cerv. medius nn. C4-7 (plexus brachialis) upper limbs

ggl. stellatum nn. C7-T1 (plexus brachialis) upper limbs

T1-11 T1-11 nn. T1-11 (nn. intercostales) body

L1-4 plexus lumbalis, plexus hips, lower limbs T8-L2 ischiadicus S1-4(5) plexus sacralis hips, perineum, lower limbs Superior cervical ganglion I.

sympathetic plexus parasympathetic caroticus m. internus tarsalis Preganglionic fibers ggl. cervicale superius • IML upper thoracic segments (spinociliar center) r m. dilatator m. orbitalis • Relay: SCG a ggl. ciliare ramus c. m. sphincter albus ramus c. Postganglionic fibers : griseusm m. ciliares paravertebral ganglion nucleus u salivatorius • internal and external carotid plexuses superior s • jugular plexus n. facialis ggl. submandibulare plexus Functions: caroticus externus chorda • vaso- and sudomotor innervation of the head tympani ggl. cervicale superius • dilatation of the (relaxed state) ggl. spinale • raising the upper eyelid (m. tarsalis,) n. spinalis • m. orbitalis • viscous salivary secretions radix glandula ventralis sublingualis • glandula vasomotor innervation of the pia mater submandibularis • fibers to the heart, pharynx, corpus pineale Superior cervical ganglion II-parotid and lacrimal glands

sympathetic parasympathetic auriculotemporal parotid gland nerve

Otic ganglion ggl. cervicale superius tympanic plexus plexus lesser caroticus petrosal n. externus tympanic nerve (CN IX/1) Sympathetic innervation:

CN IX Same pathway as in case of the

n. salivatorius submandibular and sublinguar glands inferior

plexus caroticus n. lacrimalis externus

lacrimal n. zygomaticus ggl. pterygopalatinum gland ggl. cervicale superius

n. petrosus major (CN VII/1)

n. salivatorius superior Horner’s syndrome

Symptoms: • ptosis (drooping of the upper eyelid), • (a constricted pupil) • enophtalmos (sinking of the eyeball in the ) • anhydrosis (decreased sweating over the ipsilateral forehead) • dilation of arterioles of the skin • ciliospinal reflex (pupillary-skin reflex) is absent

hypothalamus

n. nasociliaris (III).n m. dilatator

ggl. cerv. sup. g

centrum ciliospinale Hypothalamus Mesencephalon Spatium parasympathetic Spatium perichoroideale N. Westphal- perichoroideale-idegek Edinger (III.)

M. ciliaris, M. sphincter pupillae Nn. ciliares breves

r. inf. n. oculomotorii radix brevis (motoria)

Nn. ciliares longi Pons Ganglion trigeminale n. nasociliaris radix longa (sensoria) Nucleus Ggl. ciliare sensorius n. V. Nn. ciliares longi trigeminalis Plexus caroticus int. somatosensory Plexus ophthalmicus Conjunctiva, Cornea, Radix sympathica M. dilatator pupillae, M. tarsalis, M. orbitalis

sympathetic Medulla Autonomic innervation of the and Ganglion cervicale spinalis muscles in the eye superius From prof. Ágoston Szél Parasympathetic innervation of the pupil

plexus caroticus m. tarsalis internus Edinger-Westphal nucleus

ggl. cervicale superius

r m. dilatator (radial m) a ramus c. ramus c. m. sphincter mgriseus albus (circular m.) u m. ciliaris s

Preganglionic fibers: Edinger-Westphal nucleus, CN III Relay: ciliary ganglion Postganglionic fibers: short ciliary nerves Function: constriction of the pupil and the (accomodation) Parasympathetic innervation the submandibular, sublingual and lacrimal glands

n. salivatorius sympathetic parasympathetic superior

ggl. n. facialis plexus caroticus submandibulare Submandibular and sublingual glands externus Chorda Preganglionic fibers: ggl. cervicale superius tympani CN VII./3 • superior salivatory nucleus, chorda ggl. spinale r n. spinalis tympani (CN VII/3) a m Relay: radix glandula Function: secretion of watery saliva ventralis u sublingualis glandula s submandibularis n. Lacrimal gland lacrimalis Preganglionic fibers: ggl. • superior salivatory nucleus, greater lacrimal n. pterygopalatinum gland ggl. cervicale superius zygomaticus petrosal nerve (CN VII/1) Relay: pterygopalatin ganglion n. petrosus major Postganglionic fibers: , (CN VII/1) n. salivatorius communicating branch, superior Function: secretion of tears Parasympathetic innervation of the parotid gland

parotid gland ggl. cervicale superius tympanic plexus caroticus plexus lesser externus petrosal n. tympanic nerve (CN IX/1)

CN IX

n. salivatorius inferior

Preganglionic fibers: inferior salivatory nucleus, glossopharyngeal nerve (CN IX) tympanic nerve (CN IX/1), tympanic plexus, lesser petrosal nerve Relay: otic ganglion Postganglionic fibers: auriculotemporal nerve Sympathetic innervation of the heart and lung sympathetic parasympathetic Heart: ggl. • Preganglionic fibers: IML T1-T4 cervicale • Relay: and T1-4 ganglia of the trunk sup. ggl. • Postganglionic fibers: cardiac plexus -SA and AV nodes, atrium n. dorsalis nervi cervicale vagi and ventricle - heart rate and force increases med. n. ambiguus ggl. cervicale Lung: inf. heart plexus cardiacus • Preganglionic fibers: IML T1-T4 • Relay: T1-T4 ganglia of the trunk , stellate ganglion n. vagus • Postganglionic fibers: pulmonal plexus -bronchodilatation ggl. 1

Upper third of the esophagus: • Preganglionic fibers: IML T1-T6 • Relay: stellate ganglion • Postganglionic fibers: cardiac and pulmonal plexuses

r.c. albus Others: lung plexus pulmonalis • ggl. cervicale medium: larynx, pharynx, thyroid-vasoconstriction • ggl. stellatum - n. vertebralis: radix ventr. o upper limbs (vaso- and sudomotor, piloerrector) ggl. 4 Parasympathetic innervation of the heart and lung

Heart: sympathetic parasympathetic • Preganglionic fibers: n. ambiguus, dorsal motor nucleus of

ggl. vagus- cervicale • Relay: cardiac plexus sup. • Function: fibers innervate SA and AV nodes, - heart rate ggl. cervicale n. dorsalis decreases, force does not change med. nervi vagi n. ambiguus ggl. cervicale Lung: inf. heart plexus cardiacus • Preganglionic fibers: dorsal motor nucleus of vagus- vagus nerve

n. vagus • Relay: pulmonal plexus ggl. 1 • Function:-bronchoconstriction, increase in the secretion of the bronchial glands

Upper third of the esophagus: • Preganglionic fibers: n. ambiguus, dorsal motor nucleus of vagus- vagus nerve r.c. albus • Relay: submucosal and myentheric plexuses lung plexus pulmonalis • Others: radix ventr. • pharynx, larynx –vagus – innervation of the musculature ggl. 4 • pia mater vessels vasodilatation! • corpus pineale no functional relevance Sympathetic efferents

IML paravertebral ganglia T1-L2(3) (truncus sympathicus)

prevertebral ganglia

abdominal, pelvic viscera

target organs

abdominal, pelvic viscera adrenal medulla Sympathetic efferents

IML paravertebral ganglia T1-L2(3) (sympathetic chain)

prevertebral ganglia

target organ

target organ

target organ

adrenal medulla Sympathetic innervation of the GI tract

sympathetic parasympathetic Lower esophagus, stomach, liver, spleen, n. splanchnicus n. dorsalis duodenum, pancreas: major nervi vagi • Preganglionic fibers: truncus plexus myentericus ggl. celiacum and submucosus sympathicus postgangl. IML T5-11, greater and lesser Area supplied by the • Relay: celiac ganglion celiac artery: lower esophagus, stomach, liver, duodenum, pancreas, spleen ggl. Ileum, jejunum, cecum, asc. and mesentericum n. vagus superius transverse (2/3rd) colon : Area supplied by the sup. mesent. artery: • Preganglionic fibers: ileum, jejunum, cecum, asc. and IML T5-12, greater, lesser and least splanchnic transv. colon n. splanchnicus nerves minor, Relay: superior mesenteric ganglion imus

nn. splanchnici Area supplied by the lumbales inf. mesent. artery: colon transv. and plexus myentericus Transverse (1/3rd), descending, sigmoid distalis rectum, anus ggl. mes. inf. and submucosus postgangl. neurons colon, rectum, anus: r.c. albus • Preganglionic fibers: A, IML T12-L2(3), lumbar splanchnic nerves • Relay: inferior mesenteric ganglion B, sacral splanchnic nerves plexus hypogastricus • Relay: superior and inferior hypogastric Functions: plexuses • inhibition of peristalsis and the secretions of glands • contraction of the sphincters and vasoconstriction Parasympathetic innervation of the GI tract sympathetic parasympathetic

n. splanchnicus n. dorsalis Lower esophagus, stomach, liver, spleen, nervi vagi major pancreas, small intestine, cecum, truncus plexus myentericus ggl. celiacum and submucosus ascending and transverse (2/3rd) colon: sympathicus postgangl. neurons

Area supplied by the celiac artery: lower • Preganglionic fibers: esophagus, stomach, liver, duodenum, pancreas, spleen dorsal motor nucleus of vagus, vagus nerve ggl. n. vagus mesentericum • Relay: submucosal and myentheric plexuses superius Area supplied by the sup. mesent. artery: ileum, jejunum, cecum, asc. and Transverse (1/3rd), descending, sigmoid transv. colon colon, rectum, anus: n. splanchnicus minor, imus • Preganglionic fibers: IML S2-S4 ,ventral root of the spinal nerves, pelvic nerves nn. splanchnici Area supplied by the inf. mesent. artery: lumbales colon transv. and plexus myentericus distalis rectum, anus • Relay: submucosal and myentheric plexuses ggl. mes. inf. and submucosus postgangl. neurons r.c. albus Functions: • stimulation of peristalsis and secretions of glands plexus • relaxation of the sphincters hypogastricus • no direct effect on vessels Autonomic innervation of the kidney and the adrenal medulla

parasympathetic Adrenal medulla: functionally analogous sympathetic to a sympathetic ganglion n. dorsalis n. splanchnicus nervi vagi Preganglionic fibers: major • A, T5-T11 IML greater and lesser truncus ggl. celiacum sympathicus splanchnic nerves • Celiac ganglion: there is no relay! adrenal • adrenaline, noradrenaline release medulla n. vagus Kidney: n. splanchnicus Sympathetic minor • Preganglionic fibers: T5-T9 IML, kidney a. renalis greater splanchnic nerve ggl. renalis • Relay: renal ganglion n. splanchnicus major plexus renalis • Postganglionic fibers: renal plexus (mixed with parasympathetic) Parasympathetic: • Preganglionic: dorsal motor nucleus, Effects on kidney arteries: of vagus, vagus nerve sympathetic: vasoconstriction • Relay: renal plexus Autonomic innervation of the bladder sympathetic parasympathetic nn. ggl. truncus splanchnici mesentericum sympathicus lumbales inferius parasympathetic Sympathetic: preganglionar • Preganglionic fibers: IML T12-L2(3), neurons nn. lumbar splanchnic nerves r.c. Onuf’s nucleus splanchnici albus pelvini • Relay: A, inferior mesenteric ganglion B, inferior hypogastric plexus (rectal, uterovaginal, prostatic and vesical radix plexuses) ventralis plexus • Postganglionic fibers: pelvic and hypogastric hypo- nerves gastricus radix ventralis Parasympathetic: • Preganglionic fibers: IML S2–S4, vesica urinaria ventral roots, pelvic nerves, passing m. sphincter vesicae through the hypogastric plexus somatomotor • Relay: postganglionic neurons in the m. sphincter innervation urethrae externus voluntary control! bladder wall Control of micruition sympathetic parasympathetic Sympathetic effects nn. ggl. truncus splanchnici mesentericum sympathicus Allows the bladder to fill, inhibits emptying: lumbales inferius parasympathetic • closing the internal sphincter preganglionar neurons • relaxing the detrusor muscle (bladderwall) nn. r.c. Onuf’s nucleus splanchnici albus pelvini Parasympathetic effects Allows the bladder to empty:

radix • relaxing the internal sphincter ventralis • contraction the detrusor muscle plexus hypo- gastricus Moderate bladder distension inhibits parasympathetic radix ventralis activity, fullnes of the bladder stimulates it (afferents).

vesica urinaria Voluntary control of m. sphincter urethrae externus: m. sphincter vesicae • S2-4 ventral horn alpha motoneurons (Onuf’s n.) somatomotor m. sphincter innervation • tonic activity urethrae externus voluntary control! • central coordination: pons and higher centers Autonomic innervation of the sexual organs sympathetic parasympathetic Sympathetic: truncus nn. ggl. sympathicus splanchnici lumbales mesentericum • Preganglionic fibers: IML T12-L2(3), lumbar inferius parasympathetic preganglionic splanchnic nerves nn. r.c. neurons splanchnici albus • Relay: pelvini A, inferior mesenteric ganglion ( epididymis, vas

radix deferens, seminal vesicles, and prostate glands/ ventralis vagina, uterus) plexus hypo- B, inferior hypogastric plexus (penis/clitoris) gastricus radix ventralis • Postganglionic fibers: pelvic and hypogastric nerves vas deferens Parasympathetic: corpus cavernosum • Preganglionic fibers: IML S2–S4, ventral roots, prostata pelvic nerves, passing through the vesicula seminalis hypogastric plexus testis epididymis • Relay: neurons in corpora cavernosa or clitoris Autonomic innervation of the sexual organs

sympathetic parasympathetic Parasympathetic effects • dilation of the arteries • increased blood flow in the corpora cavernosa causes erection

Non-adrenergic and non-cholinergic terminals: • nitric oxide (NO) release • cGMP level increase in the nonvascular smooth muscle -relaxation • indirect contribution to erection

Sympathetic effects • contraction of smooth muscles; • vas deferens, seminal vesicles, and prostate - ejaculation Modification • contraction of uterine musculature • psychiatric factors • somatosensory inputs • integration in higher centers (cortex, limbic system, sexually dimorph nuclei) Thank you for your attention!

Anatomy: 5*