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Neurologic System CHAPTER TWENTY Neurologic System PHYSIOLOGY OF THE NERVOUS SYSTEM b. Chemical neurotransmitters (neuromediators) A. Central nervous system (CNS) (Figure 20-1). facilitate the transmission of an impulse across the B. Peripheral nervous system. synapse. 1. Twelve pairs of cranial nerves. (1) Acetylcholine. 2. Thirty-one pairs of spinal nerves. (2) Norepinephrine. 3. Autonomic nervous system (ANS). (3) Dopamine. a. Sympathetic system: “fight or flight.” (4) Histamine. b. Parasympathetic system. c. Impulses pass in only one direction. Cells of the Nervous System Central Nervous System A. Neuron: the functional cell of the nervous system. The brain and the spinal cord within the vertebral column B. Function/classification. make up the CNS (see Figure 20-1). C. Supporting cells provide support, nourishment, and pro- A. The brain and the spinal column are protected by tection to the neuron. the rigid bony structure of the skull and the vertebral D. Myelin sheath. column. 1. Dense membrane or insulator around the axon. B. Meninges: protective membranes that cover the brain 2. Facilitates function of the neuron. and are continuous with those of the spinal cord. 3. Contributes to the blood-brain barrier to protect the 1. Pia mater: a delicate vascular connective tissue layer CNS from harmful molecules. that covers the surfaces of the brain and the spinal E. Nerve regeneration: entire neuron is unable to undergo column; part of the blood-brain barrier. complete regeneration. 2. Arachnoid: a delicate nonvascular, waterproof mem- 1. Neuron regeneration in the CNS is very limited, pos- brane that encases the entire CNS; the subarachnoid sibly because of the lack of neurilemma (membrane space contains the cerebrospinal fluid (CSF). surrounding the neuron). 3. Dura mater: a tough white fibrous connective tissue, 2. Scar tissue is a major deterrent to successful cellular the outer layer of protection to the brain and spinal regeneration. cord. F. Impulse conduction. C. Cerebrospinal fluid (CSF). 1. Reflex arc. 1. Serves to cushion and protect the brain and spinal a. A reflex arc is the functional unit that provides cord; brain literally floats in CSF. pathways over which nerve impulses travel. 2. CSF is clear, colorless, watery fluid; approximately b. The passage of impulses over a reflex arc is called 100 to 200 mL in total volume, with a normal fluid a reflex act or a reflex and is an involuntary response pressure of 60 to 100 mm H2O. to a stimulus. 3. Formation and circulation of CSF (Figure 20-2). c. Reflex arc: the afferent neuron carries the stimulus a. Fluid is secreted by the choroid plexus located in to the spine, integrates it into and through the the ventricles of the brain. spine (CNS) to the efferent neuron, and crosses b. CSF flows through the lateral ventricles into the the synapse with the message from the CNS to third ventricle, then flows through the aqueduct the organ or muscle, which responds to the stimu- of Sylvius into the fourth ventricle, where the lus. This is the sequence of events evaluated when central canal of the spinal column opens. the deep tendon reflexes are tested. c. From the fourth ventricle, CSF flows around the 2. Synaptic transmission. spinal cord and brain. a. A chemical synapse maintains a one-way com- d. Because CSF is formed continuously, it is reab- munication link between neurons. sorbed at a comparable rate by the arachnoid villi. L 401 402 CHAPTER 20 Neurologic System H Cerebral c. Temporal. hemisphere H (1) Auditory area: interprets meaning of certain H sounds. H (2) Wernicke’s area for speech, sensory speech H5 Diencephalon area, comprehension and formulation of H speech (understanding spoken and written Midbrain H words). Pons Brainstem Cerebellum H { Medulla d. Occipital area: interprets vision and controls H ability to understand written words. H10 3. Motor areas of the cerebral cortex. H a. Primary function is coordination and control of H skeletal muscle activity. Spinal cord H b. Corticospinal tracts (pyramidal tracts). H (1) Descending tract from the motor area of the H15 cerebral cortex to the spinal cord. H (2) Majority of motor nerves cross in the medulla H to the opposite side before descending into the H spinal cord. H FIGURE 20-1 Major divisions of the central nervous system. (From (3) These corticospinal tracts do not cross over. H20 Lewis SL et al: Medical-surgical nursing: assessment and management c. Brain cells and the nerve fibers in the descending H of clinical problems, ed 7, St. Louis, 2007, Mosby.) tracts of the CNS are called upper motor neurons. H 4. Movement is controlled by: H a. Cerebral cortex: voluntary initiation of motor H activity. H25 b. Basal ganglia: assist in maintaining posture. Superior Arachnoid villi sagittal sinus H Subarachnoid c. Cerebellum: coordinates muscle movement. space H Lateral 5. Cerebellum: attached to the medulla and the pons. ventricle Choroid H plexus a. Primarily concerned with coordination of motor Foramen of (third H Monro movement, muscular tone, and maintenance of ventricle) H30 Choroid Cisterna equilibrium. plexus magna H (fourth b. Nerve fibers spread upward to the cerebrum and H ventricle) Foramen of downward to the pons, medulla, and spinal cord. Luschka H Foramen of (1) Visual reflexes: pupillary constriction and Magendie H Aqueduct of movement of the eye. H35 Sylvius (2) Auditory reflexes: turning of the head toward H FIGURE 20-2 Circulation of the cerebrospinal fluid. (From Monahan FD sound. H et al: Medical-surgical nursing: health and illness perspectives, ed 8, St. 6. Brainstem: consists of the pons and the medulla. H Louis, 2007, Mosby.) a. Pons: contains both motor and sensory pathways H relaying messages between the cerebrum and the H40 spinal cord; also regulates respiration. H D. Brain. b. Medulla oblongata: a continuation of the spinal H 1. Cerebrum: the largest portion of the brain; separated cord as it enters into the cranial vault in the H into hemispheres; the cerebral cortex is the surface brain. H layer of each hemisphere. (1) Conduction center and crossing center for the H45 2. Major lobes of the central cortex. upper motor neurons. H a. Frontal. (2) Maintains control of cardiac rate. H (1) Responsible for intelligence and personality. (3) Vasomotor center for constriction and dila- H (2) Coordination of voluntary skeletal muscle tion of vessels. H movement. (4) Respiratory center for changes in rate and H50 (3) Abstract thinking, morals, judgment. depth of breathing. H (4) Broca’s area for speech, motor-speech area, (5) Vomiting and swallowing reflex center. H area of expressive ability (to speak and write). c. Thalamus. H b. Parietal. (1) Organization and distribution of incoming H (1) Interprets sensory nerve impulses (pain, tem- sensory impulses. H55 perature, touch). (2) Activities related to consciousness. H56 (2) Maintains proprioception. d. Hypothalamus. H57 (3) Recognition of size, texture, and shape of (1) Homeostasis: regulation of visceral activities, H58 L objects. including body temperature, fluid and electro- CHAPTER 20 Neurologic System 403 lyte regulation, motility and secretions of the b. Nucleus pulposus is the fibrocartilaginous portion gastrointestinal tract, arterial blood pressure. of the intravertebral disk; acts as shock absorber (2) Nerve connections with the thalamus and the for the spinal cord. cerebral cortex make it possible for emotions 4. Upper motor neurons: originate in the brain; trans- to influence visceral activity (e.g., spastic mit impulses from the brain to the lower motor colon). neurons. (3) Regulation of endocrine glands via influence 5. Lower motor neurons: originate in the spinal cord; on the pituitary gland. transmit impulses to the muscles and organs. These (4) Neurosecretion of antidiuretic hormone, neurons form the reflex arc. which is stored in the pituitary gland. 6. Reflex activity. 7. Cerebral circulation. a. The reflex arc must be intact; the spinal cord serves a. The internal carotid arteries enter the cranial vault as the connection between the afferent pathway at the temporal area. (sensory) and the efferent pathway (motor). b. The circle of Willis is an arterial anastomosis at b. Testing of the reflex arc (deep tendon reflexes) the base of the brain. The circle ensures continued allows evaluation of the lower motor neuron and circulation if one of the main vessels is disrupted. the sensory/motor fibers from the spinal column. E. Spinal cord. For example, if the biceps reflex is normal, the lower 1. The spinal cord is continuous with the medulla and motor neurons and the nerve fibers at C5 and C6 extends down the vertebral column to the level of the are intact. first or second lumbar vertebrae. 2. Each column is divided into functional groups of Peripheral Nervous System nerve fibers. The cranial and spinal nerves, which connect the CNS with a. Ascending tracts: transmit impulses to the brain the body parts, constitute the peripheral nervous system. (sensory pathway). A. Cranial nerves (Table 20-1). b. Descending tracts: transmit impulses from the 1. Twelve pairs of cranial nerves. brain to the various levels of the spinal cord (motor 2. Originate from under the surface of the brain. pathways). B. Spinal nerves. 3. Structure. 1. Each pair of nerves is numbered according to the level a. Intervertebral disks lie between the vertebrae to of the spinal cord from which it originates (e.g., C1, provide flexibility to the spinal column. C2, etc.). Table 20-1 CRANIAL NERVES No. Name Function I Olfactory Sense of smell II Optic Vision: conducts information
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