Neurologic System

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Two Parts to Nervous System

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Central and Peripheral

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Central Nervous System

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includes the brain and spinal cord.

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Peripheral Nervous System

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includes all the nerve fibers outside the brain and spinal cord; The 12 pairs of cranial nerves, the 31 pairs of spinal nerves, and all their branches. The peripheral nervous system carries sensory (afferent) messages from the CNS out to muscles and glands, as well as autonomic messages that govern the internal organ and blood vessels.

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Cerebral Cortex

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The cerebrum's outer layer of nerve cell bodies, which looks like "gray matter" because it lacks myelin. Cerebral Cortex is the center for human's highest function, governing thought, memory, reasoning, sensation and voluntary movement.

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Two Hemispheres

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The left hemisphere is dominant in most 95% people, including those who are left-handed.

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Four Lobes

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Frontal, parietal, temporal, and occipital.

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Frontal

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Has areas concerned with personality, behavior, emotions, and intellectual function. Precentral gyrus of the frontal lobe initiates voluntary movement.

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The Parietal Lobes

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Primary center for sensation.

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Occipital

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is the primary visual receptor center.

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Temporal Lobe

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behind teh ear has the primary auditory reception center with functions of hearing, taste, and smell.

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Wernicke's Area

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in the temporal lobe is associated with language comprehension. When damaged in the person's dominant hemisphere, receptive aphasia results. The person hears sound, but it has no meaning, like hearing a foreign language.

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Broca's Area

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in the frontal lobe mediates motor speech. When injured in the dominant hemisphere, expressive aphasia results; the person cannot talk. The person can understand language and knows what he or she wants to say, but can produce on a garbled sound.

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Basal Gangilia

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Help initiate and coordinate movement and control automatic associated movements of the body (the arm swing alternating with the legs during walking)

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Thalamus

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Main relay station where the sensory pathways of the spinal cord, cerebellum, and brainstem form synapses (sites of contact between two neurons) on their way to the cerebral cortex.

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Hypothalmus

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a major respiratory center with basic vital functions: temperature, appetite, sex drive, heart rate, and blood pressure control; sleep center; anterior and posterior pituitary gland regulator; and coordinator of autonomic nervous system activity and stress response.

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Cerebellum

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is a coiled structure located under the occipital lobe that is concerned with motor coordination of voluntary movements, equilibrium (postural balance of the body), and muscle tone. It does not initiate movement but coordinates and smoothes it (the complex and quick coordination of many different muscles needed in playing the piano, swimming, or juggling).

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Brainstem

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Central core of the brain consisting of mostly nerve fibers. Cranial nerves III through XII originate from nuclei in the brainstem. Three Areas: Midbrain, Pons, Medulla

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Midbrain

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The most anterior part of the brainstem that still has the basic tubular structure of the spinal cord. It merges into the thalamus and hypothalmus. Contains many motor neurons and tracts.

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Pons

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the enlarged area containing ascending sensory and descending motor tracts. It has two respiratory centers (pneumotaxic and apneustic) that coordinate with the main respiratory center in the medulla.

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Medulla

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The continuation of the spinal cord in the brain that contains all ascending and descending fiber tracts. It has vital autonomic centers (respiration, heart, gastrointestinal function), as well nuclei for cranial nerves VIII through XII.

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Crossed Representation

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is a notable feature of the nerve tracts; the left cerebral cortex receives sensory information and controls motor function to the right side of the body and vise versa.

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Spinothalamic Tract

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Contains sensory fibers that transmit the sensations of pain, temperature, and crude or light touch (not precisely localized).

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Posterior (Dorsal) Columns

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These fibers conduct the sensations of position, vibration, and finely localized touch.

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Position

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Without looking, you know where your body parts are in space and in relation to each other.

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Finely Localized Touch

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without looking, you can identify familiar objects by touch.

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Sensory Cortex

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arranged in a specific pattern forming a corresponding "map" of the body. Pain in the right hand is perceived at its specific spot on the left cortex map. Some organs are absent from the brain map, such as the heart, liver, or spleen.

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Cerebellar System

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complex motor system coordinates movement, maintains equilibrium and helps maintain posture. Subconcious

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Examples of Upper Motor Neuron Diseases

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cerebrovascular accident, cerebral palsy, and multiple sclerosis. Upper motor neuron completely within the CNS.

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Lower Motor Neurons

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located mostly in the peripheral nervous system.

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Reflex Arc

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Reflexes are basic defense mechanisms of the nervous system. They are involuntary, operating below the level of conscious control and permitting a quick reaction to potentially painful or damaging situations.

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Four Types of Relexes

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Deep tendon reflexes (patellar or knee jerk)

Superficial (abdominal reflex

Visceral (pupillary response to light and accommodation)

Pathologic (abnormal) extensor plantar

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31 pairs of Spinal Nerves

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8 cervical

12 thoracic

5 lumbar

5 sacral

1 coccygeal

Mixed nerves (both sensory and motor)

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Autonomic Nervous System

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Peripheral nervous system is composed of cranial nerves and spinal nerves.

Two types of nerve fibers: Somatic, innervate the skeletal (voluntary) muscles; the autonomic fibers: innervate smooth (involuntary) muscles, cardiac muscle and glands. The autonomic system mediates unconscious activity.

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Synocope

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is a sudden loss of strength, a temporary loss of consciousness (a faint) due to lack of cerebral blood flow (Low BP)

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True Vertigo (spinning sensation)

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is rotational spinning caused by neurologic disease in the vestibular apparatus in the ear or in the vestibular nuclei in the brainstem. Dinstinguish vertigo from dizziness.

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Seizures

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occur with epilepsy, a paroxysmal disease characterized by altered or loss of consciousness, involuntary muscles movements, and sensory disturbances.

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Aura

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a subjective sensation that precedes a seizure; it could be auditory, visual or motor.

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Automatisms

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eyelid fluttering, eye rolling, lip smacking

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Tremor

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Involuntary shaking, vibrating, or trembling. Abnormalities in muscle movement.

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Paresis

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is a partial or incomplete paralysis. (Loss of muscle function).

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Paralysis

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loss of motor function due to a lesion in the neurologic or muscular system or loss of sensory innervation.

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Dymetria

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is the inability to control the distance, power, and speed of muscular action.

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Paresthesia

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abnormal sensation (burning, tingling).

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Dysarthria

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Difficulty with language comprehension or expression.

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Dysphasia

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difficulty with language comprehension or expression.

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Do you know if your child has had any environmental exposure to lead?

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Chronically elevated lead levels may cause a developmental delay or a loss of newly acquired skill or be asymptomatic.

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Screening Neurologic Examination

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on seemingly well persons who have no significant subjective findings

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Complete Neurologic Examination

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on persons who have neurologic concerns (headache, weakness, loss of coordination) or who have shown signs of neurologic dysfunction

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Neurologic Recheck Examination

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On persons who have neurologic deficits and require periodic assessments (hospitalized patients or those in extended care).

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Use this sequence for complete neurologic examination:

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Mental Status (chapter 5)

Cranial Nerves

Motor System

Sensory System

Reflexes