Comprehensive Lectures on the Central Nervous System for Medical Students Kumudini Mohan Ram
INDEX
A
Alzheimer’s disease 236
Antidiuretic hormone 202
Aphasias 241
Ascending or afferent pathways 49
Ascending reticular activating system 79
Autonomic nervous system 184
chemical transmission at autonomic junctions 192
effects of parasympathetic stimulation 189
features of autonomic function 190
sympathetic nervous system 186
visceral afferents 191
B
Basal ganglia 121
diseases 124
neurotransmitters 123
Bell Magendie law 21
Blood-brain barrier 39
Braking effect 118
Brown-Séquard’s syndrome 33, 64 (also see Sensory system)
C
Central nervous system 1
cerebral hemisphere 6
development 3
evolution 2
medulla 5
spinal cord 5, 19
thalamus 6, 54
Cerebellum 107
cerebellar cortex 111
classification 109
connections 114
features of cerebellar lesions 118
functional division 109
input 113
organization 110
pontocerebellar 117
spinocerebellum 117
structure and divisions 107
Cerebrospinal fluid 36
absorption 37
blood-brain barrier 39
circulation 36
composition 39
Queckenstedt test 38
site of formation 36
Cerveau isole preparation 81
Control of motor activity 137
Cortical association areas 230
Cutaneous sensations 44
D
Damping effect 118
Dominant hemisphere 239
E
Electrical activity of the brain 170
clinical uses of the EEG 174
electroencephalogram 171
F
Frontal lobe lesions 238
G
Grand mal epilepsy 175
H
Higher functions of the brain
learning 231
memory 233
Hypothalamic obesity syndrome 205
Hypothalamic releasing and inhibiting hormones 204
Hypothalamus
anatomy 199
and behaviour 207
feeding and satiety 204
funcions 200
relation to autonomic function 206
relation to sleep 206
sympathetic responses 206
temperature regulation 204
thirst and water intake 205
I
Inverse stretch reflex 94
Irradiation 103
J
Jendrassik’s maneuver 94
L
Lateral medullary syndrome 141
Limbic system
components 212
connections 213
fear and rage 216
functions 214
Kluver-Bucy syndrome 217
motivation 217
Lower motor neuron lesions 142
M
Maintenance of posture and postural reflexes 147
Medial medullary syndrome 140
Memory 235
lesions 236
Microglia 7
Motor cortex 130
connections 133
lesions 139
Muscle spindle 91
N
Neurotransmitters
acetyl choline 221
acetyl choline receptors 222
alpha and beta receptors 224
amino acids 225
norepinephrine and epinephrine 223
purinergic transmitters 227
Noradrenergic neurons 193
O
Oxytocin 203
P
Pain 68
brain opiate system 73
facilitation theory 71
gate-control theory 72
mechanism 71
pathway 69
receptors 69
types 70
Papez circuit 213
Parkinson’s disease 126
Petit mal epilepsy 175
Placing and hopping reactions 154
Primary afferent depolarization 15
Q
Queckenstedt test 38
R
Reciprocal innervation 102
Recruitment of motor units 103
Reflex activity 86
classification 87
decerebrate preparation 98
muscle tone 96
polysynaptic reflex 100
reaction time 101
Reticular formation 76
ascending reticular activating system 79
functions-ARAS 80
modulation of pain 83
motor and visceral functions 81
reciprocal connections 78
S
Senile dementia 236
Sensory system 41, 64
anterolateral pathways 51
brainstem lesions 66
classification 43
coding of sensory information 41
cortical lesions 66
lesion of a peripheral nerve 64
lesion of the dorsal root 64
lesions of the spinal cord 64
somatosensory tracts 49
spinocerebellar tracts 51
thalamic lesions 66
transmission in peripheral nerves 48
Sham rage 149
Simiusculus 131
Sleep 175
disorders 179
distribution of sleep stages 177
mechanism of sleeping and working 177
REM sleep 177
slow wave NREM sleep 176
Speech 240
Spinal cord 19
ascending tracts 23
descending tracts 25
functional anatomy 19
hemisection 33
lesions 29
medial longitudinal fasciculus 29
spinal gray-laminar organization 22
Spinothalamic pathways 51
Stages of spinal transection 30
degeneration 32
recovery 32
reflex activity 31
spinal shock 30
Stretch reflex 90
Synapse 8
convergence and divergence 16
electrical transmission 12
excitatory post-synaptic potential 11
ionic basis 11
properties 15
synaptic activity and learning 16
types 9
Synaptic inhibition 12
indirect inhibition 14
inhibitory post-synaptic potential 12
pre-synaptic inhibition 13
Renshaw cell inhibition 13
T
Thalamic syndrome 66
Thalamus 54
classification 56
functions 55
somatosensory cortexÿ 58
thalamic syndromes 58
Tonic neck reflexes 151
Toniclabyrinthine reflexes 152
U
Upper motor neuron lesions 142
V
Vestibular function
anatomy 159
neural pathways 163
otolith organs 163
vestibular connections 164
W
Weber’s syndrome 140
Wilson’s disease 127
Withdrawn reflex 103
×
Chapter Notes

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Introduction1

The nervous system with its intricate mechanisms of control over all bodily functions makes it indeed a fascinating study. It is supported by the endocrine system in its various functions. While the nervous system is vested with the control of rapidly changing events, the endocrine system is concerned with slower metabolic and other vegetative functions.
The central nervous system (CNS) is unique in the complexity of its functions. Anatomically, this system is a collection of cells specialized to convey signals at a rapid rate with great precision.
The system receives information concerning:
  • The internal state of the body.
  • The immediate external environment.
  • More distant objects and events in the external world; and
  • Responds by sending appropriate signals to muscles and glands and initiates action on the environment.
The brain:
  • Processes information
  • Stores data, makes final decisions for initiating action after comparing it with previous information.
The 2 main functions of the brain are:
  1. Homeostatic regulation, and
  2. Initiation of action
 
 
Homeostatic Regulation is Concerned with Mechanisms that:
  • Control body temperature
    2
  • Maintain appropriate levels of blood pressure and other parameters.
  • Maintain the body posture against the collapsing force of gravity.
The mechanisms, in general, are automatic and occur without conscious effort.
Initiation of action is concerned with those actions that are performed without any external stimulus. Though these may serve regulatory ends, they appear to be spontaneous and are seen in animals with large brains. Lastly, we have complex actions that are part of learning, thinking and remembering-understood as part of general intelligence.
 
Evolution
If one makes a study of phylogeny, it is found that in the primitive unicellular organisms which originated in the sea, biological exchange occurred through simple diffusion and locomotion took place by diapedesis which required no coordination.
During evolution, there was more and more elaboration in the organisation of the cardiovascular, respiratory and other systems. Coordinated movement needed the development of complex motor pathways and maintaining the erect posture called for appropriate mechanisms. Expansion of association areas in the cerebral cortex became necessary with the evolution of the art of communication and social interaction.
Process of Evolution makes an interesting study where, in the unicellular organism, we find a single cell differentiates from one region to the other, e.g., where the cilia around the mouth is excitable, acting as receptors and also being motile. The differentiation being due to the modification of the structure of a single cell.
Next we see as in the metazoa, special types of cells appearing for conducting the effect of a stimulus from one region to another. Later, definite sensory cells with prolongations making connections with a muscle cell are seen. Thus, we see a more complex arrangement, namely, the appearance of a ganglion cell placed between the sensory and muscle cell. A further development become necessary for efficient coordination between various parts and this called for the development of some control over the transmission of impulses from one stage to another. This became possible with the multiplication of units of conduction, introducing at the same time discontinuity in the pathway 3between the sensory and effector cells. It is at this junctional region, the so-called synapse, that control can be exercised.
The striking differences in large and small brains are:
  • the increasing number of neuronal units
  • extensive elaboration of the number and complexity of these inter-connections, and
  • the introduction of interconnective systems and sub-systems.
 
Development
All parts of the nervous system of mammals including man originate either from the neural tube or from the neural crest of the embryonic ectoderm. The neural crest gives rise to:
  1. Neurons whose cell bodies are located in the dorsal root ganglion.
  2. Homologous ganglion of cranial nerves.
  3. Post-ganglionic neurons of the autonomic nervous system.
 
The Neural Tube
The lumen of the cranial end of the neural tube becomes dilated and produces the large ventricular system in the brain. The lumen at caudal end remains small, recognizable in the adult as the tiny central canal of the spinal cord. In a human embryo, about 5 weeks old, 3 main dilatations of the neural tube can be made out:
  1. Prosencephalon or fore-brain vesicle.
  2. Mesencephalon or mid-brain vesicle.
  3. Rhombencephalon or hind brain vesicle.
Embryologically, the brain is divided into the Rhombencephalon and the cerebrum joined together by an isthmus:
4
zoom view
Fig. 1.1: Major sub-divisions of CNS
 
General Outline of the CNS
The CNS consists of the brain contained within the

Introduction1

The nervous system with its intricate mechanisms of control over all bodily functions makes it indeed a fascinating study. It is supported by the endocrine system in its various functions. While the nervous system is vested with the control of rapidly changing events, the endocrine system is concerned with slower metabolic and other vegetative functions.
The central nervous system (CNS) is unique in the complexity of its functions. Anatomically, this system is a collection of cells specialized to convey signals at a rapid rate with great precision.
The system receives information concerning:
  • The internal state of the body.
  • The immediate external environment.
  • More distant objects and events in the external world; and
  • Responds by sending appropriate signals to muscles and glands and initiates action on the environment.
The brain:
  • Processes information
  • Stores data, makes final decisions for initiating action after comparing it with previous information.
The 2 main functions of the brain are:
  1. Homeostatic regulation, and
  2. Initiation of action
 
 
Homeostatic Regulation is Concerned with Mechanisms that:
  • Control body temperature
    2
  • Maintain appropriate levels of blood pressure and other parameters.
  • Maintain the body posture against the collapsing force of gravity.
The mechanisms, in general, are automatic and occur without conscious effort.
Initiation of action is concerned with those actions that are performed without any external stimulus. Though these may serve regulatory ends, they appear to be spontaneous and are seen in animals with large brains. Lastly, we have complex actions that are part of learning, thinking and remembering-understood as part of general intelligence.
 
Evolution
If one makes a study of phylogeny, it is found that in the primitive unicellular organisms which originated in the sea, biological exchange occurred through simple diffusion and locomotion took place by diapedesis which required no coordination.
During evolution, there was more and more elaboration in the organisation of the cardiovascular, respiratory and other systems. Coordinated movement needed the development of complex motor pathways and maintaining the erect posture called for appropriate mechanisms. Expansion of association areas in the cerebral cortex became necessary with the evolution of the art of communication and social interaction.
Process of Evolution makes an interesting study where, in the unicellular organism, we find a single cell differentiates from one region to the other, e.g., where the cilia around the mouth is excitable, acting as receptors and also being motile. The differentiation being due to the modification of the structure of a single cell.
Next we see as in the metazoa, special types of cells appearing for conducting the effect of a stimulus from one region to another. Later, definite sensory cells with prolongations making connections with a muscle cell are seen. Thus, we see a more complex arrangement, namely, the appearance of a ganglion cell placed between the sensory and muscle cell. A further development become necessary for efficient coordination between various parts and this called for the development of some control over the transmission of impulses from one stage to another. This became possible with the multiplication of units of conduction, introducing at the same time discontinuity in the pathway 3between the sensory and effector cells. It is at this junctional region, the so-called synapse, that control can be exercised.
The striking differences in large and small brains are:
  • the increasing number of neuronal units
  • extensive elaboration of the number and complexity of these inter-connections, and
  • the introduction of interconnective systems and sub-systems.
 
Development
All parts of the nervous system of mammals including man originate either from the neural tube or from the neural crest of the embryonic ectoderm. The neural crest gives rise to:
  1. Neurons whose cell bodies are located in the dorsal root ganglion.
  2. Homologous ganglion of cranial nerves.
  3. Post-ganglionic neurons of the autonomic nervous system.
 
The Neural Tube
The lumen of the cranial end of the neural tube becomes dilated and produces the large ventricular system in the brain. The lumen at caudal end remains small, recognizable in the adult as the tiny central canal of the spinal cord. In a human embryo, about 5 weeks old, 3 main dilatations of the neural tube can be made out:
  1. Prosencephalon or fore-brain vesicle.
  2. Mesencephalon or mid-brain vesicle.
  3. Rhombencephalon or hind brain vesicle.
Embryologically, the brain is divided into the Rhombencephalon and the cerebrum joined together by an isthmus:
4
zoom view
Fig. 1.1: Major sub-divisions of CNS
 
General Outline of the CNS
The CNS consists of the brain contained within the skull and the spinal cord lying in the vertebral canal. The peripheral portion consists of 43 pairs of nerves:
  • 12 pairs called cranial nerves
  • 31 pairs of spinal nerves that emerge from the spinal cord.
The peripheral nerves contain 2 kinds of fibres - one group called afferent or sensory carrying impulses to the CNS.
Second group efferent or motor fibres carrying impulses from the CNS to the muscles, glands and other organs.
Each spinal nerve arises from the cord by 2 roots-posterior or dorsal carries afferent fibres while anterior or ventral carries efferent fibres.5
The nervous system can also be divided into two anatomical and functional components:
  • The somatic
  • The autonomic or visceral.
The somatic component is vested with control mechanisms in response to information arising from the surface of the body; from the muscle and joints and from the surrounding environment. The autonomic component controls the blood vessels and viscera.
The afferent nerves bring information from the external environment from receptors which are sensitive to sound, light, temperature and pressure and also information about the internal state of the body. As a result of this, the nervous system sends impulses along with efferent nerves to produce appropriate movements of muscles and secretion of glands. Sometimes the process rises to conscious levels but many of the activities of the body are carried out without one being aware of them. The activities are called reflex actions and the pathways are reflex arcs.
 
Spinal Cord
The spinal cord begins as a continuation of the medulla oblongata, the inferior part of the brain-stem and extends from the foramen magnum of the occipital bone to the level of the second lumbar vertebra. In cross section, a segment of the cord forms a central core of “H” shaped grey matter consisting mainly of the cell bodies of neurons organized in functional groups. The surrounding white matter consists of myelinated nerve fibres constituting of ascending and descending tracts. Activity at segmental levels is possible by interneurons that connect the processes of the sensory to the motor neurons of the same side, while commissural interneurons connect the symmetrical half segments making coordination between the two sides of the body possible. The axons of the sensory nerve splits into ascending and descending branches, synapsing with interneurons at each level allowing the direct spread of impulses.
 
Medulla
The ascending branch reaches a relay station in the medulla which may be considered as part of the conducting pathway to the higher regions of the brain. The medulla may be considered as an upward 6continuation of the spinal cord. The medulla contains all ascending and descending tracts that communicate between the spinal cord and various parts of the brain. The medulla contains various vital centres that control heart, respiration and so on. Spinal cord, medulla and pons roughly constitute that sensory-motor division of the CNS to and from which pass nerves from every part of the body.
The reticular formation: An area of dispersed grey matter and dense network of communicating fibres extends from the spinal cord to diencephalon - mainly functions in consciousness and arousal in addition to control of muscle tone, visceral functions and modulation of pain.
 
Thalamus
From the relay station in the medulla, information is passed on to the diencephalon by way of mesencephalon or mid-brain to terminate in a body of grey matter called the thalamus. The thalamus is a centre for the reception and coordination of the vast number of impulses derived from the sensory nerves entering the spinal cord and brainstem.
Brainstem - is the name given to those parts of the brain that lie on the main conducting pathway and is thus made up of the medulla, the pons, the isthmus and mid-brain (structures remaining after removal of the cerebral hemispheres, cerebellum and basal ganglia).
Basal Ganglia: Immediately beneath the hemispheres and belonging to the telencephalon, are the basal ganglia concerned with the control of bodily movements. They function as a relay and programming station for impulses on the way to and from the cerebral cortex.
 
Cerebral Hemisphere
The thalamus is connected with a still higher part of the brain, the telencephalon comprising mainly of the cerebral hemispheres. The cerebral hemispheres may be regarded as the highest region to which sensory impulses may be relayed. Mainly, by virtue of their interaction in the cells here, they give rise to conscious sensations which are brought into relation with past experience. It is again in the cerebral hemisphere that a considerable degree of control over the motor side of the nervous system is exerted. Nerves arising from the motor region of the cortex passing down as pyramidal tracts terminate in the cord as somatic nerves in the ventral roots.7
The cerebrum consists of an external mantle or cortex made up of grey matter, a base and an interior with ventricles and bundles of white fibres. Convoluted masses of grey matter form the gyri which are separated by fissures. Each hemisphere is divided into lobes by these fissures, e.g., frontal, parietal, temporal and occipital lobes. The brain is covered by 3 layers of meninges. They are from without inwards - the dura, the arachnoid and the pia mater. The ventricles of the brain are 2 lateral, 3rd and 4th ventricles. Between the 2 lateral ventricles is the interventricular foramen which is connected to the 3rd ventricle by foramen of Munro. The third ventricle opens into the fourth through the aqueduct of Sylvius. This is continuous with the central canal of spinal cord.
Intermingled with neurons in the brain and spinal cord are other types of cells classified together as glia:
  • One type, the neuroglia originate from the ectoderm and found in:
  • The other known as microglia are of mesodermal origin and enters the embryonic brain when it is penetrated by blood vessels. The neuroglia carry out a variety of functions.
  • They are thought to play a role in providing some structural support to the neurons.
  • Microglia have a phagocytic action against bacteria.
  • Astrocytes form a component of the blood brain barrier and protect the neurons from harmful substances in the vascular system.
skull and the spinal cord lying in the vertebral canal. The peripheral portion consists of 43 pairs of nerves:
  • 12 pairs called cranial nerves
  • 31 pairs of spinal nerves that emerge from the spinal cord.
The peripheral nerves contain 2 kinds of fibres - one group called afferent or sensory carrying impulses to the CNS.
Second group efferent or motor fibres carrying impulses from the CNS to the muscles, glands and other organs.
Each spinal nerve arises from the cord by 2 roots-posterior or dorsal carries afferent fibres while anterior or ventral carries efferent fibres.5
The nervous system can also be divided into two anatomical and functional components:
  • The somatic
  • The autonomic or visceral.
The somatic component is vested with control mechanisms in response to information arising from the surface of the body; from the muscle and joints and from the surrounding environment. The autonomic component controls the blood vessels and viscera.
The afferent nerves bring information from the external environment from receptors which are sensitive to sound, light, temperature and pressure and also information about the internal state of the body. As a result of this, the nervous system sends impulses along with efferent nerves to produce appropriate movements of muscles and secretion of glands. Sometimes the process rises to conscious levels but many of the activities of the body are carried out without one being aware of them. The activities are called reflex actions and the pathways are reflex arcs.
 
Spinal Cord
The spinal cord begins as a continuation of the medulla oblongata, the inferior part of the brain-stem and extends from the foramen magnum of the occipital bone to the level of the second lumbar vertebra. In cross section, a segment of the cord forms a central core of “H” shaped grey matter consisting mainly of the cell bodies of neurons organized in functional groups. The surrounding white matter consists of myelinated nerve fibres constituting of ascending and descending tracts. Activity at segmental levels is possible by interneurons that connect the processes of the sensory to the motor neurons of the same side, while commissural interneurons connect the symmetrical half segments making coordination between the two sides of the body possible. The axons of the sensory nerve splits into ascending and descending branches, synapsing with interneurons at each level allowing the direct spread of impulses.
 
Medulla
The ascending branch reaches a relay station in the medulla which may be considered as part of the conducting pathway to the higher regions of the brain. The medulla may be considered as an upward 6continuation of the spinal cord. The medulla contains all ascending and descending tracts that communicate between the spinal cord and various parts of the brain. The medulla contains various vital centres that control heart, respiration and so on. Spinal cord, medulla and pons roughly constitute that sensory-motor division of the CNS to and from which pass nerves from every part of the body.
The reticular formation: An area of dispersed grey matter and dense network of communicating fibres extends from the spinal cord to diencephalon - mainly functions in consciousness and arousal in addition to control of muscle tone, visceral functions and modulation of pain.
 
Thalamus
From the relay station in the medulla, information is passed on to the diencephalon by way of mesencephalon or mid-brain to terminate in a body of grey matter called the thalamus. The thalamus is a centre for the reception and coordination of the vast number of impulses derived from the sensory nerves entering the spinal cord and brainstem.
Brainstem - is the name given to those parts of the brain that lie on the main conducting pathway and is thus made up of the medulla, the pons, the isthmus and mid-brain (structures remaining after removal of the cerebral hemispheres, cerebellum and basal ganglia).
Basal Ganglia: Immediately beneath the hemispheres and belonging to the telencephalon, are the basal ganglia concerned with the control of bodily movements. They function as a relay and programming station for impulses on the way to and from the cerebral cortex.
 
Cerebral Hemisphere
The thalamus is connected with a still higher part of the brain, the telencephalon comprising mainly of the cerebral hemispheres. The cerebral hemispheres may be regarded as the highest region to which sensory impulses may be relayed. Mainly, by virtue of their interaction in the cells here, they give rise to conscious sensations which are brought into relation with past experience. It is again in the cerebral hemisphere that a considerable degree of control over the motor side of the nervous system is exerted. Nerves arising from the motor region of the cortex passing down as pyramidal tracts terminate in the cord as somatic nerves in the ventral roots.7
The cerebrum consists of an external mantle or cortex made up of grey matter, a base and an interior with ventricles and bundles of white fibres. Convoluted masses of grey matter form the gyri which are separated by fissures. Each hemisphere is divided into lobes by these fissures, e.g., frontal, parietal, temporal and occipital lobes. The brain is covered by 3 layers of meninges. They are from without inwards - the dura, the arachnoid and the pia mater. The ventricles of the brain are 2 lateral, 3rd and 4th ventricles. Between the 2 lateral ventricles is the interventricular foramen which is connected to the 3rd ventricle by foramen of Munro. The third ventricle opens into the fourth through the aqueduct of Sylvius. This is continuous with the central canal of spinal cord.
Intermingled with neurons in the brain and spinal cord are other types of cells classified together as glia:
  • One type, the neuroglia originate from the ectoderm and found in:
  • The other known as microglia are of mesodermal origin and enters the embryonic brain when it is penetrated by blood vessels. The neuroglia carry out a variety of functions.
  • They are thought to play a role in providing some structural support to the neurons.
  • Microglia have a phagocytic action against bacteria.
  • Astrocytes form a component of the blood brain barrier and protect the neurons from harmful substances in the vascular system.