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3 parts of a neuron:
a. cell body or soma - neuron’s main cellular space; houses the nucleus;
where the neuron’s main genetic information can be found
* ganglia / nuclei - nerve cell bodies occuring in clusters
* center - cluster of cell bodies with the same function
b. dendrite - receives messages from other neurons
c. axons - sends messages to other neurons
* 2 types of neurons:
1. sensory - carry impulses to the brain
2. motor - carry impulses away from the brain
> neurons are insulated by Schwann cells
* neurotransmitters:
> communicate messages from one neuron to another; or from a neuron to a specific target tissue
> action - to potentiate, terminate, or modulate a specific action and can either excite or inhibit the
target cell’s activity
> ex. of neurotransmitters -
- acetylcholine - serotonin
- norepinephrine - amino acids
- dopamine - polypeptides (not long enough to become a full-fledged amino acid)
> thalamus - acts as a relay station for all sensations except smell
> hypothalamus - regulate appetite, sleep-wake cycle, blood pressure, aggressive and
sexual behavior, emotional responses; also regulate and control the
autonomic nervous system
> basal ganglia - for controlling movement and establishing postures
2. brain stem - the stemlike part of the brain that is connected to the spinal cord; or conversely,
the extension of the spinal cord up into the brain
* composed of:
> midbrain
> pons
> medulla
> connections for CN II, IV to XII
a. frontal lobe
- largest lobe
- involved in motor function, problem solving, spontaneity, memory, language, initiation,
judgement, impulse control, and social and sexual behavior
- contains Broca’s area (motor control of speech); in the left cerebral hemisphere
> responsible for producing coherent speech
> damage to this area will result in people having trouble producing grammatical language
b. temporal lobe
- organizes and interprets auditory sensory inputs
- contains the Wernicke’s area; in the left cerebral hemisphere
> responsible for analyzing spoken language
> damage to this area results in a condition where people can hear spoken language but
cannot understand it
a. dura mater
- outermost layer
- tough, fibrous connective tissue
- between the dura and the arachnoid is the subdural space
b. arachnoid
- middle membrane
- has no blood supply
- contains the choroid plexus (responsible for the production of CSF)
- between the arachnoid and the pia is the subarachnoid space which contains the CSF
c. pia mater
- innermost membrane; vascular membrane
- transparent layer that hugs the brain closely
Cerebrospinal Fluid
> CSF is produced mainly by a structure called the choroid plexus in the right and left lateral, third
and fourth ventricles
> CSF flows from the 2 lateral ventricles to the third ventricle through the interventricular foramen
(also called the foramen of Monro)
> CSF flows from the third ventricle to the fourth ventricle through the cerebral aqueduct (also
called the Aqueduct of Sylvius)
> from the fourth ventricle CSF then flows into the cisterna magna through the lateral foraminae
of Luschka (there are two of these) and the median foramen of Magendie (only one)
* cisterna magna - opening in the subarachnoid space created by the separation of the
arachnoid and pia mater
CSF functions:
1. protection - CSF acts to cushion a blow to the head and lessen the impact
2. bouyancy - because the brain is immersed in fluid, the net weight of the brain is reduced from
about 1,400 grams to about 50 grams; therefore, pressure at the base of the brain is reduced
3. excretion of waste products - the one-way flow from the CSF to the blood takes potentially harmful
metabolites, drugs and other substances away from the brain
4. endocrine medium - CSF serves to transport hormones to other areas of the brain; hormones
released into the CSF can be carried to remote sites of the brain where they may act
* spinal cord -
> extends from the foramen magnum at the base of the skull to the level of L1-L2 or L2-L3 where it
tapers to a fibrous band called the conus medullaris
> below the conus medullaris extend the nerve roots called cauda equina because they resemble
horse’s tail
> unlike in the brain where the gray matter is external and white matter is internal, in the spinal
cord grey matter is in the center and is sorrounded on all sides by white matter
b. spinal nerves
> 31 pairs of spinal nerves
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal
> dorsal roots - sensory
ventral roots - motor
* Comparison:
UMN Lesion LMN Lesion
> loss of voluntary control > loss of voluntary control
> increased muscle tone > decreased muscle tone
> muscle spasticity > flaccid muscle paralysis
> no muscle atrophy > muscle atrophy
> hyperactive and abnormal reflexes > absent or decreased reflexes
* Decorticate Posturing
- definiton above plus: rigidity, flexion of the arms, clenched fists; the person holds the arms bent
and inward toward the body with the wrists and fingers bent and held on the chest
- indicates damage to the cerebral hemispheres
- better prognosis than decerebrate
* Decerebrate Posturing
- involves rigid extension of the arms and legs, downward pointing of the toes, and backward
arching of the head
- indicates damage to the midbrain
* Grading:
0 - absolutely no visible contraction
1 - there is visible contraction but no movement
2 - some movement but insufficient to counteract gravity
3 - barely against gravity (with inability to resist any additional force)
4 - less than normal (but more than enough to resist gravity)
5 - normal
Verbal oriented V5
confused V4
inappropriate words V3
incomprehensible sounds V2
no response V1
Somnolent - easily aroused by voice or touch; awakens and follows commands; requires
stimulation to maintain arousal
Obtunded/Stuporous - arousable only with repeated and painful stimulation; verbal output is
unintelligible or nil; with some purposeful movement to noxious stimuli
* Coma - a clinical state of unconsciousness in which the patient is unaware of self or the
environment for prolonged periods
* Akinetic mutism - a state of unresponsiveness to the environment in which the patient makes no
movement or sound but sometimes opens the eyes
* Persistent vegetative state - a condition in which the patient is described as wakeful but devoid of
conscious content, without cognitive or affective mental function
* Deep reflexes:
- are all stretch (myotatic) reflexes such as those elicited by a sharp tap in the appropriate tendon
or muscle to induce stretching of the muscle that results in a reflexive shortening of the same
muscle
* myotatic reflex - tonic contraction of the muscles in response to a stretching force, due to
stimulation of muscle proprioceptors
Grade Description
0 absent
1+ hypoactive
2+ normal
>
decreased reflexes should lead to suspicion that the reflex arc has been affected (LMN);
lesions of the UMNs result in increased reflexes at the spinal cord by decreasing tonic
inhibition of the spinal segment.
> if the DTRs are hyperactive, test for ankle clonus (with the knee partially flexed, quickly dorsiflex
the ankle
* clonus - a repetitive, usually rhythmic, and variably sustained reflex response elicited by
manually stretching the tendon; clonus may be sustained as long as the tendon is
manually stretched or may stop after up to a few beats despite continued stretch of
the tendon
* Superficial reflexes:
- are withdrawal reflexes induced by noxious or tactile stimuli
- these reflexes are quite different from the muscle stretch reflexes in that the sensory signal has
to not only reach the spinal cord, but also must ascend the cord to reach the brain; the motor
limb then has to descend the spinal cord to reach the motor neurons (polysynaptic reflex)
- these reflexes can be abolished by severe lower motor neuron damage or destruction of the
sensory pathways from the skin that is stimulated; however, the utility of superficial reflexes is
that they are decreased or abolished by conditions that interrupt the pathways between the
brain and spinal cord (such as with spinal cord damage)
* Pathologic reflexes:
> Babinski reflex
- stroke the lateral aspect of the sole of each foot and then come across the ball of the foot
medially with a sharp object
- positive: dorsiflexion of the great toe and fanning of the lesser toes
- indicative of UMN lesion