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PERIPHERAL NERVOUS SYSTEM (cranial & spinal nerves)

The peripheral nervous system (PNS) consists of nerve bers and cell bodies
outside the CNS that conduct impulses to or away from the CNS. The PNS is
organied into nerves that connect the CNS with peripheral structures. ! nerve
ber consists of an a"on# its neurolemma# and surrounding endoneurial connective
tissue. Neurolea is the outermost nucleated cytoplasmic layer of Schwann
cells that surrounds the a"on of the neuron. $t forms the outermost layer of
the nerve fiber in the peripheral nervous system ns. $n the PNS# the neurolemma
may ta%e two forms# creating two classes of nerve bers& '.The neurolemma of
myelinated nerve fibers consists of Schwann cells specific to an individual a"on#
organied into a continuous series of enwrapping cells that form myelin.
T he neurolemma of unmyelinated nerve bers is composed of Schwann cells that
do not ma%e up such an apparent series( multiple a"ons are separately embedded
within the cytoplasm of each cell. These Schwann cells do not pro)duce myelin.
*ost bers in cutaneous nerves (nerves sup)plying sensation to the s%in) are
unmyelinated. ($n CNS# a"ons are myelinated by oligodendrocytes# thus lac%
! nerve consists of&
a bundle of nerve bers outside the CNS
the connective tissue coverings that surround and bind the nerve ber and
the blood vessels (vasa nervorum) that nourish the nerve bers and their
coverings .Nerves are fairly strong and resilient because the nerve bers are
supported and protected by three connective tissue coverings.
'. +ndoneurium# delicate connective tissue immediately surrounding the
neurilemma cells and a"ons.
,. Perineurium# a layer of dense connective tissue that encloses a fascicle of
nerve bers# providing an effective barrier against penetration of the nerve
bers by foreign substances.
-. +pineurium# a thic% connective tissue sheath that surrounds and encloses a
bundle of fascicles# forming the outermost covering of the nerve( it includes
fatty tissue# blood vessels# and lymphatics.
Nerves are organied much li%e a telephone cable& The a"ons are li%e
individual wires insulated by the neurolemma and endoneurium( the insulated
wires are bundled by the perineurium# and the bundles are surrounded by the
epineurium forming the cable.s outer wrapping. $t is important to distinguish
between nerve bers and nerves# which are sometimes depicted
diagrammatically as being one and the same. ! collection of neuron cell
bodies outside the CNS is a ganglion. There are both motor (autonomic) and
sensory ganglia.
The PNS is anatomically and operationally continuous with the CNS. $ts
afferent (sensory) bers convey neural impulses to the CNS from the sense
organs (e.g.# the eyes) and from sensory receptors in various parts of the body
(e.g.# in the s%in). $ts efferent (motor) bers convey neural impulses from the
CNS to effector organs (*uscles and glands).
Nerves are either cranial nerves or spinal nerves# or derivatives of them.
Cranial nerves
+"it the cranial cavity through foramina (openings) in the cranium and are
identied by a descriptive name (e.g.# /trochlear nerve0) or a 1oman numeral
(e.g.# /CN $20). 3nly '' of the ', pairs of cranial nerves arise from the
brain( the other pair (CN 4$) arises from the superior part of the spinal cord.5
Spinal (segmental) nerves
+"it the vertebral column (spine) through intervertebral foramina. Spinal
nerves arise in bilateral pairs from a specic segment of the spinal cord. The
-' spinal cord segments and the -'pairs of nerves arising from them are
identied by a letter and number designating the region of the spinal cord and
their superior)to)inferior order (C# cervical( T# thoracic( 6# lumbar( S# sacral(
Co# Coccygeal).
Cranial nerves
Cranial nerves are nerves that emerge directly from the brain, in contrast
to spinal nerves which emerge from segments of the spinal cord. In humans,
there are 12 pairs of cranial nerves. Only the frst and the second pair
emerge from the cerebrum; the remaining 1 pairs emerge from
the brainstem.
List of cranial nerves
# Name
I Olfactory nerve
#ransmits the sense of smell;
II Optic nerve
#ransmits visual information to
the brain; $ocated in optic canal
III Oculomotor nerve
Innervates levator palpebrae
rectus, medial rectus, inferior
rectus, and inferior obli&ue,
which collectively perform most
eye movements; 'lso innervates
m. sphincter pupillae. $ocated
in superior orbital fssure
I( #rochlear nerve
Innervates the superior obli&ue
muscle, which depresses,
rotates laterally )around the
optic a*is+, and in torts the
eyeball; $ocated in superior
orbital fssure
( #rigeminal nerve
y and
-eceives sensation from the face
and innervates the muscles of
mastication; $ocated in superior
orbital fssure )ophthalmic
nerve . (
+, foramen
rotundum )ma*illary nerve . (
and foramen ovale )mandibular
nerve . (
(I 'bducent nerve
of !ons
Innervates the lateral rectus,
which abducts the eye; $ocated
in superior orbital fssure
(II 0acial nerve ,oth
y and
!ons !rovides motor innervation to
the muscles of facial e*pression,
posterior belly of the digastric
muscle, and stapedius muscle,
receives the special sense of
taste from the anterior 21/ of the
tongue, and
providessecretomotor innervatio
n to the salivary glands )e*cept
parotid+ and the lacrimal gland;
nerve )or auditory
nerveor statoacou
stic nerve+
"enses sound, rotation and
gravity )essential for balance 2
movement+. %ore specifcally.
the vestibular branch carries
impulses for e&uilibrium and the
cochlear branch carries impulses
for hearing.;
y and
-eceives taste from the
posterior 11/ of the tongue,
provides secretomotor
innervation to the parotid gland,
caries information from
baroreceptors and
3 (agus nerve
y and
innervation to most laryngeal
and all pharyngeal muscles
)e*cept provides
parasympathetic fbers to nearly
all thoracic and abdominal
viscera down to the splenic
6e*ure; and receives the special
sense of taste from the
epiglottis. ' ma7or function8
controls muscles for voice and
resonance and the soft palate.
"ymptoms of
damage8dysphagia )swallowing
nerve)or cranial
nerveor spinal
accessory nerve+
Controls sternocleidomastoid
and trape9ius muscles,
3II :ypoglossal nerve %ainly %edulla !rovides motor innervation to
%otor the muscles of the tongue
Spinal nerves& (-' pairs)
Carry nerve impulses to and from the spinal cord to body parts not served by the
cranial nerves.
Cervical )7pairs
Thoracic ', pairs
6umbar 8 pairs
Sacral 8 pairs
Coccygeal ' pair
Spinal nerves initially arise from the spinal cord as rootlets( the rootlets converge
to form two nerve roots&
'. !n anterior (ventral) nerve root# consisting of motor (efferent) bers passing
from nerve cell bodies in the anterior horn of spinal cord gray matter to effector
organs located peripherally.
,.! posterior (dorsal) nerve root# consisting of sensory(afferent) bers from cell
bodies in the spinal sensory or posterior (dorsal) root ganglion that e"tend
peripherally to sensory endings and centrally to the posterior horn of spinal cord
gray matter. The posterior and anterior nerve roots unite# within or 9ust pro"imal to
the intervertebral foramen# to form a mi"ed (both motor and sensory) spinal nerve#
which immediately divides into two rami (6.# branches)& a posterior (dorsal) ramus
and an anterior (ventral) ramus. !s branches of the mi"ed spinal nerve# the
posterior and anterior rami carry both motor and sensory fibers# as do all their
subse:uent branches. The terms motor nerve and sensory nerve are almost always
relative terms# referring to the ma9ority of ber types conveyed by that nerve.
Nerves supplying muscles of the trun% or limbs (motor nerves) also contain
about;<= sensory fibers# which convey pain and proprioceptive information.
Conversely# cutaneous (sensory) nerves contain motor bers# which serve sweat
glands and the smooth muscle of blood vessels and hair follicles. The unilateral
area of s%in innervated by the sensory bers of a single spinal nerve is called a
"era#oe( the unilateral muscle mass receiving innervation from the bers
conveyed by a single spinal nerve is a $o#oe.
>rom clinical studies of lesions of the posterior roots or spinal nerves# dermatome
maps have been devised to indicate the typical pattern of innervation of the s%in by
specic spinal nerves. ?owever# a lesion of a single posterior root or spinal nerve
would rarely result in numbness over the area demarcated for that nerve in these
maps because the bers conveyed by ad9acent spinal nerves overlap almost
completely as they are distributed to the s%in# providing a type of double coverage.
The lines indicating dermatomes on dermatome maps would thus be better
represented by smudges or gradations of color. @enerally# at least two ad9acent
spinal nerves (or posterior roots) must be interrupted to produce a discernible area
of numbness.
!s they emerge from the intervertebral foramina# spinal nerves are divided into
two rami&
Posterior (primary) rami of spinal nerves supply nerve bers to the synovial 9oints
of the vertebral column# deep muscles of the bac%# and the overlying s%in in a
segmental pattern. !s a general rule# the posterior rami remain separate from each
other (do not merge to form ma9or somatic nerve ple"uses).
!nterior (primary) rami of spinal nerves supply nerve bers to the much larger
remaining area# consisting of the anterior and lateral regions of the trun% and the
upper and lower limbs. The anterior rami that are distributed e"clusively to the
trun% generally remain separate from each other# also innervating muscles and s%in
in a segmental pattern. ?owever# primarily in relationship to the innervation of the
limbs# the ma9ority of anterior rami merge with one or more ad9acent anterior rami#
forming the ma9or somatic nerve ple"uses (networ%s) in which their bers
intermingle and from which a new set of multi segmental peripheral nerves
emerges. The anterior rami of spinal nerves participating in ple"us formation
contribute bers to multiple peripheral nerves arising from the ple"us( conversely#
most peripheral nerves arising from the ple"us contain bers from multiple spinal
nerves. !lthough the spinal nerves lose their identity as they split and merge in the
ple"us# the bers arising from a specic spinal cord segment and conveyed from it
by a single spinal nerve are ultimately distributed to one segmental dermatome#
although they may reach it by means of a multi segmental peripheral nerve arising
from the ple"us that also conveys bers to all or parts of other ad9acent
dermatomes. $t is therefore important to distinguish between the distribution of the
bers carried by spinal nerves (segmental innervation or distribution) i.e.#
dermatomes and myotomes labeled with a letter and a number# such as T;) and of
the fibers carried by branches of a ple"us (peripheral nerve innervation or
distribution# labeled with the names of peripheral nerves# such as /the median
nerve0). *apping segmental innervation (dermatomes# determined by clinical
e"perience) and mapping the distribution of peripheral nerves (determined by
dissecting the branches of a named nerve distally) produce entirely different maps#
e"cept for most of the trun% where# in the absence of ple"us formation# segmental
and peripheral distributions are the same. The over lapping in the cutaneous
distribution of nerve bers conveyed by ad9acent spinal nerves also occurs in the
cutaneous distribution of nerve bers conveyed by ad9acent peripheral nerves.
%ranial Nerves
!s they arise from the CNS# some cranial nerves convey only sensory bers# some
only motor bers# and some carry a mi"ture of both types of bers.
The types of bers conveyed by cranial or spinal nerves are as follows
Soa#ic ()ers
General sensory bers (general somatic afferent A@S!B bers) transmit
sensations from the body to the CNS( they may be e"teroceptive sensations
from the s%in pain# temperature# touch# and pressure) or pain and
proprioceptive sensations from muscles# tendons# and 9oints. Proprioceptive
sensations are usually subconscious# pro)viding information regarding 9oint
position and the tension of tendons and muscles. This information is
combined with input from the vestibular apparatus of the internal ear#
resulting in awareness of the orientation of the body and limbs in space#
independent of visual input.
Somatic motor bers (general somatic efferent A@S+B bers) transmit
impulses to s%eletal (voluntary) muscles.
Visceral ()ers5
2isceral sensory bers (general visceral afferent A@2!B bers) transmit pain or
subconscious visceral reCe" sensations (information concerning distension# blood
gas# and blood pressure levels# for e"ample) from hollow organs and blood vessels
to the CNS.
2isceral motor bers (general visceral efferent A@2+B bers) transmit impulses to
smooth (involuntary) muscle and glandular tissues. Two varieties of bers#
presynaptic and postsynaptic# wor% together to conduct impulses from the CNS to
smooth muscle or glands. Doth types of sensory bersEvisceral sensory and
general sensoryEare processes of pseudounipolar neurons with cell bodies located
outside of the CNS in spinal or cranial sensory ganglia. The motor bers of nerves
are a"ons of multipolar neurons. The cell bodies of somatic motor and presynaptic
visceral motor neurons are located in the gray matter of the spinal cord. Cell bodies
of post)synaptic motor neurons are located outside the CNS in autonomic ganglia.
$n addition to the ber types listed above# some cranial nerves also convey special
sensory bers for the special senses (smell# sight# hearing# balance# and taste).
Nerve &e*enera#ion an" Isc+eia o, Nerves
;eurons do not proliferate in the adult nervous system. #herefore,
neurons destroyed through disease or trauma are not replaced.
<hen nerves are stretched, crushed, or severed, their a*ons
degenerate mainly distal to the lesion because they depend on
their nerve cell bodies for survival. If the a*ons are damaged but
the cell bodies are intact, regeneration and return of function may
occur. #he chance of survival is best when a nerve is compressed.
!ressure on a nerve commonly causes paresthesia, thepins.and.
needles sensation that occurs when one sits too long with the legs
crossed, for e*ample. ' crushing nerve in7ury damages or =ills the
a*ons distal to the in7ury site; however, the nerve cell bodies
usually survive, and the nerve5s connective tissue coverings
remain intact. ;o surgical repair is needed for this type of nerve
in7ury because the intact connective tissue coverings guide the
growing a*ons to their destinations. -egeneration is less li=ely to
occur in a severed nerve. "prouting occurs at the pro*imal ends of
the a*ons, but the growing a*ons may not reach their distal
targets. ' cutting nerve in7ury re&uires surgical intervention
because regeneration of the a*on re&uires apposition of the cut
ends by sutures through the epineurium. #he individual nerve
bundles are realigned as accurately as possible.
'nterograde degeneration is the degeneration of a*ons detached
from their cell bodies. #he degenerative process involves the a*on
and its myelin sheath, even though this sheath is not part of the
in7ured neuron. Compromising a nerve5s blood supply for a long
period by compression of the vasa nervorum can also cause nerve
degeneration. !rolonged ischemia )inade&uate blood supply+ of a
nerve may result in damage no less severe than that produced by
crushing or even cutting the nerve. #he "aturday night syndrome,
named after an into*icated individual who >passes out? with a
limb dangling across the arm of a chair or the edge of a bed, is an
e*ample of a more serious, often permanent, paresthesia. #his
condition can also result from the sustained use of a tourni&uet
during a surgical procedure. If the ischemia is not too prolonged,
temporary numbness or paresthesia results.
#ransient paresthesias are familiar to anyone who has had an
in7ection of anesthetic for dental repairs.