The Dr.

started the lecture by saying: that he gave us everything we have to know about the Central Nervous System (CNS) and it will take us month talking about the Physiology of it,,, blah blah blah !!! The last lecture we talked about the Central & peripheral Nervous System, (CNS): composed of the spinal cord & the brain, (PNS): composed of the afferent & efferent nerve fibers (neurons). Afferent nerve fibers (sensory): connected to two cranial sister which can divide and end in the (CNS). Efferent nerve fibers (motor): divided into: 1Somatic motor neurons, which control the voluntary movements (voluntary neurons). Enteric Nervous System (involuntary neurons). Enteric Nervous System is related to the GIT, it separates the activities of the GIT away of the CNS, and it is affected by sympathetic & parasympathetic innervations. We have to differentiate between neurons & neuroglia (Glial cells): *neurons will initiate and conduct impulses. *while glial cells will support the neurons physically & metabolically >>> (homeostatically). Neuroglia (glial cells) is divided into 4 types: 1Astrocytes.

2- Autonomic motor neurons, which are subdivided more to: Sympathetic, Parasympathetic,

2- Microglia. 3- Oligodendrocytes. 4- Ependymal cells. The exchange of materials (gases) and nutrients regarding the body (not in the brain), occurs between the capillaries & the interstitial space, and it occurs mainly through the pores between the cells of capillaries, meanwhile in the brain we have the Blood Brain Barrier (BBB), and the capillaries of the brain are anatomically preventive, and physiologically restrictive. Anatomically preventive: the Astrocytes forming tight junctions between the cells of the capillaries. Now the exchange of material (gases) & nutrients (in the capillaries) occurs all over the body down concentration gradient, from concentration to concentration, and this is easy because the cell membrane is composed of 1 layer. In the brain the situation is deferent, we have to protect the brain from the chemical fluctuations that occurs all over the body, which means if there is hyperkalemia in the blood it shouldnt affect the brain.

Thats why we have the Blood Brain Barrier (BBB) which act as protector to the brain. Now we have tight junctions between the cells of capillaries preventing the exchange of components (gases & nutrients) down concentration gradient, it is not easy for substances to cross this barrier (BBB) because of the tight junctions between the capillaries.

Hyperkalemia hyper- high; kalium, potassium; -emia, "in the blood") refers to the condition in which the + concentration of the electrolyte potassium (K ) in the blood is elevated. Extreme hyperkalemia is a medical emergency due to the risk of potentially fatal abnormal heart rhythms (arrhythmia). >> Wikipedia 6aal 3omrah :P

Now the Astrocytes which are the major part of the neuroglia (glial cells), are involved in the initiation of these tight junctions, and the establishment of specific channels and carriers for the transportation of highly selected needed materials for the brain. So the exchange in the brain is anatomically prevented because of the tight junctions (there are no pores), and physiologically restricted (it allow what is needed and dont allow unneeded materials). We have to imagine the brain anatomically, from bottom to the top it is composed of cerebral components. At the bottom we have the Brain Stem, and it is composed of: 1Medulla oblongata, 2- Pons, 3- Midbrain, three parts at the bottom.

Medulla oblongata which is the 1st part of the brain stem is continues with the spinal cord. Then we will have the Cerebellum ( ,)then the Forebrain which contains: 1Diencephalon, which are: a. b. a. b. Thalamus. Hypothalamus. Basal ganglia. Cerebral cortex.

2- Cerebrum, which is composed of:

So basically we have brain cells graded from below to the top, Brain Stem (a. medulla oblongata, b. pons, c. midbrain), Cerebellum, Diencephalon (a. thalamus, b. hypothalamus), and the Cerebrum (a. basal ganglia, b. cerebral cortex).

We have two head spheres (cerebral cortex), right one and left one, ( ,) they are connected via Corpus Callosum.

*Note: the more complex the stimuli (the input), the more # of interneurons are involved in the integration process. **For example: when you feel hot or cold, the thalamus will give you this information, it is hot or cold, but if you are interested in the details i.e. where this hotness or coldness came from (the source), more neurons will work (such as somatic sensory) in addition to the working one. So multi-neurons are cooperating in the integration of a single stimulus sometimes. **Another example: you saw a flower, so the visual area in your brain worked, you want to pick it, the motor area in the parietal lobe worked, you want to smell it, the olfactory nerve worked etc. Also in urinating, it is a rhythmic process, the center is in the spinal cord, and if you want to inhibit it you have to give superior orders which are from the Brain Cortex.

Now the Cerebral Cortex is composed of lobes: 1Frontal lobe.

2- Occipital lobe. 3- Temporal lobe. 4- Parietal lobe. Every lobe has its own specific function.

We have three functional areas in the Cortex: 1Sensory area: receives and interpret sensory impulses, located posterior to the Central Sulcus. 2- Motor area: control muscles movements, located anterior to the Central Sulcus. 3- Association area: integrate complex functions, like emotions, judging, memory etc. Central Sulcus: it is deep infolding (groove), located between parietal lobe & frontal lobe. Cortical areas of functional significance, and they are: 1-Primary motor area, which is located Pre-Central Gyrus in the frontal lobe, and it is responsible for voluntary contraction of specific skeletal muscles.

2-Premotor area (motor association area), which is located anteriorly to Primary motor area, and its function is to communicate with the Primary motor area and other regions of the brain, so it controls learned, complex and skilled movements. 3-Primary somatosensory area, which is located Post-Central Gyrus in the parietal lobe, and its responsible for: a. b. Proprioception: sensory impulses for the awareness of position. Nociception: sensory impulses for the awareness of mechanical, thermal, chemical changes (pain, pressure, temperature etc.). 4-Primary visual area: which is located in the occipital lobe, and it receives impulses from retina. 5-Primary auditory area: which is located in the superior portion of the temporal lobe, it receives impulses from inner ear, and interprets ( )the basic characteristics of sound. 6-Brocas area: which is located in the frontal lobe in one side only (usually left side dominant hemi-sphere), and it is responsible for speaking ability (production of speech). 7- Wernickes area: This is located in the temporal lobe, at the junction of the parietaltemporal & occipital lobes, and it is presented in one site only (usually left side dominant hemi-sphere), and it is responsible for language comprehension (understanding bot spoken & written speech).

Note: we have right and left hemi-spheres, if there is lesion in the somatosensory area at the right hemi-sphere, left side of the body will be affected, and vice versa (opposite sites will be affected), because there is a cross section ( )between the neurons at the corpus callosum, and as mentioned previously, it connects the two lobes.

Thalamus and hypothalamus :The Thalamus: - Two oval masses of gray matter which forms the wall of third ventricle. Function of the Thalamus: 1) It is a main relay station for all Sensory impulses on their way from the spinal cord to cerebellum and brain Stem to the cerebral cortex. 2) So the preliminary processing of all sensory inputs occurs in thalamus. Integration for the sub sensory input in the thalamus without the movement of the higher sensors. Hypothalamus is located inferiorly to the Thalamus Function of hypothalamus: A major regulator of homeostasis..

Homeostasis regulating induces Controls hormone secretion Controls body Temperature Effects autonomic nervous system a)Heart rate b) Blood pressure

Regulate food intake Emotion and behavior

Controls thirst and urine output

Wikipedia Says Along unmyelinated fibers, impulses move continuously as waves, but, in myelinated fibers, they hop or "propagate by saltation." Myelin increases electrical resistance across the cell membrane.

Two terms you must know: 1-Gray matter 2-White matter Gray matter is composed mainly of neuronal cell body and dendrites White matter is composed mainly of axons of the cell Axons are covered by Myelinated sheath which are composed mainly of lipids { Whitish color of the white matter due to the myelinated sheat lipids of the axons } *What is the function of myelin sheath ? And why gray matter is composed of unmyelinated but white matter is composed of myelinated cells ? it increases the conductance of action potential , prevents leakage of impulse ------------------------------------------------------------------------------------------------------------------------The Basal Ganglia consists from a collection of neurons within cerebral white matter, they are sub cortical masses *The Doctor emphasized many times that Basal ganglia is in the Whit matter.
Sub cortical means The portion of the brain immediately below the cerebral cortex

Basal ganglia composed of:a) Caudate nucleus b) Put amen c) globus pallid us d) substantial nigra e) Sub thalamic nucleus

Basal Ganglia's function: Functions: Inhibiting muscle tone throughout the body Helping monitor and coordinate slow, sustained contractions, especially those related to posture and support Selecting and maintaining purposeful motor activity while suppressing useless or unwanted patterns of movement Those patients who has basal ganglia disease (problems) Parkinson disease (Parkinsonism) when you Get old Parkinson Disease : Deficiency of dopamine, an important neurotransmitter in the basal nuclei Wikipedia Says: Parkinsonism is a disorder characterized by muscular rigidity, This
disorder is due to a lack of dopamine in the basal ganglia. This lack of dopamine causes neuronal discharge abnormalities within the motor circuit.

Signs and symptoms: Increased muscle tone, or rigidity Involuntary, useless, or unwanted movements, such as resting tremors (e.g., hands rhythmically shaking) Slowness in initiating and carrying out different motor behaviors E.g. when someone drinks a cup of tea, Parkinson's patient doesnt' know when to stop, he may reach his eyes instead his mouth { Timing } .

Diseases of brain Neurologic diseases and psychological diseases Related to neurons itself (nerve cell) or related to the neurotransmitters.. Any disturbances either Increase or decrease in the secretion of neurotransmitters in the brain will create a problem. Neurotransmitters are two kinds: 1) excitatory 2) Inhibitory neurotransmitters Over secretion of acetylcholine leads to Schizophrenia ()
Schizophrenia is an organic defect *Organic defect is the disturbance in the neurotransmitter release either decreasing or increasing. -Treatment of these disorders is very difficult, why? Because we cannot know the degree of the defect by ourselves.

Wikipedia Says: Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness, Genetics, early environment, neurobiology, and psychological and social processes appear to be important contributory factors.

Psychological disorder are divided into Neurosis and Psychosis We must differentiate between neurosis and psychosis?! $ Neurosis is ,depression )

mental disorders involving distress (Neurosis symptoms are stress , anxiety

Wikipedia Says A neurotic disorder can be any mental imbalance that causes or results in distress. In general, neurotic conditions do not impair or interfere with normal day to day functions, but rather create the very common symptoms of depression, anxiety, or stress. It is believed that most people suffer from some sort of neurosis as a part of human nature.
But psychosis is an Organic depression We must also differentiate between organic depression and active depression Organic depressions are Kinds of depressions that cannot be treated Such as Obsessive-

compulsive neurosis disorder.

Cerebellum: it is the underneath occipital lobe (located posteriorly), attached to the back of the upper portion of brain stem. The Cerebellum has two hemispheres

*Function: 1) Concerns in Subconscious control of motor activity includes a) maintaining body balance . b) Enhancing muscle tone . c) Coordinating skilled voluntary movements.

*such as dancing, not everyone can perform professional dance, or perform for example Boxing movements The cerebellum is responsible for learning these skills 2) Comparing between motor orders (intentions) of motor area with the performance of the muscle this means It corrects any error or deviation from the intended movement e.g. when you go up on stairs, if you do that in the wrong way, by not raising your leg as much as required for one step, the cerebellum corrects that to make you go up safely 3) The cerebellum can predict also the position of different parts of the body 4) It is also important to produce Smooth, precise movement and directs the movement.

The Cerebellum Damage Alaxia Hypotonia "Decrease in the muscle tone" "Not paralysis" Delay in initiation of voluntary Movement * clumsy movement * Dysmetra * Tremor "Intention tremor" Occurs during movement

* Poor balance * Imbalance when eye closed * nystagmus

*Cranial Nerves are very important to know, you must study (Slide 45) in the CNS Slides and this is the Slide about Cranial Nerves . The trigeminal nerve (V) is the most important Cranial nerves for us (Dentists) because it is related to maxillofacial Surgery and head and neck anatomy. "The Doctor said that we must only know the sensory and motor things for every Nerve, and he won't ask us in the exam about the origin of these nerves.

The peripheral nervous system composed of a) voluntary b) Involuntary The voluntary which is the somatic motor which innervates muscles Autonomic nervous system (ANS) is a part of the peripheral nervous system, which is composed of 1) Sympathetic nervous system: is responsible for up- and down-regulating many homeostatic mechanisms in living organisms, Stress. 2) Parasympathetic nervous system: is responsible for stimulation of "rest-and-digest" activities that occur when the body is at rest, including sexual arousal. 3) Enteric. Sympathetic N.S: Nerve fibers of this system originate in the thoracic and lumbar regions of the spinal cord. So it originates from T1 to L2 Parasympathetic N.S: Nerve fibers originate from brain through cranial nerves III, VII, IX and X and in the sacral region of the spinal cord. *The Autonomic pathway from the brain and spinal cord to different tissues (target organ consists of two nerve fibers) For example

adrenergic receptor Pre-ganglionic Ganglia Somatic Parasympathetic system target tissue Ganglia Sympathetic system Post-ganglionic

Gland Muscarinic receptor Brain spinal cord (CNS)

From the figure above we can figure out !! We must differentiate between the parasympathetic and sympathetic and somatic. In the sympathetic, we have ganglia, the Preganglionic fiber is short and the Postganglionic fiber is long. And there is the target tissue (which is either a blood vessel or muscle), and it is far from ganglia. -The neurotransmitter released in both preganglionic sympathetic and preganglionic parasympathetic nerve fibers is acetylcholine

-While the neurotransmitter released in the postganglionic sympathetic nerve fibers is Norepinephrine (Nor-adrenaline). *These Nerve fibers are called (Adrenergic Nerve fibers). -Neurotransmitter released in the postganglionic parasympathetic nerve fiber is Acetylcholine. *These Nerve fibers are called (Cholinergic Nerve fibers). In the parasympathetic, we have ganglia, the Preganglionic fiber is long and the Postgangilionic fiber is short. (Parasympathetic and Sympathetic are opposite in the length Pre & Post- ganglionic ) There is a Target cell, and it is near the ganglia In the Somatic, there is no space for ganglia.

Function of ANS: It regulates the involuntary activities (subconscious activities), these activities, we are unaware about them and are not under control like digestion, sweating, heart and circulatory regulation. -Most of visceral organs are supplied by both sympathetic and parasympathetic nerve fibers Such as : Organ Heart Airways GIT Eye Liver saliva Sympathetic Stimulation HR and force of contraction Dilatation Motility ,contraction of sphincters Pupil dilatation cylycogenolysis lipolysis Thick saliva containing mucus Parasympathetic Stimulation

Constriction Motility, relaxation of sphincters Constriction ************* Water saliva containing enzyme

These organs are stimulated by both Sympathetic and Parasympathetic Some organs are only stimulated by the sympathetic N.S such as sweat glands, kidneys, adrenal medulla. A basal activity exists in both systems

In certain conditions we need more activity of one system and decrease in the activity on the other. (Dominance of one system)

Parasympathetic

sympathetic

More

Sympathetic dominance in condition of stress. (Facing emergency or threat)

Parasympathetic dominance in quite, relaxed Conditions (non-threatening circumstances)

more

That's all for Today's lecture..

Done by: 1) Khalid.Z.Mortaja 2) Maher.M.Khatib

Edited by : hashim gazo .

Khalid: I dedicate this script to my brother, Salah Mortaja ,,, and Id like to thank him for helping me in several things including the Anatomy scripts ,,, and wish him a successful life. And I cant forget my brother from another mother :P ,,, Maher Khatib (Abo-Munir) ,,, yis3ad rabbak man ,,, law biddi a7o6 ma3na tanee la kilmit kafo walla 3eer a3ayyirha la abo al-khateeb. Maher:"Me myself dedicate this Script to My brother "Saed jarrar" and to thank him for helping me, not only in this script but in life also. And take the chance to tell him and to my friend Ihab abu il 7amam, And to a special person in my life that deserves all respect and love for standing beside me all the Time. And of course to My mate in this script and in everything , and like he said (my brother from another mother :P) Khalid Mortaja (Shanfiza ) abu il waleeeeeeeed !! And from me and Khalid to our beloved friends: Dirgham , Ahmad Hassan, Hashim, Akkad, Yahya, Wirrrrrrrrrrrrrrrr, Mo2nis, Yanal, Zezo , .. And Special thanks for Gayda'a Kana'an , Saved us with a better recorder .. Khalid: Finally, some sarcastic quotes Id like to share :P : Experience is a wonderful thing. It enables you to recognize a mistake when you make it again People say that laughter is the best medicine your face must be curing the world! Maher: All I can say That Details make difference,