19 Nervous System

Midbrain

One of the original regions of the embryonic brain, the midbrain is a small region between the thalamus and pons. It is separated into the tectum and tegmentum, from the Latin words for roof and floor, respectively. The cerebral aqueduct passes through the center of the midbrain, such that these regions are the roof and floor of that canal.

Pons

The word pons comes from the Latin word for bridge. It is visible on the anterior surface of the brain stem as the thick bundle of white matter attached to the cerebellum. The pons is the main connection between the cerebellum and the brain stem. The bridge-like white matter is only the anterior surface of the pons; the gray matter beneath that is a continuation of the tegmentum from the midbrain. Gray matter in the tegmentum region of the pons contains neurons receiving descending input from the forebrain that is sent to the cerebellum.

Medulla

The medulla is the region known as the myelencephalon in the embryonic brain. The initial portion of the name, “myel,” refers to the significant white matter found in this region—especially on its exterior, which is continuous with the white matter of the spinal cord. The tegmentum of the midbrain and pons continues into the medulla because this gray matter is responsible for processing cranial nerve information. A diffuse region of gray matter throughout the brain stem, known as the reticular formation, is related to sleep and wakefulness, such as general brain activity and attention.

As you learned in the first section, the main part of a neuron is the cell body, which is also known as the soma (soma = “body”). The cell body contains the nucleus and most of the major organelles. But what makes neurons special is that they have many extensions of their cell membranes, which are generally referred to as processes. Neurons are usually described as having one, and only one, axon—a fiber that emerges from the cell body and projects to target cells. That single axon can branch repeatedly to communicate with many target cells. It is the axon that propagates the nerve impulse, which is communicated to one or more cells. The other processes of the neuron are dendrites, which receive information from other neurons at specialized areas of contact called synapses. The dendrites are usually highly branched processes, providing locations for other neurons to communicate with the cell body. Information flows through a neuron from the dendrites, across the cell body, and down the axon. This gives the neuron a polarity—meaning that information flows in this one direction. Figure 19.8 shows the relationship of these parts to one another.

Where the axon emerges from the cell body, there is a special region referred to as the axon hillock. This is a tapering of the cell body toward the axon fiber. Within the axon hillock, the cytoplasm changes to a solution of limited components called axoplasm. Because the axon hillock represents the beginning of the axon, it is also referred to as the initial segment.

Many axons are wrapped by an insulating substance called myelin, which is actually made from glial cells. Myelin acts as insulation much like the plastic or rubber that is used to insulate electrical wires. A key difference between myelin and the insulation on a wire is that there are gaps in the myelin covering of an axon. Each gap is called a node of Ranvier and is important to the way that electrical signals travel down the axon. The length of the axon between each gap, which is wrapped in myelin, is referred to as an axon segment. At the end of the axon is the axon terminal, where there are usually several branches extending toward the target cell, each of which ends in an enlargement called a synaptic end bulb. These bulbs are what make the connection with the target cell at the synapse.

Types of Neurons

There are many neurons in the nervous system—a number in the trillions. And there are many different types of neurons. They can be classified by many different criteria. The first way to classify them is by the number of processes attached to the cell body. Using the standard model of neurons, one of these processes is the axon, and the rest are dendrites. Because information flows through the neuron from dendrites or cell bodies toward the axon, these names are based on the neuron’s polarity (see Figure 19.9).

Unipolar cells have only one process emerging from the cell. True unipolar cells are only found in invertebrate animals, so the unipolar cells in humans are more appropriately called “pseudo-unipolar” cells. Invertebrate unipolar cells do not have dendrites.

Bipolar cells have two processes, which extend from each end of the cell body, opposite to each other. One is the axon and one the dendrite. Bipolar cells are not very common. They are found mainly in the olfactory epithelium (where smell stimuli are sensed), and as part of the retina.

Multipolar neurons are all of the neurons that are not unipolar or bipolar. They have one axon and two or more dendrites (usually many more). With the exception of the unipolar sensory ganglion cells, and the two specific bipolar cells mentioned above, all other neurons are multipolar.

Neurons can also be classified on the basis of where they are found, who found them, what they do, or even what chemicals they use to communicate with each other. Some neurons referred to in this section on the nervous system are named on the basis of those sorts of classifications (see Figure 19.10). For example, a multipolar neuron that has a very important role to play in a part of the brain called the cerebellum is known as a Purkinje (commonly pronounced per-KIN-gee) cell. It is named after the anatomist who discovered it (Jan Evangilista Purkinje, 1787–1869).

Glial Cells

One cell providing support to neurons of the CNS is the astrocyte, so named because it appears to be star-shaped under the microscope (astro- = “star”). Astrocytes have many processes extending from their main cell body (not axons or dendrites like neurons, just cell extensions). Those processes extend to interact with neurons, blood vessels, or the connective tissue covering the CNS that is called the pia mater (see Figure 19.11). Generally, they are supporting cells for the neurons in the central nervous system. Some ways in which they support neurons in the central nervous system are by maintaining the concentration of chemicals in the extracellular space, removing excess signaling molecules, reacting to tissue damage, and contributing to the blood-brain barrier (BBB). The blood-brain barrier is a physiological barrier that keeps many substances that circulate in the rest of the body from getting into the central nervous system, restricting what can cross from circulating blood into the CNS. Nutrient molecules, such as glucose or amino acids, can pass through the BBB, but other molecules cannot. This actually causes problems with drug delivery to the CNS. Pharmaceutical companies are challenged to design drugs that can cross the BBB as well as have an effect on the nervous system.

Like a few other parts of the body, the brain has a privileged blood supply. Very little can pass through by diffusion. Most substances that cross the wall of a blood vessel into the CNS must do so through an active transport process. Because of this, only specific types of molecules can enter the CNS. Glucose—the primary energy source—is allowed, as are amino acids. Water and some other small particles, like gases and ions, can enter. But most everything else cannot, including white blood cells, which are one of the body’s main lines of defense. While this barrier protects the CNS from exposure to toxic or pathogenic substances, it also keeps out the cells that could protect the brain and spinal cord from disease and damage. The BBB also makes it harder for pharmaceuticals to be developed that can affect the nervous system. Aside from finding efficacious substances, the means of delivery is also crucial.

Oligodendrocyte, sometimes called just “oligo,” which is the glial cell type that insulates axons in the CNS. The name means “cell of a few branches” (oligo- = “few”; dendro- = “branches”; -cyte = “cell”). There are a few processes that extend from the cell body. Each one reaches out and surrounds an axon to insulate it in myelin.

Microglia are, as the name implies, smaller than most of the other glial cells. Ongoing research into these cells, although not entirely conclusive, suggests that they may originate as white blood cells, called macrophages, that become part of the CNS during early development. While their origin is not conclusively determined, their function is related to what macrophages do in the rest of the body. When macrophages encounter diseased or damaged cells in the rest of the body, they ingest and digest those cells or the pathogens that cause disease. Microglia are the cells in the CNS that can do this in normal, healthy tissue, and they are therefore also referred to as CNS-resident macrophages.

The ependymal cell is a glial cell that filters blood to make cerebrospinal fluid (CSF), the fluid that circulates through the CNS. Because of the privileged blood supply inherent in the BBB, the extracellular space in nervous tissue does not easily exchange components with the blood. Ependymal cells line each ventricle, one of four central cavities that are remnants of the hollow center of the neural tube formed during the embryonic development of the brain. They also have cilia on their apical surface to help move the CSF through the ventricular space. The relationship of these glial cells to the structure of the CNS is seen in Figure 19.11.

Glial Cells of the PNS

One of the two types of glial cells found in the PNS is the satellite cell. Satellite cells are found in sensory and autonomic ganglia, where they surround the cell bodies of neurons. This accounts for the name, based on their appearance under the microscope. They provide support, performing similar functions in the periphery as astrocytes do in the CNS—except, of course, for establishing the BBB.

The second type of glial cell is the Schwann cell, which insulate axons with myelin in the periphery. Schwann cells are different than oligodendrocytes, in that a Schwann cell wraps around a portion of only one axon segment and no others. Oligodendrocytes have processes that reach out to multiple axon segments, whereas the entire Schwann cell surrounds just one axon segment. The nucleus and cytoplasm of the Schwann cell are on the edge of the myelin sheath. The relationship of these two types of glial cells to ganglia and nerves in the PNS is seen in Figure 19.12.

Myelin

The appearance of the myelin sheath can be thought of as similar to the pastry wrapped around a hot dog for “pigs in a blanket” or a similar food. The glial cell is wrapped around the axon several times with little to no cytoplasm between the glial cell layers. For oligodendrocytes, the rest of the cell is separate from the myelin sheath as a cell process extends back toward the cell body. A few other processes provide the same insulation for other axon segments in the area. For Schwann cells, the outermost layer of the cell membrane contains cytoplasm and the nucleus of the cell as a bulge on one side of the myelin sheath. During development, the glial cell is loosely or incompletely wrapped around the axon. The edges of this loose enclosure extend toward each other, and one end tucks under the other. The inner edge wraps around the axon, creating several layers, and the other edge closes around the outside so that the axon is completely enclosed.

Anatomy Labeling Activity

Physiology (Function) of the Nervous System

The nervous system is involved in receiving information about the environment around us (sensation) and generating responses to that information (motor responses). The nervous system can be divided into regions that are responsible for sensation (sensory functions) and for the response (motor functions). But there is a third function that needs to be included. Sensory input needs to be integrated with other sensations, as well as with memories, emotional state, or learning (cognition). Some regions of the nervous system are termed integration or association areas. The process of integration combines sensory perceptions and higher cognitive functions such as memories, learning, and emotion to produce a response.

Sensation

The first major function of the nervous system is sensation—receiving information about the environment to gain input about what is happening outside the body (or, sometimes, within the body). The sensory functions of the nervous system register the presence of a change from homeostasis or a particular event in the environment, known as a stimulus. The senses we think of most are the “big five”: taste, smell, touch, sight, and hearing. The stimuli for taste and smell are both chemical substances (molecules, compounds, ions, etc.), touch is physical or mechanical stimuli that interact with the skin, sight is light stimuli, and hearing is the perception of sound, which is a physical stimulus similar to some aspects of touch. There are actually more senses than just those, but that list represents the major senses. Those five are all senses that receive stimuli from the outside world, and of which there is conscious perception. Additional sensory stimuli might be from the internal environment (inside the body), such as the stretch of an organ wall or the concentration of certain ions in the blood.

Response

The nervous system produces a response on the basis of the stimuli perceived by sensory structures. An obvious response would be the movement of muscles, such as withdrawing a hand from a hot stove, but there are broader uses of the term. The nervous system can cause the contraction of all three types of muscle tissue. For example, skeletal muscle contracts to move the skeleton, cardiac muscle is influenced as heart rate increases during exercise, and smooth muscle contracts as the digestive system moves food along the digestive tract. Responses also include the neural control of glands in the body as well, such as the production and secretion of sweat by the eccrine and merocrine sweat glands found in the skin to lower body temperature.

Responses can be divided into those that are voluntary or conscious (contraction of skeletal muscle) and those that are involuntary (contraction of smooth muscles, regulation of cardiac muscle, activation of glands). Voluntary responses are governed by the somatic nervous system and involuntary responses are governed by the autonomic nervous system, which are discussed in the next section.

Integration

Stimuli that are received by sensory structures are communicated to the nervous system where that information is processed. This is called integration. Stimuli are compared with, or integrated with, other stimuli, memories of previous stimuli, or the state of a person at a particular time. This leads to the specific response that will be generated. Seeing a baseball pitched to a batter will not automatically cause the batter to swing. The trajectory of the ball and its speed will need to be considered. Maybe the count is three balls and one strike, and the batter wants to let this pitch go by in the hope of getting a walk to first base. Or maybe the batter’s team is so far ahead, it would be fun to just swing away.

Controlling the Body

The nervous system can be divided into two parts mostly on the basis of a functional difference in responses. The somatic nervous system (SNS) is responsible for conscious perception and voluntary motor responses. Voluntary motor response means the contraction of skeletal muscle, but those contractions are not always voluntary in the sense that you have to want to perform them. Some somatic motor responses are reflexes, and often happen without a conscious decision to perform them. If your friend jumps out from behind a corner and yells “Boo!” you will be startled and you might scream or leap back. You didn’t decide to do that, and you may not have wanted to give your friend a reason to laugh at your expense, but it is a reflex involving skeletal muscle contractions. Other motor responses become automatic (in other words, unconscious) as a person learns motor skills (referred to as “habit learning” or “procedural memory”).

The autonomic nervous system (ANS) is responsible for involuntary control of the body, usually for the sake of homeostasis (regulation of the internal environment). Sensory input for autonomic functions can be from sensory structures tuned to external or internal environmental stimuli. The motor output extends to smooth and cardiac muscle as well as glandular tissue. The role of the autonomic system is to regulate the organ systems of the body, which usually means to control homeostasis. Sweat glands, for example, are controlled by the autonomic system. When you are hot, sweating helps cool your body down. That is a homeostatic mechanism. But when you are nervous, you might start sweating also. That is not homeostatic, it is the physiological response to an emotional state.

There is another division of the nervous system that describes functional responses. The enteric nervous system (ENS) is responsible for controlling the smooth muscle and glandular tissue in your digestive system. It is a large part of the PNS, and is not dependent on the CNS. It is sometimes valid, however, to consider the enteric system to be a part of the autonomic system because the neural structures that make up the enteric system are a component of the autonomic output that regulates digestion. There are some differences between the two, but for our purposes here there will be a good bit of overlap. See Figure 19.13 for examples of where these divisions of the nervous system can be found.

Functions of the Cerebral Cortex

The cerebrum is the seat of many of the higher mental functions, such as memory and learning, language, and conscious perception, which are the subjects of subtests of the mental status exam. The cerebral cortex is the thin layer of gray matter on the outside of the cerebrum. It is approximately a millimeter thick in most regions and highly folded to fit within the limited space of the cranial vault. These higher functions are distributed across various regions of the cortex, and specific locations can be said to be responsible for particular functions. There is a limited set of regions, for example, that are involved in language function, and they can be subdivided on the basis of the particular part of language function that each governs.

Cognitive Abilities

Assessment of cerebral functions is directed at cognitive abilities. The abilities assessed through the mental status exam can be separated into four groups: orientation and memory, language and speech, sensorium, and judgment and abstract reasoning.

Orientation and Memory

Orientation is the patient’s awareness of his or her immediate circumstances. It is awareness of time, not in terms of the clock, but of the date and what is occurring around the patient. It is awareness of place, such that a patient should know where he or she is and why. It is also awareness of who the patient is—recognizing personal identity and being able to relate that to the examiner. The initial tests of orientation are based on the questions, “Do you know what the date is?” or “Do you know where you are?” or “What is your name?” Further understanding of a patient’s awareness of orientation can come from questions that address remote memory, such as “Who is the President of the United States?”, or asking what happened on a specific date.

Memory is largely a function of the temporal lobe, along with structures beneath the cerebral cortex such as the hippocampus and the amygdala. The storage of memory requires these structures of the medial temporal lobe. A famous case of a man who had both medial temporal lobes removed to treat intractable epilepsy provided insight into the relationship between the structures of the brain and the function of memory.

The prefrontal cortex can also be tested for the ability to organize information. In one subtest of the mental status exam called set generation, the patient is asked to generate a list of words that all start with the same letter, but not to include proper nouns or names. The expectation is that a person can generate such a list of at least 10 words within 1 minute. Many people can likely do this much more quickly, but the standard separates the accepted normal from those with compromised prefrontal cortices.

 

Read this article to learn about a young man who texts his fiancée in a panic as he finds that he is having trouble remembering things. At the hospital, a neurologist administers the mental status exam, which is mostly normal except for the three-word recall test. The young man could not recall them even 30 seconds after hearing them and repeating them back to the doctor. An undiscovered mass in the mediastinum region was found to be Hodgkin’s lymphoma, a type of cancer that affects the immune system and likely caused antibodies to attack the nervous system. The patient eventually regained his ability to remember, though the events in the hospital were always elusive. Considering that the effects on memory were temporary, but resulted in the loss of the specific events of the hospital stay, what regions of the brain were likely to have been affected by the antibodies and what type of memory does that represent?

Language and Speech

Language is, arguably, a very human aspect of neurological function. There are certainly strides being made in understanding communication in other species, but much of what makes the human experience seemingly unique is its basis in language. Any understanding of our species is necessarily reflective, as suggested by the question “What am I?” And the fundamental answer to this question is suggested by the famous quote by René Descartes: “Cogito Ergo Sum” (translated from Latin as “I think, therefore I am”). Formulating an understanding of yourself is largely describing who you are to yourself. It is a confusing topic to delve into, but language is certainly at the core of what it means to be self-aware.

The neurological exam has two specific subtests that address language. One measures the ability of the patient to understand language by asking them to follow a set of instructions to perform an action, such as “touch your right finger to your left elbow and then to your right knee.” Another subtest assesses the fluency and coherency of language by having the patient generate descriptions of objects or scenes depicted in drawings, and by reciting sentences or explaining a written passage.

An important example of multimodal integrative areas is associated with language function (see Figure 19.14). Adjacent to the auditory association cortex, at the end of the lateral sulcus just anterior to the visual cortex, is Wernicke’s area. In the lateral aspect of the frontal lobe, just anterior to the region of the motor cortex associated with the head and neck, is Broca’s area. Both regions were originally described on the basis of losses of speech and language, which is called aphasia. The aphasia associated with Broca’s area is known as an expressive aphasia, which means that speech production is compromised. This type of aphasia is often described as non-fluency because the ability to say some words leads to broken or halting speech. Grammar can also appear to be lost. The aphasia associated with Wernicke’s area is known as a receptive aphasia, which is not a loss of speech production, but a loss of understanding of content. Patients, after recovering from acute forms of this aphasia, report not being able to understand what is said to them or what they are saying themselves, but they often cannot keep from talking.

The two regions are connected by white matter tracts that run between the posterior temporal lobe and the lateral aspect of the frontal lobe. Conduction aphasia associated with damage to this connection refers to the problem of connecting the understanding of language to the production of speech. This is a very rare condition, but is likely to present as an inability to faithfully repeat spoken language.

Sensorium

Those parts of the brain involved in the reception and interpretation of sensory stimuli are referred to collectively as the sensorium. The cerebral cortex has several regions that are necessary for sensory perception. Several of the subtests can reveal activity associated with these sensory modalities, such as being able to hear a question or see a picture. Two subtests assess specific functions of these cortical areas.

The first is praxis, a practical exercise in which the patient performs a task completely on the basis of verbal description without any demonstration from the examiner. The second subtest for sensory perception is gnosis, which involves two tasks. The first task, known as stereognosis, involves the naming of objects strictly on the basis of the somatosensory information that comes from manipulating them. The patient keeps their eyes closed and is given a common object, such as a coin, that they have to identify. The patient should be able to indicate the particular type of coin, such as a dime versus a penny, or a nickel versus a quarter, on the basis of the sensory cues involved. For example, the size, thickness, or weight of the coin may be an indication, or to differentiate the pairs of coins suggested here, the smooth or corrugated edge of the coin will correspond to the particular denomination. The second task, graphesthesia, is to recognize numbers or letters written on the palm of the hand with a dull pointer, such as a pen cap.

Judgment and Abstract Reasoning

Planning and producing responses requires an ability to make sense of the world around us. Making judgments and reasoning in the abstract are necessary to produce movements as part of larger responses. For example, when your alarm goes off, do you hit the snooze button or jump out of bed? Is 10 extra minutes in bed worth the extra rush to get ready for your day? Will hitting the snooze button multiple times lead to feeling more rested or result in a panic as you run late? How you mentally process these questions can affect your whole day.

The prefrontal cortex is responsible for the functions responsible for planning and making decisions. In the mental status exam, the subtest that assesses judgment and reasoning is directed at three aspects of frontal lobe function. First, the examiner asks questions about problem solving, such as “If you see a house on fire, what would you do?” The patient is also asked to interpret common proverbs, such as “Don’t look a gift horse in the mouth.” Additionally, pairs of words are compared for similarities, such as apple and orange, or lamp and cabinet.

Everyday Connections

Left Brain, Right Brain

Popular media often refer to right-brained and left-brained people, as if the brain were two independent halves that work differently for different people. This is a popular misinterpretation of an important neurological phenomenon. As an extreme measure to deal with a debilitating condition, the corpus callosum may be sectioned to overcome intractable epilepsy. When the connections between the two cerebral hemispheres are cut, interesting effects can be observed.

The reason for this is that the language functions of the cerebral cortex are localized to the left hemisphere in 95 percent of the population. Additionally, the left hemisphere is connected to the right side of the body through the corticospinal tract and the ascending tracts of the spinal cord. Motor commands from the precentral gyrus control the opposite side of the body, whereas sensory information processed by the postcentral gyrus is received from the opposite side of the body. For a verbal command to initiate movement of the right arm and hand, the left side of the brain needs to be connected by the corpus callosum. Language is processed in the left side of the brain and directly influences the left brain and right arm motor functions, but is sent to influence the right brain and left arm motor functions through the corpus callosum. Likewise, the left-handed sensory perception of what is in the left pocket travels across the corpus callosum from the right brain, so no verbal report on those contents would be possible if the hand happened to be in the pocket.

People who have had their corpus callosum cut can perform two independent tasks at the same time because the lines of communication between the right and left sides of his brain have been removed. Whereas a person with an intact corpus callosum cannot overcome the dominance of one hemisphere over the other, this patient can. If the left cerebral hemisphere is dominant in the majority of people, why would right-handedness be most common?

Common Nervous System Abbreviations

Disease and Disorders

Neurodegenerative Diseases – Alzheimer’s Disease, Parkinson’s Disease, Amyotrophic Lateral Sclerosis (ALS) , Multiple sclerosis (MS)

A class of disorders that affect the nervous system are the neurodegenerative diseases: Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis (ALS), Creutzfeld–Jacob disease, multiple sclerosis (MS), and other disorders that are the result of nervous tissue degeneration. In diseases like Alzheimer’s, Parkinson’s, or ALS, neurons die; in diseases like MS, myelin is affected. Some of these disorders affect motor function, and others present with dementia. Some are the result of genetics, such as Huntington’s disease, or the result of autoimmunity, such as MS; others are not entirely understood, such as Alzheimer’s and Parkinson’s diseases.

Several diseases can result from the demyelination of axons. The causes of these diseases are not the same; some have genetic causes, some are caused by pathogens, and others are the result of autoimmune disorders. Though the causes are varied, the results are largely similar. The myelin insulation of axons is compromised, making electrical signaling slower (Betts, et al., 2013).

Multiple sclerosis (MS) is one such disease. It is an example of an autoimmune disease. The antibodies produced by lymphocytes (a type of white blood cell) mark myelin as something that should not be in the body. This causes inflammation and the destruction of the myelin in the central nervous system. As the insulation around the axons is destroyed by the disease, scarring becomes obvious (Betts, et al., 2013).

Guillain-Barre (pronounced gee-YAN bah-RAY) syndrome is an example of a demyelinating disease of the peripheral nervous system. It is also the result of an autoimmune reaction, but the inflammation is in peripheral nerves. Sensory symptoms or motor deficits are common, and autonomic failures can lead to changes in the heart rhythm or a drop in blood pressure, especially when standing, which causes dizziness (Betts, et al., 2013).

Other Nerve Disorders

Infection, trauma, and congenital disorders can all lead to significant signs, as identified through the neurological exam. It is important to differentiate between an acute event, such as stroke, and a chronic or global condition such as blunt force trauma. Responses seen in the neurological exam can help. A loss of language function observed in all its aspects is more likely a global event as opposed to a discrete loss of one function, such as not being able to say certain types of words. A concern, however, is that a specific function—such as controlling the muscles of speech—may mask other language functions. The various subtests within the mental status exam can address these finer points and help clarify the underlying cause of the neurological loss (Betts, et al., 2013).

Damage to the nervous system can be limited to individual structures or can be distributed across broad areas of the brain and spinal cord. Localized, limited injury to the nervous system is most often the result of circulatory problems. The loss of blood flow to part of the brain is known as a stroke, or a cerebrovascular accident (CVA). There are two main types of stroke, depending on how the blood supply is compromised: ischemic and hemorrhagic. An ischemic stroke is the loss of blood flow to an area because vessels are blocked or narrowed. This is often caused by an embolus, which may be a blood clot or fat deposit. Ischemia may also be the result of thickening of the blood vessel wall, or a drop in blood volume in the brain known as hypovolemia. A hemorrhagic stroke is bleeding into the brain because of a damaged blood vessel. Accumulated blood fills a region of the cranial vault and presses against the tissue in the brain (see Figure 19.15) (Betts, et al., 2013).

Cerebral Palsy

Cerebral Palsy (CP) is caused by an interruption to the normal development of a person’s brain leading to weakness with muscles. Depending on the area of the brain that is affected, signs and symptoms will vary in the type and severity between individuals. Balance and coordination are often challenging due the inability to control muscles (Centers for Disease Control and Prevention, 2019, Ontario Federation for Cerebral Palsy, 2018). To learn more about cerebral palsy please visit the Centers for Disease Control and Prevention’s web page on cerebral palsy.

Traumatic Brain Injury (TBI)

According to the Minister of Health, approximately 20,000 people in Canada are hospitalized (each year) for traumatic brain injures. Brain injuries range from moderate to severe and include concussions. TBI can be caused by falls, automobile accidents, sports, assaults and strokes. Investment has been made to educate people on how to prevent TBIs with a focus on concussions from sports (Taylor, 2019).

Medical Terms in Context

Medical Specialties

Primary Specialist – Neurologist

Tensilon Test

This procedure can help a neurologist diagnose myasthenia gravis. In this test, the doctor injects with a medicine called Tensilon. Then they observe how it affects muscle movements (Bergen, 2018).  For more information visit Healthline’s Tensilon Test web page.

Electromyography (EMG)

An EMG measures electrical activity between your brain or spinal cord to a peripheral nerve. This nerve is found in your arms and legs, and is responsible for muscle control during times of movement and rest. EMGs can help your neurologist diagnose spinal cord disease as well as general muscle or nerve dysfunction (Moores & Cirino, 2018).

Electroencephalogram (EEG)

With electrodes applied to your scalp, an EEG measures electrical activity in the brain. It’s used to help diagnose conditions of the brain, including inflammation, tumors, and injuries, as well as seizures and psychiatric disorders.

Nervous System Vocabulary

Afferent nerves

Nerves that carry sensory signals (nerve impulses) toward the CNS from the periphery.

Aphasia

Loss of language function.

Arachnoid mater

Middle layer of the meninges named for the spider-web–like trabeculae that extend between it and the pia mater.

Astrocyte

Glial cell type of the CNS that provides support for neurons and maintains the blood-brain barrier.

Autonomic nervous system (ANS)

Functional division of the nervous system that is responsible for homeostatic reflexes that coordinate control of cardiac and smooth muscle, as well as glandular tissue.

Axon

Single process of the neuron that carries an electrical signal (action potential) away from the cell body toward a target cell.

Axon hillock

Tapering of the neuron cell body that gives rise to the axon.

Axon segment

Single stretch of the axon insulated by myelin and bounded by nodes of Ranvier at either end (except for the first, which is after the initial segment, and the last, which is followed by the axon terminal).

Axon terminal

End of the axon, where there are usually several branches extending toward the target cell.

Axoplasm

Cytoplasm of an axon, which is different in composition than the cytoplasm of the neuronal cell body.

Babinski Sign

Dorsiflexion of the foot with extension and splaying of the toes in response to the plantar reflex, normally suppressed by corticospinal input.

Bipolar

Shape of a neuron with two processes extending from the neuron cell body—the axon and one dendrite.

Blood-brain Barrier (BBB)

Physiological barrier between the circulatory system and the central nervous system that establishes a privileged blood supply, restricting the flow of substances into the CNS.

Brain

The large organ of the central nervous system composed of white and gray matter, contained within the cranium and continuous with the spinal cord.

Brain Stem

Region of the adult brain that includes the midbrain, pons, and medulla oblongata and develops from the mesencephalon, metencephalon, and myelencephalon of the embryonic brain.

Broca’s Area

Region of the frontal lobe associated with the motor commands necessary for speech production and located only in the cerebral hemisphere responsible for language production, which is the left side in approximately 95 percent of the population

Brodmann’s Areas

Mapping of regions of the cerebral cortex based on microscopic anatomy that relates specific areas to functional differences, as described by Brodmann in the early 1900s.

Cauda Equina

Bundle of spinal nerve roots that descend from the lower spinal cord below the first lumbar vertebra and lie within the vertebral cavity; has the appearance of a horse’s tail.

Caudate

Nucleus deep in the cerebrum that is part of the basal nuclei; along with the putamen, it is part of the striatum.

Central nervous system (CNS)

Anatomical division of the nervous system located within the cranial and vertebral cavities, namely the brain and spinal cord.

Central Sulcus

Surface landmark of the cerebral cortex that marks the boundary between the frontal and parietal lobes.

Cerebellum

Region of the adult brain connected primarily to the pons that developed from the metencephalon (along with the pons) and is largely responsible for comparing information from the cerebrum with sensory feedback from the periphery through the spinal cord.

Cerebral Cortex

Outer gray matter covering the forebrain, marked by wrinkles and folds known as gyri and sulci.

Cerebrum

Region of the adult brain that develops from the telencephalon and is responsible for higher neurological functions such as memory, emotion, and consciousness.

Cerebral Hemisphere

One half of the bilaterally symmetrical cerebrum.

Cerebrospinal Fluid (CSF)

Circulatory medium within the CNS that is produced by ependymal cells in the choroid plexus filtering the blood.

Choroid Plexus

Specialized structure containing ependymal cells that line blood capillaries and filter blood to produce CSF in the four ventricles of the brain.

Corpus callosum

Large white matter structure that connects the right and left cerebral hemispheres.

Dendrite

One of many branchlike processes that extends from the neuron cell body and functions as a contact for incoming signals (synapses) from other neurons or sensory cells.

Descending tract

Central nervous system fibers carrying motor commands from the brain to the spinal cord or periphery.

Diencephalon

Region of the adult brain that retains its name from embryonic development and includes the thalamus and hypothalamus.

Direct pathway

Connections within the basal nuclei from the striatum to the globus pallidus internal segment and substantia nigra pars reticulata that disinhibit the thalamus to increase cortical control of movement.

Dorsal (posterior) nerve root

Axons entering the posterior horn of the spinal cord.

Dura mater

Tough, fibrous, outer layer of the meninges that is attached to the inner surface of the cranium and vertebral column and surrounds the entire CNS.

Efferent nerves

Nerve tissue that carries impulses away from the CNS towards the peripheral that result in motor response (movement).

Embolus

Obstruction in a blood vessel such as a blood clot, fatty mass, air bubble, or other foreign matter that interrupts the flow of blood to an organ or some part of the body.

Enteric nervous system (ENS)

Neural tissue associated with the digestive system that is responsible for nervous control through autonomic connections.

Ependymal cell

Glial cell type in the CNS responsible for producing cerebrospinal fluid.

Epithalamus

Region of the diencephalon containing the pineal gland.

Fissures

A groove, natural division or elongated cleft, furrow or tear; naturally occurring in the brain, they are also known as sulcus/sulci.

Foramen magnum

Large opening in the occipital bone of the skull through which the spinal cord emerges and the vertebral arteries enter the cranium.

Frontal lobe

Region of the cerebral cortex directly beneath the frontal bone of the cranium.

Ganglion

Localized collection of neuron cell bodies in the peripheral nervous system.

Glial cell

One of the various types of neural tissue cells responsible for maintenance of the tissue, and largely responsible for supporting neurons.

Gray matter

Regions of the nervous system containing cell bodies of neurons with few or no myelinated axons; actually may be more pink or tan in color, but called gray in contrast to white matter.

Gyrus/gyri

Ridge formed by convolutions on the surface of the cerebrum or cerebellum.

Hemorrhagic stroke

Disruption of blood flow to the brain caused by bleeding within the cranial vault.

Hydrocephalus

An abnormal buildup of cerebrospinal fluid (CSF) in the ventricles of the brain.

Hypothalamus

Major region of the diencephalon that is responsible for coordinating autonomic and endocrine control of homeostasis.

Ischemic stroke

Disruption of blood flow to the brain because blood cannot flow through blood vessels as a result of a blockage or narrowing of the vessel.

Integration

Nervous system function that combines sensory perceptions and higher cognitive functions (memories, learning, emotion, etc.) to produce a response.

Initial segment

First part of the axon as it emerges from the axon hillock, where the electrical signals known as action potentials are generated.

Lumbar puncture

Procedure used to withdraw CSF from the lower lumbar region of the vertebral column that avoids the risk of damaging CNS tissue because the spinal cord ends at the upper lumbar vertebrae.

Medulla oblongata

The continuation of the spinal cord within the skull, forming the lowest part of the brainstem, contains the control centers for heart and lung nerve function.

Meninges

Protective outer coverings of the CNS composed of connective tissue.

Microglia

Glial cell type in the CNS that serves as the resident component of the immune system.

Midbrain

A portion of the brainstem, positioned above the pons, also called mesencephalon, assist in motor reflexes associated with visual and auditory stimuli.

Motor nerves

Peripheral, efferent, myelinated nerve tissue that stimulates muscle contraction.

Multipolar

Shape of a neuron that has multiple processes—the axon and two or more dendrites.

Myelin

Lipid-rich insulating substance surrounding the axons of many neurons, allowing for faster transmission of electrical signals.

Myelin sheath

Lipid-rich layer of insulation that surrounds an axon, formed by oligodendrocytes in the CNS and Schwann cells in the PNS; facilitates the transmission of electrical signals.

Nerve

Cord-like bundle of axons located in the peripheral nervous system that transmits sensory input and response output to and from the central nervous system.

Neuron

Neural tissue cell that is primarily responsible for generating and propagating electrical signals into, within, and out of the nervous system.

Neuroglia

Supportive tissue of the nervous system, including the network of branched cells in the central nervous system (astrocytes, microglia, and oligodendrocytes) and the supporting cells of the peripheral nervous system (Schwann cells and satellite cells), also called glia.

Neurotransmitter

Chemical that is released from a nerve cell, transmits an impulse from a nerve cell to another nerve, muscle, organ, or other tissue.

Node of Ranvier

Gap between two myelinated regions of an axon, allowing for strengthening of the electrical signal as it propagates down the axon.

Nucleus

In the nervous system, a localized collection of neuron cell bodies that are functionally related; a “center” of neural function.

Occipital lobe

Region of the cerebral cortex directly beneath the occipital bone of the cranium.

Olfaction

Special sense responsible for smell, which has a unique, direct connection to the cerebrum.

Oligodendrocyte

Glial cell type in the CNS that provides the myelin insulation for axons in tracts.

Paresis

Partial loss of, or impaired, voluntary muscle control.

Parietal lobe

Region of the cerebral cortex directly beneath the parietal bone of the cranium.

Peripheral nervous system (PNS)

Anatomical division of the nervous system that is largely outside the cranial and vertebral cavities, namely all parts except the brain and spinal cord.

Pia mater

Thin, innermost membrane of the meninges that directly covers the surface of the CNS.

Pons

Latin word meaning bridge, essential part of the brain located above the medulla, action in regulation and controls of vital functions primarily sleep, respiration, swallowing, bladder control, hearing, balance (equilibrium), taste, ocular movement, facial expression and sensation.

Process

In cells, an extension of a cell body; in the case of neurons, this includes the axon and dendrites.

Response

Nervous system function that causes a target tissue (muscle or gland) to produce an event as a consequence to stimuli.

Satellite cell

Glial cell type in the PNS that provides support for neurons in the ganglia.

Schwann cell

Glial cell type in the PNS that provides the myelin insulation for axons in nerves.

Sensation

Nervous system function that receives information from the environment and translates it into the electrical signals of nervous tissue.

Soma

In neurons, that portion of the cell that contains the nucleus; the cell body, as opposed to the cell processes (axons and dendrites).

Somatic nervous system (SNS)

Functional division of the nervous system that is concerned with conscious perception, voluntary movement, and skeletal muscle reflexes.

Spinal cord

Organ of the central nervous system found within the vertebral cavity and connected with the periphery through spinal nerves; mediates reflex behaviours.

Stimulus

An event in the external or internal environment that registers as activity in a sensory neuron.

Stroke

(also, cerebrovascular accident (CVA)) loss of neurological function caused by an interruption of blood flow to a region of the central nervous system.

Subarachnoid space

Space between the arachnoid mater and pia mater that contains CSF and the fibrous connections of the arachnoid trabeculae.

Sulcus/sulci

Groove formed by convolutions in the surface of the cerebral cortex; see fissure.

Synapse

Narrow junction across which a chemical signal passes from neuron to the next, initiating a new electrical signal in the target cell.

Synaptic end bulb

Swelling at the end of an axon where neurotransmitter molecules are released onto a target cell across a synapse.

Sympathetic nervous system (SNS)

Part of the nervous system that serves to accelerate heart rate, constrict blood vessels and raise blood pressure in response to stress.

Temporal lobe

Region of the cerebral cortex directly beneath the temporal bone of the cranium.

Thalamus

Major region of the diencephalon that is responsible for relaying information between the cerebrum and the hindbrain, spinal cord, and periphery.

Tract

Bundle of axons in the central nervous system having the same function and point of origin.

Transient ischemic attack (TIA)

Temporary disruption of blood flow to the brain in which symptoms occur rapidly but last only a short time.

Unipolar

Shape of a neuron which has only one process that includes both the axon and dendrite.

Ventricle

Central cavity within the brain where CSF is produced and circulates

Wernicke’s area

Region at the posterior end of the lateral sulcus in which speech comprehension is localized.

White matter

Regions of the nervous system containing mostly myelinated axons, making the tissue appear white because of the high lipid content of myelin.

References

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Centers for Disease Control and Prevention. (2018). Mental health. CDC. https://www.cdc.gov/mentalhealth/learn/index.htm

Centers for Disease Control and Prevention. (2019). TBI: Get the facts. CDC. https://www.cdc.gov/conjunctivitis/about/causes.html

Centers for Disease Control and Prevention. (2020). Cerebral palsy (CP). CDC. https://www.cdc.gov/conjunctivitis/about/causes.html

Cherney, K. & De Pietro, M. (2019). Neurologist. Healthline. https://www.healthline.com/find-care/articles/neurologists/neurologist

[CrashCourse]. (2015, Feburary 23). The nervous system, part 1: Crash course A&P #8 [Video]. YouTube. https://www.youtube.com/watch?v=qPix_X-9t7E

Merriam-Webster. (n.d.). Neurologist. In Merriam-Webster.com dictionary. https://www.merriam-webster.com/dictionary/neurologist

Moores, D., & Cirino, E. (2018). Electromyography (EMG). Healthline. https://www.healthline.com/health/electromyography

Unless otherwise indicated, this chapter contains material adapted from Anatomy and Physiology (on OpenStax), by Betts, et al. and is used under a a CC BY 4.0 international license. Download and access this book for free at https://openstax.org/books/anatomy-and-physiology/pages/1-introduction.