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Nervous system

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Introduction
The nervous system is the master controlling and
communicating system of the body.
Along with the endocrine system it is responsible for
regulating and maintaining body homeostasis.
The nervous system is composed basically of
specialized cells, whose function is to receive sensory
stimuli and to transmit them to effector organs,
whether muscular or glandular.
The nervous system has three overlapping functions
Gathering of sensory input
Integration or interpretation of sensory input
Causation of a response or motor output
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Organization
The nervous system is
divided into two main
parts, for purposes of
description:
The central nervous
system, which consists
of the brain and spinal
cord, and
The peripheral nervous
system, which consists
of the cranial and spinal
nerves and their
associated ganglia.
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Common terms related to Nervous system
Gray Matter - general term concentrations of nerve cell
bodies in CNS.
A nucleus - a definable group of cell bodies in the CNS.
Cerebral & Cerebellar cortices - layered arrangements
of cell bodies on the surface of the cerebrum and
cerebellum.
A ganglion - collection of cell bodies in the PNS.
White Matter is general term for collections of axons.
A tract is a bundle of axons that originates and
terminates within the CNS.
Decussations are axons that cross the midline to
terminate on the contralateral side.
Nerves are axons passing between the CNS and PNS.
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The central nervous system

is composed of large numbers
of excitable nerve cells and
their processes, called neurons
which are supported by
specialized tissue called
neuroglia.
The long processes of a nerve
cell are called axons or nerve
fibers.

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The interior of the central nervous system

is organized into gray and white matter.

Gray matter consists of nerve cells embedded in

neuroglia; it has a gray color.
White matter consists of nerve fibers embedded in
neuroglia; it has a white color due to the presence of
lipid material in the myelin sheaths of many of the nerve
fibers.

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Gross Appearance of the Spinal Cord

The spinal cord of adult humans extends from the
foramen magnum to the level of the first or second
lumbar vertebra.
Approximately 45 cm long in males and 42 cm in females,

It has a cylindrical shape in the upper cervical and

thoracic segments and
An oval shape in the lower cervical and lumbar
segments, which are sites of the brachial and
lumbosacral nerve plexuses, respectively.
Spinal cord ends lower border of L1 because since it
grows slower than the vertebral column
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at 3 months intrauterine life - at coccyx

At birth - at L3

During childhood - at the level of the intervertebral disc

between L1 and L2
But it does vary among people, ranging from T12 to the
superior margin of L3
The spinal cord is fusiformly enlarged; referred to as the
cervical and lumbar enlargements.
In the cervical region, where it gives origin to the brachial
plexus and lumbar regions, where it gives origin to the
lumbosacral plexus.
Inferiorly, the spinal cord tapers off into the conus
medullaris, from the apex of which a prolongation of the
pia mater, the filum terminale, descends to be attached to
the posterior surface of the coccyx.
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Below the site of spinal cord

termination (conus medullaris), a
sac filled with cerebrospinal fluid
and devoid of spinal cord forms
in the subarachnoid space.
This sac is a favorable site for
clinicians to introduce a special
spinal needle to obtain
cerebrospinal fluid for
examination or to inject drugs or
dyes into the subarachnoid space
for purposes of treatment or
diagnosis.
This procedure is called lumbar
puncture or spinal tap.
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This collection of nerve roots at the inferior end of the

vertebral canal is the cauda equina;horses tail).
The spinal cord is also anchored to the dura by two
lateral series of denticulate ligaments,
Denticulate ligaments serve as useful landmarks for the
neurosurgeon in identifying the anterolateral segment of
the cord when performing operations such as cor-
dotomies for the relief of intractable pain.
There are 20 or 21 pairs of denticulate ligaments
extending between the first lumbar and first cervical
vertebrae.

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The human spinal cord comprises 31 segments (8 cervical,

12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal),
Spinal nerves leave the vertebral canal through the
intervertebral foramina.
Each of which, except the first cervical segment, has a
pair of dorsal and ventral roots and a pair of spinal
nerves.
The first cervical segment has only a ventral root.
The dorsal and ventral roots join in the inter vertebral
foramina to form the spinal nerves.
Just proximal to its junction with the ventral root in the
inter vertebral foramen, each dorsal root has an oval
swelling: dorsal root ganglion containing
pseudounipolar sensory neurons.
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The first cervical nerve emerges above the atlas;

The eighth cervical nerve emerges between the seventh
cervical (C-7) and the first thoracic (T-1) vertebrae.
The fourth and fifth sacral nerves and the coccygeal
nerve arise from the conus medullaris.
The spinal cord segments are located superior to where
their corresponding spinal nerves emerge through the
intervertebral foramina.
This discrepancy is most pronounced in the lumbar and
sacral regions of the cord: The lumbar cord segment L1 is
located at vertebra T11, and the sacral cord segment S1 is
at vertebra L1.
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The level of spinal segments relative to the tip vertebrae

spine is clinically important.
In the cervical region the tip of the vertebral spine
corresponds to the next cord segment
at upper thoracic levels a tip of a vertebral spine
corresponds to the cord two segments lower
In the lower thoracic region there is a difference of three
segments
The 11th thoracic spine overlies the third lumbar
segment,

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DERMATOMES AND MYOTOMES

The area of skin supplied by a single posterior (dorsal)
nerve root constitutes a dermatome. Familiarity with
dermatomal maps is essential for localization of the level
of lesion in the spinal cord.
Groups of muscles innervated from a single spinal cord
segment constitute a myotome. Familiarity with clinically
relevant myo-tomes is useful in localization of the level of
lesion in the spinal cord.

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The Dura Mater

The spinal cord terminates at L-1 and L-2 vertebrae,
whereas the dura mater extends down to the level of the
S-1 and S-2 vertebrae.
The spinal dura is separated from the vertebral
periosteum by the epidural space.
The spinal epidural space contains adipose tissue and a
venous plexus and is largest at the level of the second
lumbar vertebra.
The spinal epidural space is used for injection of local
anesthetics to produce paravertebral nerve block known
as epidural anesthesia for relief of pain during obstetrical
delivery.
The epidural space is also used to inject drugs
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The Arachnoid Mater

lies just deep to the dura mater .the space between the
dura and arachnoid subdural space
Rupture of these veins results in accumulation of blood
a condition known as subdural hematoma.
The space between the arachnoid and pia (subarachnoid
space),
in contrast, is wider and contains the cerebrospinal fluid,
and it also contains the large blood vessels that supply
the neural tissue.

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The Pia Mater

The innermost layer, is a delicate connective tissue richly
vascularized with fine blood vessels.
Unlike the other meninges, it clings tightly to the surface
of the spinal cord.
As arteries enter the neural tissue, they carry ragged
sheaths of pia mater internally for short distances.
Inferiorly, the dura and arachnoid extend to the level of
S2.
The pia mater extends into the coccyx covering the filum
terminale.

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MENINGITIS
An inflammation of the meninges caused by a bacterial or
viral infection is called meningitis.
The infection can spread to the underlying nervous tissue
and cause brain inflammation, or encephalitis.
Meningitis is usually diagnosed by taking a sample of
cerebrospinal fluid from the subarachnoid space and
examining it for the presence of microbes.

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External features
2 deep grooves, the posterior median sulcus and the
anterior median fissure run the length of the cord and
divide it into right and left halves
31 pairs of spinal nerves (PNS) that arise from the spinal
cord by paired roots
Anterior root motor exit
Posterior root sensory entry
Exit from the vertebral column via the intervertebral
foramina

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Internal structure of the Spinal Cord

The spinal cord is composed of an inner core of gray
matter,
which is surrounded by an outer covering of white
matter.

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Gray Matter of the Spinal Cord

In cross section, the gray matter of the spinal cord is
shaped like the letter H.
The crossbar of the H is called the gray commissure and
is composed of unmyeliated axons that cross from one
side of the CNS to the other.
is a gray-colored zone that surrounds the hollow central
cavity of the CNS.
Within the gray commissure is the narrow central cavity
of the spinal cord the central canal.

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In the spinal cord it is a butterfly shaped region in which

the dorsal half contains cell bodies of interneurons and
the ventral half contains cell bodies of motor neurons .
The two posterior arms of the H are the dorsal
(posterior) horns, and the two anterior arms are the
ventral (anterior) horns.
Additionally, small lateral gray matter columns called
lateral hornsare present in the thoracic and superior
lumbar segments of the spinal cord.

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Nerve Cell Groups in the Anterior gray horn

Contains multipolar motor neurons, axons of which
constitute the major component of the ventral root.
Contain cell bodies of motor neurons whose axons run
out of the cord in ventral roots to supply muscles and
glands
Interneuron also occur in the anterior horns

The size is depend on skeletal musculature innervated;

largest in the cervical and lumbar regions of the cord,
which innervate the upper and lower limbs respectively
For practical purposes, the nerve cells of the anterior
gray column may be divided into three basic groups:
medial, central, and lateral.
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1. Medial group - is present in most segments of the spinal

cord and is responsible for innervating the skeletal
muscles of the neck and trunk, including the intercostal
and abdominal musculature.

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2. Central group is the smallest and is present in some

cervical and lumbosacral segments.
A. In the cervical part of the cord C3-5 diaphragm and
called phrenic nucleus
B. In the upper five or six cervical segments - trapezius,
sternocleidomastoid; accessory nucleus for spinal
root of accessory nerve
C. The lumbosacral nucleus present in the second
lumbar down to the first sacral segment of the cord is
made up of nerve cells whose axons have an
unknown distribution.

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3. Lateral group is present in the cervical and lumbosacral

segments of the cord and is responsible for innervating
the skeletal muscles of the limbs

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Nerve Cell Groups in the Posterior Gray Horn

receives axons of the dorsal root ganglia via the dorsal
roots and contains cell clusters concerned with sensory
function.
There are four nerve cell groups of the posterior gray
column:
Two that extend throughout the length of the cord and
two that are restricted to the thoracic and lumbar
segments.
1. The substantia gelatinosa
is situated at the apex of the posterior gray column
throughout the length of the spinal cord.
receives afferent fibers concerned with pain,
temperature, and touch from the posterior root.
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2. The nucleus proprius

is a group of large nerve cells situated anterior to
the substantia gelatinosa throughout the spinal
cord.
receives fibers that are associated with the senses
of position and movement (proprioception), two-
point discrimination, and vibration.
3. The nucleus dorsalis (Clarke's column)
is a group of nerve cells extending from the eighth
cervical segment caudally to the third or fourth
lumbar segment.
Most of the cells are comparatively large and are
associated with proprioceptive endings
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4. The visceral afferent nucleus

is a group of nerve cells of medium size situated lateral
to the nucleus dorsalis;
it extends from the first thoracic to the third lumbar
segment of the spinal cord.
It is believed to be associated with receiving visceral
afferent information.

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Nerve Cell Groups in the Lateral Gray horn

The intermediolateral group of cells form the small
lateral gray column, which extends from the first
thoracic to the second or third lumbar segment of
the spinal cord.
The cells are relatively small and give rise to
preganglionic sympathetic fibers.
A similar group of cells found in the second, third,
and fourth sacral segments of the spinal cord give
rise to preganglionic parasympathetic fibers.

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The Gray Commissure and Central Canal

o In the center of the gray commissure is situated the
central canal.
o The part of the gray commissure that is situated
posterior to the central canal is often referred to as the
posterior gray commissure;
o similarly, the part that lies anterior to the canal is called
the anterior gray commissure.
o The central canal is present throughout the spinal cord.
Superiorly, it is continuous with the central canal of the
caudal half of the medulla oblongata,

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The spinal gray matter can be further classified according

to the innervation of the somatic and visceral regions of
the body.
This scheme recognizes four zones of spinal cord gray
matter:
somatic sensory (SS)
visceral sensory (VS),
visceral motor (VM), and
somatic motor (SM).
These zones are equivalent to the functional divisions of
the PNS.

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white matter
which contains no neuron cell bodies but millions of
axons.
Composed of myelinated and unmyelinated axons,
neuroglia & blood vessels
Its white color comes from the myelin sheaths around
many of the axons.
Most of these axons either ascend from the spinal cord
to the brain or descend from the brain to the spinal cord,
Allowing these two regions of the CNS to communicate
with each other.

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These fibers are classified as being one of three types,

according to the direction in which they carry nerve
impulses:
1. Ascending - carry sensory information from the
sensory neurons of the body to the brain
2. Descending -carry motor instructions from the brain
to the spinal cord to muscles and glands
3. Commissural - cross from one side of the cord to the
other
NB: The ascending & descending tracts make up most of
the white matter of the spinal cord

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The white matter is divided into three white funiculi

Posterior funiculi - also called dorsal white column;
between posterior gray horn
Anterior funiculi -adjacent the anterior median fissure
Lateral funiculi between anterior and posterior grays
horn
Each of these funiculi contains one or more tracts or
fasciculi.
In general, the name of a tract denotes its origin and
destination; for example, the spino-cerebellar tract
connects the spinal cord and cerebellum and the
corticospinal tract connects the cerebral cortex and
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POSTERIOR FUNICULUS
Nerve fibers in this funiculus are concerned with two
general modalities related to conscious proprioception.
These are kinesthesia (sense of position and movement)
and discriminative touch (precise localization of touch,
including two-point discrimination).
Lesions of this funiculus therefore will be manifested
clinically as loss or diminution of the following sensations:
Position sense

Two-point discrimination

Touch

Form recognition

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LATERAL AND ANTERIOR FUNICULI

Whereas the posterior funiculus contains only one
ascending tract or fiber system (the posterior column
system), the lateral and anterior funiculi contain several
ascending and descending tracts.

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