Blood supply of CNS = Circle of Willis (major pathology = stroke)
CNS PNS
Components - Brain - Cranial nerves (emerge from brain) = 12 pairs
- Brainstem - Spinal nerves (emerge from spinal cord) = 31 pairs
- Spinal cord (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal)
Myelination of Oligodendrocytes Schwann cells
neurons
Bundle of axons Tracts innervate contralateral (most) Nerves innervate ipsilateral side DO NOT cross
or ipsilateral side may cross over over midline
midline
Cluster of cell bodies Nucleus Ganglia
Cervical spinal cord = 8 pairs of nerves
Thoracic spinal cord= 12 pairs of nerves
Lumbar spinal cord = 5 pairs of nerves @ level of Thoracic vertebrae
o Ends @ L1-2 therefore can perform Lumbar Puncture (remove CSF)
Sacral spinal cord = 5 pairs of nerves @ level of Lumbar 1-2 vertebrae
Cervical enlargement (upper extremities) + Lumbosacral enlargement (legs) = location of motor + sensory neuron
cell bodies + fibers (axons) for appendages
Inhibitory Neurotransmitters cause hyperpolarization = IPSP
GABA (brain + brainstem) binds GABA receptor allows Cl- to go through current (carried by ion + always
positive) = coming OUT
Glycine (spinal cord)
Excitatory Neurotransmitter cause depolarization = EPSP
Glutamate = #1 excitatory CNS neurotransmitter
MAJOR PARTS OF CNS
Brain
o Telencephalon = Cortex (3-6 layers) = CONSCIOUSNESS
o Diencephalon = Thalamus (superior) + Hypothalamus (inferior)
Left + right thalamus connected via Interthalamic adhesion
Brainstem
o Midbrain + Pons + Medulla
Spinal Cord
SENSORY (AFFERENT = coming in)
INVOLVES 3 SENSORY NEURONS
PNS: Pseudounipolar neuron (CB in PNS + axon termini in CNS) free nerve ending of pseudounipolar neuron
senses stimuli (P.I.T, fine touch, proprioception) + travels to CNS
CNS: Pseudounipolar neuron releases glutamate on neuron #2 glutamate binds + opens GluR neuron #2
releases glutamate on neuron #3 glutamate binds + opens GluR neuron #3 releases glutamate on sensory
cortex
MOTOR (EFFERENT = going out)
INVOLVES 2 MOTOR NEURONS (UMN + LMN)
SOMATIC Voluntary movement of skeletal muscle
o CNS (motor tracts): UMN (CB in cortex) releases glutamate on LMN glutamate binds + opens GluR on
LMN LMN travels to PNS
o PNS (motor nerves): LMN releases Ach on endplate of skeletal muscle binds + opens nAchR on endplate
of skeletal muscle EPP more Na+ enters via VNa+ AP muscle contraction
o 2 RECEPTORS NEEDED FOR MUSCLE CONTRACTION = nAchR and VNa+
AUTONOMIC Involuntary movement of smooth + cardiac muscle
o SYMPATHETIC
CNS: Hypothalamus releases glutamate on preganglionic neuron (CB in nuclei located in spinal
cord = T1-L3 = Thoracolumbar) glutamate binds + opens GluR on pre-ganglionic neuron
pre-ganglionic neuron travels to PNS
PNS: Pre-ganglionic neuron releases Ach + binds nAchR on post-ganglionic neuron post-
ganglionic neuron releases norepinephrine + binds adrenergic receptors on smooth + cardiac
muscle
o PARASYMPATHETIC
CNS: Hypothalamus releases glutamate on preganglionic neuron (CB in nuclei located in spinal
cord = S 2, 3, 4 = Craniosacral or brainstem CN 3, 7, 9, 10) glutamate binds + opens GluR on
pre-ganglionic neuron pre-ganglionic neuron travels to PNS
PNS: Pre-ganglionic neuron releases Ach + binds nAchR on post-ganglionic neuron post-
ganglionic neuron releases Ach + binds muscarinic receptors on smooth + cardiac muscle
ION CHANNELS
Leak Channels = open 24/7
o Ex’s = K+, Na+ (20:1)
o Resting Vm = 70 mV
Only K+ leak channels open Vm = -90 mV (EK of K+ = -90 mV)
Only Na+ leak channels open Vm = +60 mV (ENa of Na+ = +60 mV)
Equal # of K+ and Na+ leak channels Vm ~ 30 mV (anywhere between -90 mV and + 6- mV)
Gated Channels = closed 24/7
o (1) Voltage gated
Ex’s = VNa+, VK+
Located in the Nodes of Ranvier
o (2) Mechanical gated
o (3) Ligand gated
Located in dendrites + cell bodies = post-synaptic area integrate incoming info = summation of
EPSP’s + IPSP’s potentials travel passively via electrotonic conduction to axon hillock
(A) IONOTROPIC = FAST = DIRECT
nAchR = nicotinic cholinergic receptor
o Non-specific cation channel (both Na+ and K+ are equally permeability)
o Na+ enters, K+ exits EPP = depolarization on endplate (Vm = -20 mV)
o More Na+ enters than K+ exits because it has a greater driving pressure = Ohm’s
Law
o Current = movement of ions end plate current causes end plate potential
o Sarin gas keeps nAchR open membrane potential ~30 mV threshold for
nAchR = -50 mV do not reach threshold therefore NO MUSCLE CONTRACTION
GluR = major receptor for excitation
o (1) NMDA (N-methyl D-aspartate)
Ca2+ and Na+ enter, K+ exits EPSP
Contains Mg2+ in middle of receptor
DOES NOT OPEN W/ GLUTAMATE ALONE NEEDS VOLTAGE
Dually gated = ligand + voltage gated
Voltage gated via AMPA voltage needed to pop out Mg2+
Ligand gated via glutamate
o (2) AMPA
Non-specific cation channel (both Na+ and K+ are equally permeability)
Na+ enters, K+ exits AMPA more Na+ enters vs. K+ exits due greater
driving pressure depolarization on dendrite = EPSP electrotonic
passive current travels to VNa+ AP
AP’s travelling from dendrites to axon hillock DECREMENT (get smaller)
because there is NO MYELINATION therefore current exits through leak
channels
o (3) Kanate
GABA channel
o Cl- enters IPSP
o Benzodiazepines + Barbituates keep channel open
(B) METABOTROPIC = SLOW = INDIRECT = G protein coupled receptors
DERMATOMES = SENSORY body map for sensation
MYOTOMES = MOTOR opposite of dermatomes
AXIAL/HORIZONTAL plane CORONAL plane SAGITTAL plane
BRAIN IMAGING
(1) Axial CT (Computerized Tomography) contains hyperdense bone = white*
(2) Coronal slice of brain post-mortem no bone
o White area = axons covered in oligodendrocytes
o Grey area = cell bodies = cortex (3-6 layers deep)
(3) Sagittal MRI bone = black*
o White area between bone + brain = bone marrow
o White area outside bone = scalp
SPINAL CORD SEGMENTS (31 segments 31 pairs of nerves exit)
ANTERIOR: cleavage contains ASCA (Anterior Spinal Cord Artery)
POSTERIOR: septum
White area = AXONS
o 3 columns:
Dorsal = SENSORY
Lateral = MOTOR
Anterior/ventral
Grey area = CELL BODIES
o 3 columns:
Dorsal/posterior horn = SENSORY
Ventral/Anterior horn = MOTOR
VERY TINY IN THORACIC SEGMENTS few thoracic muscles = few LMN CB’s in horn
Lateral horn = MOTOR + SENSORY
ONLY IN THORACIC SEGMENTS
Contains Intermediolateral cell column (IML cell column) SNS: T1-L3
Intermediate zone
SENSORY TRACTS (3 afferent neurons)
CB neuron #1 in Dorsal Root Ganglion (DRG)
CB neuron #2 in Dorsal Horn
CB neuron #3 in Ventral Posterior Lateral Nucleus (VPL) (in thalamus)
Axons in Dorsal Columns
PIMS = Posterior Intermediate Septum divides gracilus + cuneatus tracts @ T5-6
AP’s encoding VIBRATIONS + FINE TOUCH + PROPRIOCEPTION
TRACT GRACILUS (throughout spinal cord) OR TRACT CUNEATUS (ONLY in C1 T5-6)
Pacinian corpuscles sense vibrations APs travel down neuron # 1 = pseudounipolar neuron (CB in DRG)
pseudounipolar neuron (myelinated by schwann cells) goes through DRG into dorsal horn (neuron myelinated by
oligodendrocytes) where it diverges (splits) or collateralizes into: dorsal white (up) or ventral (down)
pseudounipolar neuron travels up dorsal column then synapses + releases glutamate onto neuron #2 (CB in
caudal medulla) neuron #2 crosses over midline to contralateral side in caudal medulla neuron #2 synapses
+ releases glutamate onto neuron #3 (CB in VPL) neuron #3 releases glutamate onto sensory cortex
AP’s encoding PAIN + ITCH + TEMPERATURE
Free nerve endings sense P.I.T APs travel down neuron #1 = pseudounipolar neuron (CB in DRG)
pseudounipolar neuron (myelinated by schwann cells) travels through DRG into dorsal horn (neuron myelinated
by oligodendrocytes) neuron #1 synapses + releases glutamate onto neuron #2 (CB in dorsal horn)
neuron #2 crosses over midline to contralateral side + runs through white matter in spinal cord neuron #2
synapses + releases glutamate onto neuron #3 (CB in VPL) neuron #3 releases glutamate onto sensory
cortex
MOTOR TRACTS (2 efferent neurons)
SOMATIC
CB of UMN in Motor Cortex
CB of LMN in Brainstem CBT
or
CB of LMN in Spinal Cord/Ventral Horn CST
Axons of LMN travel through Ventral root
AP’s encoding VOLUNTARY MOVEMENT OF SKELETAL MUSCLE
CORTICOBULBAR TRACT (CBT) or CORTICONUCLEAR TRACT (CNT)
UMN (CB in motor cortex) travels down to brainstem where it cross over + releases glutamate onto LMN = Facial
Nerve = CN 7 (CB in brainstem = Facial nucleus) glutamate binds + opens GluR = AMPA or Kanate LMN
travels to skeletal muscle where it synapses + releases Ach skeletal muscle = facial muscle (for facial expression)
CORTICOSPINAL TRACT (CST)
UMN (CB in motor cortex) travels through cerebral peduncle (bundle of motor axons) down to caudal medulla
where it crosses over (decussates) + continues down lateral white column to lumbosacral region where it
synapses + releases glutamate on LMN (CB in ventral horn of spinal cord) glutamate binds + opens GluR
LMN travels to skeletal muscle where it synapses + releases Ach skeletal muscle
C7 SPINAL CORD SEGMENT = myotome (motor) innervates hand muscle
UMN (CB in motor cortex) synapses + releases glutamate on LMN (CB in ventral horn of spinal cord)
glutamate binds + opens GluR LMN travels through ganglia in ventral root then innervates + releases Ach on
hand muscle
AUTONOMIC
SYMPATHETIC
Hypothalamus secretes glutamate on pre-ganglionic neuron CB
CB of sympathetic pre-ganglionic neuron in IML cell column (SNS) T1-L3 in Lateral horn
Axons of sympathetic pre-ganglionic neuron travel through Ventral root
CB of sympathetic post-ganglionic neuron in Autonomic ganglion
AP’s encoding INVOLUNTARY MOVEMENT OF SMOOTH + CARDIAC
HYPOTHALAMOSPINAL TRACT (HST)
Hypothalamus releases glutamate on sympathetic pre-ganglionic CBs in IML cell column (in lateral horn)
pre-ganglionic neuron goes through ventral root + synapses onto autonomic ganglia (in PNS) post-
ganglionic neuron releases NE + innervates smooth/cardiac muscle
Spinal cord segment Details
Cervical Gracilus + Cuneatus tracts
Thoracic (T1-6) Gracilus + Cuneatus tracts
Thoracic (T6-12) Gracilus tract
Tiny ventral horns
Lateral horn (w/ IML cell column)
Lumbar Gracilus tract
Sacral Gracilus tract
ANATOMIC VIEW pt. on their belly or anterior (head first)
CLINICAL VIEW pt. on their back or posterior (feet first)
SPINAL CORD
Dorsal = Sensory
Ventral = Motor
BRAINSTEM
Lateral = Sensory
Medial = Motor
MAIN COMPONENTS OF VENTRAL BRAINSTEM
(1) Arterial blood supply runs rostral
Medulla:
o Vertebral artery supplies O2 + glucose
o PICA (Posterior Inferior Cerebellar Artery) wraps around medulla supplies O2 + glucose LATERALLY
(loss of PICA would affect sensory nerves sensory CB’s = lateral)
o AICA (Anterior Inferior Cerebellar Artery)
o ASA (Anterior Spinal Artery)
Pons:
o Basilar artery
Midbrain:
o SCA (Superior Cerebellar Artery)
o PCA (Posterior Cerebral Artery)
o Pcomm (Posterior Communication Artery)
o MCA (Middle Cerebral Artery)
o ACA (Anterior Cerebral Artery)
o ICA (Internal Carotid Artery)
o Acomm (Anterior Communication Artery)
(2) Cranial nerves
Motor nerve CB’s = medial brainstem
Sensory nerve CB’s = lateral brainstem
CN 1 (Olfactory) SENSORY
CN 2 (Optic) SENSORY
CN 3 (Oculomotor) MIDBRAIN MOTOR - Pre-ganglionic parasympathetic
- Exits into PNS - Innervates skeletal muscles of eye (keeps eyelid open)
ventrally via
interpeduncular fossa
CN 4 (Trochlear) MIDBRAIN MOTOR - Innervates skeletal muscles of eye
- Only CN that exits
dorsally (*exception)
CN 5 (Trigeminal) PONS MIXED - Sensory P.I.T + vibration + proprioception in face = 1st
(mostly (corneal reflex)
sensory) - Motor muscles of mastication
- Helps annunciate words
CN 6 (Abducens) PONS MOTOR
CN 7 (Facial) PONS MIXED - Pre-ganglionic parasympathetic
- Exits near cerebellar (mostly - Motor facial muscles + corneal reflex = close eyelid = 2nd
pontine angle motor) (corneal reflex)
- Sensory taste
- Motors lips
- Facial expression
CN 8 PONS SENSORY - Innervates auditory canal
(Vestibulocochlear) - Exits near cerebellar Optic tract: Geniculate Pathway
pontine angle auditory info = frequency/sound CN 8 (PNS) + cell body
of neuron #1 in auditory ganglion (PNS) axon of neuron #1
travels up brainstem + releases glutamate in inferior colliculus
= nucleus which contains cell bodies of neuron #2 axon of
neuron #2 travels through brachium of inferior colliculus
releases glutamate in medial geniculate nucleus axons of
MGN go to + release glutamate in auditory cortex
Sensory info exiting inferior colliculus = efferent going
afferent to MGN via brachium
CN 9 MEDULLA - Pre-ganglionic parasympathetic
(Glossopharyngeal) - Exits via post-olivary
sulcus near cerebellar
pontine angle
CN 10 (Vagus) MEDULLA - Pre-ganglionic parasympathetic
- Exits via post-olivary
sulcus near cerebellar
pontine angle
CN 11 (Accessory) MEDULLA MOTOR
- Travels through
foramen magnum
back up through
jugular foramen
CN 12 MEDULLA MOTOR
(Hypoglossal)
Interpeduncular space/fossa = Cistern of CSF = Interpeduncular cistern
o Cistern of CSF in PNS in subarachnoid space (SAS)
o Ventricle of CSF in CNS
Pre-olivary sulcus (medial = motor) CN 12 exits = motor tongue
Post-olivary sulcus (lateral) CN 9 + 10 exit (autonomic, parasympathetic)
Junction between pons + medulla CN 6 + 7 + 8 exit myelinated by schwann cells #1 tumor in PNS =
VESTIBULAR SCHWANOMA grows in cerebellar pontine angle results in slow, ipsilateral hearing loss
