MindMap Gallery Neuroscience Curriculum
This mind map, created using EdrawMind, outlines a 12-week neuroscience curriculum. It starts with advanced neurotransmission and ANS in Week 1, followed by neurodevelopment in Week 2. The subsequent weeks cover blood supply, the peripheral nervous system, cranial nerves, sensory pathways, processing, disorders, special senses (vision, hearing, vestibular structures), motor processing, pain, higher cerebral functions, and concludes with nerve injury, repair, and neurodegenerative disorders in Week 12. Additionally, it categorizes topics under pathways, Parkinson's, and Alzheimer's for focused study.
Edited at 2025-01-07 01:27:32NEURO
Week 1 - Advanced Neurotransmission / ANS
Week 2 - Neurodevelopment
Week 3 - Blood Supply
Week 4 - Peripheral Nervous System
Week 5 - Crainial Nerves
Week 6 - Sensory pathways, processing, & disorders
Week 7 - Special Senses – Vision
Week 8 - Special Senses – Hearing & Vestibular Structures
Week 9 - Motor Processing
Week 10 - Pain
Week 11 - Higher Cerebral Functions
Week 12 - Nerve Injury & Repair & Neurodegenerative Disorders
Alzeihmer's
Parkinson's
Pathways
Neuro Week 1
LO6 Describe the synthesis pathways and processes for enzymatic breakdown and/or uptake for the following neurotransmitters and neuromodulators
dopamine
synthesis pathways
DA synthesised from tyrosine → L-DOPA → dopamine
Rate limiting step is tyrosine hydroxylase
Action of DA is terminated by two mechanisms: ezymatic breakdown/reuptake
Reuptake via DAT
Enzymatic breakdown via MAO and COMT
5-HT
synthesis pathways
precurser is glutamine
Rate limiting step is glutaminase
ezymatic breakdown/reuptake
Reuptake occurs via SERT
Enzymatic breakdown via MAO
Glutamate
synthesis pathways
precursor Glutamine
glutaminase
ezymatic breakdown/reuptake
Reuptake into terminals via excitatory amino acid transporters (EAATs)
Taken up by glial cells and is converted into glutamine → glutamine is then transported out of the glial cells and into nerve terminals (glutamate-glutamine cycle)
GABA
synthesis pathways
precurser is glutamate
Rate limiting step is GAD
ezymatic breakdown/reuptake
Reuptake via GAT-1
Enzymatic breakdown by gamma-aminobutyric acid transaminase (GABA-T)
LO7 Outline the transmission process for:
Opiods - endorphins, enkephalin
Neuropeptides
Involved in pain control
There are 4 subtypes of opioids receptors (GPCRs) that are present in the CNS and in many peripheral tissues
μ receptors
κ receptors
δ receptos
NOP (ORL1 receptors)
Purines
Adenosine
Role
Acts more like a local hormone than a neurotransmitter
Main effects include vasodilation, bronchoconstriction and inhibition of cardiac conduction, inhibition of platelet aggregation, protection form ischemia
Synthesised from hydrolysis of ATP
Acts on GPCRs:
A1 receptors
A2 receptors
A3 receptors
ATP
Role
Involved in smooth muscle, pain and inflammation
Often co-released with noradrenaline in the ANS
Acts via:
P2x (ligand-gated ion channel)
P2y (GPCR)
Nitric oxide
Recently shown to be an important mediator in the PNS and CNS
Synthesised from L-arginine by the enzyme nitric oxide synthase (NOS)
Does not act at a receptor:
Directly activated second messenger guanylate cyclase to produced cGMP
LO8 For each of the above neurotransmitters and neuromodulators, name the receptor subtypes, indicate their functional type, and identify the synaptic responses they mediate
dopamine
receptor subtypes
Major neurotransmitter in the CNS acting at GPCRs:
D1 – D5 receptors
synaptic responses they mediate
excitatory
5-HT
receptor subtypes
Acts on a large number of receptors all of which are GPCRs (except 5-HT3 = ligand-gated ion channel):
o 5-HT1 – 5-HT7
synaptic responses they mediate
Glutamate
receptor subtypes
Glutamate acts on two receptors:
o Inotropic glutamate receptors – these are separated into 3 types on the basis of selective agonists
NMDA receptors: activation → EPSPs → also allow the entry of Ca2+ → ↑ intracellular Ca → Ca acts as a second messenger to activate intracellular signalling cascades
Bind extracellular Mg
Hyperpolarised membrane potentials, this ion blocks the port of the NMDA receptor channel
Depolarisation, however, pushes Mg out of the pore, allowing other cations to flow
Thus, NMDA receptors pass cations only during depolarisation of the postsynaptic cell – a property that is the basis for some forms of synaptic plasticity
Another unusual property is that opening the channel of the receptor requires the presence of glycine
AMPA receptors: activation → EPSPs
Kainite receptors: activation → EPSPs
Metabotropic glutamate receptors – these have 8 known subtypes
These receptors modulate postsynaptic ion channels indirectly
They activate G-proteins, which dissociate from the receptor and interact with ion channels or bind to other effector proteins that make intracellular messengers that open/close ion channels
functional type
Main excitatory neurotransmitter in the CNS and is found in all regions of the CNS
GABA
receptor subtypes
GABA acts via two receptor subtypes:
GABA-A receptors – ligand-gated Cl- channels which mediate fast inhibitory synaptic transmission
GABA-B receptors – GPCRs which mediates prolonged hyperpolarisation (inhibition) of postsynaptic neurons and also mediates presynaptic inhibition of transmitter release
functional type
It is an inhibitory CNS neurotransmitter, along with glycine
synaptic responses they mediate
inhibitory
opioids
receptor subtypes
• 4 subtypes of opioid receptor (all GPCRs)
• μ-receptors
κ-receptors
δ-receptors
NOP (ORL1) receptors
functional type
synaptic responses they mediate
purines
ATP
receptor subtypes
acts via P2x (LGIC) and P2y (GPCR)
functional type
synaptic responses they mediate
Adensosine
receptor subtypes
acts on A1, A2 and A3 receptors (all GPCRs)
functional type
synaptic responses they mediate
nitric oxide
receptor subtypes
Does not act at a receptor:
Directly activated second messenger guanylate cyclase to produced cGMP
functional type
mediator in the PNS/CNS
synaptic responses they mediate
LO9 Outline the CNS pathways and functional roles for the main CNS neurotransmitters
ACh
All parts of the forebrain and cortex, midbrain, brainstem
Major nuclei in the nucleus basalis
Functional roles include memory, arousal, movement
Most CNS effects are mediated via mAChRs
Noradrenaline
Cell bodies in clusters in pons and medulla – locus coeruleus (LC)
Provides extensive projections (via median forebrain bundle) which branch to supply the cortex, hippocampus, cerebellum and hypothalamus
Also projections to spinal cord
Roles in arousal, mood, pain, blood pressure control, etc.
5-HT
Many cell bodies in the raphe nuclei in the pons and medulla
Project to the cortex, hippocampus, basal ganglia, limbic system, hypothalamus, cerebellum and spinal cord
Functional roles in mood, behaviour, etc.
Dopamine
Mesolimbic: ventral tegmental area (VTA) to the limbic system (amygdala, nucleus accumbens), hippocampus and prefrontal cortex
Reward, desire, emotion
Mesocortical: VTA to front cortex
Cognition, motivation, emotion
Nigrostriatal: substantia nigra to striatum
Movement
Tubuloinfundibular: hypothalamus to posterior pituitary
Prolactin secretion
LO4 Compare and contrast the effects of the PNS and SNS on the following organs:
salivary glands
PNS
Stimulates secretion of watery saliva
SNS
Stimulates secretion of thick, viscous saliva
Sympathetic Receptor
α1, β2
Paraympathetic Receptor
iris
PNS
Stimulates sphincter pupillae muscles; constricts pupils
SNS
Stimulates dilator pupillary muscles; dilates pupils
Sympathetic Receptor
α1
Paraympathetic Receptor
heart
Heart (muscle)
PNS
Decreases rate; slows heart
SNS
↑ rate and force of heartbeat
Sympathetic Receptor
β1, β2
Heart (coronary blood vessels)
PNS
No effect
SNS
(vasodilation)
Paraympathetic Receptor
blood vessels
PNS
Little or no effect
SNS
Constricts most vessels and ↑ BP; constricts vessels of abdominal viscera and skin to divert blood to muscles, heart, and brain when necessary; adrenaline weakly dilates vessels of skeletal muscles during exercise
Sympathetic Receptor
α1
Paraympathetic Receptor
lungs
PNS
Constricts bronchioles
SNS
Dilates bronchioles
Sympathetic Receptor
β2
Paraympathetic Receptor
GI tract
PNS
↑s motility and amount of secretion by digestive organs; relaxes sphincter to allow foodstuffs to move through tract
SNS
Decreases activity of glands and muscles of digestive system; constricts sphincters
Sympathetic Receptor
α1, β2
Paraympathetic Receptor
adrenal medulla
PNS
No effect
SNS
Stimulates medulla cells to secrete adrenaline and noradrenaline
Sympathetic Receptor
Nicotinic
Paraympathetic Receptor
sweat glands
PNS
No effect
SNS
Stimulates copious sweating (cholinergic fibers)
Sympathetic Receptor
Muscarinic
Paraympathetic Receptor
external genitalia
Penis
PNS
Causes erection (vasodilation)
SNS
Causes ejaculation
Vagina/clitoris
PNS
Causes erection (vasodilation) of clitoris; ↑s vaginal lubrication
SNS
Causes vagina to contract
Paraympathetic Receptor
LO3 Compare the somatic and autonomic nervous systems in relation to their effectors, efferent pathways, neurotransmitters released, and receptors activated
LO2 Describe the major processes of neuronal integration of postsynaptic potentials, including presynaptic and postsynaptic modulation
postsynaptic potentials
Neurons communicate with other neurons by using transmitters which act via receptors to alter the membrane potential of the postsynaptic neuron
Neurotransmitter receptors evoke graded potentials that vary in size with:
the amount of neurotransmitter released and
the time neurotransmitter stays in the area
EPSP
excitatory (depolarisation – usually Na+ entry)
↓ with distance
If strong enough (many EPSPs) → reach threshold at trigger zone
IPSP
inhibitory (hyperpolarisation – usually Cl- entry or K efflux)
↑ -ve potential
Makes membrane more negetive
↓ chance of reaching threshold
↓ chance of AP
LGIC vs GPCR
LGIC
Can be fast and direct
GPCR
slow and modulatory
presynaptic modulation
It is common for nerve terminals to receive synaptic input which modulates the amount of neurotransmitter released when activated
Usually inhibitory and mediated by GPCRs: Gi
↓ cAMP -> ↓ activity of voltage-gated Ca2+ channels -> ↓ neurotransmitter release
Can be auto-inhibitory (i.e. negative feedback)
Can be excitatory and ↑ neurotransmitter release when activated: Gs
LO1 Describe the general cellular processes of chemical neurotransmission, including storage and release and recycling of transmitters, activation of receptors and signal termination (review)
Stimulus generates graded potential → if graded potential reaches threshold at trigger zone, AP is activated → AP is conducted along axon to terminal → neurotransmitter released acts at receptors on the target cell
The synaptic vesicle cycle:
Synaptic vesicles are filled with neurotransmitters by active transport (1)
and join the vesicle cluster that may represent a reserve pool (2).
Filled vesicles dock at the active zone (3)
where they undergo an ATP-dependent priming reaction (4)
that makes them competent for calcium-triggered infusion (5)
After discharging their contents, synaptic vesicles are recycled through one of several routes. In one common route, the vesicle membrane is retrieved via clathrin-mediated endocytosis (6)
and recycled directly (7)
or by endosomes (8).
Neuro Week 2
LO6 Describe the location of the reticular formation and its function
Dysfunction of reticular formation can result in sleep, arousal, attention and movement disorders.
Anxiety and depression
Narcolepsy
ADHD
Small clusters of grey matter interspersed among small bundles of white matter
Throughout brainstem
Reticular formation is composed of a diverse group of nuclei, both scattered and organized in a columnar fashion. It arises from each of the three parts of the brainstem.
The reticular formation, through its connections with the thalamus and cortex, maintains wakefulness, alertness, and attention.
Contains nuclei involved in the modulation of wakefulness, sleep-wake transitions, and the regulation of the sleep cycle.
Exerts inhibitory or facilitatory effects on motor activity, contributing to motor control, coordination, and reflex responses.
LO7 Identify the cerebellum and describe its role in movement
Located at the back of the brain, behind the brainstem, lying beneath the tentorium cerebelli, a dural fold.
Divided into two hemispheres, separated by a midline structure called the vermis. Each hemisphere is further divided into lobes:
Vermis is a narrow, worm-like structure located along the midline of the cerebellum, separating the two hemispheres. It is involved in axial and trunk movements.
anterior lobe
posterior lobe
flocculonodular lobe
Surface of hemispheres is highly folded, forming numerous small ridges called folia. Folia ↑ the SA, providing more space for neurons and connections.
Outer grey matter cortex, and the white matter lies deep within.
Further, located within the white matter, there are four pairs of deep cerebellar nuclei, receiving input from cerebellar cortex and send output signals, influencing motor control and coordination.
Functions:
Receives sensory information; proprioceptive input from muscles, tendons, and joints, as well as feedback from the vestibular system and visual information to monitor and adjust coordination.
• Receives information about the intended motor commands from the cerebral cortex, and sensory feedback about the actual movements occurring. It compares the expected motor commands with the actual sensory feedback to detect any discrepancies or errors. IF an error is detected, it generates corrective signals to adjust the ongoing muscle contractions.
• Fine-tunes the duration, intensity, and sequencing of muscle activity, allowing for smooth and well-coordinated movements.
• Receives feedback about the consequences of previous movements and uses this information to refinefuture muscle contractions. Through repetitive practice and error correction, the cerebellum helps in the development of skilled movements.
Receives sensory input from vestibular system, which senses changes in head position and movement, and integrates this information to adjust muscle contractions to maintain balance.
Connected to the rest of the brain through cerebellar peduncles.
superior cerebellar peduncles (connecting to the midbrain)
middle cerebellar peduncles (connecting to the pons)
inferior cerebellar peduncles (connecting to the medulla oblongata).
Functional subdivisions:
Viscerocerebellum (vestibulocerebellum)
Regulate balance, posture, and eye movements.
Receives input from the vestibular system, which senses changes in head position and movement, and integrates this information to control equilibrium and coordination of eye movements.
Spinocerebellum
It receives sensory input from the spinal cord regarding proprioception, muscle tone, and touch.
Coordinating and refining voluntary movements, muscle synergy, and maintaining muscle tone.
Ensure smooth and accurate execution of motor activities and coordination of posture.
Cerebrocerebellum (neocerebellum)
It receives input from motor cortex, involved in motor planning, coordination, and fine motor control.
contributes to the timing, precision, and coordination of movements, including skilled and voluntary movements of the limbs, speech articulation, and cognitive processes related to motor tasks.
LO8 Describe the structure and function of the diencephalon
thalamus
anatomical location?
at the base of each hemisphere
egg-shaped and centrally located on either side of the 3rd ventricle
Above the midbrain, below the corpus callosum, between the cerebral hemispheres.
anatomical relations?
bounded by the fornix superiorly
medially, the thalami are connected by grey matter (interthalamic adhesion)
the posterior limb of the internal capsule (white matter) fibres is the lateral limit
central internal medullary lamina (Y-shaped band) divides it into 5 nuclei
more on the functions of thalamus in week 6 (focus on know there are 5 nuclei, but reletively LY) (just know that the thalamus is a major relay station and focus on week 6)
anterior nucleus?
emotion, memory, and learning (related to the limbic brain)
relay information from the hypothalamus to the cingulate gyrus
lies anterior to the internal medullary lamina
medial nuclei?
conscious awareness of emotional states, by connecting the basal nuclei and emotional centres in the hypothalamus with the prefrontal cortex of the cerebrum
with projections to the prefrontal cortex and limbic structures, the medial nuclei integrates visceral information with emotions, thought processes, and judgement
On the right of the internal medullary lamina.
ventral nuclei?
planning and fine-tuning movement
relaying somatosensation from the spinal cord and brainstem to the primary sensory cortex of the parietal lobe (ventral posterior nuclei)
lateral nuclei?
visceral-sensory integration (connections → cingulate gyrus/ parietal lobe)
integration of sensory modalities with higher mental functions
Lies to the left of the internal medullary lamina on the image above.
posterior nuclei?
pulvinar = integrates sensory information to projection to association areas
lateral geniculate body mediates visual reflexes
medial geniculate body mediates auditory reflexes
hypothalamus
anatomical location?
forms the floor of the 3rd ventricle and extends from the area superior to the optic chiasm anteriorly, to the mamillary bodies posteriorly
Features: mamillary bodies and pituitary stalk
how is the hypothalamus connected to the pituitary gland?
posterior to the optic chiasm, the infundibulum (pituitary stalk) extends inferiorly, connecting the hypothalamus to the pituitary gland
functions?
controls and integrates the function of the ANS and the endocrine system
epithalamus
anatomical location?
dorsomedial to the thalamus and next to the roof of the 3rd ventricle
function?
habenular nucleus = ANS function such as emotional and visceral responses to odours
pineal gland = influences pituitary function and produces melatonin to maintain seasonal and circadian rhythms
subthalamus
anatomical location?
inferior to the thalamus
between the thalamus and tegmentum (roof) of the midbrain
Functionally part of the basal ganglia
prominent gray matter nuclei involved in motor control.
function?
responsible for sequencing of patterned movement
Regulating motor output and contributing to the control of voluntary movements, including initiating and inhibiting specific motor patterns.
LO9 Describe human brain development from neural tube the 5 vesicle stage.
Can imagine Monika writting a mean Q on this
Telencephalon forms the cerebrum
Diencephalon forms the thalamus, hypothalamus, subthalamus & epithalamus
Mesencephalon forms the midbrain
rhombencephalon - undergoes segmentation and differentiates into two vesicles:
Metencephalon forms the pons and cerebellum
Myelencephalon forms the medulla
LO10 Describe how the brain develops within the cranium
Brain grows more rapidly than the skull, so two flexures develop:
the midbrain and cervical flexures
Allows brain to change its shape for the small space which it is accomidation
Telencephalon is responsible for formation of cerebral hemispheres.
As telencephalon grows and develops, it undergoes expansion and rotation (curves and encircles the midbrain). This expansion and rotation contribute to "cephalization," with increasing complexity of the brain in the head region.
During this, cerebral hemispheres grow laterally and dorsally, extending and covering the more primitive midbrain structures. Midbrain becomes hidden or buried beneath the cerebral hemispheres, surrounded by the encircling telencephalon.
Expansion and encircling of the midbrain is an essential aspect of brain development.
Continuous growth causes surfaces to crease and fold.
The development of sulci (grooves) and gyri (ridges) on the surface
higher SA so more neurons can be squeezed into a small place
LO5 Identify and describe the anatomical structures that comprise the brainstem and the functions of each area
Midbrain
CN III & CN IV nuclei
Relaying sensory and motor information between the brain and the spinal cord.
Cerebral peduncles
2023 SA exam asked to lable peduncles
Fiber tracts that connect the cerebrum with the rest of CNS
Carry motor info from cerebral cortex to spinal cord and other parts of the body.
colliculi
Superior colliculi are involved in visual processing and contribute to the coordination of eye movements and visual reflexes.
"Eyes are above your ears"
Inferior colliculi role in auditory processing and relay auditory information to the thalamus.
Substantia nigra
Dysfunction associated with Parkinson's.
dopamine-producing nucleus involved in motor control, reward, and movement coordination.
Functionally is part of the basal ganglia.
Pons
Features:
CN nuclei V to VIII
4th ventricle lies posterior, between pons and cerebellum
It acts as a bridge between different brain regions, connecting the cerebrum and cerebellum via the superior, middle and inferior cerebellar peduncles.
Respiratory centers
pneumotaxic center and apneustic center, regulate the rate, rhythm, and depth of respiration.
Receive input from chemoreceptors, and help maintain levels of O2 and CO2.
Superior (S), middle (M) and inferior (I) peduncles attach the midbrain, pons & medulla to cerebellum respectively
Transverse fibers are fiber tracts that connect different regions within the brainstem and facilitate communication.
Pyramidal (corticospinal) tracts, are motor pathways that descend from the cerebral cortex through the pons and into the spinal cord, controlling voluntary movements.
Medulla
CN nuclei VIII to XII
Nucleus gracilis & cuneatus (post)
Corticospinal (motor) tracts,
lie on the anterior aspect within the pyramids.
90% of fibres cross the midline at the decussation of the pyramids.
Autonomic centres
The cardiac center
regulates HR and CO
Respiratory center
controls breathing, regulating the rhythm and depth of respiration.
Vasomotor center
regulates BP by controlling the diameter of blood vessels.
The olive
Ventrolateral portion of the medulla and contains the inferior olivary nucleus.
Feedback to the cerebellum fand part of an involuntary motor pathway.
Gracile and cuneate nuclei
Posterior aspect of the medulla and involved in processing of sensory information.
Both nuclei receive primary sensory information from the fasciculus gracilis (lower limbs) and fasciculus cuneatus (upper limbs), respectively.
Serve as relay stations, where the first order neurons synapse with second-order neurons.
LO4 Describe the structures of the limbic system and their roles
Becs said to focus on anatomy as Naga will talk in more detail about functions
Cingulate gyrus
involved in emotional processing, attentional control, and decision-making.
Role in regulating emotional responses and monitoring errors in behavior.
Parahippocampal gyrus
important role in memory
Amygdala nuclei
Processing and regulation of emotions, particularly fear and aggression.
FYI ONLY: Amygdala is hyperactive in conditions like PTSD
Role in the formation of emotional memories and the recognition of facial expressions.
Hypothalamus
Regulates numerous physiological processes, including temperature control, hunger, thirst, sleep and sexual appetite.
Regulation of the ANS and release of hormones from the pituitary gland.
Mammillary bodies, located in the hypothalamus, are involved in memory formation and retrieval.
Fornix
White matter tract that connect the hypothalamic and hippocampus systems. serves as a major pathway for communication between various limbic structure
Transmission of signals related to memory and emotional processing.
Hippocampus
Formation and retrieval of new declarative memories, which include facts and events.
Contributes to spatial navigation and consolidation of memories from short-term to long-term storage.
LO3 Describe the gray matter nuclei of the basal ganglia and their functions
Grey matter nuclei deep within the cerebrum:
Caudate Nucleus
Putamen
Globus Pallidus
Caudate Nucleus & Putamen = Striatum
Putamen & Globus Pallidus = Lentiform Nucleus
Caudate nucleus is C-shaped, like the lateral ventricles
Head is medial, tail is lateral
Lentiform nucleus is lateral to caudate and thalamus
LO2 Identify the cerebral hemispheres. Describe the cerebral hemispheres in terms of their structure, their roles in motor and sensory processing and routes of communication within and between gyri, lobes and hemispheres`
Association fibres – connect gyri and lobes
arcuate fasciculus, which connects Broca's area and Wernicke's area, is a prominent example, aiding in language processing.
Commisural fibres – connects cerebral hemispheres
corpus callosum is the largest commissural fiber, linking the two cerebral hemispheres and enabling them to share information.
Projection fibres - connect the cerebral cortex with lower part of the brain & spinal cord
internal capsule is a major projection fiber that carries motor signals from the cerebral cortex to the brainstem and spinal cord and sensory signals back to the cortex.
Sensory
Primary sensory cortex - somatosensory input (conscious sensations)
Somatosensory Association Cortices
Responsible for sensory integration
Motor
Primary motor cortex – motor control
Premotor and supplementary motor – motor planning
Broca’s – motor planning for speech
LO1 Describe early embryonic nervous system development (neurulation) and subsequent brain development
Neurulation
Critical developmental process where the neural tube develops, which forms the brain and spinal cord.
Initially, the ectoderm on the dorsal side of the embryo thickens and invaginates, creating the neural groove with neural folds on each side.
Neural folds elevate, move towards each other, and fuse in the midline to form the neural tube.
Tube then separates from the ectoderm, which will give rise to the future epidermis.
Neural Crest
During neurulation, neural crest cells form at the edges of the neural folds .
As the neural tube closes and separates from the ectoderm, these neural crest cells first joint from both sides, divide and begin to migrate to various parts of the embryo.
Differentiate into diverse cell types, including neurons, glial cells, and components of the PNS.
Neural Tube Closure
Day 24 cranial end & day 25-26 caudal end of neural tube closes
Closure of neural tube is a critical step in neurulation, occurring in a bidirectional manner.
Begins around day 22 of embryonic development, starting at the midline and proceeding both proximally (towards the head) and distally (towards the tail).
Proximal part closes by ~ day 25
Distal part closes by ~ day 27.
Neural Tube Defects
Disturbance of neurulation results in brain and spinal cord abnormalities by:
Exposure to waste products
Mechanical damage to nervous tissue
when neural tube fails to close correctly, leaving nervous tissue vulnerable to external factors, results in significant abnormalities to brain and spinal cord.
Spina Bifida
Three categories:
Spina bifida occulta
Spina bifida cystica
Meningocele
Myelomeningocele
Occurs when there is defective closure of the distal nueral tube - day 27.
Anencephaly
Occurs when there is defective closure of the proximal nueral tube - day 25
NEURO Week 3
LO6 List the factors that control blood flow to the brain.
factors determine cerebral blood flow?
blood viscosity
blood vessel dilation
cerebral perfusion pressure
factors affect control of blood flow to the brain?
CO2 concentration
O2 concentration
pH (H+)
LO7 Explain what autoregulation is and how it works.
Monro-Kellie doctrine states that the skull is a rigid compartment and contains three components:
Brain tissue
CSF
Blood
If an ↑ occurs in the volume of one component, the volume of one or more other components must decrease, or ICP will be elevated
LO8 Briefly explain the different types of cerebrovascular accidents, what causes them and how the brain attempts to autoregulate.
Sensorimotor Deficit → Site of Arterial Occlusion
Broca’s aphasia?
left MCA
3 types of stroke?
ischemic stroke
embolic stroke
due to a distant clot breaking off and travelling to and obstructing a cerebral artery
thrombotic stroke
due to plaque rupture and thrombosis of a cerebral artery
• Atherosclerotic plaque (common cause)
• Plaques often form at branches or curve points
Obstruction of blood flow → reduced oxygen → causes infarction
Associated with cerebral oedema and ↑ intracranial pressure
Occlusion of the MCA
upper division
Paresis - motor cortex (frontal lobe)
Sensory loss – sensory cortex (parietal lobe)
Broca’s aphasia – Broca’s area (frontal lobe)
Contralateral neglect syndrome – half of the visual field and/or half of the body is ignored.
lower division
Contralateral homonymous hemianopia (visual field loss on the left or right side of the vertical midline) – occipital lobe
Wernicke’s aphasia – Wernicke’s area
Alexia (inability to read or understand words) – angular cortex
Ideomotor apraxia (inability to correctly imitate hand gestures) – lower portion of motor cortex
hemorrhagic stroke
RADIOLOGY MSAT HY
Subarachnoid
Spontaneous arterial bleeding into the subarachnoid space
Can lead to hydrocephalus
Intracerebral
Rupture of microaneurysms and degeneration of small deep penetrating arteries
Blood is bypassing the BBB
Local signals are elevated and the response is not helpful!
Cerebellar
Extradural
Skull vault fracture tearing a branch of the middle meningeal artery
Blood accumulates rapidly over minutes and hours
No extradural space normally in the cranium, as the dura is adherent to the skull
Fracture of the inner table of the skull (e.g. at the pterion) can tear arteries and veins that run between the dura and the skull
A blow to the head may cause instant deformation of the skull without a fracture. This can cause vascular tears too
Bleeding from these vessels lifts the dura off of the skull forming an extradural space in which the blood can clot
Extradural hematomas develop most commonly with fractures of the squamous portions of the temporal and parietal bones that tear the middle meningeal vessels
Subdural
Accumulation of blood in subdural space due to rupture of a vein
May occur by the rupture of an emissary vein,which runs between the surface of the brain and the skull
Individuals with brain atrophy (e.g. elderly), in whom the emissary veins are stretched, there is more room for the brain to move within the skull, are especially prone to developing subdural hematoma
Large subdural hematomas raise the intracranial pressure and compress the brain
LO9 Explain what some of the causes of raised intracranial pressure are.
Hydrocephalus
cause
CSF overproduction
obstructed CSF flow
decreased absorption of CSF
complications in adults vs infants?
↑d ICP in adults
large cranial vault in infants (due to enlarged ventricles)
normal range of ICP?
0-15mm Hg
The problems of raised ICP:
Pressure on parts of the brain – neuronal injury
Blood supply may be compromised to rest of the brain
BBB may be bypassed by a haemorrhage
Stroke
Arterial occlusion → Reduced oxygen → vasodilation → fluid leaks out of vessel → cerebral oedema
Haemorrhage → the elevated CO 2 and H + ions are not being washed away → increasing the strength of the signal → vessels are further dilating → more blood leaks out of the vessel
LO4 Describe the arrangement of the pia, arachnoid and dura mater within the cranial cavity and in relation to the brain. Describe the reflections of the dura mater and the formation of the venous sinuses.
arrangement of the pia mater within the cranial cavity
adherent to surface of brain, follows sulci and gyri, cannot be removed from brain.
Most Internal
arrangement of the arachnoid mater within the cranial cavity
Spiderweb like over surface of brain, bridging sulci
Middle layer
arrangement of the dura mater within the cranial cavity
tough mother. Very tough outer covering of the brain. Forms dural folds. Stuck to inside of cranium.
Most external
Falx means sickle shaped – thick at one end but narrow at the other
Falx cerebri – in longdituninal fissue between the hemispheres
Falx cerebelli – same but in the cerebellum
Tentorium cerebelli – tent over the cerebellum
Diaphragma sellae – over the sella turcica
Middle Menigeal Artery
One punch to the head and immediate death is due to the punch hitting the tperion which causes damage to the middle meningeal artery and thus causing a subdural hematoma
Through foramen spinosum, travel over lateral aspect of skull, two branches anterior and posterior. Branches put grooves into the bone.
Supplies dura and calvaria of the skull.
Potential for vessel to be torn, particularly over the pterion. Bone is thin, blow to the side of the head can cause a fracture, vessel can tear leading to an extradural hematoma. Blood is now leaking into a sealed box (the skull). It has no where to go and will squash the brain,
Dural septa
Project into the cranial cavity and partially subdivide the cranial cavity
Functions:
o Provides protection
o Prevents lateral displacement of the brain
Falx cerebri:
Downward projection
Extends between the cerebral hemispheres
Tentorium cerebelli:
Horizontal projection
Extends between the occipital lobes of the hemispheres and the cerebellum
Falx cerebelli:
Small midline projection in the posterior cranial fossa
Its anterior edge is free and is between the two cerebellar hemispheres
Diaphragma sellae:
Small horizontal shelf
Covers the hypophysial fossa in the sella turcica of the sphenoid bone
There is an opening in the centre through which the infundibulum passes, connecting the pituitary gland with the base of the brain, and any accompanying blood vessels
LO5 Describe the anatomy of the dural venous sinuses. Explain the entrance of cerebral veins into the superior sagittal sinus in relation to subdural haemorrhage. Explain how connections between sinuses and extracranial veins may permit intracranial infection.
anatomy of the dural venous sinuses
entrance of cerebral veins into the superior sagittal sinus in relation to subdural haemorrhage
connections between sinuses and extracranial veins may permit intracranial infection
Cavernous sinus drains into the cerebral and the opthalamic viens
Extends from the superior orbital fissure to pertrous temporal bone
Surrounds pituaitary gland
ICA passes through
Drain via the petrosal sinuses
Risk of infection spread as infection on the face can track back to the cavernous sinus and then track back to the brain - clinically relevent but exceptionally rare
LO3 Demonstrate the origin, course and major branches of the common, internal and external carotid arteries and locate the carotid pulse.
common carotid arteries
origin
aorta
left common carotid artery
carotid arteries
brachiocephalic artery
right common carotid artery
carotid arteries
major branches
Bifurcate into Internal and External Carotid Arteries
Where does it bifurcate?
Superior level of thyroid cartilage
internal carotid arteries
course
passes superiorly in the neck to the base of the skull
enters the carotid canal
passes within the petrous part of the temporal bone anteromedially
major branches
ophthalmic artery
course?
enters the orbit through the optic canal
supplies?
orbital contents, scalp, sinuses, and nose
anterior cerebral artery (ACA)
leision of ACA would affect medial and superior surfaces of the frontal and parietal lobes manifesting in symptoms like motor sensation disturbances (2023 exam Q)
- course?
passes anteriorly and travels on midsagittal surface above the corpus callosum
supplies?
medial and superior surfaces of the frontal and parietal lobes
prefrontal cortex, premotor cortex, and primary motor and sensory cortices
middle cerebral artery (MCA)
leision of MCA would affect lateral surface of the frontal, parietal, occipital, and temporal lobes (2023 exam Q)
- course?
runs laterally and emerges through the lateral fissure
supplies?
lateral surface of the frontal, parietal, occipital, and temporal lobes
premotor cortex and primary motor and sensory cortices
Broca’s and Wernicke’s area
Lateral surface of the frontal, parietal and occipital lobe
Branches
medial lenticulostriate penetrating arteries.
lateral lenticulostriate penetrating arteries.
anterior temporal artery (largest branch)
polar temporal artery.
uncal artery (which may branch from the anterior choroidal artery)
orbitofrontal branch (same territory as orbitofrontal artery)
posterior communicating artery
connects the internal carotid with the posterior cerebral arteries, thus connecting the anterior and posterior cerebral circulations.
supratrochlear and supraorbital arteries from the internal carotid artery
external carotid arteries
major branches
Superior thyroid artery
Ascending pharyngeal artery
pharynx
Lingual artery
tongue
Facial artery
anterior aspect of the face
Occipital artery
posterior aspect of the skull
Posterior auricular artery
posterior auricular area (skin of and behind the ear)
Maxillary artery
course of the maxillary artery?
arises posterior to the neck of the mandible
passes through the parotid gland
continues medial to enter the infratemporal fossa then pterygopalatine fossa
Superficial temporal artery
Some Anatomists Like Freaking Out Poor Medical Students
Arterial Circle (of Willis)
Function
Equalise vascular supply
Alternate flow if blocked (lessening affect of stroke)
1 – ICA
2 – Pos cerebral
leision of PCA would affect the occipital lobe and mainifest in symptoms such as visual disturbance, and visual recognition loss (2023 exam Q)
originates at the terminal bifurcation of the basilar artery (BA).
Runs along the inferior brain surface to supply anterior and inferior temporal lone and inferior and medial ocipital lobe
lateral branch of the posterior cerebral artery
Temporal Branches
Occipitotemporal Artery
3 – Anterior Cerebral
4 – Anterior Cerebral
5 – middle cerebral
6 – basilar
7 - vertebral
Arise from subclavian arteries
Travel through transverse foramina
Through foramen magnum
Unite to form the Basilar Artery over surface of the pons
Two terminal branches - Posterior cerebral arteries
locate the carotid pulse
Your carotid pulse can be taken on either side of your neck approximately the level of the thyroid cartilage
LO2 Describe how the blood brain barrier protects the CNS.
BBB is a selective barrier that separates blood circulation from brain tissue to maintain a stable and controlled environment for optimal neural function.
Astrocytes, type of glial cell, provide structural support to neurons and blood vessels. Processes wrap around blood vessels, help maintain integrity of BBB.
Endothelial cells are interconnected by tight junctions, preventing passage of molecules between cells.
Substances allowed to pass through freely are oxygen, carbon dioxide and water.
Substances transported are glucose, amino acids, nutrients and certain ions.
LO1 Describe the location, function, production, circulation and drainage of cerebrospinal fluid (CSF).
The ventricular system (loction)
“network” of interconnected, fluid-filled spaces within the brain that plays a crucial role in the production, circulation, and absorption of cerebrospinal fluid (CSF).
The lateral ventricles are the largest ventricles and are located symmetrically within the cerebral hemispheres.
The third ventricle is a narrow, midline cavity located between the left and right thalamic nuclei. Enlarged portion of the neurocoele that was located between the two sides of the diencephalon.
The mesencephalic aqueduct is a narrow canal that connects the third ventricle to the fourth ventricle. It runs through the midbrain.
The fourth ventricle is associated with the brainstem, posterior to pons and medulla, and anterior to cerebellum.
function
The ventricular system responsible for CSF production, circulation, and maintenance
functions of CSF
Remove waste products and metabolic byproducts from neural tissue.
Carry essential nutrients, ions, and metabolic products to the neural tissue.
Act as a cushion, absorbing and distributing mechanical forces that could potentially damage the neural tissues.
Regulates ICP
Regulate temperature by dissipating heat and maintaining stable thermal environment.
Allow the brain to float within the skull, preventing crushing of CNs and blood vessels.
production
The choroid plexus is a network of blood vessels and specialized ependymal cells.
The capillaries are permeable, allowing plasma, to filter through the capillaries of the choroid plexus. Ependymal cells lining the choroid plexus actively transport certain ions and molecules from plasma into the fluid-filled ventricular spaces. Selectively allows certain substances to pass through while excluding others. Ultrafiltrate contains a mix of water, ions, glucose, proteins, and other molecules, different from the plasma from which this filtrate is derived.
circulation
drainage of CSF
Movement of CSF from the ventricles to the subarachnoid space, where it is then absorbed into the bloodstream.
Arachnoid villi are finger like projections of the arachnoid mater within the dural venous sinuses (predominantly in the superior sagittal sinus)
Superior sagittal sinus is a venous sinus produced by the diverging layers of the dura mater.
CSF relies on a pressure gradient between the subarachnoid space and the dural venous sinuses. CSF in subarachnoid space has a slightly higher pressure than blood within dural venous sinuses. Pressure difference promotes movement of CSF through arachnoid villi into the bloodstream.
Neuro Week 4
LO3 Explain the mechanism of referred pain from T1-5 sympathetic afferents to the chest wall and relate it to the thoracic viscera.
Surface of skin is divided into specific areas, derived from a somite.
myotome
Muscle mass receiving innervation from the fibres conveyed by a single spinal nerve
Specific muscle groups innervated by motor fibres from a single spinal nerve root. They can be used to assess and localize spinal cord injuries by evaluating muscle strength and motor function.
By testing muscle strength in specific myotomes, clinicians can identify areas of weakness or paralysis.
dermatome
Area of skin innervated by cutaneous branches of a single SN
Dermatomes exist for each of these spinal nerves, except for C1.
Dermatomes overlap, so lesion of one spinal nerve is of little consequence
A lesion of a single spinal nerve would not results in numbness over that area normally supplied by that nerve. At least 2 adjacent nerves must be interrupted to produce discernible area of numbness.
sclerotome, which gives rise to the vertebrae (bones).
Referred Pain
Pain perceived at a different location to the site of the stimulus
Visceral pain cannot be localized accurately… instead, it is experienced on the body wall surrounding the organ, or on other territories with the same segmental innervation
Cardiac pain is perceived in the central chest wall, because the central chest is innervated by T1–4
Afferents from viscera and body wall converge onto common neurons in dorsal horn
Due to convergence, the brain cannot determine the exact peripheral origin of information arriving to it from the spinal cord
LO4 Describe the sympathetic innervation of the head and neck including the features and main causes of Horner’s syndrome. Describe the parasympathetic innervation of the head and neck.
Horner’s syndrome
Cause
lesion along the sympathetic pathway due to stroke, tumor, spinal cord injury or aneurysm of the carotid artery
Clinical Features
ptosis
decrease pupil size
reduced pupillary reflex
anhidrosis (on the affected side of the face)
red conjunctivae
LO5 Compare and contrast sensory and motor ganglia.
Sensory
Cell bodies of the pseudounipolar neurons
NO SYNAPSES
CNs containing sensory fibres always have a sensory ganglia too
sensory ganglia - where the cell bodies of the pseudounipolar neurons are located.
Basic principle: Every spinal nerve contains sensory nerves and hence there is a sensory ganglion for every spinal nerve. These ganglia are called dorsal root ganglia and are ALWAYS located in an intervertebral foramen
Sensory CNs also have sensory ganglia… ALWAYS.
Motor
Site of synapse between presynaptic and postsynaptic neurons
ALWAYS SYNAPSES!
These are visceral motor ganglia = part of ANS
Associated with spinal nerves and cranial nerves
There are two nerve chains known as the sympathetic chains associated with the spinal cord.
These are the ganglia associated with the visceral motor fibres of the spinal nerves.
Visceral motor ganglia are similarly associated with cranial nerves, which contain visceral motor fibres.
sensory vs motor ganglia?
cell bodies of pseudounipolar neurons and no synapses
site of synapse between presynaptic and postsynaptic neurons
LO2 Compare the anatomic location and functions of the sympathetic and parasympathetic nervous systems, their origins and pathways.
SNS
Origins
Found only in the thoracic and lumbar regions between T1 to L2.
Cell bodies always in lateral horn of T1 to L2
anatomic location
Sympathetic chain runs along the spinal column on both sides, connecting to SN
Organised somatotopically (head is most superior, pelvis is most inferior).
functions
Supply blood vessels, arrector pili muscles, sweat glands & viscera
Pathways
Pathways
Preganglionic neurons have their cell bodies in the lateral horn of the spinal cord segments T1-L2, exit the spinal cord through the ventral roots and enter the sympathetic chain, can either synapse with postganglionic neurons within the sympathetic chain or pass through the chain to synapse in prevertebral ganglia
Postganglionic fibers then extend to the target organs.
As soon as presynaptic enters the anterior primary rami, they leave via white rami communicantes to sympathetic trunk. One of the following occurs:
Ascend in sympathetic trunk to synapse with postsynaptic neuron of a higher paravertebral ganglion, these will reach the H&N and the U.L.
Enter and synapse immediately with a postsynaptic neuron of the paravertebral ganglion at the same level. These supply the organs of the trunk.
Descend in sympathetic trunk to synapse with postsynaptic neuron of a lower paravertebral ganglion. These innervate the L.L.
Pass through the sympathetic trunk without synapsing. Then continuing through a splanchnic nerve, to reach the prevertebral ganglia to supply abdominopelvic organs.
Sympathetic to Suprarenal Gland
Some presynaptic fibres pass through the celiac ganglia without synapsing, terminating directly on the cells of the medulla of the suprarenal gland
Postsynaptic cells are the cells of the adrenal medulla that release their neurotransmitter into the blood stream for a widespread response
Splanchnic Nerves
Splanchnic nerves carry visceral efferent and afferent fibres to and from viscera in the abdomen via:
Thoracic splanchnic
Greater splanchnic
synapse in the celiac ganglion and supplies the foregut.
Lesser splanchnic
synapse in the superior mesenteric ganglion and innervates the midgut structures.
Least splanchnic
synapse in the renal ganglion. Conveys pain from the kidney and suprarenal glands.
Lumbar splanchnic
synapse in the inferior mesenteric ganglion and supplies the hindgut and rectum.
Arise from sympathetic trunk in thorax and travel inferiorly to provide sympathetic innervation to abdomen.
Plexuses, which contain S and P fibres to provie dual innervation, to ↑ or reduce HR as an example.
Cell bodies of postsynaptic neurons are in paravertebral ganglia (sympathetic chain) or prevertebral (preaortic) ganglia
Paravertebral ganglia and the nerve fibres that travel between them form the sympathetic chains.
Prevertebral ganglia form plexuses that surround the unpaired visceral branches of the aorta (celiac, superior mesenteric, inferior mesenteric AND aorticorenal)
The presynaptic fibres are short, the postsynaptic are long
Effects of ANS
The pupils of the eyes dilate
HR force of heart contraction and BP ↑
airways dilate allowing faster movement of air into and out of the lungs
blood vessels that supply the kidneys and GIT constrict, decreasing BF, resulting in reduced urine formation and digestive activities
Blood vessels of skeletal muscles, cardiac muscles, liver and adipose tissues dilate, allowing greater BF
Liver cells perform glycogenolysis to ↑ glucose in the bloodstream and lipolysis
Peristalsis of GIT and digestive secretions slow down/stop
PNS
Origin
originates from the craniosacral regions (brainstem [CNs III, VII, IX, X] and sacral spinal cord [S2-S4]), with long preganglionic and short postganglionic fibers.
Presynaptic parasympathetic neuron cell bodies are in the brainstem and leave through CNs III, VII, IX and X. Each has a visceral motor ganglion
Ventral Roots S2-S4
Presynaptic neuron cell bodies are in the brainstem.
This constitutes the cranial outflow.
These fibres leave through cranial nerves III, VII, IX and X.
In the head, there are 4 ganglia:
oculomotor nerve
Ciliary ganglion -
facial nerve
Pterygopalatine ganglion -
Submandibular ganglion -
glossopharyngeal nerve
Otic ganglion -
Sacral parasympathetic outflow exits from the S2-S4 spinal segments and innervates the lower abdominal and pelvic organs.
S2 to S4 cell bodies in lateral horn of spinal cord
Leave through S2 to S4 spinal nerves – pelvic splanchnic
Supplies hindgut, bladder and genitalia
Cranial parasympathetic outflow travels via CNs, with the vagus nerve being particularly significant as it innervates many thoracic and abdominal organs.
Pathways
Preganglionic neurons ihave their cell bodies in the brainstem or sacral spinal cord.
Preganglionic fibers are generally long and travel to ganglia that are located very close to or within the walls of the target organs.
The postganglionic neurons are typically short because they are near or within the target tissue.
Effects of the ANS
This division enhances rest and digest activities that support body functions that conserve and restore body energy during times of rest and recovery
Impulses to the digestive glands and the smooth muscles of the gastrointestinal track allows food to be digested and absorbed
There is a reduction in body functions that support physical activity.
Pathway Comparisons
SNS
Preganglionic fibers: Short, as they synapse close to the spinal cord in the sympathetic chain or prevertebral ganglia.
Postganglionic fibers: Long, as they extend from the ganglia to the target organs.
PNS
Preganglionic fibers: Long, as they travel to ganglia near or within the target organs.
Postganglionic fibers: Short, because they are close to or within the target organs.
LO1 Describe the anatomy of a typical spinal nerve, including its origin from dorsal and ventral spinal roots, its main motor and cutaneous branches and any autonomic component.
All neural structures outside the CNS:
12 pairs of CNs
31 pairs of spinal nerves
ANS carried by the cranial & spinal nerves
The information carried by PNS is divided into two main types:
Afferent (sensory) nerve fibres
transmit sensory information from the body’s receptors to CNS
Includes sensations like pain, temperature, touch, and proprioception
Somatic afferents
Superficial (cutaneous) fibres convey touch, pressure, temperature and superficial somatic (sharp and well localised) pain.
Deep somatic (proprioceptive) fibres convey joint position and vibration sense, skeletal muscle stretch and deep somatic (dull ache) pain.
Visceral afferent fibres are non-myelinated and conduct slowly, conveying smooth muscle stretch and visceral (e.g. ‘vague’) pain.
Peripheral Distribution of SN
Interoceptors - within the body
Exteroceptors – outside environment.
This information is afferent and enters via the first order neuron.
The sensory neurons are ALWAYS associated with a sensory ganglion.
Cell bodies of these neurons are ALWAYS found in the DRG and they project into grey matter (dorsal horn) in the spinal cord.
Where neuron will synapse in the dorsal horn, depends on type of sensory information it is carrying
Efferent (motor) nerve fibres
transmit motor commands from CNS to muscles and glands
Motor pathways
Somatic
Under voluntary control, supply skeletal muscles.
Signal arises in primary motor cortex in upper motor neuron which will synapse with a lower motor neuron that leaves the ventral horn and pass directly to skeletal muscle.
Lower motor neuron and will form the motor unit
Visceral (autonomic)
Structures under involuntary control.
Arise from the lateral horn
Motor information always leaves via the ventral root, into the spinal nerve.
Neurons ALWAYS synapse prior to reaching its target smooth muscle cell, and this occurs in a peripheral ganglion
Further divided into:
Sympathetic
Parasympathetic
Spinal nerves arise from the spinal cord as rootlets, the rootlets converge to form roots.
The posterior (dorsal) root
consists of afferent fibres and their cell bodies lie in the dorsal root ganglion.
Extend peripherally to a sensory receptor and centrally to the dorsal horn of the spinal cord gray matter.
The anterior (ventral) root
consists of efferent fibres passing from nerve cell bodies in the anterior horn of the spinal cord to effector organs
anterior and posterior roots unite to form a mixed spinal nerve.
It immediately divides into two rami: anterior and posterior primary rami. These and all of their branches are mixed nerves, containing both sensory and motor information.
Grey Matter Organisation
Visceral and somatic sensory information are conveyed to different parts of the grey matter of the dorsal horn.
Motor neurons located medially in the ventral horn innervate axial musculature and proximal muscles of the body
Laterally placed motor neurons supply distal muscles of the body.
White Matter Organisation
Areas of the white matter where specific types of information travel in the spinal cord.
Both the ascending and descending tracts are the same on both sides of spinal cord.
Sensory, Ascending Tracts
Dorsal column (top)
fine touch, pressure, vibration, and conscious proprioception
Spinothalamic (bottom)
pain and temperature
These are both taken to the thalamus, and then to the cerebrum so we are consciously aware of these sensations.
Spinocerebellar (middle)
unconscious proprioception
Motor, Descending Tracts
volentary motor pathways
corticospinal pathway
akes voluntary motor information to the body (via spinal nerves),
origin: cerebrum
endpoint: spinal cord via spinal nerves to the body
corticobulbar pathway
takes voluntary motor information to the head and neck (via CNs).
origin: cerebrum
endpoint: brainstem via cranial nerves to the H&N
involuntary motor pathways
Reticulospinal
Rubrospinal
Vestibulospinal
Tectospinal
sensory (Ascending) is in blue and motor (descending) is in red
Rami
White rami
Carry preganglionic fibres from spinal cord to paravertebral or prevertebral ganglia
Communicantes exist only at the levels where lateral horn is (T1-L2).
Gray rami
Carry postganglionic fibres from paravertebral or prevertrebral ganglia to target organ
Communicantes exist at EVERY LEVEL OF THE SPINAL CORD.
Postganglionic neurons from paravertebral ganglia to their destination and carrying those preganglionic nerve fibres which enter the paravertebral ganglia but do not synapse.
NEURO Week 5
LO6 Describe the anatomy of the motor and sensory nerves to the head and neck and apply this knowledge to how their integrity is tested clinically.
Olfactory (I)
Damage can result in anosmia, loss or impairment of the sense of smell, also affect the perception of taste.
Passes through ethmoid bone to olfactory bulb, then tract to the temporal lobe
Olfactory nerve fibres pass through the cribriform plate of the ethmoid bone, making it susceptible to injury in cases of trauma to the head.
Optic (II)
Passes through optic canal to optic chiasm, then to tract to the primary visual cortex
Transmitting visual information from the retina to the brain. It originates from the retinal ganglion cells and exits the orbit via the optic canal.
The nerve continues as the optic tract to the lateral geniculate nucleus of the thalamus and then to the primary visual cortex (occipital lobe).
Oculomotor (III)
Injured CN III
Levator palpebrae superioris
All recti except LR 6 SO 4
Ciliary muscle
Pupillary sphincter
Ptosis
Affected eyeball deviates down and laterally
Inability to accommodate causes blurred vision
Pupillary dilatation causes glare
Motor nerve controls most extrinsic muscles of the eye
Primarily a motor nerve innervates most of the extrinsic muscles of the eye, including the superior, inferior, and medial rectus muscles, and the inferior oblique muscle, allowing for eye movement.
Controls the levator palpebrae superioris muscle, which elevates the upper eyelid.
Trochlea (IV)
Motor nerve that innervates the superior oblique muscle of the eye.
(GSE) function. It innervates the superior oblique muscle of the eye
originates from the midbrain and exits the skull through the superior orbital fissure.
Abducens (VI)
Motor nerve that innervates the lateral rectus muscle of the eye (GSE), responsible for abducting the eye.
Originates from the pons and exits the skull through the superior orbital fissure.
Cranial nerves 3, 4 and 6 all exit the cranium to enter the orbit through the superior orbital fissure.
These cranial nerves all supply the extraocular muscles of the eyes, carrying GSE (general somatic efferent) fibres.
Trigeminal (V)
Branches provide sensation to the face and innervate the muscles of mastication.
GLS: Give the name of the cranial nerve that is most responsible for conveying somatosensation from the head and neck and detail the branches/divisions of this nerve plus the area/structures supplied:
The trigeminal has three branches: the ophthalmic (V1), maxillary (V2), and mandibular (V3) which leave the skull through the superior orbital fissure, foramen rotundum and foramen ovale, respectively.
Ophthalmic Division (V1):
Branches:
Frontal nerve: Supplies the forehead, scalp, and upper eyelid.
Lacrimal nerve: Supplies the lacrimal gland, conjunctiva, and lateral upper eyelid.
Nasociliary nerve: Supplies the cornea, iris, upper eyelid, and parts of the nasal cavity.
Areas Supplied:
Forehead, scalp, cornea, upper eyelid, nose (dorsum), and part of the nasal cavity.
Maxillary Division (V2):
Branches:
Infraorbital nerve: Supplies the lower eyelid, upper lip, and upper teeth.
Zygomatic nerve: Supplies the cheek and part of the temple.
Superior alveolar nerves: Supplies the upper teeth and part of the maxillary sinus.
Areas Supplied:
Lower eyelid, upper lip, upper teeth, palate, part of the nasal cavity, and cheek.
Mandibular Division (V3):
Branches:
Buccal nerve: Supplies the cheek and buccal mucosa.
Lingual nerve: Supplies the anterior two-thirds of the tongue (general sensation)
Inferior alveolar nerve: Supplies the lower teeth and gives off the mental nerve, which supplies the chin and lower lip.
Auriculotemporal nerve: Supplies parts of the ear, external acoustic meatus, and the temple.
Areas Supplied:
Lower teeth, lower lip, chin, anterior two-thirds of the tongue, parts of the ear, temple, and buccal mucosa.
Ophthalmic and maxillary branches are purely sensory, while the mandibular branch has both sensory and motor components.
Innervates all structures that were derived from the 1st pharyngeal arch.
Largest CN and has both sensory (GSA) and motor (SVE) functions. Sensation in the face, scalp, and mucous membranes of the mouth and nose, and it controls the muscles involved in mastication.
The trigeminal nerve (CN V) has 3 sensory nuclei located in the brainstem
Mesencephalic Nucleus:
Involved in proprioception, the sense of position and movement of muscles.
Receives input from the muscles of mastication and transmits information about muscle stretch and tension, helping to coordinate jaw movements.
Main/Chief/Principal Sensory Nucleus:
Located in the pons, responsible for processing tactile sensation, including light touch and pressure from the face, scalp, and oral cavity.
It is analogous to the dorsal column nuclei in the spinal cord, which process similar sensations from the rest of the body.
Spinal Trigeminal Nucleus:
Extends from the pons down into the cervical spinal cord and processes pain and temperature sensations from the face.
It is functionally similar to the spinothalamic tract in the spinal cord, which transmits pain and temperature information from the body.
Vestibulocochlear (VIII)
this sensory nerve is responsible for hearing and balance.
Sensory nerve that is divided into two branches:
the cochlear nerve, which transmits sound information from the cochlea to the brain.
the vestibular nerve, which carries information about balance and head position from the vestibular apparatus.
Both branches carry SSA, which pass through internal acoustic meatus into the petrous part of the temporal bone where they innervate the cochlea and semicircular canals.
Glossopharngeal (IX)
Mixed nerve, contributes to swallowing, taste from the posterior one-third of the tongue, and sensation from the throat and some visceral organs.
Cutaneous sensation of external ear and posterior 1/3 of tongue
Visceral sensation from parotid gland, pharynx
Special sensation from posterior 1/3 of tongue
Branchial motor to stylopharyngeus
Parasympathetic supply to parotid gland
Innervates all structures that were derived from the 3rd pharyngeal arch.
Emerges from the lateral aspect of the medulla and leaves the cranial cavity through the jugular foramen, along with the vagus and accessory nerves.
Carries virtually every type of information:
General somatic afferent – cutaneous sensation from external ear and posterior 1/3 of tongue
General visceral afferent – visceral sensations from parotid gland, carotid body, pharynx and middle ear
Special visceral afferent – taste sensation from posterior 1/3 of tongue
Special visceral efferent – (NOT GSE because it’s not from somites) is branchial, provide motor to stylopharyngeus muscle, which assists with swallowing
General visceral efferent – parasympathetic fibres that supply the parotid gland with secretomotor fibres.
Hypoglossal (XII)
Motor nerve
Intrinsic and extrinsic muscles of the tongue
Arises from the anterior aspect of the medulla, passes through the hypoglossal canal and supplies the intrinsic and extrinsic muscles of the tongue.
Innervates all intrinsic and extrinsic muscles of the tongue except for the palatoglossus muscle, which is innervated by the vagus nerve.
crucial for speech, swallowing, and manipulating food within the mouth.
Ansa cervicalis, small plexus is formed by the fibres of C1 travels with the hypoglossal nerve. This contains the hypoglossal nerve as well as C1, C2 and C3. These supply muscles in the neck region called the infrahyoid muscles.
how their integrity is tested clinically
asking the patient to protrude their tongue
Damage to the hypoglossal nerve causes paralysis of the tongue
Functional Groupings
Some Say Marry Money But My Brother Says Big Boobs Matter More
S – sensory
M – motor
B – both
Sensory (afferent):
V, VII, IX and X (somatosensation)
I, II, VII, VIII, IX, X (special senses)
Motor (efferent):
III, IV, VI, XI, XII (somatic)
V, VII, IX, X (branchial)
III, VII, IX, X (visceral/parasympathetic)
Carry visceral motor fibers, which are involved in parasympathetic control of cardiac muscles, smooth muscles, and glands.
CN III, which supplies the ciliary muscles of the eye for lens accommodation and pupillary constriction (sphincter pupillae)
CN VII, which innervates the lacrimal gland, submandibular, and sublingual glands for tear and saliva production.
CN IX stimulates the parotid gland for salivation
CN X provides extensive parasympathetic innervation to thoracic and abdominal viscera, regulating heart rate, digestive functions, and respiratory rhythm.
Sensory fibres (afferent)
General Somatic Afferent (GSA): From somatic structures. Carry sensory information such as touch, pain, and temperature from the skin and mucous membranes.
General Visceral Afferent (GVA): From visceral structures. Transmit sensory signals from the internal organs, like the heart and digestive tract, including sensations such as distension and discomfort.
GLS: Give an example of a cranial nerve that is responsible for conveying visceral sensation, detail the branches/divisions of this nerve plus the area/structure supplied
Special Visceral Afferent (SVA): Special sensation. convey information related to special senses, namely taste and smell.
Special Somatic Afferent (SSA): Special sensation. convey information related to special senses, including vision, hearing, and balance.
Motor fibres (efferent)
Voluntary (skeletal) muscles
General Somatic efferent (GSE):
GLS: Give an example of one cranial nerve that carries somatic motor fibres detailing the branch/division of the nerve plus the structure(s) innervated:
CN III
Branch/Division:
Superior division of the oculomotor nerve
Structures Innervated:
Levator palpebrae superioris muscle: responsible for elevating the upper eyelid.
Superior rectus muscle
elevates, adducts, and medially rotates the eye.
Responsible for innervating most of the extrinsic muscles of the eye, which are involved in controlling eye movements and maintaining an open eyelid.
Carry somatic motor fibers, which are responsible for voluntary muscle movements GSE
CN III, controlling most of the eye's movements
CN IV, which controls the superior oblique muscle of the eye
CN VI, which innervates the lateral rectus muscle for eye abduction
CN XII, responsible for tongue movements
CN XI, which controls the sternocleidomastoid and trapezius muscles.
special visceral efferent (branchial motor) (SVE)
provide motor innervation to skeletal muscles of the pharyngeal arches unlike GSE
GLS: Give an example of one cranial nerve that carries branchial motor fibres, detailing the branch/division of the nerve plus the structure(s) innervated:
facial nerve (cranial nerve VII)
Branch/Division:
Temporal branch of the facial nerve
Structures Innervated:
Frontalis muscle
: Part of the occipitofrontalis muscle, this muscle is responsible for raising the eyebrows and wrinkling the forehead.
Orbicularis oculi muscle
: This muscle is involved in closing the eyelids.
Branchial motor fibers, also known as special visceral efferent (SVE) fibers, innervate muscles derived from the pharyngeal (branchial) arches, and the facial nerve innervates the muscles of facial expression, which are derived from the second pharyngeal arch.
Carry branchial motor* fibers, which innervate muscles derived from the pharyngeal arches. (SVE)
CN V for muscles of mastication
CN VII for muscles of facial expression
CN IX for the stylopharyngeus muscle
CN X for muscles of the larynx, pharynx, and soft palate.
Involuntary muscles (GVE)
General visceral efferent (GVE) (parasympathetic)
GLS: Give an example of one cranial nerve that carries visceral motor fibres detailing the branch/division of the nerve plus the structure(s) innervated:
vagus nerve (cranial nerve X)
Branch/Division:
Cardiac branches of the vagus nerve
Structures Innervated:
Heart
Parasympathetic innervation to the heart, specifically to SA node and the (AV) node. This innervation helps to decrease the HR and promote a restful state.
Visceral motor fibers, (GVE) fibers, are part of the ANS and are involved in regulating the function of internal organs. The vagus nerve is a major component of the PNS and innervates various structures in the thorax and abdomen.
Motor (efferent)
These nuclei are responsible for generating the motor output that controls various muscles in the head and neck.
Somatic motor nuclei
Associated with CNs that innervate skeletal muscles, such as those controlling eye movements, facial expressions, and tongue movements. Examples include CN III for eye muscles and the CN XII for tongue muscles.
Grey matter nuclei are formed by the cell bodies of the lower motor neurons of CNs.
Visceral motor nuclei
Involved in the autonomic control of organs and glands and are associated with parasympathetic fibers. These fibers control functions such as salivation, tear production, and regulation of heart rate and digestive processes.
Grey matter nuclei are formed by the cell bodies of the parasympathetic fibres which will travel to a smooth muscle, cardiac muscle or gland via of CN III, VII, IX and X.
LO7 Compare and contrast cranial nerve sensory and motor ganglia.
Parasympathetic ganglia
The parasympathetic ganglia associated with cranial nerves include the
ciliary ganglion
Associated with the CN III
Receives presynaptic fibers from the brainstem nuclei and sends postsynaptic fibers to the sphincter pupillae and ciliary muscles of the eye, controlling pupil constriction and lens accommodation, respectively.
pterygopalatine ganglion
Linked to CN VII
Receives presynaptic fibers from the greater petrosal nerve and relays postsynaptic fibres to the lacrimal gland and nasal mucosa, facilitating tear production and nasal secretion.
submandibular ganglion
Associated with CN VII
Receives presynaptic fibers from the chorda tympani and sends postsynaptic fibers to the submandibular and sublingual glands, promoting saliva production.
otic ganglion
Associated with CN IX,
Receives presynaptic fibers via the lesser petrosal nerve and sends postsynaptic fibers to the parotid gland for saliva secretion.
Vagus nerve, although not directly associated with specific parasympathetic ganglia in the head, sends presynaptic fibers to various ganglia located within the walls of target organs in the thorax and abdomen, such as the heart, lungs, and digestive tract, where they synapse with postsynaptic neurons to modulate heart rate, bronchoconstriction, and digestion.
Autonomic nerves ALWAYS have a pre and post-ganglionic fibre where they synapse OUTSIDE the CNS. Remember: PNS ganglia have long pre-ganglionic fibres and short postganglionic fibres as they typically synapse close or within the target organ.
CN III – Oculomotor
Ciliary Ganglia Iris and Ciliary muscle
CN VII – Facial
Pterygopalatine Ganglion àLacrimal gland
Submandibular Ganglion àSublingual and
Submandibular gland
CN IX – Glossopharyngeal
Otic Ganglion àParotid Gland
CN X – Vagus
Cardiac Ganglia/ PlexusàSuperficial and Deep part of plexus
Oesophageal Ganglia/ Plexus
Pulmonary Ganglia/ Plexus
Many ganglia within the abdomen and walls of abdominal viscera
Sympathetic ganglia
Sympathetic fibers begin in the thoracic region of the spinal cord. These presynaptic fibers exit the spinal cord and enter the sympathetic chain and ascend to reach the superior cervical ganglion.
Cervical ganglion is near the base of the skull and includes the cell bodies of postganglionic fibers that travel along (hitchhike on) the internal and external carotid arteries to reach their target organs. These fibers innervate smooth muscles and glands, e.g. smooth muscles in the walls of blood vessels (vasoconstriction) and glands such as the salivary and lacrimal glands, regulating secretion of saliva and tears, respectively.
In summary, postsynaptic sympathetic fibers hitchhike on the internal and external carotid arteries to get into the H&N and will supply the same structures that the parasympathetic NS supplies, with opposing actions.
Sensory neurons are unipolar thus the CN sensory cell bodies are located outside the brainstem. JUST like the Doral Root Ganglion contains the sensory cell bodies of spinal sensory nerves.
CN IX – Glossopharyngeal (GSA, GVA, SA)
Superior and Inferior Ganglion
CN X – Vagus (GSA, GVA, SA)
Superior and Inferior Ganglion of Vagus (Nodose)
LO8 Describe the origin, course and distribution of the accessory, vagus and phrenic nerves.
accessory XI
supplies the sternocleidomastoid and trapezius muscles.
origin
Cranial Root
Arises from the nucleus ambiguus in the medulla.
Spinal Root
Arises from motor neurons in the spinal accessory nucleus in the upper cervical spinal cord (C1-C5/C6).
course
these ascend and enter the skull through the foramen magnum and it exits the skull through the jugular foramen.
After exiting the cranium via the jugular foramen, the cranial and spinal roots typically separate.
Spinal Part: Descends along the internal jugular vein, passing deep to the sternocleidomastoid muscle and then innervates it. It continues across the posterior triangle of the neck to the trapezius muscle, which it also innervates.
Cranial Part: combines with the vagus nerve to contribute to innervating muscles of the pharynx, larynx, and soft palate.
distribution
Spinal Part:
primarily innervates the sternocleidomastoid and trapezius muscles, which are involved in head movement and shoulder elevation.
Cranial Part:
Contributes to the motor innervation of the pharynx, larynx, and soft palate via the vagus nerve.
joins the vagus nerve
vagus X
Major component of the PNS.
GSA – carry sensation from auricle, external acoustic meatus and dura mater of posterior cranial fossa
GVA – visceral sensations from pharynx, larynx, trachea, bronchi, heart, oesophagus, stomach and intestines, up to the left colic flexure
SVA – special sensation of taste from epiglottis and palate
SVE – branchial, provide motor to muscles of the pharynx (except stylopharyngeus), larynx, palate (except tensor veli palatini) and superior 2/3 of oesophagus
GVE – parasympathetic innervation to the smooth muscles and glands of the trachea, bronchi, coronary arteries and the gastrointestinal tract. It supplies the pulmonary, cardiac and oesophageal plexuses in the thorax and descends into the abdomen to supply parasympathetic innervation to the foregut and midgut.
origin
Arises from the medulla
course
Exits the cranium via the jugular foramen.
Descends in the neck within the carotid sheath, alongside the internal jugular vein and common carotid artery.
Travels down into the thorax, giving off branches like the recurrent laryngeal nerve (which loops under the aorta on the left and the subclavian artery on the right) before continuing into the abdomen.
distribution
is a mixed nerve with the widest distribution, supplying the thoracic organs, foregut and midgut with parasympathetic innervation.
Cervical Region: Supplies branches to the pharynx, larynx (including the recurrent laryngeal nerve), and soft palate. The superior laryngeal nerve (branch of the vagus) also supplies the cricothyroid muscle and provides sensory innervation above the vocal cords.
Thoracic Region: : Provides parasympathetic innervation to the heart (cardiac branches) and lungs (pulmonary branches), regulating heart rate and bronchoconstriction.
Abdominal Region: Extends into the abdomen, providing parasympathetic innervation to the majority of the gastrointestinal tract up to the splenic flexure, including the stomach, liver, pancreas, kidneys, and intestines.
phrenic nerves.
origin
arises from the anterior rami of the cervical spinal nerves C3, C4, and C5, with C4 being the primary contributor ("C3, 4, and 5 keep the diaphragm alive").
course
Descends along the anterior scalene muscle in the neck, passing posterior to the subclavian vein and anterior to the subclavian artery.
Enters the thorax by passing between the subclavian artery and vein.
In the thorax, the phrenic nerve descends anteriorly to the root of the lung, passing along the pericardium of the heart.
distribution
Motor Innervation: primarily innervates the diaphragm
Sensory Innervation: central part of the diaphragm, the pericardium, and parts of the pleura and peritoneum (lining the thoracic and abdominal cavities, respectively).
LO5 Describe the main muscles of the face and summarise their nerve supply and the consequences of injury to their nerve supply.
Primarily innervated by the facial nerve
Facial (VII)
Mixed nerve
Innervates all structures that were derived from the 2nd pharyngeal arch.
Fibre types
GSA – general sensation to ear
SVA – taste from the anterior 2/3 of tongue
GVE – Parasympathetic to lacrimal, submandibular & sublingual glands
SVE - parotid gland where it divides into 5 terminal branches: supplies the muscles of facial expression. Branchial motor to muscles of facial expression
temporal
Frontalis
Raises the eyebrows and wrinkles the forehead.
zygomatic
Zygomaticus Major and Minor
Elevates the corners of the mouth (smiling).
temporal & zygomatic
Orbicularis Oculi
Closes the eyelids; aids in the drainage of tears.
buccal
Orbicularis Oris
Closes and protrudes the lips (puckering, kissing).
Buccinator
Compresses the cheek against the teeth (aids in chewing and whistling).
Risorius
Pulls the corner of the mouth laterally (grinning).
mandibular
Depressor Anguli Oris
Depresses the corner of the mouth (frowning).
Mentalis
Elevates and protrudes the lower lip (pouting).
cervical
Platysma
Depresses the mandible and tenses the skin of the lower face and neck (expresses tension or stress).
Hitchhiking
VII CN → chorda tympani → lingual nerve → sublingual + submandibular glands
Facial nerve branch called the chorda tympani hitchhikes onto the lingual nerve to get into the oral cavity
The chorda tympani carries visceral motor fibers to the submandibular ganglion to supply the submandibular and sublingual salivary glands and it also brings back taste sensation from the anterior 2/3 of the tongue
LO4 Match cranial nerves V, VII, IX and X to the pharyngeal arches they supply.
Pharyngeal arches develop on the ventral aspect of the embryo
Give rise to skin, muscles, and skeletal components of the head and neck (similar to somites)
6 pharyngeal arches
1st arch with the trigeminal nerve (CN V)
2nd with the facial nerve (CN VII)
3rd with the glossopharyngeal nerve (CN IX
4th and 6th arches with the vagus nerve (CN X)
LO3 Name each of the 12 cranial nerves, identify their brainstem origin and list the fibre types they carry.
Olfactory (I)
brainstem origin
Does not originate in the brainstem; fibers arise from the olfactory epithelium.
list the fibre types they carry.
SVA
Sensory Nerve
Special sensation of smell
Optic (II)
brainstem origin
Does not originate in the brainstem; fibers arise from the retina.
list the fibre types they carry.
SSA
Sensory nerve
Special sensation of vision
Oculomotor (III)
brainstem origin
Midbrain (oculomotor nucleus and Edinger-Westphal nucleus).
list the fibre types they carry.
- GSE
- GVE
motor nerve
controls most of the extrinsic muscles of the eye, the intrinsic muscles of the eye.
Trochlea (IV)
brainstem origin
Midbrain (trochlear nucleus).
list the fibre types they carry.
GSE
motor nerve
innervates the superior oblique muscle of the eye.
Trigeminal (V)
brainstem origin
Pons (trigeminal motor nucleus and sensory nuclei).
list the fibre types they carry.
- GSA
- SVE
mixed nerve
provide sensation to the face and innervate the muscles of mastication.
Abducens (VI)
brainstem origin
Pons (abducens nucleus).
list the fibre types they carry.
GSE
motor nerve
controls the lateral rectus muscle.
Facial (VII)
brainstem origin
Pons (facial nucleus, superior salivatory nucleus).
list the fibre types they carry.
GSA
SVA
SVE
GVE
mixed nerve
controls the muscles of facial expression, provides taste sensations from the anterior two-thirds of the tongue, and supplies the submandibular and sublingual salivary glands and the lacrimal glands.
Vestibulocochlear (VIII)
brainstem origin
Pons/Medulla junction (vestibular and cochlear nuclei).
list the fibre types they carry.
SSA
Sensory nerve
hearing and balance.
Glossopharngeal (IX)
brainstem origin
Medulla (nucleus ambiguus, inferior salivatory nucleus).
list the fibre types they carry.
GSA
GVA
SVA
SVE
GVE
Mixed nerve
contributes to swallowing, taste from the posterior one-third of the tongue, and sensation from the throat and some visceral organs.
Vagus (X)
brainstem origin
Medulla (nucleus ambiguus, dorsal motor nucleus of the vagus).
list the fibre types they carry.
GSA
GVA
SVA
SVE
GVE
Mixed nerve
supplying the thoracic organs, foregut and midgut with parasympathetic innervation. speech and swallowing.
Accessory (XI)
brainstem origin
Medulla (nucleus ambiguus) and spinal cord (spinal accessory nucleus in the cervical region).
list the fibre types they carry.
GSE
Motor nerve
supplies the sternocleidomastoid and trapezius muscles.
Hypoglossal (XII)
brainstem origin
Medulla (hypoglossal nucleus).
list the fibre types they carry.
GSE
Motor nerve
muscles of the tongue
“Oh Oh Oh To Touch A Fresh Virgin Girl’s Vagina And Hymen”
LO2 Identify the major foramina of the skull, both internally and externally, and list the structure(s) that each transmits.
Cribriform plate
Ethmoid bone
Olfactory nerve fibers (CN I)
Anterior ethmoidal artery
Optic canal (foramen)
Sphenoid bone
Optic nerve (CN II)
Ophthalmic artery
Superior orbital fissure
Sphenoid bone
Oculomotor nerve (CN III)
Trochlear nerve (CN IV)
Abducens nerve (CN VI)
Ophthalmic branch of the trigeminal nerve (V1)
Superior ophthalmic vein
Foramen rotundum
Sphenoid bone
Maxillary nerve (V2)
Foramen ovale
Sphenoid bone
Mandibular nerve (V3)
Accessory meningeal artery
Lesser petrosal nerve (occasionally)
Foramen spinosum
Sphenoid bone
Middle meningeal artery
Middle meningeal vein
Meningeal branch of the mandibular nerve (V3)
Internal acoustic meatus
Temporal bone
Facial nerve (CN VII)
Vestibulocochlear nerve (CN VIII)
Labyrinthine artery
Jugular foramen
Between the temporal and occipital bones
Glossopharyngeal nerve (CN IX)
Vagus nerve (CN X)
Accessory nerve (CN XI)
Internal jugular vein
Inferior petrosal sinus
Sigmoid sinus
Hypoglossal canal
Occipital bone
Hypoglossal nerve (CN XII)
Foramen magnum
Occipital bone
Medulla oblongata
Vertebral arteries
Spinal roots of the accessory nerve (CN XI)
Anterior and posterior spinal arteries
Dural veins
LO1 Describe the boundaries, walls and floors of the cranial fossae.
Neuro Week 6
LO4 Differentiate the types of afferent fibers
Anatomical Classification
Simple
Naked nerve endings
Pain and temperature receptor
Complex
Elaborate structures around nerve endings
Pressure, vibration and stretch
Receptor Location
Exteroceptors → Respond to external stimuli
Interoceptors → Respond to internal stimuli
Proprioceptors → Interoceptors associated with musculoskeletal structures
Fibre Types
Aα fibers → Large-diameter, fast-conducting; carry proprioceptive information.
Aβ fibers → Medium-diameter; conduct touch and pressure sensations.
Aδ fibers → Small-diameter, fast-conducting; transmit sharp pain and cold sensations.
C fibers → Small-diameter, slow-conducting; carry dull, aching pain and warmth.
Proprioceptors
Proprioceptors
Sensory receptors in the muscles, joints, tendons and skin
Protect the muscle and provide a sense of the position of the muscle
Most structurally and functionally complex of general sensory receptors
Major receptors for proprioception are muscle spindles and Golgi tendon organs
Muscle spindle
Complex receptors – lie parallel with the fibers - located in the muscle belly
Senses length and rate of change in length
Detects both static and dynamic changes in muscle length
Consist of intrafusal muscle fibers in parallel with extrafusal muscle fibers
Types of Muscle Fibers
Intrafusal fibers: sensory components of muscle spindles
Small, specialized muscle fibers that function as sensory receptors within the muscle spindle
Have no actin or myosin in their center → do not contract in this region
Center is dedicated to sensory reception
Two types
Nuclear Bag Fibers
Detect rate of change in muscle length (dynamic changes)
Innervated by Type Ia sensory afferents
Nuclear Chain Fibers
Detect static changes in muscle length
Innervated by Type II sensory afferents
When the muscle stretches (↑ length) → stretches muscle spindle → stimulates both Type Ia and Type II sensory afferents
Muscle Spindles
Type Ia fibers
These fibers stimulate α-motor neurons in the spinal cord
Leading to muscle contraction and shortening → opposes initial stretch → maintain muscle length
γ-Motor Neurons
Adjust the sensitivity of the muscle spindle
Ensuring it can respond appropriately during muscle contraction
Extrafusal Fibers
Make up the bulk of the muscle
Stimulated by α-motor neurons and provide the force necessary for muscle contraction
Co-activation of α- and γ-motor neurons
Ensures muscle spindles remain sensitive to changes in muscle length during contraction
Physiologic Function of the Muscle Spindle
Acts as a comparator of length between intrafusal and extrafusal muscle fibers
Opposes changes in muscle length by returning the muscle to its original length when stretched - triggering the stretch reflex
Golgi Tendon Organ
Located at the musculotendinous junction
Senses tendon tension and rate of change in tension
Protect muscles and tendons from damage due to overstretching
LO5 Explain the role of thalamus in sensory processing
Major sensory relay station
Gateway to the sensory cortex
All afferent impulses are relayed here (except two being)
Unconscious proprioception
Olfaction
Local processing happens
crude sensation perception happens
also plays a role in emotional status
ventral posterolateral nucleus (VPL)
Recieves input from the body and posterior head
ventral posteromedial nucleus (VPM)
Recieves input from the face
LO6 What are the parts of cerebral cortex involved in sensory processing? LO7 Describe the roles of different parts of sensory cortex in sensory processing
astereognosis
Inability to discriminate the size and shape object with eyes closed
Sensory deficit due to the lesion in Area 2 of S1.
Area 2 of S1 is specifically responsible for processing complex tactile information, including the integration of sensory inputs related to object size, shape, and spatial aspects.
With a lesion in Area 2, can still receive basic sensory input (such as touch, temperature, and pain) from area 1, loses the ability to integrate this information into a cohesive sense of the object’s dimensions.
Anterior parietal lobe contains two main sensory areas
Somatosensory Area I (S1)
Also called primary somatosensory area.
Inputs from thalamus and is more extensive in processing sensory information
Processes basic touch info, including location, texture, and shape.
S1 comprises four sub-areas (1, 2, 3a, and 3b)
Each sub-area processes different types of sensory information, with area 3b being the largest and most crucial for touch perception.
Sensory Homunculus
The S1 somatosensory cortex contains a somatotopic map, known as the somatosensory homunculus (“little human”)
This map reflects the proportional representation of body regions according to their sensory receptor density
Regions with more sensory receptors (like the hands) occupy larger areas on cortex
Receptor density in a body region determines size of its corresponding cortical area
Stimulating different parts of the sensory cortex generates sensations that are projected to specific parts of the body
Somatosensory Area II (S2)
contribute to localization, learning, and memory processes
involved in higher-level functions, such as recognizing object size and texture and integrating bilateral sensory inputs.
Somatosensory association areas
Brodmann Areas
Located behind S1 → integrate sensory inputs → form comprehensive understanding of stimuli.
Areas 5 and 7, located behind S1
Integrate sensory information such as temperature and pressure to form a comprehensive understanding of stimuli
Deciphers the meaning of stimuli
Allows for the perception of size, texture, and the relationship between parts
Plasticity of Cortical Circuits
Cortical circuits can reorganize in response to differential stimulation or training, which ↑s sensory input
They can also reorganize in response to amputation, compensating for the loss of sensory input
LO3 Describe sensory pathways from receptor to cerebral cortex
Somatosensory Pathways
Sensory information
Sensory info from the somatic segments to the spinal cord through the dorsal roots of the spinal nerves
Spinal cord to the brain by ascending pathways
Directly to brain stem via cranial nerves
Two important pathways
The dorsal column system/dorsal column–medial lemniscal system
The anterolateral system
1st-order neuron → primary afferent neuron
Primary afferent neurons have their cell bodies in dorsal root or cranial ganglia, and their axons synapse on somatosensory receptor cells
2nd-order neuron is located in the spinal cord or in the brain stem
Axons of 2nd-order neurons cross midline, either in the spinal cord (anterolateral system) or in the brain stem (dorsal column system)
Decussation means that somatosensory information from one side of the body is received in the contralateral thalamus
3rd-order neuron is located in one of the somatosensory nuclei of the thalamus
Thalamus has a somatotopic arrangement of somatosensory information
Dorsal Column-Medial Lemniscal Pathway (Posterior column pathway)
Paired tracts of the dorsal white column
Fasciculus cuneatus and fasciculus gracilis
Transmitting sensory info about
Touch sensations requiring a ↑ degree of localization and transmission of fine gradations of intensity
Vibratory sensations
Sensations that signal movement against the skin
Position sensations from the joints
Pressure sensations related to fine degrees of the judgment of pressure intensity
1st-order neurons have their cell bodies in the dorsal root ganglion cells or cranial nerve ganglion cells → Ascend ipsilaterally to dorsal medulla → synapse in the dorsal column nuclei (the cuneate and gracile nuclei) → 2nd-order neurons decussate immediately to opposite side of brain stem → continue upward through medial lemnisci to the thalamus → medial lemniscus joined by additional fibres from sensory nuclei of the trigeminal nerve → 2nd-order neurons synapse in ventral posterior lateral (VPL) nucleus of the thalamus → 3rd-order neurons ascend to somatic sensory area I
Anterolateral pathway
Ventral/Anterior and lateral spinothalamic tracts
Transmits sensory info about
Anterior – Pressure, crude touch
Lateral – Pain, temperature
Consists mainly of group III and group IV fibers
1st-order neurons have cell bodies in dorsal horn and connect thermoreceptors and nociceptors in skin → In spinal cord, 2nd-order neurons cross midline and ascend to contralateral thalamus
Fast pain is carried on A delta, group II, and group III fibers - has a rapid onset and offset, and is precisely localized
Slow pain is carried on C fibers - and is poorly localized
Trigeminothalamic Pathway
KNOW THIS SENSORY PATHWAY
The sensations of touch, pain and temperature from the face and oral cavity, including teeth, and proprioceptive information from the jaw muscles are carried by the trigeminal nerve
The trigeminal lemniscus serving the face
Tansmits sensory info to the primary sensory trigeminal nucleus in the pons
Receptors associated with these pathways have small receptive fields
1st-order neurons located in the trigeminal ganglion (equivalent to the dorsal nerve root ganglia) → 2nd-order neurons cross the midline (as trigeminal lemniscus) and enter VPM nucleus of the thalamus → Sensory info relayed from thalamus via 3rd-order neurons to somatosensory cortex
Sensory roots enter the brainstem in the pons to terminate in
Principal sensory trigeminal nucleus – Fibers carrying tactile impulses
Spinal nucleus – Fibers carrying pain and temperature
Mesencephalic nucleus – Fibers carrying proprioceptive impulses
Spinocerebellar pathway
Ventral and dorsal spinocerebellar tracts
Proprioception (muscle and tendon stretch)
Convey unconscious proprioceptor information to the cerebellum
Receptors – Muscle spindle and Golgi tendon organs
Tract - Terminates to the same side of the cerebellum (ipsilateral)
Function - Movement and position mechanisms
Two ascending pathways
Dorsal spinocerebellar tract
info from skeletal muscles and joints - Trunk and lower limbs
1st-order neuron relay to nucleus dorsalis (Clarke's nucleus) (C8 to L3) → 2nd-order neurons – through the inferior cerebellar peduncle to the the vermis and intermediate zones of the cerebellum
Ventral spinocerebellar tract
Afferent fibers from muscle spindles (mostly from Golgi tendon organs) → 2nd-order neurons – the majority of fibers cross to the opposite side and ascend → Fibers recross to enter the ipsilateral cerebellum → Enter through superior cerebellar peduncle to the cerebellum
LO1 Name the types of touch and pressure receptors found in the skin. LO2 Describe the receptors that mediate the sensations of pain and temperature.
Type of Stimulus:
Mechanoreceptors - cutaneous receptors for touch and pressure
Meissner’s corpuscles
dendrites encapsulated in connective tissue
respond to changes in texture and slow vibrations
sensitive to low frequency mechanical stimulation
detects slippage between skin and an object held, to control grip
Merkel cells
expanded dendritic endings
respond to sustained pressure and touch
- highest spatial resolution with sensitivity to points, edges, and curvature
Ruffini corpuscles
enlarged dendritic endings with elongated capsules
respond to sustained pressure
Pacinian corpuscles
consist of unmyelinated dendritic endings of a sensory nerve fiber
encapsulated by concentric lamellae of connective tissue
respond to deep pressure and fast vibration
respond to transient, high frequency stimulation
Other Classifications
Visceral sensations are those from the viscera of the body sensations from the internal organs
Deep sensations are those that come from deep tissues, such as from fasciae, muscles, and bone
- deep pressure, pain, and vibration
Chemoreceptors - change in environmental chemical composition (CO2, O2 , H+)
Nociceptors – potentially harmful stimuli such as pain, extreme heat, and extreme cold
Respond to noxious stimuli that can produce tissue damage
Thermal or mechanical nociceptors
Myelinated Aδ fibers
Stimuli such as sharp, pricking pain
Polymodal nociceptors
Unmyelinated C fibers
High intensity mechanical or chemical stimuli, hot and cold stimuli
Thermoreceptors
Free nerve endings – terminate in subcutaneous layers - Slowly adapting
Cold and warm receptors
Warm involves TRP (transient receptor potential) channels
Cold involves TRPM8, which is opened by compounds like menthol
Photoreceptors - in the rods and cones in the retina that respond to light
Adaptation of Sensory Receptors
Receptors adapt to stimuli - desensitization
When a constant stimuli is applied for a period of time - initially, the frequency of AP is high – this frequency declines even though the stimulus continues
PHASIC (rapidly adapting)
Detect rapid changes in the stimulus
Detect onset and offset of a stimulus
Communicates the dynamic nature of the stimulus – when it begins and when it ends – to provide a sense of stimulus movement
Some tactile receptors
TONIC (slowly adapting)
Detect steady pressure
Encode duration and intensity
Communicates the static nature of the stimulus (size, shape)
Pain, proprioception; some tactile receptors
Sensory Transduction and Receptor Potentials
Sensory Transduction
Stimulus energy converted into information processed by CNS
Ion channels or second messengers initiate membrane potential change
Mediated through opening or closing specific ion channels
RP
RP is a change in membrane potential of the sensory receptor
RP is graded
Non-propagated depolarizing potential
↑ stimulus strength → magnitude of the RP ↑
Magnitude of generator potential above 10 mV an AP is generated → nerve impulse
Produced in the unmyelinated nerve terminal
RP summate to threshold stimulus → initiates an AP
Sensation
The particular form of energy to which a receptor is most sensitive is called its adequate stimulus
The sensory unit
A single sensory axon and all of its peripheral branches
Area supplied by one sensory unit usually overlaps and interdigitates with the areas supplied by others
The receptive field of a sensory unit
Spatial distribution from which a stimulus produces a response in that unit
Two-point discrimination
Ability to distinguish two nearby objects touching the skin as two distinct points
Stereognosis
It is the perception of the form and nature of an object without looking at it
Receptive Fields
An area of the body that when stimulated results in a change in firing rate of a sensory neuron
Excitatory Receptive fields → produce an ↑ in the firing rate
Inhibitory Receptive fields → produce a decrease in the firing rate
Receptive fields vary in size
Smaller receptive field → more precisely the sensation can be localized or identified
Considerable overlap with neighboring sensory afferents
Higher the order of the CNS neuron → more complex the receptive field
1st-order sensory neurons have the simplest receptive fields
3rd-order sensory neurons have complex receptive fields
Fine Touch → extremely sensitive → narrow receptive field
Crude Touch and Pressure → large receptive fields
Neuro Week 7
LO7 Explain the route of visual information processing
Signal Transmission in the Retina
Transmission of signals in retina is by electrotonic conduction
Allows graded response - proportional to light intensity
Only ganglion cells have AP
Processing of visual information in the retina involves the formation of three images
The first image
By the action of light on the photoreceptors
The second image in the bipolar cells
In the formation of the second image, the signal is altered by the horizontal cells
The third image in the ganglion cells
In the formation of the third, it is altered by the amacrine cells
Little change in the impulse pattern in the lateral geniculate bodies (in the thalamus)
The third image reaches the occipital cortex
Visual Pathways
Temporal visual fields project onto the nasal retina
Nasal fields project onto the temporal retina
Optic chiasm
All fibers from nasal halves of retina cross to the opposite side and join fibers from the opposite temporal retina to form optic tract
Nerve fibers from each nasal hemiretina cross at the optic chiasm and fibers from each temporal hemiretina remain uncrossed
Retina to thalamus
Axons from retinal ganglion cells form the optic nerves and optic tracts synapse in the thalamus
Synapse in dorsal lateral geniculate nucleus (LGN)
From LGN to primary visual cortex - optic radiation
Two principal functions of LGN
Relay information to primary visual cortex via optic radiation
“Gate control” of information to primary visual cortex
Thalamus - Lateral Geniculate Nucleus
Magno and parvocellular layers in LGN
“M” ganglion cells of the retina neural network have large cell bodies, and their axons ascend to the magnocellular layer of the LGN
“P” ganglion cells of the retina have small cell bodies, and their axons ascend to the parvocellular layer of the LGN
Damage to the parvocellular layer decreases acuity and colour perception but not motion detection
Damage to the magnocellular layer decreases ability to perceive motion but not to analyse size, shape and colour of objects
Visual Cortex
LGN projects to primary visual cortex or striate cortex by way of the visual radiations
The primary visual cortex - Brodmann area 17 or V1
discerning the intensity, shape, size, and location of objects in the visual field.
The visual cortex contains a retinotopic map
Representation of the macula occupies the most posterior and largest part of both gyri
Fovea has several hundred times as much representation in the primary visual cortex
Extrastriate Visual Cortex
Other cortical areas for vision include – Brodmann area 19, medial temporal and medial superior temporal (on the lateral aspect of the temporal lobe), and Bradmann area 7a of the parietal lobe
These are the secondary visual areas - also called visual association areas
For analysis of visual meanings
Dark and Light Adaptation
Dark Adaptation
Deficiency of Vitamin A – impaired dark adaptation – Night blindness
Conditions causing night blindness (nyctalopia)
Nearsightedness, cataracts, retinitis pigmentosa, Vitamin A deficiency, Cystic fibrosis, pancreatic insufficiency ( due to reduced fat absorption and Vit A deficiency
Vitamin A - involved in multiple physiologic and developmental functions
It is the precursor of 11-cis retinal - essential for photoreceptor function
One of the earliest signs of vitamin A deficiency is
inability to completely replenish the rhodopsin in retinal rods during dark adaptation - resulting in difficulty seeing in dim light
Vitamin A deficiency first alters rod function
Concomitant cone degeneration occurs as Vitamin A deficiency develops
Prolonged deficiency
Associated with anatomic changes in the rods and cones
Degeneration of the neural layers of the retina
Moving from brightly lit area to a dimly lighted environment - the individual becomes “accustomed to the dark”
Retina becomes more sensitive to light - with increasing time spent in darkness
Decline in visual threshold - is known as dark adaptation (20 min)
Rods are responsible for the dark adaptation response
Dark adaptation time depends on the rate of regeneration of rhodopsin (depends on Vitamin A)
Light Adaptation
Moving from dim to a brightly lighted environment
Intense light – uncomfortably bright
In sustained bright light, a large proportion of rhodopsin will dissociate to retinal and opsin
Eyes becomes adapted to light by having less visual pigment available for phototransduction
Visual threshold ↑s – light adaptation (5 min)
Pupillary Light Reflex
Argyll Robertson pupil - A pupil that fails to respond to light but does respond to accommodation
Loss of pupillary light reflex in CNS. Damage to visual signal transmission from the retinas to the Edinger-Westphal nucleus
Pupillary Constriction and Dilation
Size of the pupil modulates light that reaches photoreceptors
Pupils constrict when the amount of light entering eyes ↑
Functions to help eyes adapt to extremely rapid changes in light conditions
Regulate the amount of light entering the eye
Change in the size of the pupil
Inner circular smooth muscle: constrictor
Outer radial smooth muscle: dilator
Parasympathetic nerves excite pupillary sphincter muscle, decreasing pupillary aperture (miosis) – pupillary constriction
Sympathetic nerves excite radial fibers of iris, increasing pupillary aperture (mydriasis) - pupillary dilation
When light is directed into one eye, the pupil constricts (direct light response)
The pupil of the other eye also constricts (consensual light response)
Pathway - The optic nerves to the pretectal nuclei - secondary impulses pass to the Edinger-Westphal nucleus - back through parasympathetic nerves to constrict the sphincter of the iris
Function - to help the eye adapt extremely rapidly to changing light conditions
LO8 Discuss the effects of lesion at various sites in the visual pathway
Optic nerve
Optic nerve lesion - causes blindness in the ipsilateral eye
All sensory information coming from that eye is lost because the cut occurs before any fibers cross at the optic chiasm
Optic chiasm
Lesion at the optic chiasm causes heteronymous (both eyes) bitemporal (both temporal visual fields) hemianopia (loss of vision in half the visual field)
Information from the temporal visual fields from both eyes is lost
Optic tract
Damage to the optic tract causes homonymous (vision loss on the same side of the visual field in both eyes) contralateral hemianopia
Homonymous hemianopia - a visual field defect involving either the two right or the two left halves of the visual fields of both eyes
Caused by lesions of the optic tract, the lateral geniculate nucleus, the optic radiations, and the cerebral visual (occipital) cortex
Retinopathy
A vascular disease of the retina which affects patients with diabetes mellitus
Retinopathy is a major (microvascular) complication of diabetes mellitus
Prolonged hyperglycemia causes irreversible pathological changes in the retina
Two main classes: non-proliferative and proliferative
Proliferative - there is neovascularisation in the retina
Non-proliferative - without neovascularisation
As the disease progresses, it may progress into proliferative diabetic retinopathy (PDR)
Hyperglycemia-induced cellular damage in the retina occurs through the polyol pathway, production of advanced glycation end products (AGEs), ↑d oxidative stress and activation of the protein kinase C (PKC) pathway
Polyol pathway (sorbitol-aldose reductase pathway)
Excess glucose metabolized to sorbitol by aldose reductase
Sorbitol and fructose (polyols) cause oxidative damage to cells
Cause osmotic cell swelling and cell death
Advanced glycation end products (AGEs)
Glucose forms covalent adducts with proteins through a non-enzymatic process known as glycation
Hyperglycemia induce glycation of various structural and functional proteins including plasma proteins and collagen
AGE’s accumulate in retina
Cataract
Any opacity in the lens or its capsule
Clouding of the lens in the eye due to clumping of lens proteins
Crystallin – the water-soluble structural protein in the lens
Three basic mechanisms which cause cataracts
Damage to the lens capsule that changes its membranous properties
Change in the lens fibre protein synthesis
Senile cataract
Common eye abnormality that occurs mainly in older people
Develop slowly - leading to gradual impairment of vision
Decreased levels of total proteins, amino acids and potassium associated with an ↑d concentration of sodium and marked hydration of the lens, followed by coagulation of proteins
Treatment
Surgical extraction of the opacified lens
A plastic or silicone intraocular lens is placed within the empty lens capsule
Glaucoma
A group of disorders in which intraocular pressure is raised above the tolerance limit of the affected eye
Results in damage to the optic nerve head and irreversible visual field defects
Normal intraocular pressure is 15 mm Hg (± 2 mmHg)
As the pressure rises, the axons of the optic nerve are compressed
Open-angle glaucoma
The slow clogging of the drainage canals (trabecular meshwork blockage)
Results in accumulation of intraocular fluid and ↑d eye pressure
Has a wide and open angle between the iris and cornea
The angle where the iris meets the cornea is as wide and open
Aqueous humor drainage is inadequate
The production of aqueous humor by the ciliary body is normal
Causes
Scarring caused by trauma or infection
Plugging of channels by detached iris pigment
Abnormal protein deposits
Degeneration of trabecular meshwork
Closed-angle glaucoma
The outflow of aqueous humor is obstructed by the iris root of the dilated pupil
The drainage channels for aqueous humor appear normal
Accounts for the majority of all cases of glaucoma
Causes
By decreased permeability through the trabeculae into the canal of Schlemm, which leads to an ↑ in IOP
The disease is often bilateral and has a genetic component
Anatomy
Name the bones that form the orbit, which houses the eyeballs
The Orbits
The eyes are the organs of vision, located in the orbit
Bones of the orbit: frontal bone, frontal process of maxilla, lacrimal bone, ethmoid, sphenoid & zygomatic
Within the orbit are the eyes and the accessory structures that support or move them
The medial walls of the orbits are parallel, lateral walls at a 90 degree angle
The axes of the eyes are at 45 degree but the optical axes are parallel
Describe the structure of the eyes
The Eyes
The eyes comprise three chambers:
Anterior (b/w cornea and iris)
Posterior (b/w iris and lens)
Vitreous (b/w lens and retina)
The eyes comprise three layers:
Fibrous layer (sclera and cornea)
Vascular layer (choroid, ciliary body and iris)
Inner layer (with optic and non-visual components)
Fibrous Layer
Sclera
is white, fibrous layer covering the posterior 5/6 of the eye
Allows for attachment of the extraocular and intraocular muscles
Cornea
covers the remaining 1/6 of the eye
Vascular Layer
The choroid is a dark brow layer that lines the sclera
It is highly vascular
The choroid is continuous with the ciliary body and the iris anteriorly
Ciliary Body
The ciliary body connects the choroid with the circumference of the iris and provides attachment for the lens
Ciliary processes secrete aqueous humor, which fills the posterior chamber of the eye through the pupil it circulates to the anterior chambers where it is reabsorbed by the scleral venous sinus
↑d production of aqueous humor or reduction in absorption results in glaucoma
The Iris
The iris lies on the anterior surface of the lens and its function is to regulate the amount of light that enters the eye
There are two involuntary muscles controlling the size of the pupil:
Sphincter pupillae
Constricts the pupil (miosis) in response to light.
Parasympathetic fibers.
Oculomotor nerve (cranial nerve III).
Dilator pupillae
Dilates the pupil (mydriasis) in low light conditions.
Sympathetic fibers.
Sympathetic innervation via the superior cervical ganglion.
The Lens
It is a colourless, transparent biconvex structure enclosed within a capsule
The capsule suspends the lens in the eye via zonular fibres
Ciliary muscles contract or relax to change the shape of the lens
Inner Layer – The Retina
Has optic and non-visual components
The optic part has a neural layer (light receptive) and a pigmented layer (that prevents scatter of light in the eyeball)
The non-visual layer is an anterior extension of the pigmented layer
Optic disc – where optic nerve and vessels enter the eye
Macula has special photoreceptors called cones
Central artery of the retina supplies the retina
Neural layer derives its nutrients from the capillary network of the choroid
Explain the axes of the eyes and how the muscles move the eyes around these axes
Extraocular Muscles
Levator palpebrae superioris
4 recti (superior, inferior, medial & lateral)
2 obliques (superior & inferior)
Eye Movements
Other Supporting Structures
Conjunctiva
is over the surface of the sclera and anteriorly the cornea. It is reflected onto the deep surface of the eyelids
Eyelids
protect the eyes from light, injury and distribute tears over the eyes
Lacrimal gland
secretes lacrimal fluid (saline) into the conjunctival sac
The fluid is distributed over the conjunctiva from lateral to medial
The fluid drains through puncta to the lacrimal sac and to the nasolacrimal duct into the nasal cavity
Innervated by both divisions of the ANS:
Sympathetic
Parasympathetic (from CN VII)
Name the nerves that supply the intraocular and extraocular muscles of the eye
Nerves of the Eye
The optic nerves convey special sensory visual information
General sensory information from the conjunctiva are carried via ophthalmic nerve (CN V1)
Motor fibres: SO4 LR 6 , all other muscles by CNIII
LO6 Describe phototransduction
Photopigment
Photoreception
converts light energy into electrical energy (phototransduction)
Light activation
graded change in membrane potential
changes in rate of transmitter release
Rhodopsin
Lack of vitamin A causes a decrease in retinal, which results in decreased production of rhodopsin; and a lower sensitivity of retina to light (night blindness)
composed of opsin (a protein belonging to the super family of G protein–coupled receptors) and retinal (an aldehyde of vitamin A)
Retinal is a light absorbing molecule – synthesized from Vitamin A
Pigmented layer – local reservoir of Vitamin A
Retinal has two isomers (3D forms)
11-cis
a bent structure when connected to opsin
All-trans
when struck by light – and change the shape of opsin to its active from
11-cis to all-trans transformation is the light dependent step
Retinal is coupled opsin
Rhodopsin (rhodopsin is formed and accumulated in the dark)
Rhodopsin has seven transmembrane domains of the opsin
Pigmented Epithelium in the Retina
Absorbs scattered light
Nourishes retinal layer
Control ion homeostasis of the retinal layer
Phagocytosis of photoreceptor outer segments
Site of resynthesis of 11-cis retinal during the visual cycle
Secretes growth factors and signal molecules (PDGF, TGF-β, IGF-1, and ATP)
Visual Pigments
Rhodopsin
Photosensitive visual pigment - in the discs of the rod outer segments
Consists of a protein opsin (called scotopsin) and a carotenoid called retinal (aldehyde of vitamin A)
Absorption of light changes shape of the retinal, causing it to dissociate from opsin
Cone pigments are somewhat different from the rhodopsin in that they respond to specific wavelengths of light, giving rise to colour vision
Light absorbed by the rhodopsin converts its 11-cis-retinal into all-trans-retinal
Light-induced isomerization of 11-cis-retinal into all-trans-retinal occurs through formation of many intermediates
Metarhodopsin II- activated rhodopsin of the chain reaction
Acts as an enzyme to activate many molecules of transducin
The activated transducin triggers the phototransduction
Retinoid Cycle and Photoadaptation
Activated rhodopsin is phosphorylated rapidly by rhodopsin kinase
Following photoisomerization, all-trans retinal is converted into all-trans retinol
All-trans retinol is transported into the pigment epithelium
All-trans retinol is converted to 11-cis retinal and transported back to the outer segment (via IRBP- it recombines with opsin)
Photoreception
In the dark
Pigment in 11 cis form
cGMP gated channels - Outer segment Na+ channels bind to cGMP on the intracellular side - open by cGMP
In dark cGMP opens Na+ channels – inflow of sodium – reduces membrane potential from -70 to - 40mV - Dark current
Rod receptor potential : - 40mV in the dark
Na+ pumped out of the inner segment by Na+-K+ATPase pump (maintains ionic equilibrium)
Depolarization - cell is active – ↑ transmitter (glutamate) release
In Light
Light strikes the retina
11-cis retinal is converted to all-trans retinal
Series of conformational changes occur in the opsin that culminate in the production of metarhodopsin II
Metarhodopsin II – is activated rhodopsin
Metarhodopsin II activates transducin
Activated transducin stimulates a phosphodiesterase that catalyzes the conversion of cGMP to 5′-GMP
↑d breakdown of cyclic GMP will decrease cyclic GMP levels
Decreased cGMP will close cGMP gated sodium channels
Hyperpolarization and decreased transmitter (glutamate) release
Generates a signal in the bipolar cells that ultimately leads to AP in ganglion cells
Receptor potential is proportional to logarithm of light intensity - very important for discrimination of light intensity
The AP are transmitted to the brain
Mechanism for Light to Decrease Sodium Conductance
Neurotransmitters in Vision
Two types of glutamate receptors on bipolar and horizontal cells
Type of receptor determines whether the response on bipolar and horizontal cells will be depolarization (excitation) or hyperpolarization (inhibition)
Ionotropic receptors (iGluR) – AMPA & Kainate subtypes
which are depolarizing (excitatory)
Metabotropic receptors (mGluR6)
which are hyperpolarizing (inhibitory)
Decreased release of glutamate that interacts with ionotropic receptors will result in hyperpolarization - inhibition of the bipolar or horizontal cell
Decreased release of glutamate that interacts with metabotropic receptors will result in depolarization - excitation of the bipolar or horizontal cell
This process will establish the on-off patterns for visual fields
LO5 Explain photoreceptor anatomy and function
Visual Acuity
Measurement of the threshold of discrimination of two spatially separated targets
(a function of the fovea centralis – hence a measurement of central vision)
Clinical tests determining visual acuity measure the form sense or reading ability of the eye. Tested using Snellen’s chart – Normal vision 20/20 or 6/6
For testing distant visual acuity, the patient is seated at a distance of 6 m (20 ft) from the chart
the rays of light are practically parallel
the patient exerts minimal accommodation
Visual acuity is influenced by
Optical factors
state of image-forming mechanism (intact retina, optic nerve, visual pathway)
Visual acuity is low in patients having refractive errors
Retinal factors
state of cones
Visual acuity is maximum at fovea centralis
Stimulus factors
distance, size, illumination, and brightness of the object
Photoreceptors
RODS
Outer segments are long and consist of stacks of free-floating double-membrane discs
These discs are lined with rhodopsin – the light sensitive pigment
Many rods synapse on a single bipolar cell
Accounts for the lower acuity but the higher sensitivity of the rods
Light striking any one of the rods will activate the bipolar cell
CONES
Short, cone-shaped outer segments, which consist of infoldings of surface membrane
A smaller amount of rhodopsin than in the rods
Only a few cones synapse on a single bipolar cell - which synapses on a single ganglion cell
Accounts for higher acuity and lower sensitivity of cones
Acuity is highest in the fovea, where one cone synapses on one bipolar cell, which synapses on one ganglion cell
Colour Vision
Colour Blindness - Lack of a particular type of cone
recessive X-linked
Monochromacy
Lack of two cone receptor type
Dichromacy
lack of one type of cone receptor
red-green blindness
unable to distinguish between red and green due to the fewquencies
Most colour blindness results from lack of red or green cones
Lack of a red cone, protanope
Lack of a green cone, deuteranope
Lack of a blue cone, tritanopia (rare)
Sensation of any given colour being determined by the relative frequency of the impulses from each of these cone systems
Three types of cones:
S Cone (Blue cone): responds best to 420 nm
M Cone (Green cone): responds best to 530 nm
L Cone (Red cone): responds best to 560 nm
Each type responds best (not exclusively) to its colour
Colour perception
Brain compares responses of cones
Cone comparison = color perception
LO4 Explain the retinal neural network
The retina
A specialized sensory epithelium - contains photoreceptors and other cell types arranged in layers
Five basic classes of neurons – Photoreceptors, Bipolar Cells, Ganglion Cells, Horizontal Cells, Amacrine Cells
Pigment Epithelium
Melanin-containing layer – reduces light scattering
Nourish photoreceptor layer
Cell processes surround the tips of photoreceptor outer segments
Old outer segment disks are shed and new disks are continuously formed
Older disk segments are phagocytosed by the pigment layer
Pigment layer also regenerate photopigment molecules
Different types of nerve cells associated with the retina
Photoreceptors (rods and cones)
Horizontal cells
Connect laterally between rods and cones and bipolar cells
Output of horizontal cells is always inhibitory
Prevents lateral spread of light excitation on the retina
Lateral inhibition, the function of horizontal cells
Amacrine cells
A type of interneuron that aids in the beginning of visual signal analysis
Some respond strongly to the onset of the visual signal, some to the lack of the signal
Some respond to the movement of light signals across the retina
Bipolar cells
Two types of bipolar cells
Depolarising bipolar cells - when excited
Hyperpolarising bipolar cells - when excited
Provide opposing excitatory and inhibitory signals in the visual pathway
Ganglion cells
Only ganglion cells have AP
Spontaneously active with continuous AP
Many excited by changes in light intensity
Typically show sustained ON-center, OFF-surround responses or sustained OFF- center, ON-surround responses
LO3 Explain the refractive errors of the eye
Hyperopia (far sightedness)
Image of the object is focused behind the retina
Eyeball is too short or lens is too weak
Near objects are blurry while distant objects are clear (because of accommodation)
Correction – convex lens
Myopia (near sightedness)
Image of the object is focused in front of the retina
Eyeball is too long or lens is too strong
Near objects are clear while distant objects appear blurry
Correction – concave lens
Presbyopia
Physiological type of error of refraction
Reading and close work becomes difficult
Increasing hardness of the lens with aging
Caused by progressive denaturation of proteins in lens
Correction - convex lens
Astigmatism
Defect in the curvature of cornea
Light rays after refraction never focused at a single point
Images are blurry/distorted
Correction – cylindrical lens
LO2 Describe the process of accommodation
Accommodation
Presbyopia: Loss of accommodation
The distance from the lens to the retina is fixed
Power of the lens can be altered
Refractive power of the lens can be ↑ to 34 diopters by making the lens thicker
Contraction of the ciliary muscles reduces tension on the lens - pulls ligament forward causing the lens to become thicker
For close objects, the lens curvature is ↑
For far objects, the lens curvature decreased
Near Vision
Convergence
Medial rotation of the eyeballs toward the object being viewed
Constriction
Pupillary reflex constricts the pupils to prevent divergent rays from entering the eye
Accommodation
Changing the lens shape by ciliary muscles to ↑ refractory power
LO1 Describe the functions of different components of the eye
Eye has three layers
Outer fibrous: The sclera
Fibrous layer – Cornea, Corneal epithelium, Conjunctiva, and Sclera
Cornea - Transparent, central anterior portion - Allows light to pass through
The curved transparent area where light enters the front of the eye
Forms the main refracting medium of the eye
It is a transparent structure
The endothelial surface is bathed in the aqueous humor
In addition, Na+ and water are actively pumped out of the cornea
Function
to act as a major refracting medium, so that a clear retinal image is formed
Sclera - White connective tissue layer - seen anteriorly as the “white of the eye” – gives shape to the eyeball
Sclerocorneal junction has canal of Schlemn
middle vascular: the choroid
Vascular layer - Composed of choroid, ciliary body and iris
Vascular layer is modified anteriorly into two structures
Ciliary body —smooth muscle attached to lens
Iris — a diaphragm – surrounding the pupil
Regulates amount of light entering eye
Contains pupillary muscles (pupillary sphincter/ pupillary constrictor - smooth muscle)
Pupil — rounded opening in the iris
Autonomic reflexes regulate pupillary diameter
inner sensory: the retina
Retina contains two layers
Outer pigmented layer
Helps to absorb stray light rays
Inner neural layer
Contains receptor cells
Contains five distinct neuron types
Photoreceptors
Cones
Responsible for colour vision
are the only photoreceptor present in the fovea
Rods
highly sensitive to light
Most sensitive at low levels of illumination
, are the predominant photoreceptors in the periphery of the retina
Macula and Fovea Centralis
At the posterior pole of the eye is a yellowish spot, the macula lutea
The center of macula is a depression called the fovea centralis
the fovea centralis - the most sensitive part of the retina
The image is projected onto the central fovea, the site where vision is the sharpest
It is composed almost entirely of cones
These cones have a special structure that aids their detection of detail in the visual image
Most of the visual input that reaches the cortex comes from the fovea
Chambers of the Eye
Anterior (aqueous) segment
Anterior to lens – smaller anterior chamber (behind cornea) - Contains aqueous humor
Posterior (vitreous) segment
Posterior to lens – larger posterior chamber - Contains vitreous humor - 80% of eye volume
Intraocular fluid - Keeps eyeball round and distended
Aqueous humor
A clear liquid which is similar to blood plasma
Continuously formed from plasma by epithelialcells of ciliary body
Supplies nutrients and some oxygen to the ocular avascular tissues - cornea and lens
Drained into the venous blood circulation via the canal of Schlemm
Vitreous humor
Organic clusters or cells or debris in the vitreous humor - floaters
Gelatinous mass with little fluid flow
Nutrition, and has phagocytic cells (remove cellular debris in the visual field)
intraocular pressure
Obstruction to the fluid outlet leads to glaucoma (opened angle) – ↑ intraocular pressure
Fluid pressure within the eye
Determined by the production and drainage of aqueous humor
Optic Disc
Signals leave the retina toward the brain through the optic nerve
Optic Disk or Optic Nerve Head
Papilledema – edema of optic disc secondary to ↑ intracranial pressure
Scotoma
Abnormal blind spots in the visual fields
A spot in the visual field that can be dark, very light, blurred, or flickering
cause by Stroke, tumour, trauma, multiple sclerosis, glaucoma, methyl alcohol poisoning, use of tobacco
Central scotomas
loss of macular vision
Central/paracentral scotomas can be found in optic neuritis and open-angle glaucoma
Circular region just medial to fovea
Origin of optic nerve (ganglion cells axons) and retinal vessels
Blind spot
Because the disc contains no photoreceptors, light incident on the disc does not elicit a response
Optic disc is where the optic nerve leaves the eyeball
cannot see images focused on the optic disc
has no photoreceptors
The functional portions of the retina cover the entire posterior eye, with the exception of the blind spot
Neuro Week 8
LO5 Explain how the vestibular apparatus detects movement
Vestibular System
For posture and equilibrium
Detection and conscious perception of head position and movement
Coordinate compensatory eye movements during head movement, providing stabilisation of the visual image and target fixation
Coordinate the postural adjustments of the trunk and limb muscles following head movement
Major connections are to;
Spinal cord, the cerebellum, and cranial nerve nuclei of III, IV, and VI
Location - within the temporal bone, adjacent to the auditory apparatus (the cochlea)
The vestibular organ – consists of a membranous labyrinth within the bony labyrinth
Membranous labyrinth
Consists of three perpendicular semicircular canals (horizontal, superior, and posterior) and two otolith organs (utricle and saccule)
Five sense organs: the utricle, the saccule and, at the base of each semicircular canal, the ampulla
Perilymph and Endolymph
Inner ear consists of the bony labyrinth (bony space), a series of interconnected cavities in the petrous part of the temporal bone
Inside the bony labyrinth is the membranous labyrinth, a system of tubes and sacs
Fluid called perilymph fills the space between the bony and membranous labyrinths
Membranous labyrinth contains endolymph (high K, less Na)
Vestibular System
Vestibular receptor organs monitor two components of motion
Angular acceleration
Detection of rotational movements
Linear acceleration
Detection of motion with respect to gravity
Vestibular Apparatus
Three semicircular canals
Two sac like organs: Utricle and saccule
All these structures are filled with endolymph
The Semicircular Canals
For angular acceleration/deceleration of the head
Three canals - oriented perpendicular to each other in the horizontal, anterior and posterior planes
Anterior and posterior canals are vertical, while the lateral canal is horizontal
Each canal detects motion in a single plane
Signal the brain regarding the direction and speed of rotation of the head
Structure of Semicircular canals
Base of each canal is an enlarged chamber – ampulla
Within the ampulla is a structure called the crista
Each crista has a gelatinous mass – cupula
In the capula there is a large kinocilium and a cluster of stereocilia
Rotation of the head in the plane of the canal, the inertia of the endolymph causes it to wash over the cupula, deflecting the hair cells - the endolymph moves with rotation
Stimulation
When the head is rotated - The cupula is dragged through the endolymph - causing the bending of the cilia on the hair cells
Stereocilia bent toward the kinocilium – depolarization (K+ enters- endolymph)
Stereocilia bent away from the kinocilium – hyperpolarization (K+ channel closed)
Afferent nerve CN VIII carry vestibular information to the brain
When the head stops – inertia causes the endolymph to keep rotating – the cupula returns to resting position after a delay
Rotation of the head to the left stimulates the left semicircular canals
Rotation to the right stimulates the right semicircular canals
Brain compares the input from the 3 semicircular canals in order to deduce the direction of rotation
Canals on either side of the head operate in a push-pull rhythm
When one is excited, the other is inhibited
Specifically, excitation occurs in the direction of rotation
If both sides push at once, debilitating vertigo and nausea result
Activation of the vestibular afferent fibers is detected by the brain and is relayed via the vestibular nuclei to pathways that mediate compensatory eye movements, neck movements, and adjustments to posture
Otolith Organs
The utricle (horizontal acceleration) and saccule (vertical)
Pair of relatively large chambers near the center of the labyrinth
Utricle and saccule detect linear acceleration and the pull of gravity
Each organ has a sheet of hair cells and supporting cells — the macula (gelatinous otolith membrane)
The macula (sensory epithelium) is vertically oriented within the saccule and horizontally oriented within the utricle
Gel has small crystals of calcium carbonate embedded in it, called otoliths (or otoconia)
Otoconia - are crystals of calcium carbonate, that give the otolithic membrane a higher density than the surrounding endolymph
Hair cells are exposed to endolymph at their apex and perilymph at their base
Cilia are connected by tip links and are embedded in a gelatinous mass, just like the semicircular canals
Otoliths provide the inertia so that when movement to one side occurs, the otolith – gel mass causes the hair cells to deviate
Note striola centre- kinocilium change “sides” on either side of it- helps detemine what way direction or gravity is
Otolith Organ Functions
A major function of the saccule and utricle is to keep the head vertically oriented with respect to gravity
Receptors in the saccule – sensitive to vertical forces
Receptors in the utricle – sensitive to horizontal forces
Head tilt or linear acceleration causes the otoconia and otolithic membrane to move - distorts the hair cells
Head tilt distorts hair cells relative to the plane of gravity
Linear acceleration causes otoconia to lag behind otolithic membrane and cells
Head tilt - Gravitational forces cause the otolith mass to slide across the vestibular hair cells
Stereocilia bend toward (depolarization) or away from the kinocilium (hyperpolarization)
For each position of the head, there is a unique pattern of activity from the afferent nerves innervating the otolith organs
LO6 Describe the route of vestibular information
Vestibular Pathways
Afferent nerves from vestibular hair cells terminate in vestibular nuclei of the medulla (superior, medial, lateral, and inferior nuclei)
Medial and superior nuclei
Receive input from the semicircular canals and project to nerves to extraocular muscles via the medial longitudinal fasciculus
Lateral vestibular nucleus
Receive input from the utricles and projects to spinal cord via the lateral vestibulospinal tract
Projections of the lateral vestibular nucleus for maintaining postural reflexes
Inferior vestibular nucleus
Receives its input from the utricles, saccules, and semicircular canals
Projects to
The brain stem and the cerebellum (to the vestibulocerebellum (flocculo-nodular lobe and uvula)
To the sensory cortex (S1, area 5)
Input to the sensory cortex is important for body orientation
LO7 Describe the receptors and neural pathways for taste and smell
OLFACTION
Detection of chemical stimuli and transduction into electrical energy that can be transmitted in the NS
Nasal cavity
Respiratory segment and the olfactory segment
Olfactory segment
Located on the dorsal roof of the nasal cavity
Two layers
Olfactory Epithelium
pseudostratified columnar epithelium
Three cell types
Supporting cells
Columnar cells lined with microvilli and filled with secretory granules
Basal cells
Base of the olfactory epithelium
Undifferentiated stem cells give rise to olfactory receptor cells
New olfactory sensory neurons are generated by basal stem cells
Olfactory Receptor cells
Each olfactory receptor is a bipolar neuron
Each neuron has a short, thick dendrite with an expanded end – Olfactory rod
Cilia project to the surface of the mucus
Very thin axon emerging from one side of the cell body and a single dendrite extending from the other side toward the surface of the epithelium
Odorant molecules bind to receptors on the cilia, which extend into the nasal mucosa
Axons pierce the cribriform plate of the ethmoid bone and enter the olfactory bulb
Produce depolarizing receptor potentials - trigger trains of AP
Although there are many subtly different types of olfactory receptor neurons, all have the same morphology and use the same G protein–coupled transduction mechanism
Olfactory glands (Bowman’s glands)
Produce mucus that is used to dissolve odour molecules so that transduction occurs
Odorant molecules dissolve in mucus and bind to odorant receptors on cilia of olfactory sensory neurons
Lamina propria
Olfactory Transduction
Encoding of Olfactory Stimuli
There are at least 1000 different olfactory receptor proteins (members of the superfamily of G protein–coupled receptors)
Each encoded by a different gene and each found on a different olfactory receptor cell
Receptor proteins are selective - responding to some odorants more than others
Each odorant produces a unique pattern of activity across a population of receptors, which is projected onto targeted glomeruli in the olfactory bulb (“odor map”)
The CNS then interprets these odor maps
Olfactory Pathways
Anosmia - Absence of the sense of smell Hyposmia - Impaired sense of smell (Early sign of Parkinson’s disease Dysosmia - A distorted sense of smell
Axons from the receptors pass through the cribriform plate - synapse on mitral cells in the olfactory bulb
These synapses occur in clusters called glomeruli
In the glomeruli, approximately 20000 olfactory receptor axons converge onto 1 mitral cell
Each glomerulus receives afferent inputs from a single receptor type
Olfactory bulb contains granule cells and periglomerular cells
These cells are inhibitory interneurons that synapse on mitral cells
The inhibitory inputs sharpen the information projected to the CNS
Mitral cell axons travel posteriorly through the olfactory tract and reach the base of brain
Axons of the olfactory tract bypass the thalamus and terminate on the piriform cortex, the amygdala (emotional response to smell), the hypothalamus, and the hippocampus (olfactory memories)
Conscious discrimination of odours is dependent on the pathway to orbitofrontal cortex
Taste
Ageusia – Absence of taste sensation Hypogeusia - Diminished taste sensitivity (drug induced – chemotherapy drugs, antibiotics) Dysgeusia – Disturbed sense of taste (chemotherapy, asthma treatment, zinc deficiency)
Taste cells - Monitors of nutrient intake
Detect the general constituents of food and beverages and lead to taste sensations of salt, sweet, sour, bitter, and umami
Upper surface of tongue is covered in papillae and taste buds - Kept moist by saliva
Rich nerve and blood supply
Taste sensation is closely linked to olfaction
Taste cells are non-neural epithelium
Taste cells are elongated, modified epithelial cells with microvilli at one end that protrude through an opening
Each taste cell is sensitive to only one taste
Like other epithelial cells, taste cells are replaced throughout life
The Tongue and Taste
Taste buds on the tongue are organized in specialized papillae
Three types of papillae that contain taste buds
Circumvallate papillae - About 9 that contain 100 –300 taste buds – at the rare of the tongue
Fungiform papillae— Scattered over the tongue rounded with taste buds (5 taste buds each)
Foliate papillae - Located in postero-lateral trenches of the tongue—most of their taste buds degenerate in early childhood
Filiform papillae - cover the entire surface of the tongue - contain tactile receptors but no taste buds
A small population of taste buds in the pharynx, larynx, epiglottis, and esophagus
Taste Buds and Taste Receptors
Taste receptors – within taste buds on the tongue, palate, pharynx, and larynx
Three cell types: supporting cells, basal cells, and receptor cells
Basal cells are undifferentiated stem cells - serve as precursors to taste receptor cells
Undergo continuous replacement (new cells generated every 10 days)
Taste receptor cells
Specialized epithelial cells -chemoreceptors
Line the taste buds and extend microvilli into the taste pores
Afferent nerves innervate the receptor cells
Produce depolarizing receptor potentials in response to exposure to an appropriate tastant
Three cranial nerves are involved the sense of taste
Facial nerve carries taste information from the anterior 2/3 of the tongue.
Glossopharyngeal nerve carries taste information from the posterior 1/3 of the tongue.
Vagus nerve carries taste information from taste buds on the epiglottis and in the throat
Taste Transduction
Differential sensitivity of areas on the tongue
The tip of the tongue is most responsive to sweet, salty, and umami
The posterior tongue is most responsive to bitter
The sides of the tongue are most responsive to sour
Taste transduction results in depolarization of the receptor membrane
Mechanism of Taste Transduction
Taste Pathways
Depolarizing receptor potentials in the taste receptor
AP in primary afferent neurons innervating the tongue
Signals ascend in the solitary tract
Terminate on second-order neurons in the solitary nucleus of the medulla
The lateral part of the rostral end of the nucleus of the solitary tract is its gustatory subdivision
Neurons here project to
the reticular formation (for taste-related reflexes such as salivation)
the hypothalamus and amygdala (contributing to feelings of hunger, satiety, and pleasure)
the thalamus (leading to conscious awareness of taste)
LO4 Describe the route of auditory information processing
Auditory Pathways
Information is transmitted from the hair cells to the afferent cochlear nerves
Cochlear nerves synapse on neurons of the dorsal and ventral cochlear nuclei of the medulla
Cochlear nuclei of the medulla send out axons that ascend in the CNS
Information from both ears converges on each superior olivary complex, (2nd synapse) and beyond this, most of the neurons respond to inputs from both sides
Some of the nerves cross to the contralateral side and ascend in the lateral lemniscus to the inferior colliculus
Other axons remain ipsilateral
Inferior Colliculus - contains a topographical representation of auditory space (localization of sound)
Then to the Medial genticulate nucleus (MGN) thalamus, then to primary auditory cortex
Auditory Cortex
MGN for temporal and spectral assessment of sound relevant to communication
Tonotopic map, generated at the level of the organ of Corti, is preserved at all levels of the CNS
Because some auditory fibers are crossed and some are uncrossed, a mixture of ascending nerve fibers represents both ears at all levels of the CNS
Auditory cortex and other areas in the brain - conscious perception of sounds, especially speech
Temporal lobe - Brodmann areas 41, 42
Extends also to area 22 (Wernicke’s area)
Sound frequencies are represented in an orderly tonotopic map in auditory cortex
Auditory pathways are also very plastic, and, like the visual and somatosensory pathways, they are modified by experience
LO3 Explain how the cochlea transduces pressure waves into an electrical representation of sound
Organ of Corti
Cortical Deafness
Deafness in which the cochlea, auditory pathways in the brainstem are normal but there is a lesion localized to the auditory cortex which causes deafness
Meniere’s Syndrome
A labyrinthine disorder that affects both the semicircular canals and cochlea – repeated attacks of vertigo, nausea and vomiting
Sensory transduction apparatus – within the cochlea
Lies on the basilar membrane - extends from the apex to the base of the cochlea
Bathed in the Endolymph contained in the Scala media
Contains auditory hair cells (auditory receptors)
Inner hair cells
single row
small number
main transducers of sound in the cochlea.
Basilar membrane vibrates due to sound waves, inner hair cells' stereocilia move.
Movement opens ion channels, leading to an influx of K ions and triggering an electrical signal in the cell.
Signal Transmission:
Once inner hair cells generate electrical signals, they release neurotransmitters at their base, which activate the auditory nerve fibers connected to them.
Nerve fibers then carry the auditory information to the brain, where it is processed and interpreted as sound.
Precision and Clarity
Unlike outer hair cells, inner hair cells do not amplify sound.
Instead, they are highly sensitive to specific frequencies and intensities of sound.
Sensitivity allows them to accurately encode the pitch, loudness, and timing of sounds, contributing to the clarity and precision of auditory perception.
Outer hair cells
parallel rows
more numerous than inner hair cells
Amplification of Sound
Outer hair cells act as amplifiers.
Detect sound vibrations, change shape rapidly (electromotility)
Movement enhances vibrations of basilar membrane within the cochlea, increasing sensitivity of inner ear to sound, particularly for low and moderate intensity sounds.
Frequency Selectivity
Amplifying certain frequencies more than others, outer hair cells help sharpen the tuning of the cochlea.
Allows the inner ear to distinguish between sounds of different pitches more accurately, contributing to better frequency resolution.
Protection Mechanism
Protect the inner ear from damage due to loud sounds
Reduce their amplification role in response to high-intensity sounds, thus acting as a protective mechanism to prevent overstimulation of the inner ear.
Signal Enhancement
Enhancing mechanical response of basilar membrane, outer hair cells indirectly ↑ response of inner hair cells, which are the primary sensory receptors for sound
Helps in transmitting a clearer and more precise auditory signal to the brain
Bodies of the hair cells are in contact with the basilar membrane
Hair cells cilia - embedded in the tectorial membrane (sound vibrates it)
Axons of vestibulocochlear nerve synapse at the base of the hair cells - transmits information to the CNS
90-95% of sensory neurons innervate the inner hair cells
5–10% innervates the more numerous outer hair cells
Each sensory neuron innervates several outer hair cells
Electrical Responses in the Hair Cells
Project into the endolymph - the bases are bathed in perilymph
Endolymph - formed in the scala media by the stria vascularis - has a high concentration of K+ and a low concentration of Na+
Scala media is electrically positive by 85 mV relative to the scala vestibuli and scala tympani (high K+!)
Resting membrane potential of the hair cells is about – 60 mV
When the stereocilia are pushed toward the kinocilium, the membrane potential is ↑ to – 50 mV (SLIDE 16)
Stereocilia is pushed in the opposite direction, the cell is hyperpolarized
Hair processes provide a mechanism for generating changes in membrane potential proportional to the direction and distance the hair moves
Mechanism of Hearing: Ossicular conduction
Conduction waves to the fluid of the inner ear via the tympanic membrane and the auditory ossicles
Air conduction
Sound waves also initiate vibrations of the secondary tympanic membrane that closes the round window
Bone conduction (eg speaking)
Transmission of vibrations of the bones of the skull to the fluid of the inner ear
Encoding of Sound
We have to ability to deferetiate between different frequencies
Different auditory hair cells are activated by different frequencies
Frequency that activates a particular hair cell depends on the position of that hair cell along the basilar membrane
Basilar membrane acts as a sound frequency analyzer
Pitch coding
Base of basilar membrane is nearest the stapes and is narrow and stiff
Hair cells located at the base respond best to high frequencies
High frequency disturb the short, stiff fibers of the basilar membrane
Receptor cells close to the oval window are stimulated
Apex of basilar membrane is wide and compliant
Hair cells located at the apex respond best to low frequencies
Low frequency disturb the long, floppy fibers of the basilar membrane
Specific hair cells further along the cochlea are affected
Volume coding:
Degree of distortion of hair cells by a sound wave
Number of hair cells distorted by sound wave as it travels along the Organ of Corti
Direction coding
Ability of the hair cells in the Organ of Corti to rapidly respond to the sound waves plays – for sound localization
LO2 Explain how hair cells transduce auditory information
Vibration in fluid causes vibration of basilar membranemoves hair cells
Steps in Auditory Transduction
Organ of Corti has mechanoreceptors
Vibration of organ of Corti – bending of hair cells cilia
Change in K+ conductance of the hair cells membrane
Depolarization
↑ in K+ conductance (when hair cells bend in one direction)
Opens voltage-gated Ca2+ channels in the presynaptic terminals of the hair cells
Release of glutamate (excitatory neurotransmitter)
AP in the afferent cochlear nerves
Hyperpolarization
Decrease in K conductance (when hair cells bend in the opposite direction)
Decreased release of glutamate
Changes in membrane potential of hair cells – receptor potential – cochlear microphonic potential
Stereocilia (mechanosensing organelles of hair cells) are joined by tip links
Tip links gate mechanosensitive nonselective cation channels (NSCC) which preferentially mediate K+ currents due to the composition of the endolymph
Basal level of neurotransmitter release when the stereocilia are vertical
Deflection toward the tallest stereocilium (shorter to longer) opens the channels, allowing K influx, creating an excitatory receptor potential (depolarisation) and increasing neurotransmitter release
Deflection away closes the channels, reducing the K current and thereby causing hyperpolarisation, decreasing neurotransmitter release
LO1 Describe the regions of the ear and their functions
Tinnitus
The perception of noise or ringing in the ears
↑ neural activity in the auditory nerve
It is a symptom of cochlear nerve degeneration
Also results from inflammation of the middle or inner ear
Appearance of tinnitus (and vertigo) may indicate the maximum, non-toxic doses of drugs, such as gentamicin
Presbycusis
In older patients (> 50 years) - a history of gradual bilateral sensorineural hearing loss, particularly of higher frequencies
Most common type of sensorineural hearing loss
Patients typically have a normal physical examination and report that the symptoms are worse in noisy or crowded environments
Smoking, medications are risk factor for presbycusis
Auditory System
Comprises the cochlea, cochlear nerve, and the central auditory pathway
Auditory pathway from the cochlear nuclei in the brainstem to cortex of temporal lobe
Receptors for two sensory modalities (hearing and equilibrium) are housed in the ear
External, Middle, and Inner ear
Conduction: Outer & Middle ear (conductive hearing loss
Sensory transduction: Inner ear (cochlea) sensorineural hearing defects
Structure of the Ear
External ear
transfers sound to the tympanic membrane
Consists of pinna and external auditory canal
Pinna is external part that collects sound waves and funnels them into ear canal.
Sound waves travel through ear canal (external auditory canal) to reach the eardrum.
Ceruminous glands that secrete cerumen
Function
Direct sound waves into the auditory canal and protection
Middle Ear
transfers sound to the inner ear (via the ossicles)
Consists of the tympanic membrane and a chain of auditory ossicles
tympanic membrane
separates the external ear from the middle ear
When sound waves hit the eardrum, they cause it to vibrate.
Auditory ossicles
Vibrations of the eardrum are transmitted to three tiny bones in the middle ear called the ossicles.
Malleus (hammer)
Attached to the eardrum, it receives vibrations and transmits them to the incus.
Incus (anvil)
Middle bone, it passes the vibrations from the malleus to the stapes.
Stapes (stirrup)
Transfers the vibrations from the incus to the oval window of the inner ear.
An oval window and a round window lie between the middle ear and the inner ear
strapes has a footplate , which inserts into the oval window
Opening of the eustachian tube
Otitis media (infection)
Common cold can block this tube and cause pain
Route for infection - particularly in children - due to the shallow angle relative to the nose
equalizes pressure between the middle ear and the nose
Skeletal muscles
Tensor tympani and stapedius muscles - Protects the inner ear from loud sound
When amplitude of the sound is very high these muscles contract – reducing movement of ossicles
Vibrations from the eardrum are transmitted by the lever system formed by the ossicular chain to the oval window of the scala vestibuli
The combination of the four suspensory ligaments produces a virtual pivot point –
Stapedius (facial nerve) and tensor tympani (trigeminal nerve) muscles modify the lever function of the ossicular chain
Contraction of the tensor tympani pulls the manubrium of the malleus medially and decreases the vibrations of the tympanic membrane
Contraction of the stapedius pulls the foot plate of the stapes out of the oval window
Stapedius (S for CN VII) Tensor Tympani (T for CN V)
Attenuation Reflex (Acoustic Reflex)
One ear is facing towards noise and the other isnt, only the one ear will responsond (essentially they are independant systems)
When loud sounds are transmitted through the ossicular system, there is reflex contraction of the stapedius and the tensor tympani muscles
Tensor tympani pulls the handle of the malleus inward
Stapedius pulls the stapes outward
Reflex causes the entire ossicular system to develop ↑ rigidity
Thus cannot protect against sudden loud sounds (explosion)
Function
Protect cochlea from damaging vibrations caused by excessively loud sound
To mask low-frequency sounds in loud environments
Decreases the hearing sensitivity to one’s own speech
Impedance Matching
Important going from an air to fluid medium and thus must ↑ the pressure
Measure by which the ease of sound travels through a medium
Sound waves travelling through air must be converted into pressure waves in fluid
Combination of the tympanic membrane and the ossicles serves as an impedance-matching device that makes this conversion
Pressure of sound vibrations on the tympanic membrane is ↑ by ossicles when transmitted to inner ear
Pressure exerted by stapes on the fluid of cochlea is ↑ by about 22 times more than the pressure exerted by the sound waves on the tympanic membrane
Impedance matching is required to overcome the inertia of fluid in inner ear
Internal Ear
location of the cochlea (for hearing) and semicircular canals (for equilibrium)
Consists of a bony labyrinth and a membranous labyrinth
Bony labyrinth - Three semicircular canals (lateral, posterior, and superior)
Membranous labyrinth - Scala vestibuli, Scala media and Scala tympani (membrane bound chambers)
Six groups of hair cells in each inner ear: one in each of the three semicircular canals, one in the utricle, the saccule, and in the cochlea
Oval Window
Stapes presses against the oval window, membrane-covered opening to the inner ear.
This action creates waves in the fluid-filled cochlea.
The Cochlea
Spiral-shaped, fluid-filled structure in the inner ear. The waves in the cochlear fluid stimulate tiny hair cells, which convert the mechanical energy of the sound waves into electrical signals.
Contains the organ of Corti
Spiral-shaped structure composed of three tubular canals
Divided into three chambers by Reissner’s membrane and Basilar membranes into
Scala vestibuli
Base of the cochlea, the ends at the oval window, closed by the footplate of stapes
Scala media
Endolymph - fluid in the scala media
Ionic composition like ICF (high K+ and a low Na+ concentration)
For sensory transduction within the Organ of Corti
Scala tympani
End at the round window
Perilymph - Fluid in the scala vestibuli and scala tympani
Similar to ECF
Functions
Sensory transduction of pressure waves
Amplifies sound waves
Deconstructs sound waves into component frequencies (works as a mechanical frequency analyser - allowing detection of complex or multiple sounds)
Hair Cells
hair cells cannot be regenerated if damaged by loud noises
Specialized cells are located on the basilar membrane within the cochlea. They move in response to the fluid waves and generate nerve impulses.
Neuro Week 9
LO4 Describe the functions of cerebellum in motor processing
Disorders of the Cerebellum (and results of cerebellar leisions)
Dysmetria
Movements overshoot their intended mark
Past pointing (manifestation of dysmetria)
Ataxia
Incoordination due to errors in rate, range, force and direction of movement
Failure to predict motor movement, patients will overshoot intended target
Intention tremor
No tremors at rest but appears when the patient attempts to perform some voluntary action
Dysdiadochokinesia
Failure of orderly progression of movement - a person is unable to perform rapid, alternating movements
Dysarthria
Failure of orderly progression in vocalization
Due to lack of coordination of muscles of speech
Cerebellar nystagmus
Tremor of eyeballs usually when one attempts to fixate the eyes on a scene
Overview
Control the rate, range, force, and direction of movements
Connected to the brain stem by three cerebellar peduncles, which contain both afferent and efferent nerve fibers
Responsible for coordinating motor activity
Sequences the motor activity
Monitors and makes corrective adjustments in activities initiated by other parts of the brain
Compares actual motor movements with intended movements and makes corrective changes
Through its connections with the cerebral cortex, the cerebellum establishes memory of corrected movement for the next time
Functional Organization of the Cerebellum
Vestibulocerebellum – In association with brain stem and spinal cord it is concerned with balance and eye movements
Spinocerebellum –It receives proprioceptive input from the body as well as a copy of the motor plan from the motor cortex. Controls synergy of movements (rate, range, force, and direction of movements)
Neocerebellum - Dominated by cerebral input, via pontine nuclei, and controls the planning and initiation of movements
Cerebellar Connections
Afferents
Corticopontocerebellar pathway - from the motor and premotor area, somatosensory cortex as well as some pontine nuclei
Brainstem inputs - Olivocerebellar tract, vestibulocerebellar tract, reticulocerebellar tract
Cortical and brainstem inputs transmit information about intended motion
From the periphery
Dorsal spinocerebellar tract - information from muscles spindle but also Golgi tendon organs, tactile, and joint receptors
Ventral spinocerebellar tract - signals from anterior horn, and interneurons
Efferents
To cortical motor areas - Cerebellothalamocortical tract
Coordinates agonist and antagonist muscle contractions
Fine-tunes movement to reduce error
Establishes memories of corrected movements
To reticular nucleus – Equilibrium control
To brainstem motor areas
Involuntary postural reflexes
Functions
Aids cerebral cortex in planning the next sequential event in advance thus helping to progress smoothly from one movement to the next
Skeletal muscles with precise timing and appropriate patterns of contraction needed for smooth, coordinated movements
Damping function to stop the movement from overshooting its mark
Calculates momentum and inertia and initiates acceleration and braking activity
Rapid ‘turn-on signals’ for agonist muscles and ‘turn-off’ of antagonist’s muscles at beginning of a motion
Concerned with learned adjustments that make coordination easier when a given task is performed over and over
During rapid muscular activities (Running, typing, playing the piano and even talking)
LO6 Describe the functions of primary motor cortex. LO7 Outline the roles of different brain regions in motor processing
Motor Cortex
Motor cortex comprises three different areas of the frontal lobe – Primary Motor Cortex, Premotor Cortex, and Supplementary Motor Cortex
Primary Motor Cortex (Area 4)
Location - Precentral gyrus and on the anterior paracentral lobule on the medial surface of the brain
Main motor area involved in execution of voluntary movements
Fine movement elicited with least amount of electrical stimulation
For simple movements
It encodes the force, direction, extent, and speed of a movement
Premotor Cortex (Areas 6, 8, 44, 45)
Location – rostral to the primary motor cortex
For the sensory guidance of movement
Receives inputs from parietal lobe and primary motor cortex
Neurons signal the preparation for movement and to develop strategy for movement
For more complex movements (to perform a specific task)
For ‘observed’ movement
Sensitive to the behavioural context of a particular movement
It signal ‘correct’ and ‘incorrect’ actions
Supplementary Motor Area
Location - Medial surface in front of primary motor area
For bilateral movements
Involved in planning of complex and two handed movements
Involved with the transformation of kinematic to dynamic information
Responds to mental rehearsal of sequence of movements (generating idea for movement)
Functions in concert with premotor area to provide attitudinal, fixation or positional movement for the body
Coordinates posture
Specialized Areas of Motor Cortex
Broca area
damage causes decreased speech capability.
closely associated area controls appropriate respiratory function for speech
Eye fixation and head rotation area
for coordinated head and eye movements
Hand skills area
damage causes motor apraxia - the inability to perform fine hand movements
LO7 Outline the roles of different brain regions in motor processing
Motor System
Sensory fibers enter cord and are transmitted to higher centers, or they synapse locally to elicit motor reflexes
Motor neurons – Upper and Lower Motor Neurons
Alpha Motor
Neurons Large type Aα fibers
Stimulation can excite 3 to >100 extrafusalmuscle fibers
Gamma Motor Neurons
Smaller type Aγ fibers
Stimulation excites intrafusal fibersin muscle spindle -a special type of sensory receptor in the muscle
Motor Unit - A single motor neuron and a muscle fiber that it innervates
Motor Processing
Start - Internal representation of the state of the body generated by sensory processing (proprioception)
Sense of where the body already sits is the starting point for the ‘desired purpose of movement’
Requires - continuous updates of internal representation from sensory information (proprioception)
To maintain accuracy of movement, as movement occurs
Learning component - to correct errors in movement
Motor Control
Four highly interactive subsystems
Local circuit neurons
Local integration to directly initiate reflexes based on sensory input
Brain centres and Motor cortex
Reflexes supporting posture
Decision making and learning
Basal Ganglia
Initiation of movement
Suppressing inappropriate movement
Cerebellum
Learning
Memory
Postural reflexes
Quality control
Movements can be controlled
Reflexively (knee jerk)
Rhythmically (walking)
Voluntarily (kicking a ball)
What are the effects of upper and lower motor nerve lesions?
Fibrillation
rapid, irregular, and unsynchronized muscle contraction; Fasciculation - small, local, involuntary muscle contraction and relaxation
Damage to both UMN and LMN
Amyotrophic lateral sclerosis (ALS) - is a degenerative disease that selectively attacks both upper and lower motor neurons
Affected individuals have variable combinations of atrophy and fasciculations (from LMN loss), ↑d tone and reflexes (from UMN loss), and weakness (from both)
The name comes from the combined muscle atrophy (“amyotrophic”) and degeneration of the lateral corticospinal tract (“lateral sclerosis”)
A complex of descending systems
Conveys impulses from the motor areas of the cerebrum and subcortical brain stem to the anterior horn cells of the spinal cord (lie entirely within the CNS)
All motor neurons above LMN are considered as UMN
Major component being corticospinal tract
Upper Motor Neurons
Can modulate the activity of LMNs either directly or indirectly
Inhibitory or excitatory [control voluntary activation of lower motor neurons ]
UMN are those in the cortex and brain stem that activate the lower motor neurons
Lesion - stroke, infectious disease, multiple sclerosis, amyotrophic lateral sclerosis
Lower Motor Neurons
Nerve cells in the anterior gray column of the spinal cord or brain stem
Have axons that pass by way of the cranial or peripheral nerves to the motor end-plates of the muscles
Final common motor pathway (nerve fibers of LMN are part of PNS)
LMN extend from the anterior horn of the spinal cord (or from cranial nerve motor nuclei) directly to skeletal muscle
LMN lesion - poliomyelitis, trauma, stroke, tumor, amyotrophic lateral sclerosis
LO3 Explain the role of the basal ganglia in motor function
Basal Ganglia - Disorders
Hyperkinetic type
Excessive and abnormal movement (chorea, athetosis and ballism)
Hypokinetic type
Difficulty in initiating - akinesia
Slowness of movement - bradykinesia
Globus pallidus lesion
Athetosis - spontaneous writhing movements of the hand, arm, neck, and face
Putamen lesion
Chorea - flicking movements of the hands, face, and shoulders
Substantia nigra lesion
Parkinson’s disease - rigidity, tremor and akinesia
Loss of dopaminergic input from substantia nigra to the caudate and putamen
Subthalamus lesion
Hemiballismus - sudden flailing movements of the entire limb
Caudate nucleus and putamen lesion
Huntington chorea - loss of GABA containing neurons to globus pallidus and substantia nigra
Parkinson's Disease
Characterized by a combination of rigidity, bradykinesia, tremor, and postural instability
Cause - Widespread destruction of portion of substantia nigra (ventral pars compacta)
Abnormal accumulation of Alpha-synuclein protein in the form of Lewy bodies
Dopaminergic inputs provided by the substantia nigra pars compacta are diminished - more difficult to generate the transient inhibition from the caudate and putamen
↑ in the tonic inhibition from the internal segment of the globus pallidus to the thalamus, making thalamic excitation of the motor cortex less likely
Overall ↑ in inhibitory output to the thalamus and brain stem disorganizes movement
Motor Inhibition - reduced activation of cortical motor systems, and the development of parkinsonian features
Huntington's Disease
Size of the caudate and putamen (the striatum) is dramatically reduced in patients with advanced Huntington’s disease
Projection from the caudate and putamen to the external segment of the globus pallidus is diminished. This effect ↑s the tonic inhibition from the globus pallidus to the subthalamic nucleus (thicker arrow), making the excitatory subthalamic nucleus less effective in opposing the action of the direct pathway (thinner arrow)
Thalamic excitation of the cortex is ↑d (thicker arrow) - leads to the expression of unwanted motor activity
Basal Nuclei
Basal ganglia are the principle subcortical components of a family of parallel circuits linking the thalamus with the cerebral cortex
Are the deep nuclei of the telencephalon
The term basal ganglia (or basal nuclei) is generally applied to five interactive structures on each side of the brain
Anatomically, the basal ganglia include - the caudate nucleus, the putamen, and the globus pallidus
Functionally, the basal ganglia and their interconnections form - the extrapyramidal system, which includes midbrain nuclei such as the substantia nigra, and the subthalamic nuclei
Striatum - Caudate nucleus and putamen
Lenticular nucleus - Putamen and globus pallidus
Globus Pallidus - Internal and External segments
The substantia nigra is divided into a pars compacta and a pars reticulata
Functions
Basal ganglia control the voluntary movements which are initiated by the motor cortex
Planning and programming of the movement
Timing and scaling of the intensity of movements
Subconscious execution of some movements
Control of reflex muscular activity
The basal ganglia exert an inhibitory effect on spinal reflexes and regulate the activity of muscles which maintain posture
Control of muscle tone
Muscle spindles and the gamma motor neurons of the spinal cord are controlled by substantia nigra
Role in arousal mechanism
Globus pallidus and red nucleus are involved in the arousal mechanism because of their connections with the reticular formation
Extensive lesions in globus pallidus are associated with drowsiness and sleep
Cognitive control of motor activity
Caudate nucleus in close association with association areas of the cerebral cortex (running away from danger)
Inputs
The pathways into and out of the basal ganglia are complex
Almost all areas of the cerebral cortex project topographically onto the striatum
Motor cortical regions → corpus striatum
Substantia nigra pars compacta → corpus striatum
The striatum then communicates with the thalamus and then back to the cortex via two different pathways
Outputs
Main:
Corpus striatum → globus pallidus internal → VA/VL complex → cortex
Other:
Corpus striatum → globus pallidus external → subthalamic nucleus → globus pallidus internal → VA/VL complex → cortex
Direct and Indirect Pathways
Actual movements will reflect a balance between the two pathways, plus the input of the other levels of control
Direct Pathway
Direct Pathway → EXCITATION - Activates cortical activity - overall motor activity in the body will be ↑
Activation of the direct pathway facilitates movement by allowing positive feedback through the thalamocortical pathway
In the direct pathway, transiently inhibitory neurons in the caudate and putamen project to tonically active inhibitory neurons in the internal segment of the globus pallidus, which project in turn to the VA/VL complex of the thalamus
There are transiently excitatory inputs to the caudate and putamen from the cortex and substantia nigra
There is transiently excitatory input from the thalamus back to the cortex
Indirect Pathway
Indirect pathway – INHIBITION → Inhibits cortical activity (suppresses inappropriate movement)
Activation of the indirect pathway inhibits movement by suppressing the VLN of thalamus
The indirect pathway (shaded) - Modulates the effects of the direct pathway
Transiently active inhibitory neurons from the caudate and putamen project to tonically active inhibitory neurons of the external segment of the globus pallidus
Influence of nigral dopaminergic input to neurons in the indirect pathway is inhibitory
Globus pallidus (external) neurons project to the subthalamic nucleus, which also receives a strong excitatory input from the cortex
Subthalamic nucleus projects to the globus pallidus (internal), where its transiently excitatory drive acts to oppose the disinhibitory action of the direct pathway
LO2 What are the descending tracts involved in voluntary motor control?
Descending Tracts
Motor signals are transmitted directly from motor cortex to the spinal cord through the Corticospinal tracts (Descending Tracts/Motor pathways)
Components of the descending tracts that innervate cranial nerve nuclei, reticular formation and the red nucleus – Corticobulbar tracts
Descending tracts convey efferent impulses from different parts of the brain to the spinal cord – control various motor activities of the body
Tracts end in the anterior horn cells or local circuitry within the spinal cord or brain stem nuclei
Two types of descending tracts
Pyramidal tracts
Corticospinal Tracts
Leision
Lesion from the cortex up to the medulla before decussation
Motor loss on opposite side
Lesion below the level of decussation in the spinal cord
Motor loss on the same side
Carries motor impulses for initiation of movements, provides fine, precise movement and voluntary control of distal muscle groups
Origin: In the motor cortex (majority of fibers)
About 30% from the primary motor cortex, 30% from the premotor and supplementary motor areas, and 40% from the somatosensory areas
Fibers from giant pyramidal cells, called Betz cells - found only in the primary motor cortex
Betz cells are about 60 micrometers in diameter, and their fibers transmit nerve impulses to the spinal cord at a velocity of about 70 m/sec,
Course: All fibers converge as corona radiata, descend through the internal capsule, midbrain and pons
Majority of fibers cross to the opposite side in the medulla and descend in lateral corticospinal tracts
In the medulla they give the appearance of a pyramid
Another 10% descend in anterior white column and some cross before they end on anterior horn cells
uncrossed fibers (cross in spinal cord) are concerned with postural movements
Corticospinal fibers synapse with interneurons or anterior motor neurons and a few sensory relay neurons in cord gray matter
Corticobulbar tracts
Composed of the fibers that innervate the cranial nerves supplying head and face
Neurons end either directly on the cranial nerve nuclei or on neuronal circuits within the brain stem
Tract innervation is bilateral for most of the cranial nerves
Functions – LMN inputs to the nuclei innervating muscles of the face, muscles of mastication, muscles of the tongue, pharynx, larynx, sternocleidomastoid, and trapezius, etc.
Accompanies the corticospinal fibres as far as the brain stem before peeling off to innervate the cranial nerve motor nuclei (bilaterally in most cases)
Extrapyramidal Tracts
Arise mainly from the Brain Stem
Responsible for orienting the body, head and eyes in response to somatic, auditory, visual or vestibular stimuli and for regulating muscle tone
Vestibulospinal tract:
Helps for posture and equilibrium
Reticulospinal tract:
Helps for maintenance of tone, respiration, regulation of diameter of blood vessels, postural control of head & body
Rubrospinal tract:
Originates from red nucleus - Control small distal limb muscles especially of upper limbs
Tectospinal tract:
Originates from superior colliculus - Controls postural reflex responses to auditory, visual & somatic cues
LO1 Describe the components of a reflex arc
LMN and Local Circuit Neuron Control of Motor Activity
Stimulation of receptors may elicit (or modify) reflex muscular movement or modifies glandular secretion
Reflex action is the involuntary response resulting from stimulation of a receptor organ
Reflex - a rapidly executed, automatic and stereotyped response to a given stimulus
Reflexes are important in the diagnosis and localization of neurologic lesions
Reflex Arc
Reflex action depends on integrity of reflex arc
Five Steps in a Neural Reflex
Step 1: Arrival of stimulus, activation of receptor. Physical or chemical changes
Step 2: Activation of sensory (afferent) neuron. Graded depolarization
Step 3: Information processing by postsynaptic cell. Triggered by neurotransmitters
Step 4: Activation of motor (efferent) neuron. AP
Step 5: Response of peripheral effector
Classification of Reflexes
Number of synapses
Monosynaptic reflex (stretch reflex)
Disynaptic reflex (inverse stretch reflex)
Polysynaptic reflex (withdrawal reflex)
Development
Innate and Acquired
Site of information processing
Cranial and Spinal reflexes
Nature of resulting motor response
Somatic
(if effector is skeletal muscle)
Visceral or autonomic reflexes
(if effector is smooth muscle or visceral organ or cardiac muscle).
Stretch Reflex
Skeletal muscle with an intact nerve supply when stretched → muscle contracts
Monosynaptic
Stretch → afferent impulses to spinal cord → excites α motor neuron → contraction
Stretch reflex helps to maintain muscle tone and posture
Receptor - Muscle spindle
Muscle stretches when gamma motor neuron discharges - intrafusal fibers are also stretched
Sensory neurons innervating intrafusal fibers fire rapidly
Initiates reflex contraction of the muscle
Relieves the stretch on the muscle
Stretch reflex
Sense organ is muscle spindle
Stimulus is stretch of the muscle
Response is the contraction of the muscle
Inverse Stretch Reflex
Number of synapses: Disynaptic reflex arc
Autogenic inhibition reflex
A sudden relaxation of muscle at very high muscle tensions
Stimulus → Strong stretch of muscle and active contraction of muscle
Afferent fibers: Type Ib
Receptor → Golgi Tendon Organ
Response → Relaxation of the muscle
Only affects an individual muscle (adjacent muscles are not affected)
Function - Protects the muscle from tear by powerful stretch
Patellar Reflex (Knee Jerk)
Westphal’s Sign
Absence or decrease in patellar reflex
Receptor damage, peripheral nerve disease, lesion in motor cortex or pyramidal tracts, interruption of sensory and/or motor impulse transmission in femoral nerve
Multiple oscillations of leg is a sign of cerebellar disease
Tendon is pushed in by tapping - the thigh muscles (quadriceps femoris) to which it is attached are activated
AP generation in the afferent nerve fibers from the stretch receptors - to motor neurons that control these same muscles
Contraction of quadriceps femoris muscle - subject’s lower leg is extended to give - the knee jerk
Type Ia afferent stimulates α-motor neuron in L4 (without interneurons – a monosynaptic reflex arc)
Antagonistic flexor (hamstring) relaxes via an inhibitory interneuron
Proper performance of the knee jerk tells the physician that there is
Normal afferent and efferent input to the muscle
Balance of synaptic input to the motor neurons
Neuromuscular junctions and the muscles themselves
Multiple oscillations of leg is a sign of cerebellar disease
Spinal Centre
L2-L4
Flexor Reflex
A spinal reflex
Withdrawal reflex
Painful stimulus causes limb to withdraw from stimulus
Nociceptor activation transmitted to spinal cord - synapses with interneurons that diverge to muscles for withdrawal - inhibit antagonist muscles
Polysynaptic and ipsilateral complex
Reciprocal inhibition
Override inputs from spinal pathways
Plantar Reflex and Babinski’s Reflex
Spinal center: L5 - S1
Plantar Reflex
Stimulus
Stroking the lateral part of the sole with a sharp object
Response
Plantar flexion of the big toe and flexion and adduction of the other toes
Babinski’s Reflex
UMN leision
Stimulus
Stroking the lateral part of the sole
Response
dorsiflexion of the big toe and extension and abduction ("fanning") of the other toes
This abnormal response - the extensor plantar reflex
Indicates abnormality in the corticospinal system upstream (UMN lesion)
In the absence of descending inhibition
Extensor reflex has been observed in structural lesions such as hemorrhage, brain and spinal cord tumors, and multiple sclerosis, and in abnormal metabolic states such as hypoglycemia, hypoxia, and anesthesia
Crossed Extensor Reflex
Painful stimulus elicits an extensor reflex in opposite limb
Polysynaptic and contralateral complex
Response
Ipsilateral flexion; contralateral extension
Serves to push body away from stimulus, also to shift weight to opposite limb
Cerebral cortex
Initiates movement
Carbidopa & Benserazide
frontal cortex
direct pathway
Substantia nigra
Caudate and Patamen : Striatum
Lovadopa
KEY green arrow = Glutamate Red Arrow = GABA Green box = on red box = off
Uptake via DAT
GPi
VA/VL of thalamus
Destruction of the substantia nigra
Higher concentration of ACh
Tyrosine
Dopamine (hydrophilic)
L-Dopa (lipophilic) can passthrough the BBB
Breakdown via COMT & MAO
Inhibits movement
Indirect pathway
frontal cortex
substantia nigra
Caudate and Patamen : Striatum
GPe
VA/VL of thalamus
Subthalamus
GPi
Neuro Week 10
LO5 Discuss the mechanisms responsible for central pain sensitization LO6 Explain mechanisms responsible for phantom limb pain
Hyperalgesia and Allodynia
Hyperalgesia
An exaggerated response to a noxious stimulus
↑ pain from a stimulus that normally provokes pain
Primary hyperalgesia
Excessive sensitivity of pain receptors
Nociceptor sensitization is partly mediated by the release of toxic substances (potassium, prostaglandin, bradykinins, and substance P) from damaged tissue
These toxic substances excite nociceptors and ↑ their sensitivity to pain (hyperalgesia)
Secondary hyperalgesia
Substance P, released by an axon reflex, induces vasodilation and mast-cell degranulation leading to histamine and serotonin release
These inflammatory agents sensitize damaged tissue and surrounding nociceptors even further prolonging the hypersensitivity state (secondary hyperalgesia)
Allodynia
Sensation of pain in response to a normally innocuous stimulus
E.g., Light touch causing pain
Damaged nerve fibers undergo sprouting
Fibers from touch receptors synapse on spinal dorsal horn neurons that normally receive only nociceptive input
A-beta fibers communicate with and activate pain pathways, through different sodium channel types associated with pain
Neuropathic Pain
Diabetic Neuropathy
Caused by damage to the large peripheral nerves by inflammation and demyelination
Excess of smaller myelinated fibers activity causes loss of inhibitory input from the spinal cord with unopposed nociceptive afferent bombardment
Clinical manifestations: burning pain, numbness, tingling, weakness, loss of vibratory sense and proprioception
Tissue injury in which the nerves themselves become damaged or dysfunctional
Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system
Unrelated to current peripheral tissue injury
Associated with hyperalgesia, allodynia and dysesthesia
Two types
Peripheral neuropathic pain
Central neuropathic pain
May result from altered central processing of nociceptive input
Mechanisms of Neuropathic Pain
Pain sensitisation: When neurons responsible for sensing pain become sensitized, it means that they sense pain in situations where they previously would not have.
Peripheral sensitization
After nerve damage, afferent nerves can develop ongoing spontaneous activity
Abnormal excitability and ↑ sensitivity to chemical, thermal and mechanical stimuli
Changes in expression of Na+ channels leading to ↓ threshold or a relatively ↑ firing frequency
↓ expression of K+ channels (meaning the resting membrane potential may be more negetive than expected thus making depolarisation more likely/easier to achieve)
↑ cytokines (TNF and IL-1β) which enhance nociceptive transmission
Peripheral nerve injury - altered TRP channel expression in dorsal horn
Chemical mediators are released in response to tissue damage. Injured tissues release pain chemicals
Bradykinin and substance P
Histamine - from mast cells; Calcitonin gene-related peptide, ATP
Serotonin from platelets; Prostaglandins from cell membranes
Pro-inflammatory cytokines and chemokines
Sensitize or directly activate nociceptors
Some substances stimulate the release of other pain-producing chemicals
Bradykinin activates pain nerve endings and ↑s synthesis and release of prostaglandins - Prostaglandin E2 produces hyperalgesia
Peripheral Sensitization by NGF, Bradykinin, and Prostaglandins
Substance P and CGRP are neuropeptides released at both the central and peripheral terminals of nociceptive C fibres
Contributes to heat, redness and swelling associated with injury
Substance P
Acts on mast cells to cause degranulation and release histamine, which activates nociceptors
CGRP dilates blood vessels
Peripheral sensitization usually ceases once the tissue injury or inflammation heals
Central sensitization
Similar mechanisms as mentioned earlier
Cross talk between sympathetic/visceral sensory and somatosensory nerves
↑ in the excitability of neurons in the dorsal horn following high levels of activity in the nociceptive afferents
Due to repeated stimulation
‘Wind-up’ – Progressive ↑ in discharge rate
Synaptic potentials steadily ↑ in amplitude in response to repeated stimuli
Recruitment of non-nociceptive fibers (e.g., Aβ fibers) into the nociceptive pathway
Innocuous stimuli activate second-order neurons
Neurochemical mediators ↑ the level of membrane excitability
Substance P, CGRP, CCK, glutamate, aspartate, nitric oxide
Activation of voltage-gated L-type Ca+2 channels
By removal of Mg block to NMDA receptors
↑d NMDA activity is critical in the development of chronic pain syndromes
Central sensitization usually continues even after the initial injury has healed
Due to synaptic potentiation between the central terminals of nociceptive primary afferents and secondary neurons in the dorsal horn
The mechanisms are triggered and/or facilitated by a large number of extracellular mediator molecules, many of which are released by glial cells (astrocytes and microglia)
Results in the amplification of pain messages being relayed to higher brain centers
Clinically central sensitisation may be distinguished from peripheral sensitisation based on;
-pain evoked by innocuous stimuli (allodynia)
-pain hypersensitivity in areas with no demonstrable pathology
-pain that outlasts the stimulus (after sensations)
-enhanced temporal summation
-the maintenance of pain by low frequency stimuli that normally do not evoke any ongoing pain
Nerve Growth Factors in Pain Sensitization
Nerve Growth Factor (NGF)
Is a neurotrophic protein essential for the growth, differentiation, and survival of sensory afferent neurons during development
The NGF released by tissue damage is picked up by nerve terminals
Produced during inflammation
Transported retrogradely to cell bodies in DRG where it can alter gene expression
NGF binds to TrkA receptors on nociceptive afferents – forms NGF-TrkA complex
↑ gene expression for
Neuropeptides
CGRP
substance P
BDNF
Receptors
TRPV1
P2X3
Na + channels (NAV1.8)
In the DRG the NGF ↑s the production of substance P and converts non-nociceptive neurons to nociceptive neurons (a phenotypic change)
NGF Effects on Nociception
Peripheral Injury
Causes release of NGF from a variety of cell types
Short-term action on nociceptor
NGF binds to TrkA on the peripheral terminal of nociceptors
NGF-TrkA complex upregulates the expression of pro-nociceptive channels TRPV1, Na, Ca, and K
The overall effect is sensitization of the nociceptor
Long-term action on nociceptor
NGF-TrkA complex retrogradely transported to the neuronal cell body in the DRG
The signalling ↑s the synthesis of pro-nociceptive components such as Substance P, CGRP, BDNF, NMDA receptors, Nav 1.8 channels, ASIC channels, and bradykinin receptors
These components contribute to neuronal sensitization
↑d nociceptive signalling
NGF-TrkA mediated neuronal sensitization ↑s nociceptive signalling through the dorsal horn and supraspinal structure
NGF binding to TrkA on inflammatory cells induces the release of inflammatory mediators such as histamine, 5-HT, PGE2, and NGF itself
These mediators bind receptors on the peripheral terminal nociceptors, contributing to sensitization
Brain-Derived Growth Factor (BDNF)
Is a brain-derived neurotrophic factor
Released from primary afferent nerve terminals
Also activates kinase-linked TrkB receptor on postsynaptic dorsal horn neurons
Leads to NMDA receptor sensitization
Facilitates impulse transmission in dorsal horn
LO7 Explain the ‘gate-control’ theory of peripheral pain regulation
Electroacupuncture and Analgesia
Electroacupuncture is an ancient therapeutic technique for pain treatment
A technique that is done by inserting the acupuncture needles in the scalp and then connecting the electro-machine to stimulate the point
Has been proved to have a promising analgesic effect on chronic pain disorders
The technique enhance the synthesis of endogenous analgesic neurotransmitters
Stimulates the function of the endogenous pain inhibitory system
Activates ascending sensory pathways that emit collaterals in the PAG and in the brainstem serotonergic and catecholaminergic regions
It has been showed that 2 Hz stimulation induces analgesia by release of β-endorphin, enkephalin and orphanin, and their effect on μ receptors
The high frequency stimulation (typically 80–100 Hz) releases dynorphin, which stimulates κ receptors
Pain Transmission in Dorsal Horn
Spinothalamic first-order neurons synapse with the second-order neurons in the dorsal horn
Activation of a nociceptor leads to the release of glutamate and substance P from its first-order nerve terminals
This leads to the depolarisation of spinothalamic tract projection neurons
There are interneurons in the superficial regions of the dorsal horn that contain endogenous opioid peptides (enkephalin and dynorphin)
Interneurons terminate in the region of the dorsal horn, where nociceptive afferents terminate
Opioid receptors are located on the terminals of nociceptive fibers and dendrites of dorsal horn neurons
Enkephalin-containing interneurons exert both presynaptic and postsynaptic inhibition
Modulation of Pain Transmission
Capsaicin Induced Analgesia
Activation of TRPV1 by capsaicin results in sensory neuronal depolarization, and can induce local sensitisation to activation by heat, acidosis, and endogenous agonists
High concentrations of capsaicin or repeated applications can produce a persistent local effect on cutaneous nociceptors
Described as ‘defunctionalization’ and constituted by reduced spontaneous activity and a loss of responsiveness to a wide range of sensory stimuli
Capsaicin-induced defunctionalization
Depolarization block – By inactivation of voltage-gated Na + channels
Direct pharmacological desensitization of plasma membrane TRPV1
Contribute to an immediate reduction in neuronal excitability and responsiveness
Overwhelming of intracellular Ca2+ buffering capacity by extracellular Ca 2+ entering through TRPV1 and being released from intracellular stores
Subsequent activation of calcium-dependent proteases and cytoskeleton breakdown
Microtubule depolymerization may interrupt fast axonal transport
Capsaicin can also render mitochondria dysfunctional by directly inhibiting electron chain transport
Capsaicin can produce highly localized loss of nociceptive nerve fibre terminals in the epidermis and dermis
Calpain is a calcium-activated protease that exists as an inactive proenzyme in the cytosol. When intracellular calcium level is overloaded, it triggers to convert the proenzyme to its active form
Activated calpain then cleaves cytoplasmic and nuclear substrates
Analgesia system in the brain and spinal cord
The nociceptive information process in the dorsal horn is modulated
The gate-control mechanism of pain modulation
Impulses carried by large myelinated cutaneous fibers (Aβ) could “close the gate” on nociceptor impulses
Pain signals would be blocked in the spinal cord dorsal horn and not allowed to progress centrally through the spinothalamic tract to the brain
Gate-control mechanisms - in the spinal cord and at higher relay synapses
Stimulation of mechanosensitive afferents activates inhibitory interneurons in the dorsal horn
These interneurons inhibit transmission from primary nociceptor afferents
Stimulation of large type A β sensory fibers from tactile receptors decreases pain signals from the same body area
The use of transcutaneous electrical nerve stimulation (TENS) for pain relief
This method uses electrodes to activate Aα and Aβ fibers near the injury
Shaking Hand – Pain perception
Shaking hand vigorously relieves pain temporarily
The mechanical stimuli → activate non-nociceptive sensory afferents (arger diameter afferents (Aβ fibers)) → stimulate inhibitory interneurons in the dorsal horn → inhibit transmission from nociceptive neuron to the second order projection neurons.
Cold Spray and Pain
The cold spray - used for the temporary relief of minor sports injuries
Commonly used vapocoolants include ethyl chloride, fluorohydrocarbon, and alkane mixtures (butane, propane, and pentane)
are primarily used to provide rapid pain relief from acute muscular injuries
Rapid evaporation of the volatile liquid spray from the skin surface causes a drop in temperature
Results in temporary interruption of pain sensation, possibly through desensitization of pain receptors or activation of ion channels involved in pain transmission
Cold spray induced vasoconstriction – reduce pain mediators release
Pain Transmission Modulation in Dorsal Horn
Opioids are a commonly used analgesic
Exert their effects at various places in the CNS - including in the spinal cord and dorsal root ganglia
Opioids have different effects depending on the types of receptors they activate
Types: mu (m), kappa (k), and delta (d)
Mu (brain) and kappa (spinal cord) receptors have analgesic activities
Opioid receptors inhibit pain transmission via two mechanisms:
Presynaptic
↑ K+ conductance in terminals -> hyperpolarisation -> inhibit voltage-gated Ca channels -> decrease release of glutamate and substance P
Postsynaptic
↑ K+ conductance in dorsal horn neurons -> hyperpolarisation (away from the threshold)
Net effect - reduced duration of the EPSP in the dorsal horn neuron
Opioids reduce sensory transmission in pain pathways at the level of the DRG and spinal cord dorsal horn region
Most pain therapeutics, including morphine, methadone, and oxycodone, target the mu opioid receptor (MOPr)
MOPr expression within the
Descending pain modulatory pathway - which includes the ventrolateral periaqueductal gray (PAG), rostral ventromedial medulla (RVM)
The dorsal horn of the spinal cord
GABA neurons within the PAG are a critical site of action by opioids
↑ PAG output to RVM is a main contributor to opioid-induced antinociception
Postsynaptic MOPr activates GIRK channels via Gαproteins, resulting in K+ release and hyperpolarisation of the neuron
Additionally, MOPr activate Gi/o proteins, which result in the inhibition of adenylyl cyclase and decrease cAMP production
Opioids binding of presynaptic MOPr inhibits voltage-dependent Ca2+ conductance activated voltage-dependent potassium conductance via Phospholipase A
Overall Effect - Block release of GABA, therefore suppressing inhibition, increasing output of the PAG neurons projecting to RVM
Central Modulation of Pain
Electrical or pharmacological stimulation of regions of midbrain produces pain relief
Due to activation of descending pain-modulating pathway
Regulate pain transmission to higher centers
Descending pathway project to the dorsal horn and to the trigeminal nucleus
Three major components
PAG and periventricular areas of the mesencephalon
Connections from these areas to
Lower pons - Raphe magnus nucleus
Lateral Medulla - Nucleus reticularis paragigantocellularis
Connections from these areas to dorsal horn of the spinal cord
Analgesia signals block the pain before it is transmitted to the brain
Primary transmitters involved in the analgesia system are serotonin and enkephalins
LO8 Describe the descending inhibition of peripheral pain transmission
Descending Pathways in Pain Control
Descending pathways promote the release of several mediators, including endogenous opioids, NA, serotonin and GABA, which modulate the transmission between primary and secondary neurons
RVM is a key structure in descending pain modulation
PAG
Descending opioid-mediated inhibition of nociceptive inputs
PAG receives inputs from
Cortical sites and has reciprocal connections with the amygdala
Ascending nociceptive inputs from the spinal dorsal horns by way of the parabrachial nuclei
Higher centres influencing PAG in the midbrain
Amygdala, hypothalamus, anterior cingulate cortex, and insular cortex
PAG stimulation ↑s the stimulation of the descending analgesia system
Analgesia produced by PAG stimulation or microinjection of opioids is naloxone–reversible
PAG connects to pons and medulla
Two descending pathways to the spinal cord
Serotonergic pathway from nucleus raphe magnus (from medulla)
Noradrenergic pathway from the locus coeruleus (from pons)
Inhibit the activity of dorsal horn neurons due to the activation of the dorsal horn enkephalin-containing interneurons
Inhibit activity of dorsal horn neurons due to the activation of the dorsal horn enkephalin-containing interneurons
Transmitters involved in the regulation of descending pain control
Enkephalin, Endorphin, Dynorphin, GABA, Serotonin, Noradrenaline
Descending pathway acts on opioid receptors on primary nociceptive sensory neurons and second order neurons to inhibit ascending pain transmission
Descending projections from these serotonin and norepinephrine neurons activate local inhibitory neurons in dorsal horn which release enkephalin
LO4 Describe the ascending pathway carrying pain sensation to the brain
Pain Pathways
Cordotomy
Cordotomy involves the surgical ablation of the spinothalamic tract within the spinal cord to treat pain
The spinal cord part opposite to the side of pain is lesioned
Consequently, it reduces the sensation of touch and temperature in addition to pain
The pain management nurse observes a patient with complex regional pain syndrome who is not wearing the right-side jacket sleeve. The patient reports intense, right arm pain upon light touch. What type of pain the patient is experiencing?
Allodynia
Pain due to a stimulus that does not normally provoke pain
Light touch now causes pain
Could be due to cross talk so that non- nociceptive sensory neurons (touch) now activate central pain pathways
Normal non-nociceptive neurons have now changed modality and now respond to pain
Fast-sharp pain pathway
Aδ fibers
Slow-chronic pain pathway
Unmyelinated C fibers
Upon entering the spinal cord fibers terminate on the relay neurons in the dorsal horns
spinothalamic tract
Neospinothalamic tract
Fast pain - Aδ fibers - terminate in lamina I and V - second order neurons cross –anterolateral spinothalamic tract
A few fibers to reticular area of brain stem - most second order neurons to thalamus – third order neurons to cortex
Paleospinothalamic tract
Slow pain – Type C fiber types – terminate in lamina II (mostly) and III – second order neurons cross – anterolateral spinothalamic tract
Terminates widely in the brain stem
Reticular nuclei of medulla, pons
The tectal area (superior and inferior colliculi)
Periaqueductal region
Multiple short fibers to thalamus, hypothalamus and other basal regions of brain
Parallel Pain Pathways
Second order neurons in the pain pathway project to a number of different structures in the brain stem and forebrain
Reticular formation, Tectal area, Periaqueductal gray (PAG), Amygdala, Hypothalamus, Cingulate cortex, Insular cortex
These destinations mediate different aspects of the sensory and behavioural response to pain stimulus
Important for conscious perception of pain
↑d overall excitability associated with chronic pain
Thalamus
Ventral posterior lateral (VPL) nucleus of thalamus
For sensory discriminative aspects of pain
Discriminative aspects of facial pain are mediated by projections to the contralateral ventral posterior medial (VPM) nucleus
Reticular formation, superior colliculus, central gray, and amygdala
Affective/motivational aspects of pain
Unpleasant feeling, fear, and anxiety
Hypothalamus
Neuroendocrine response and cardiovascular response
Central Relay of Pain Sensation
Cortical Regions
Cingulate gyrus
Anterior cingulate cortex
Selectively and strongly activated by noxious somatosensory stimuli
Part of limbic system - involved in emotional response to pain
Primary and secondary somatosensory cortex
Receives information about sensory – discriminative aspects
Pain localization
The amygdala, frontal lobe, and the insular cortex are also activated
Pain Matrix – Somatosensory cortex, insular cortex, amygdala, anterior cingulate cortex
For multidimensional experience of pain with sensory, motor, emotional, and cognitive effects
LO3 Describe the cellular mechanisms responsible for generating peripheral nociceptive signals
Mechanism of Anti-inflammatories for Pain Relief
COX inhibitors inhibit synthesis of pain mediators at the site of injury (peripheral)
Block the pain sensitization induced by bradykinin
Pain Sensation
The neural mechanisms by which pain is perceived involve a process that involves four major steps
Transduction
Pain - Transduction
Pain Receptors
Nociceptors – Free nerve endings
Widespread in the skin and internal organs like the arterial walls, joint surfaces, etc.
Relatively unspecialized nerve cell endings that initiate the sensation of pain
Arise from cell bodies in dorsal root ganglia/trigeminal ganglion
Send one axonal process to the periphery and the other into the spinal cord/brainstem
Types of Nociceptors
Three major classes of nociceptors in the skin
Aδ mechanosensitive nociceptors
Respond to mechanical stimuli
Aδ mechanothermal nociceptors
Faster-conducting Aδ nociceptors respond either to dangerously intense mechanical or to mechanothermal stimuli
Polymodal nociceptors
Unmyelinated nociceptors (unmyelinated C fibers)
Respond to thermal, mechanical, and chemical stimuli
Receptive fields
Of all pain-sensitive neurons are relatively large
Detection of pain is more important than its precise localization
Pain Fiber Types
Peripheral nerve cells are stimulated by noxious, pressure, heat, or chemical forces
Sufficient stimulus generates an AP at nociceptors on A-δ fibers and C fibers
Primary afferent nociceptors, 1st-order neurons in processing of nociceptive stimuli
Primary afferent fibers traverse through the dorsal root ganglia into the dorsal horn of the spinal cord where various connections are made - transmit pain signal to brain
Aδ fibers
Myelinated - 5 to 30 m/sec
Fast, sharp (first), pricking, well localized pain sensation
Type I Aδ fibers – dangerously intense mechanical and chemical stimuli
Type II Aδ fibers – low threshold for heat, but high threshold for mechanical stimuli
C fibers
Unmyelinated – 0.6 – 2 m/sec
Dull, diffuse, burning (second), aching pain sensation
Neurotransmitters
Glutamate
Transmitter for fast pain
Secreted at the type Aδ fibers nerve fiber endings
Mainly through AMPA receptors
Substance P/calcitonin gene-related peptide (CGRP)
Slow-chronic pain
Ion channels
Transient receptor potential (TRP) channels
Acid sensing ion channels (ASIC)
ASIC3 responsible for muscle and cardiac pain resulting from ischemia
When H⁺ ions bind to these channels, they open and allow Na⁺ to flow into the cell, leading to depolarization.
Na+ channels (NAV1.7 sodium channels), K+ channels
Ligand gated ion channels
ATP - P2X3 receptors
When ATP binds to these receptors, they open, allowing the influx of Na⁺ and Ca²⁺ ions into the neuron. This leads to depolarization and the initiation of an AP.
G protein coupled receptors
P2Y2 receptors
TRPM8 (Transient Receptor Potential Melastatin 8) channels
These channels respond to cold temperatures. Upon activation, TRPM8 allows the influx of Na⁺ and Ca²⁺ ions, leading to depolarization.
Transient Receptor Potential Channels in Pain
Ca ++ and Na + permeable ion channels expressed on neurons
Activated by chemicals, heat, cold, mechanical stimuli
TRPV1
Important role in nociception
Activated by endovanilloids, capsaicin, heat, changes in pH
Activity modulated by inflammatory mediators
GLS: Extreme heat depolarizes nociceptive neurons through: TRPV1 channels: These are heat-sensitive ion channels. When exposed to extreme heat, TRPV1 channels open, allowing the influx of Na⁺ and Ca²⁺. This depolarizes the nociceptive fibers.
GLS: Although primarily activated by heat, TRPV1 channels can also be sensitized by acidic conditions (low pH), causing them to open and allow Na⁺ and Ca²⁺ influx, contributing to depolarization.
TRPA1
Sensitive to diverse group of chemical irritants
Transmission
Process of converting painful stimuli to neuronal AP at the sensory level
Conversion of a mechanical, thermal, or chemical stimulus into a neuronal AP
Stimulated nociceptors transmit impulses to the CNS by means of specialized sensory fibers
Perception
Not all nociceptive stimuli are perceived as pain
If there is sufficient modulation of signals and perception of nociceptive events is prevented, there is no pain
Modulation
Modulation, either enhancing or inhibiting nociception
Most pain management techniques probably mimic endogenous pain inhibition processes
Pain that is difficult to relieve probably results from enhanced nociceptive signals
LO2 Define and compare ‘acute’, ‘chronic’, ‘neuropathic’ , and ‘referred’ pain
Acute Pain
Fast pain - Has as a sudden onset and recedes during the healing process
Clinical manifestations: elevated heart rate, respiratory rate, and blood pressure; pallor, sweating, and nausea
Serves an important protective mechanism (withdrawal reflex)
Chronic Pain
Slow pain – begins only after 1 sec or more after a pain stimulus
May be associated with a disease process
Inflammation or nerve injury -including diabetic neuropathy, toxin-induced nerve damage, and ischemia
Persists long after recovery from an injury (>6 months) –burning pain/throbbing pain nauseous pain
No protective role in preventing further tissue damage
Nociceptive Pain
Type of mechanical injury to somatic (skin, muscle, or bone) or to visceral tissues
Injury or inflammation induced activation of nociceptors in skin and soft tissue
Neuropathic Pain
Phantom Limb Pain
Describes the pain in a body part that is no longer present
More intense in the distal portions of the phantom limb
Pain in the phantom is often like the pain felt in the limb before amputation
Causes:
Changes along the neuroaxis may contribute to the experience of phantom-limb pain
Spinal mechanisms are characterized by
↑d excitability of the dorsal horn neurons
Reduction of inhibitory processes
Structural changes at the central nerve endings of the primary sensory neurons, interneurons, and the projection neurons
Reorganization of the somatosensory cortex and in the thalamus
Pain resulting from damage to PNS or CNS tissue or from altered processing of pain in the CNS
Pain caused by a lesion or disease of the somatosensory system
Abnormal neural activities secondary to injury or disease causing pain
Phantom limb pain, thalamic pain, diabetic neuropathy, shingles
LO1 Discuss the physiological role a of pain, and the different approaches to classifying pain
PAIN
Painful stimuli initiate potent withdrawal and avoidance responses
Functions of Pain Sensation
Protect the body and maintain homeostasis
Detecting and localize potential/actual tissue-damaging processes
Minimize tissue and cellular damage to prolong survival
Encourages adoption of behaviors that remove the organism from a ‘dangerous environment’ and allow for tissue repair
Pain Chemicals
Bradykinin
Chemical agent most responsible for causing pain after tissue destruction
Bradykinin is synthesised by a cascade that is triggered by the activation of the clotting cascade
Bradykinin acts by specific bradykinin receptors (B1/B2) to activate free nerve endings
Acetyl choline
Acids
Serotonin
Histamine
CGRP
Noxious Stimuli and Nociceptor Stimulation
ATP
Activate P2X2 ligand-gated ion channels - influx of cations
H+
Directly depolarize via influx via acid sensitive ion channels (ASICs)
Extreme heat
Heat-sensitive TRP ion channels (TRPV1) – influx of Na+ and Ca 2+
Extreme cold
Cold-sensitive TRP ion channels (TRPA1 or TRPM8) – influx of Na+ and Ca 2+
Mechanical pressure
Numerous mechanoreceptive channels identified including TRP and ASICs and others – influx of Na+ and Ca 2+
Physiologic responses to pain
↑d heart rate
↑d respiration
Dilated pupil
Perspiration
↑d blood glucose
Decreased gastrointestinal motility
Decreased bladder motility
↑d muscle tone
Piloerection
Visceral Pain
Pain arising from the internal organs
Thoracic, abdominal, and pelvic visceral pain – true visceral pain
General characteristics
Gradual onset
Poorly localized
Produces nonspecific responses
Produces strong autonomic responses
Pallor, profuse sweating, nausea, GI disturbances and changes in body temperature, blood pressure and heart rate
Leads to sensitization
Produces strong affective responses
Visceral sensory afferents - thin, unmyelinated C-fibres
Viscera are also innervated by ‘silent’ nociceptors
Mechanically insensitive afferents (MIAs)
These can acquire mechanosensitivity following inflammation
Mechanism
Intermingling of second-order neurons in dorsal horn of the spinal cord from skin and viscera
Different from Peripheral pain
Nerve fiber type – unmyelinated C types
Terminates widely in the brain stem
Reticular nuclei of the medulla, pons
The tectal area (superior and inferior colliculi)
Periaqueductal region
To the thalamus, hypothalamus and other basal regions of the brain
Poorly localised
Referred to other areas
Visceral afferents are in the autonomic nerves
Referred Pain
Visceral pain often referred (radiates) to other areas
Localized to dermatome of embryological origin
Pain originating in the viscera can appear to originate in undamaged areas of the skin
Pain is felt not at that site but in a somatic structure
Cardiac Pain (angina) - inner aspect of the left arm
Esophageal pain – chest wall
Ureter pain - lower abdominal wall
Sites of reference are not stereotyped, and unusual reference sites occur (cardiac pain to right shoulder)
Pain is referred to a structure that developed from the same embryonic segment as the structure in which the pain originates
The heart and the arm have the same segmental origin
The testicle migrated with its nerve supply from the primitive urogenital ridge from which the kidney and ureter also developed
The convergence-projection theory
There is a convergence of somatic and visceral pain fibers on the same second-order neurons in the dorsal horn
Somatic and visceral neurons converge in the ipsilateral dorsal horn
When the visceral stimulus is prolonged - facilitation of activity from the somatic fibre-endings occurs
This stimulates the second-order neurons
Brain cannot determine whether the stimulus came from viscera or the area of referral
Parietal Pain
Arises from noxious stimulation of the parietal peritoneum
Common causes
Ischemia
Chemical irritation
Inflammation
Stretching of parietal peritoneum
Transmitted through A delta fibres
Stimulation of these fibres activates local regulatory reflexes and long spinal reflexes mediated by the autonomic nervous
Pain is sharp, intense, and well-localized with abdominal, rebound tenderness
In acute appendicitis the early vague periumbilical visceral pain is followed by the localized parietal pain that is produced by inflammatory involvement of the parietal peritoneum
Exacerbated by changes in tension of the peritoneum
Pain is usually aggravated by movement or vibration
NEURO Week 11
LO5 Explain the characteristics of REM and NREM sleep
Non-REM Sleep
Slow-wave sleep
Sleep mostly begins with non-REM sleep
Physiological changes
Muscle tone decreases progressively
HR, BP, and RR are decreased
Body metabolism is lowered
Pituitary shows pulsatile release of GH and gonadotropin
Eyes begin slow, rolling movement until they finally stop
In stage 4 (deep sleep) with eyes turned upwards
Behavioral changes
Progressive reduction in consciousness
Increasing resistance to being awakened
Dreams not remembered
There is some response to meaningful stimuli even in sleep
Sensory processing continues at some level after the onset of sleep
Genesis of Non-REM sleep
By interaction of neurons in the
Diencephalic sleep zones – in Hypothalamus and Thalamus
Sleep facilitatory center in the anterior hypothalamus
Medullary synchronising zone
Reticular formation of the medulla at the level of the nucleus of the tractus solitarius
Basal forebrain sleep zone
Pre-optic area
Stimulation of these zones produces sleep
GABAergic neurons in these neurons that mediate sleep
REM Sleep
Eyes undergo rapid movements even though the person is still asleep
EEG
Fast wave (desynchronised) sleep, or ‘paradoxical sleep’ or ‘dream sleep
High-frequency and low-amplitude pattern (β rhythm)
‘paradoxical sleep’
EEG exhibits unsynchronized, high-frequency, low-amplitude waves (beta rhythm)
EEG waves more typical of the awake state than sleep, yet difficult to arouse
ANS is in a state of excitation
BP and HR are ↑d, and breathing is irregular
Physiological changes
Rapid eye movements
HR and RR become irregular
↑d BP and decreased GI motility
Muscle tone is reduced - Inhibition of spinal motor neurons via brain stem mechanisms
Twitching of limb musculature occurs occasionally
Teeth grinding (bruxism) may be seen in children
Behavioral changes
It is difficult to arouse an individual from REM sleep - as it is from deep sleep
The individual is unresponsive to environment stimuli
Dreaming occurs during REM sleep - ‘dream sleep’
Dream recall from approximately 80% of arousals from REM sleep
It is difficult to arouse an individual - as it is from a deep sleep
However, when awakened from REM sleep, the individual is immediately alert and aware of the environment
Unresponsive to environmental stimuli
Genesis of REM sleep
Interaction of neurons in caudal midbrain + pons with neurons in medulla + forebrain
Cholinergic neurons of the midbrain and the adjacent dorsal pons
An important component of the mid-brain arousal system
Maximally active during waking and REM sleep
LO6 Describe different types of brain waves and their occurrence during sleep stages
Electroencephalogram (EEG)
Records electrical activity of the cerebral cortex via electrodes placed on the skull
Four classes based on frequency
Alpha waves: regular, rhythmic, low amp
Relaxed, wakefulness
During quiet resting state - disappears when there is a specific mental activity
Beta waves: rhythmic, less regular, low amp
During intense mental activity or stress
Related to cognition
Theta waves: irregular, varied amp
Not often present in wakefulness
Occur during emotional stress in adults
Delta waves: high amplitude
Occur during deep sleep
slow waves have a frequency of 3 Hz or less
Delta waves are abnormal in the awake adult
They have the largest amplitude of all waves
Stage of wakefulness
Results due to stimulatory impulses from RAS to cerebral cortex
EEG pattern - asynchronous and low-amplitude brain waves called β waves
State of quiet, awake rest with eyes closed
Period in between the stage of wakefulness and stage of sleep
EEG pattern - characterized by α waves
Highly synchronized, large waves having a frequency of 8–13 cycles/s
Characteristics of EEG at the highest and lowest state of alertness
Highest state of alertness (beta waves), when sensory input is greatest, the waves are of high frequency and low amplitude, as many units discharge asynchronously
Sensory input is at its lowest in a deep sleep, a synchronized EEG has the characteristics of low frequency and high amplitude (delta waves)
Sleep Stages
(KNOW THE 4 STAGES OF SLEEP) - andrew
The sequence in which the different sleep stages typically occur in a “sleep cycle”
Typically goes from Wakefulness -> N1 -> N2 -> N3 -> N2 -> REM -> N2 -> N3
Stage N1 of non-REM sleep (stage of very light sleep)
EEG - low amplitude mixed frequency activity
Still considerable sensitivity to sensory stimuli
Mild to moderate stimuli are often unable to produce a full arousal
Stage N2 of non-REM sleep
Stage of light sleep - Characterized by the appearance of sleep spindles
EEG - Bursts of α-like waves
Bursts of α-like waves
K-complexes in the EEG
K-complex consists of one or two high-voltage waves followed by a brief 14 Hz activity
Auditory stimuli during this phase readily evoke the K complexes in the EEG
They also occur spontaneously
Stage N3 of non-REM sleep – Deep Sleep
Stage of deep sleep
EEG
High amplitude slow waves called δ waves
Pattern of rhythmic slow waves, indicating marked synchronization
K Complex
Drugs that inhibit REM sleep also decrease K-complex
High-amplitude biphasic wave
Composed of an initial negative sharp wave (deflection up) followed by a slow wave
Followed by bursts of sleep spindles
Begin and define stage 2 sleep
Occur both spontaneously and in response to sensory stimuli during NREM sleep
Mostly generated from cortical regions
Drugs that inhibit REM sleep also decrease K-complex
Alpha Block
Attention is focused on something, the alpha rhythm is replaced by an irregular low-voltage activity, the beta rhythm
Can be produced by any form of sensory stimulation or mental concentration, such as solving arithmetic problems
When the eyes open or when conscious mental activity is initiated, the EEG shifts from an alpha to a beta pattern
LO7 What are the major neurotransmitters for sleep and wakefulness
Sleep Chemicals
Serotonin
• Neurons in the raphe nuclei(brainstem) – promotes wakefulness
Noradrenaline
• Locus coeruleus – discharge during wakefulness
Dopamine
• Stimulates wakefulness, inhibits REM
Histamine
• stimulates wakefulness
Orexin (hypocretin)
Narcolepsy is due to immune destruction of orexin neurons
Released by a subset of hypothalamus neurons
GABA
Important role in inhibiting cortical neurons during sleep
Melatonin
Mostly from the pineal gland
Controlled by suprachiasmatic nuclei, inhibited by light, affects the latency to sleep
Adenosine
Caffeine works by blocking adenosine receptors
activator of sleep deficit processes
It accumulates during wakefulness during metabolism
Important role in inhibiting cortical neurons during sleep
Melatonin
Melatonin is used to treat insomnia and other sleep disorders
Mostly from the pineal gland
Controlled by suprachiasmatic nuclei, inhibited by light, affects the latency to sleep
Located in the center of the brain but outside the blood– brain barrier
Causes drowsiness and lowers body temperature
Release in inhibited by light
Binds to MT1 receptors and stimulate sleep
Brain Areas in Sleep and Wakefulness
RAS, Hypothalamus, Thalamus, Locus Coeruleus, Raphe Nucleus, preoptic area
Reticular activating system (RAS)
Is a network of neurons located in the brain stem
Project anteriorly to the hypothalamus to mediate behavior, as well as both posteriorly to the thalamus and directly to the cortex for activation of awake, desynchronised cortical EEG patterns
Mediates wakefulness and alertness
Centre for Circadian Rhythms
Suprachiasmatic nucleus of hypothalamus
Intrinsic circadian timekeeping system modulates sleep, wakefulness, and many other physiological systems, including daily rhythms in core body temperature, cortisol, and appetite
Underlying principle of circadian clocks is successive gene activation in the form of a cycle
There is an auto-regulatory feedback loop for which one cycle takes about 24 h
LO4 Outline the cellular and molecular mechanisms responsible for memory
Amnesia: loss of memory
Anterograde amnesia
Inability to establish new long-term memories
Lesions involving the hippocampus
Inability to form new long-term memories from the time of injury onward
Retrograde amnesia
Inability to recall memories
Amnesia is much greater for events of the recent past than those of the remote past
Lesions involving the temporal lobe (temporal lobe syndrome)
Inability to recall memories from injury onward
Dissociative Amnesia
Forgets key elements of their life
Abnormal memory loss
Dissociates from a full understanding of themselves and their current state
Often following trauma or severe stress
Four distinct types of processing : Encoding, Consolidation, Storage, Retrieval (KNOW THESE FOUR)
Encoding
Information for each memory is assembled from the different sensory systems and translated into whatever form necessary to be remembered
Conversion of perceived sensory information into a form that can be stored/linked
This is presumably the domain of the association cortices and perhaps other areas
Consolidation
Hippocampal and surrounding areas apparently accomplish this
Memories are codified into different classes of information
Physical changes are made to the neurons in the memory areas
Required to convert short-term memory into long-term memory - to ensure it is permanently stored
Process
Expression of genes and synthesis of new proteins
Giving rise to structural changes that store memory stably over time
Structural changes
↑ in the number of synaptic vesicle release sites
↑ in the number of available synaptic vesicles
An ↑ in the number of synaptic terminals
Changes in the shape or number of postsynaptic spines
Storage
Physiological processes in the neural substrate associated with the storage of short-term explicit memory
In the hippocampus
Continuous neural activity in reverberating circuits
Activation of synapses on pre-synaptic terminals that typically result in prolonged facilitation
Long-term potentiation or long-term depression
Accumulation of calcium in axon terminals may eventually lead to enhanced synaptic output from the terminal
Neural substrate for long-term storage memory
Various parts of the memories — visual, olfactory, auditory, etc. are located in the cortical regions concerned with these functions
Stored in the various parts of the cortex
The actual deposition of the memories into the final resting places–this is thought to be in the association cortex
What parts of the brain stores memory, how they store it and what they are used for - Andrew
Retrieval
Memories are of little use if they cannot be read out for later use
Long term VS SHort term
Mechanism of Short-Term Memory
Changes in the effectiveness of synaptic transmission
Pre-synaptic and postsynaptic sites producing changes in the strength of synaptic transmission
Post-tetanic potentiation and pre-synaptic facilitation occur at the synapses↑ in the number of transmitter release
Mechanism of Long-Term Memory
↑ in number of presynaptic terminals in release sites of chemical transmitters
Generation of new receptor sites
Gene expression changes
New protein synthesis
Long Term Potentiation (LTP)
(know the differences between long term and short term potentiation) - Andrew
During normal - low-frequency synaptic transmission
Glutamate released from presynaptic terminal and acts on both metabotropic and non-NMDA (AMPA) receptors
Na+ and K+ flow through AMPA channels
Normally NMDA (Ca2+) channels are blocked
Mg2+ blockage of this channel at resting potential
Persistent enhancement (more prolonged) of the postsynaptic potential response
Potentiation is the persistent strengthening of synapses based on recent patterns of activity
In LTP – The strengthening of synapses
Early Phase of LTP - During high-frequency repetitive stimulation
Postsynaptic membrane is depolarised by the action of glutamate at AMPA receptors
Removes the Mg2+ block of the NMDA channels
Allows Ca2+ to flow through the channel
A rise in Ca2+ in the dendrites triggers Ca2+ dependent kinases
Phosphorylate AMPA receptors and ↑s their sensitivity to glutamate
Activates previously silent channels
Late phase of LTP
Due to changes in gene expression and protein synthesis
With repeated stimuli, continued Ca2+ influx activates enzymes that
Modify proteins of pre and postsynaptic terminal
Activates cAMP kinases
Translocation to nucleus, phosphorylates CREB
CREB activates targets that cause structural changes in pre + postsynaptic neuron
LO3 Identify the main brain regions believed to involved in different categories of learning and memory
Speech Disorders
Aphasia
A loss of ability to produce or understand language
Inability to express the spoken or written speech
in the absence of mental confusion or motor deficit (THIS IS IMPORTANT)
Depending upon the site of lesion, the aphasia are of three types
Sensory Aphasia
Lesion in the Wernicke's area
Difficulty in understanding the meaning of speech
Capable of hearing or identifying written or spoken words
Motor speech is intact and the patients talk very fluently
Motor Aphasia
Lesions involving the Broca's area
Comprehension of written or spoken speech is good
•Difficulty in speaking -Speech is non-fluent
Global Aphasia
Result of loss of both Wernicke's and Broca's areas
Total inability to use language communication
UNDERSTAND THE KEY DIFFERENCES
Dysarthria
Disorder of speech in which articulation of words is impaired
The comprehension of spoken and written speech is not affected
Lesions of the pyramidal tract, cranial nerves, cerebellum and basal ganglia
Neurophysiology of Language and Speech
Development of Speech
Wernicke's area (22)
Larger in the dominant hemisphere
Comprehension of visual & auditory information
Primary loci underlying the comprehension of speech
Wernicke’s area (area 22)
Projects to Broca’s area (44)
Broca's area (44)
Processes from sensory and Wernicke’s area
Special area of the premotor cortex - situated in the inferior frontal gyrus
Primary auditory cortex (41 and 42), and neighboring frontal and temporo-parietal association areas are also necessary for speech
For the coordinated pattern of vocalisation
Primary loci for the production of speech
Development of speech occurs in two stages
First stage
Association of certain words with visual, tactile, auditory and other sensations
Second stage
Definite pathway between the auditory area (area 41) and motor area for the muscles of articulation, which helps in speech (area 44) is established
Understanding of Speech
Understanding of spoken speech
Primary auditory areas - Brodmann’s areas 41 and 42
Recognition and understanding of the spoken words
Carried by auditory association areas
Interpretation and comprehension of the speech ideas
Wernicke's area (22)
Understanding of written speech
Primary visual cortex (17)
Interpretation of written speech
Visual association areas (18 and 19)
General Language Pathway and Mechanism of speech
Language input from visual or auditory cortex ->
Wernicke's area (posterior temporal lobe), which performs the final stages of language comprehension ->
Wernicke's area connects to Broca's area (posterior inferior frontal lobe) ->
Broca's area is responsible for production of meaningful language ->
Output from Broca's area goes to motor cortex for control of the voluntary muscles required to speak or write words
Learning
Process of acquisition of new information of every sort and new skills of all kinds
Involves changes in NS produced by experience
Physical changes occur in the brain when we learn something new
Thicker cortex, more glial cells, and more ACh
Connections grow between brain areas
Involves interaction among motor, sensory and memory systems
Learning a permanent behavior occurs as a result of practice, training or experience
Strengthening of existing responses and formation of new responses to existing stimuli
Reflexive Learning
Info about how to perform something - Acquired through experience and repetition
Expressed primarily in performance, not in words
Motor skills, habits, behavioral reflexes and the learning of certain types of procedures and rules
Stored as non-declarative or implicit memory
Habituation = decreased response to stimulus
Sensitisatition = ↑d response to stimulus
LO2 Describe the different categories of long-term
Implicit Memory
Reflexive or non-declarative memory
How to perform something
Acquired through experience and repetition
Motor skills, habits, behavioral reflexes and learning types of procedures and rules
Different brain regions
Memory through fear conditioning - amygdala
Memory through operant conditioning - striatum and cerebellum
Memory through classical conditioning - sensory and motor systems
Classified as
Working memory
Current representations of goal-relevant knowledge
mental arithmetic, remembering the name of someone you just met, participating in a conversation, giving instructions, remembering a new phone number etc.
Procedural memory
Memory used to perform skills or actions
tying shoelaces, playing piano, driving a car, etc.
Explicit Memory
Declarative or recognition memory
Factual knowledge of people, places, things and what these facts mean
Acquired through experience and repetition
Classified as
Semantic memory (memory of facts)
Knowledge of objects, facts and concepts as well as words and their meaning
Neocortex and association cortices
Knowing what a cat is, how letters put together can make a word, what semantic memory means, where Perth is located on a map etc.
Episodic memory (memory for events and personal experience)
Stored in association areas of the prefrontal cortex
usually stored in the temporal lobe
What happened at my 18th birthday party, how I felt when I failed an exam, what meat lover’s pizza tastes like etc.
LO1 Compare and contrast working and long-term memory
Memory - acquisition, storage and retrieval of sensory information
A phenomenon by which learned information, skills or habits are stored and retrieved
Memory Classification: based on how information is stored and recalled
Implicit memory (procedures/skills)
Explicit memory (events/facts)
Depending upon the permanency of storage
Short-term memory
Primary memory or working memory
Limited capacity
Lasts for seconds to hours
Intermediate long-term memory
Secondary memory
Lasts for days to weeks but is eventually lost
Long-term memory
Tertiary memory
Once stored, can be recalled years later or for a lifetime
Nuero Week 12
LO3 Describe the pathophysiology of Alzheimer’s disease
Dementia
Acquired decline in intellectual function resulting in loss of social independence
Symptoms progress over months to years
Alertness is preserved until the very late stages of disease
Causes for Dementia
Alzheimer’s disease (AD), multiple cerebral infarcts, dementia with Lewy bodies, alcoholism, Parkinson disease
Hypothyroidism, vitamin B12 deficiency, neurosyphilis, brain tumor, hydrocephalus, and chronic subdural hematoma
Alzheimer’s Disease
AD is a neurodegenerative disorder of uncertain cause and pathogenesis that primarily affects older adults and is the most common cause of dementia
Three forms
Nonhereditary sporadic or late-onset AD (70% to 90%)
ApoE4 allell on chromosome 19
Early-onset familial AD (FAD)
Linked to three genes with mutations on chromosome 21 (abnormal APP, abnormal presenilin 1, and abnormal presenilin 2 )
Early-onset AD (very rare)
Risk factors
The greatest risk factors are age and family history
Diabetes, midlife hypertension, hyperlipidemia, midlife obesity, smoking, depression, cognitive inactivity or low educational attainment, estrogen deficit in menopause, physical inactivity, head trauma, elevated serum homocysteine and cholesterol levels, oxidative stress, and neuroinflammation
Protective factors
Lifelong activity, the presence of ApoE2 and antioxidant substances, omega-3 fatty acids, estrogen replacement at the time of surgical menopause, low-calorie diet
Clinical Features
Slowly progressive disorder
Typically begins with impairment of learning and recent memory
Anomia, aphasia, and acalculia
Spatial disorientation causes patients to become lost easily
Frontal lobe gait disorder may appear
Short, shuffling steps, flexed posture, difficulty turning, tendency to fall backward
Later stages, social graces are lost
Psychiatric symptoms such as paranoia, hallucinations, and delusions may appear
Neuronal degeneration progresses
Series of abnormalities in the brain that selectively affect neurons in specific regions
In the neocortex, the entorhinal area, hippocampus, amygdala, nucleus basalis, anterior thalamus, locus coeruleus and raphe complex
There is a severe loss of cholinergic neurosis in the affected areas
Terminally ill patients are bedridden, mute, and incontinent
Pathology of AD
Microscopic features are characteristic of AD
Extracellular neuritic plaques
Containing a core of abnormally folded amyloid beta and tau proteins, intraneuronal neurofibrillary tangles
In the cortex and in the walls of meningeal and cerebral blood vessels (amyloid angiopathy and disturbance in BF)
Amyloid material surrounded by axons and dendrites, reactive astrocytes, and microglia
Neurofibrillary tangles
Tangles - paired helical filaments composed of a hyperphosphorylated protein tau
Neuritic plaques and neurofibrillary tangles are more concentrated in the cortex and hippocampus
The tau protein
Normally
A microtubule-binding protein
Tau is a microtubule-associated protein that aids in microtubule assembly
Binds to and stabilizes microtubules
Supporting axonal transport of organelles, and neurotransmitters throughout neuron
Detaches and forms an insoluble filament called a neurofibrillary tangle
Contributes to neuronal death
In AD, tau becomes hyperphosphorylated and aggregates to form paired helical filament tau
Major component of neurofibrillary tangles within the neuronal cytoplasm
Transmission of pathologic forms of tau between neurons has been proposed to account for the spread of AD in the brain
A distinct progression across brain regions as AD advances
Other structural changes include
Degeneration of basal forebrain cholinergic neurons with loss of acetylcholine
Misfolded and aggregated proteins trigger immune responses
Activation of glial cells release cytokines -> neuroinflammation and oxidative stress
Decreased oxygen and glucose transport; molecular changes in vascular smooth muscle and in the blood-brain barrier; and mitochondrial defects
All pathologic changes in AD are most prominent in the hippocampus, entorhinal cortex, association cortex, and basal forebrain
Early symptoms of memory loss and disturbance of higher cortical functions
Preservation of primary sensory and motor function until later in the course
Changes in the brain in AD
Loss of neurons results in brain atrophy
Decreases in brain weight and volume
The sulci widen and the gyri thin (especially in the frontal and temporal lobes)
The ventricles enlarge to fill the space
Loss of synapses, ACh, and other neurotransmitters contributes to the decline of memory and attention
Major Histopathologic Changes in Alzheimer Disease. Beta-amyloid protein deposits (plaques) in the neutrophil (long arrows) and neurofibrillary tangles (short arrows)
Comparison of Normal and Alzheimer Brain. The brain decreases in volume and weight, the sulci widen, and the gyri thin, especially in the temporal and frontal lobes. The ventricles enlarge to fill the space
Amyloid Beta Peptide (Aβ)
Major protein in neuritic plaques is amyloid β-peptide (Aβ)
Proteolytically derived from a membrane protein, amyloid precursor protein (APP)
APP mutations result in either ↑d production of Aβ and Aβ42
Aβ42 self-aggregates and promotes plaque formation
Aβ42 is toxic to neurons and stimulates production of cytokines from microglial cells
Aβ42 also triggers the release of glutamate from glial cells and may injure neurons through excitotoxicity
Thus Aβ causes the neurodegeneration
Early Markers to Predict AD (LY)
Cerebrospinal fluid proteins
AD in early stages may cause changes in CSF levels of beta-amyloid, phosphorylated tau, Ab42, BACE (b-secretase, generates Ab42 or Ab40 in Alzheimers)
Blood and urine tests
AD causes consistent, measurable changes in urine or blood levels of tau, and beta-amyloid before symptoms appear
Neuroanatomical
Pathological changes leading to loss of synapses and neurons correlate with tissue atrophy, which can be detected by imaging
CT scan and MRI scan
Molecular imaging by PET - to directly visualise the fibrillar Aβ load in the brain
Genetic markers
APP
PSEN1 and PSEN 2
APOE4
Mild cognitive impairment ↑s risk of developing AD within a few years
Amyloid imaging
Helping to differentiate AD from various types of dementia in those who present with atypical course or symptoms
LO4 Outline the basic pathophysiology of epilepsy
Both acute symptomatic seizures and epilepsy occur as a consequence of diseases and conditions that more commonly affect older adults
Major causes of epilepsy in older adults include
Cerebrovascular disease, neurodegenerative dementia, intracranial tumors, and trauma
A significant portion (one-third to one-half) are of unknown etiology
Enhanced excitatory neurotransmission
Reduced inhibitory neurotransmission
Many drugs ↑ seizure risk
Causes of epilepsy are broadly categorized as
Result of a shift in the normal balance of excitation and inhibition within the CNS
Genetic, structural, metabolic, immune, infectious, and unknown
Focal seizures
Aassociated with structural abnormalities of the brain
Generalized seizures
result from cellular, biochemical or structural abnormalities
Other causes of seizures and epilepsy
Complex interplay between endogenous factors (eg. genetics), epileptogenic factors (eg. injury), and precipitating factors (eg. stress, sleep deprivation, hormonal changes, toxins, drugs, diet etc.)
LO5 Describe the seizure types associated with different forms of epilepsy
Seizures and Epilepsy
Seizures and epilepsy are common in older adults
Seizures are episodes of transient neurologic change due to hypersynchronous, hyperexcited neuronal activity
Divided into two categories
Provoked seizures
Also known as acute symptomatic seizures
Occur with an identifiable proximate cause and are not expected to recur in the absence of that particular cause or trigger (eg, hypoglycemia, alcohol withdrawal)
Unprovoked seizures
Occur without an identifiable proximate cause
Epilepsy is defined as a condition of recurrent unprovoked seizures
In epilepsy, the seizures appear to occur spontaneously and are expected to recur in the absence of treatment
Epilepsy Types
Generalised
Seizures involve whole brain (cortical and subcortical)
Involvement of thalamus and RAS system results in loss of consciousness
Tonic-clonic
‘grand mal’ or convulsion
Absence
‘petit mal’ or staring fit
Atonic/Tonic
Drop attack - fall down
Myoclonic seizures
Sudden muscle jerks
Epilepsy and EEG
status epilepticus is a seizure lasting for more than 5 minutes which is an emergency
Grandmal (generalized tonic-clonic seizure)
Is characterized by
Serious fit accompanied by convulsions with tonic muscle contractions, clonic jerks and loss of consciousness
• Clonic jerks
Loss of consciousness
There will be rigidity (tonus) and tremors (clonus)
The resulting hypoxia may cause brain damage
There will be a loss of bladder control, and severe biting of tongue
EEG
Wave form shows continuous spike or sharp wave
typical high voltage activity
Causes - strong emotional stimuli, alkalosis caused by over breathing, drugs, fever, and loud noises or flashing lights
Petit-mal (generalised absent seziure)
Involve thalamocortical brain activating system
Is characterized by
a sudden loss of consciousness lasting only for few seconds
No convulsive movements
sometimes slight localized twitchings occur
Expression goes blank for few seconds
Memory affected
EEG
wave form generally shows spike slow wave complex of 3 Hz
spike and dome pattern
know the generalised seizures in detail, tonic clinic and absent are the most important to know myoclonic-Irregular twitching tonic- rigid, muscle contract Clonic- tremor jerking Atonic- loss of muscle tone (head fall)
LO2 Describe the steps in the process of peripheral nerve repair
Responses to Nerve Axon Damage:
CNS
Rarely regenerate due to the formation of scar tissue by glial cells, release of inhibitory molecules, and the absence of growth-promoting factors.
PNS
Schwann cells promote axonal regeneration by forming regeneration tube, secreting growth factors, and clearing debris, facilitating repair and functional recovery.
Why Nerves Can Not Regenerate?
CNS injury usually causes neuronal cell death
Glial cells actively inhibit axon growth and cell repair
Oligodendrocytes have growth-inhibiting proteins that prevent CNS axon regeneration
Astrocytes at injury site form scar tissue containing chondroitin sulfate that blocks axonal regrowth
Nerve Regeneration
Stage of degeneration is followed by the stage of regeneration - under favourable circumstances
May take several months to one year for complete recovery
Factors Affecting Regeneration
A nerve is crushed than when it is severed
Two cut ends are near each other (does not exceed 3 mm) and remain in same line
Presence of neurilemma
Axons in CNS once degenerated never regenerate - (have no neurilemma)
Presence of nucleus in the neuronal cell body
Regenerative Changes
Axis cylinder from the proximal cut end of the axon elongates and gives out fibrils in all directions
These fibrils enter into endoneural tube
Schwann cells from the distal cut end guide the regenerating fibrils to enter their endoneural tube
Axonal fibril growing through the endoneural tube establishes contact with a peripheral end organ
The process takes about 3 months
Stage of myelination - The myelin sheath is then formed by the cells of Schwann
The myelination is completed in 1 year
Changes in the cell body of neuron
Nissl granules and Golgi apparatus appear in the cell body
The cell loses excess fluid and regains its normal size
The nucleus occupies the central position
These changes are completed in 80 days
Complete genesis of new neurons (neurogenesis)
Occurs rarely, mechanisms not understood
Requires presence of pluripotent stem cells, appropriate environmental factors etc.
Restoration of damaged CNS neurons
More complex and requires more help from other neurons and glia, growth factors etc.
Usually fails in the CNS because glial cells produce mediators which inhibit cell growth
Little regrowth of CNS axons, other than those that project into the periphery
Most CNS injury involves neuronal cell death - Trauma , hypoxia (due to ischemia) , neurodegenerative diseases
Excitotoxicity - damage leads to overactivity of glutamate systems
Leads to cell death
Central glial cells less sensitive to injury and proliferate
Glial scarring - blocks axon regrowth
syn: Excitotoxicity in the CNS
Ability of glutamate and related compounds to destroy neurons by prolonged excitatory synaptic transmission
Abnormally high concentrations of glutamate accumulate in the cleft
Glutamate accumulates in the synaptic cleft and over-activates NMDA receptors
Over-activated NMDAR triggers an influx of calcium and sodium
Stimulates the production of reactive oxygen species and reactive nitrogen species.
High intracellular Ca2+, ROS, and RNS induce neuronal cell death
Activating proteases that damage cellular architecture
Damage cell structures such as components of the cytoskeleton and membrane
Peroxidising lipids, which disrupt membrane integrity
Stimulating microglia to produce cytotoxic factors
Disrupting mitochondrial function
Inducing pyknosis (chromatin condensation, causes fragmentation of nucleus)
Peripheral Nerve Injury
Damaged axons regenerate
Axon regrow over distances
Re-establish synaptic connections with their targets in the periphery
Damaged peripheral nerves are invaded by macrophages
Rapid removal of fragments of degenerating axons and myelin
Schwann cells and other non-neuronal cells produce cell adhesion molecules, extracellular matrix components, and an array of neurotrophins
promote axon growth
CNS - Nerve Injury
Axons typically fail to regenerate
Remnants are not cleared efficiently
Remnants can persist for many weeks
Substantial impediment to regeneration
Astrocytes express additional inhibitors of axon extension
Glial cells ↑ their growth and inhibit nerve regeneration
CNS neurons – generally, they are not replaced
Limited ability of the brain to alter and repair
Brain does not produce large numbers of new neurons post-development
Neurons lack the centrioles - mitosis is not possible so they can't divide
Central glial cells less sensitive to injury and proliferate - cause glial scarring and block axon regrowth
LO1 Describe the cellular changes that occur in response to nerve injury
Types of Nerve Injuries: Seddon’s Classification
Neuropraxia
Injury due to minor nerve stretch/pressure
Results in conduction block without any structural damage
No denervation muscle changes are present
Once remyelinated - complete recovery occurs
Axonotmesis
Due to excessive stress injury to the nerve
The continuity of axons is lost
The endoneurium, perineurium, and epineurium remain intact
Internal architecture is relatively well preserved
Cause Wallerian degeneration distal to the injury
Recovery is complete with axons reinnervating their original motor and sensory targets
focal nerve injury classification
A focal neuropathy means only one or, at most, a few nerves are injured
Neurotmesis
Occurs as a result of penetrating injury to the nerve
All the sheaths are disrupted
Physical gaps in the nerve may occur
No recovery unless repair is undertaken
Unrepaired nerve will be completely replaced by fibrous tissue - there is complete loss of anatomic continuity
Types of Nerve Injuries: Sunderland’s Classification
First degree injury (Neuropraxia)
Most common types of injury to nerves
Caused by pressure, occlusion of blood flow, hypoxia
Mild demyelination occurs without axonal damage
Conduction block results
Second degree injury (Axonotmesis)
Severe prolonged pressure on the nerves
May cause Wallerian degeneration
Repair and restoration of the nerve takes long time
Third degree injury (Axonotmesis)
Incomplete recovery at three months
Endoneurium is interrupted
Epineurium and perineurium are intact
Recovery is slow, may be incomplete
Fourth degree injury (Axonotmesis)
No recovery at three months
Patient requires surgery to restore neural continuity
Epineurium and perineurium are also interrupted
Regeneration is incomplete
Fifth degree injury (Neurotmesis)
Complete transaction of the nerve
Mixed nerve injury that combines other degrees of nerve injuries
Surgery to restore neural continuity
Nerve Degeneration
Anterograde Degeneration (Wallerian Degeneration)
The degenerative changes - distal to the site of injury
Degenerative changes start within few hours and continue for about 3 months
Axis cylinder becomes swollen and irregular in shape
Breaks up into small fragments, neurofibrils within it break down into granular debris
Myelin sheath shows slow disintegration
Myelin is converted into fat droplets containing cholesterol esters
Neurilemmal sheath is unaffected - but the Schwann cells start multiplying rapidly
Macrophages invade region to remove degenerating axons, myelin and cellular debris
Neurilemmal tube becomes empty
Retrograde Degeneration
The degenerative changes - proximal to the injury
Changes in the cell body of injured neuron start within 48 h
Nissl substances
Undergo disintegration and dissolution (chromatolysis)
Begins near the axon hillock and spreads to other parts
Golgi apparatus, mitochondria and neurofibrils
Fragmented and eventually disappear
Cell body
Draws in more fluid, enlarges and becomes spherical
Nucleus
Displaced to the periphery
Sometimes the nucleus is extruded out of the cell
Neuron atrophies and finally disappears completely
Transneural Degeneration
examples
Optic nerve injury leads to degeneration of the lateral geniculate body
Injury to posterior nerve root leading to degeneration of dorsal horn of spinal cord
Trans-synaptic degeneration
Phenomenon in which injured neurons spread injury to previously uninjured neurons connected by a synapse
Degeneration of the neuron with which the injured afferent nerve synapses
Alzheimer's
Neuronal death
Brain atrophy ventricles enlarge to fill the space The sulci widen and the gyri thin (especially in the frontal and temporal lobes)
Basal forebrain and brainstem nuclei
Neurotransmitter deficits (loss of Ach)
crerbral cortex and hippocampus
Inability to encode and consolidate memories Inability to transfer working memory to long term memory
Aβ aggregation
Oligomers
extracellular Neuritic plaques
Inflammation, mitochondrial damage & oxidative stress
release of glutamate
excitotoxicity
Pathogenisis
mutated tau protein
becomes hyperphosphorylated and aggregates
Form paired helical filament tau
intracellular neurofibrillary tangles
Genes
Presenilin 1 & 2 Amyloid Precursor Protein (APP) mutations on chromosome 21
β-secretase
increased (Aβ40) formation
increased (Aβ42) formation
clearance (inhibited)
ApoE4 on chromosome 19
Inhibits clearance of Aβ
Pathways
Descending tracts
volentary motor pathways Pyramidal tracts
Lesions of the pyramidal tract
Dysarthria
• Disorder of speech in which articulation of words is impaired • The comprehension of spoken and written speech is not affected
Corticospinal Tracts
Carries motor impulses for initiation of movements, provides fine, precise movement and voluntary control of distal muscle groups
Origin: In the motor cortex (majority of fibers)
About 30% from the primary motor cortex, 30% from the premotor and supplementary motor areas, and 40% from the somatosensory areas
Fibers from giant pyramidal cells - found only in the primary motor cortex
Course: All fibers converge as corona radiata, descend through the internal capsule, midbrain and pons
Majority of fibers cross to the opposite side in the medulla and descend in lateral corticospinal tracts to anterior horn cells
Corticospinal fibers synapse with interneurons or anterior motor neurons and a few sensory relay neurons in cord gray matter
akes voluntary motor information to the body (via spinal nerves),
origin: cerebrum
endpoint: spinal cord via spinal nerves to the body
Corticobulbar tracts
Composed of the fibers that innervate the cranial nerves supplying head and face
Either directly on the cranial nerve nuclei or on neuronal circuits within the brain stem
Tract innervation is bilateral for most of the cranial nerves
Functions – lower motor neuron inputs to the nuclei innervating muscles of the face, muscles of mastication, muscles of the tongue, pharynx, larynx, sternocleidomastoid, and trapezius, etc.
Corticobulbar pathway accompanies the corticospinal fibres as far as the brain stem before peeling off to innervate the cranial nerve motor nuclei (bilaterally in most cases) takes voluntary motor information to the head and neck (via CNs).
origin: cerebrum
endpoint: brainstem via cranial nerves to the H&N
involuntary motor pathways Extrapyramidal tracts
Vestibulospinal tract:
Helps for posture and equilibrium
Reticulospinal tract:
Helps for maintenance of tone, respiration, regulation of diameter of blood vessels, postural control of head & body
Rubrospinal tract: (cross)
Originates from red nucleus - Control small distal limb muscles especially of upper limbs
Tectospinal tract: (cross)
Originates from superior colliculus - Controls postural reflex responses to auditory, visual & somatic cues
Week 4
Somatic afferents
Superficial (cutaneous) fibres convey touch, pressure, temperature and superficial somatic (sharp and well localised) pain.
Deep somatic (proprioceptive) fibres convey joint position and vibration sense, skeletal muscle stretch and deep somatic (dull ache) pain.
Visceral afferent fibres are non-myelinated and conduct slowly, conveying smooth muscle stretch and visceral (e.g. ‘vague’) pain.
Ascending tracts
Dorsal Column-Medial Lemniscal Pathway (Posterior column pathway)
Transmitting sensory info about
Touch sensations requiring a ↑ degree of localization and transmission of fine gradations of intensity
Vibratory sensations
Sensations that signal movement against the skin
CONSCIOUS Position sensations from the joints
Pressure sensations related to fine degrees of the judgment of pressure intensity
(origin) 1st-order neurons have their cell bodies in the dorsal root ganglion cells or cranial nerve ganglion cells → Ascend ipsilaterally to dorsal medulla → synapse in the dorsal column nuclei (the cuneate and gracile nuclei) → (transmission) 2nd-order neurons decussate immediately to opposite side of brain stem → continue upward through medial lemnisci to the thalamus → medial lemniscus joined by additional fibres from sensory nuclei of the trigeminal nerve → 2nd-order neurons synapse in VPL thalamus → 3rd-order neurons ascend to somatic sensory area I
Anterolateral pathway (spinothalamic)
Transmits sensory info about
Anterior – Pressure, crude touch
Lateral – Pain, temperature
Consists mainly of group III and group IV fibers
(origin) 1st-order neurons have thermoreceptors and nociceptors in skin and connect to cell body in the dorsal horn → (transmission) In spinal cord, 2nd-order neurons cross midline and ascend to contralateral thalamus via the lateral spinothalamic tract → (termination) in the VPN of the thalamus the 2nd order nurons synapse with 3rd order neurons which then project to the primary somatosensory cortex
Neospinothalamic tract
Fast pain is carried on A delta, group II, and group III fibers - has a rapid onset and offset, and is precisely localized
Fast pain - Aδ fibers - terminate in lamina I and V - second order neurons cross –anterolateral spinothalamic tract
A few fibers to reticular area of brain stem - most second order neurons to thalamus – third order neurons to cortex
Paleospinothalamic tract
Slow pain is carried on C fibers - and is poorly localized
Slow pain – Type C fiber types – terminate in lamina II (mostly) and III – second order neurons cross – anterolateral spinothalamic tract
Terminates widely in the brain stem
Reticular nuclei of medulla, pons
The tectal area (superior and inferior colliculi)
Periaqueductal region
Multiple short fibers to thalamus, hypothalamus and other basal regions of brain
Trigeminothalamic Pathway ↑↓→
The sensations of touch, pain and temperature from the face and oral cavity, including teeth, and proprioceptive information from the jaw muscles are carried by the trigeminal nerve
The trigeminal lemniscus serving the face
Tansmits sensory info to the primary sensory trigeminal nucleus in the pons
Receptors associated with these pathways have small receptive fields
1st-order neurons located in the trigeminal ganglion (equivalent to the dorsal nerve root ganglia) → 2nd-order neurons cross the midline (as trigeminal lemniscus) and enter VPM nucleus of the thalamus → Sensory info relayed from thalamus via 3rd-order neurons to somatosensory cortex
Sensory roots enter the brainstem in the pons to terminate in
Principal sensory trigeminal nucleus – Fibers carrying tactile impulses
Spinal nucleus – Fibers carrying pain and temperature
Mesencephalic nucleus – Fibers carrying proprioceptive impulses
Spinocerebellar pathway
Ventral and dorsal spinocerebellar tracts
Proprioception (muscle and tendon stretch)
Convey unconscious proprioceptor information to the cerebellum
Receptors – Muscle spindle and Golgi tendon organs
Tract - Terminates to the same side of the cerebellum (ipsilateral)
Function - Movement and position mechanisms
Two ascending pathways
Dorsal spinocerebellar tract
info from skeletal muscles and joints - Trunk and lower limbs
1st-order neuron relay to nucleus dorsalis (Clarke's nucleus) (C8 to L3) → 2nd-order neurons – through the inferior cerebellar peduncle to the the vermis and intermediate zones of the cerebellum
Ventral spinocerebellar tract
Afferent fibers from muscle spindles (mostly from Golgi tendon organs) → 2nd-order neurons – the majority of fibers cross to the opposite side and ascend → Fibers recross to enter the ipsilateral cerebellum → Enter through superior cerebellar peduncle to the cerebellum
LO3 Describe sensory pathways from receptor to cerebral cortex
Parkinson's Disease
normal dopamine in
when the substantia nigra neurons have decreased dopamine
Parkinson's Disease
Characterized by a combination of rigidity, bradykinesia, tremor, and postural instability
Cause - Widespread destruction of portion of substantia nigra (ventral pars compacta)
Abnormal accumulation of Alpha-synuclein protein in the form of Lewy bodies
Involuntary movements or resting tremors
Due to abnormal synchronicity of BG and thalamus neuronal activity
Akinesia (difficulty in initiation of movements)
Rigidity
Mask like face
The disease is progressive, and leads to increasing disability with time
In Parkinson’s disease, the dopaminergic inputs provided by the substantia nigra pars compacta are diminished - more difficult to generate the transient inhibition from the caudate and putamen
↑ in the tonic inhibition from the internal segment of the globus pallidus to the thalamus, making thalamic excitation of the motor cortex less likely
The overall ↑ in inhibitory output to the thalamus and brain stem disorganizes movement
Motor Inhibition - reduced activation of cortical motor systems, and the development of parkinsonian features
Main Topic
Aetiology: Parkinson's disease (PD) is primarily caused by the progressive degeneration of dopaminergic neurons in the substantia nigra, a part of the basal ganglia that is critical for movement control. The exact cause of this neuronal loss is not fully understood, but contributing factors include genetic mutations (e.g., in the LRRK2, PINK1, or SNCA genes) and environmental toxins, such as pesticides and heavy metals.
Pathophysiology: Dopamine Deficiency: The loss of dopaminergic neurons leads to decreased dopamine levels in the striatum, a region of the brain involved in initiating and controlling movement. Imbalance of Neurotransmitters: This dopamine deficiency disrupts the balance between excitatory (glutamate) and inhibitory (GABA) neurotransmitters, affecting the output from the basal ganglia to the motor cortex. Lewy Body Formation: Abnormal protein aggregates, known as Lewy bodies (composed primarily of α-synuclein), accumulate in surviving neurons, contributing to cell dysfunction and death. Relation to Symptoms: Bradykinesia (slowness of movement): Due to impaired activation of motor circuits, patients experience slow, delayed movements. Tremor: Resting tremor (often seen in PD) is a result of abnormal, compensatory feedback loops in the basal ganglia. Muscle rigidity: Rigidity arises from excessive excitatory input due to the imbalance between inhibitory and excitatory pathways. Postural instability: Loss of dopamine affects the body's ability to maintain balance and coordination. These mechanisms explain the hallmark motor symptoms of Parkinson’s disease such as tremors, rigidity, bradykinesia, and postural instability.
Treatment
dopamine
synthesis pathways
Dopamine is synthesised from tyrosine -> L-DOPA -> dopamine
Rate limiting step is tyrosine hydroxylase
The action of dopamine is terminated by two mechanisms: ezymatic breakdown/reuptake
o Reuptake via DAT
o Enzymatic breakdown via MAO and COMT
Dopamine
Mesolimbic: ventral tegmental area (VTA) to the limbic system (amygdala, nucleus accumbens), hippocampus and prefrontal cortex
o Reward, desire, emotion
Mesocortical: VTA to front cortex
o Cognition, motivation, emotion
Nigrostriatal: substantia nigra to striatum
o Movement
Tubuloinfundibular: hypothalamus to posterior pituitary
o Prolactin secretion
Medication treatment
Levodopa (Precursor L-dopa)
MOA
1. ↑ extraneuronal DA in synapses
2. L-dopa/DA uptake by surviving neuron and ↑ DA release
Precursor for DA (hydrophilic and cannot cross the BBB) → Levodopa (lipophilic) crosses BBB → Dopa decarboxylase converts levodopa to DA → ↑ extraneuronal DA in synapses
Coadministered with carbidopa or benserazide — peripheral dopa decarboxylase inhibitor
Advantages of carbidopa or benserazide coadministration:
Inhibits peripheral levodopa to dopamine conversion, less peripheral effects — nausea, vomiting, hypotension
More levodopa to CNS → use lower dose
indicate
Motor symptoms
1st-line agent → in elderly/cognitive impaired
• Improvements in symptoms (rigidity, hypokinesia > tremor)
ACh
All parts of the forebrain and cortex, midbrain, brainstem
Major nuclei in the nucleus basalis
Functional roles include memory, arousal, movement
Most CNS effects are mediated via mAChRs
intergrative
Classically associated with
loss of dopaminergic neurons in the substantia nigra
Lewy bodies
intracytoplasmic protein inclusions that contain alpha-synuclein
Now recognised as heterogeneous, with clinically important non-motor features
Pathology involves extensive regions of the CNS, various neurotransmitters, and protein aggregates other than just Lewy bodies
Can also affect cholinergic neurons of the nucleus basalis, norepinephrine neurons of the locus coeruleus, 5-HT neurons in the raphe nuclei, neurons of the olfactory system, cerebral hemispheres, spinal cord, and ANS
Lewy bodies
Aggregates of misfolded α-synuclein and other proteins (ubiquitin and neurofilament protein) within the neuronal cell bodies
Appear histologically as intracellular hyaline eosinophilic globules
Also in brainstem, substantia nigra, and cortex
Loss of dopaminergic neurons in substantia nigra pars compacta, causing depigmentation of substantia nigra on gross and microscopic examination
Functional Role of the Basal Ganglia
The basal ganglia form an interconnected network, involved in not only motor function, but cognitive function
The cortex generates motor / cognitive commands, but the execution and/or maintenance of these commands relies on the integrity of the basal ganglia as a feedback system to sustain activity
Among several possible actions, a subset are selected by striatum; competing actions are suppressed by lateral inhibition at several levels of the circuit
Network output is integrated at the level of the basal ganglia output nuclei, the GPi and SNr, which inhibit or disinhibit thalamocortical and/or brainstem areas to suppress or promote specific actions
The network can be subdivided into two major pathways: the direct and indirect pathways
direct pathway stimulates movement
indirect pathway suppresses movement
Dopamine differentially acts on the two major pathways at the level of the striatum
Stimulates direct pathway (D1 - excitatory)
Inhibits indirect pathway (D2 - inhibitory)
Dopamine, therefore, promotes motor activity
Loss of DA neurons in PD results in hypokinesia
Resting tremors due to other unknown changes
Motor Control
Four highly interactive subsystems
Local circuit neurons
For local integration to directly initiate reflexes based on sensory input
Brain centres and Motor cortex
Reflexes supporting posture
Decision-making and learning
Basal Ganglia
Initiation of movement
Suppressing inappropriate movement
Cerebellum
Learning
Memory
Postural reflexes
Quality control
Mechanism of Cell Death
Cell death may be caused by α-synuclein aggregation, proteosomal and lysosomal system dysfunction, and reduced mitochondrial activity
Gene mutations are associated with impairment of one or several of these mechanisms
In addition, secondary changes such as excitotoxicity and inflammation are likely to play a relevant role in progressive neuronal degeneration
Alpha-synuclein and PD
A 140 amino acid natively unfolded protein, mainly localized at presynaptic terminals
In the striatum, hippocampus, olfactory bulb, neocortex, thalamus and cerebellum
Exist in and cycle between two forms
The soluble cytosolic form
The membrane bound helical form
Functions in membrane fusion in the cascade of synaptic events
α-syn is important for regulating protein and neurotransmitter release by promoting SNARE complex formation and vesicle docking during the exocytosis process
Abnormal forms of α-syn trigger selective and progressive neuronal death through mitochondrial impairment, lysosomal dysfunction, and alteration of calcium homeostasis
Neuroinflammation in PD
timeline of motor and non-motor features
Degeneration of dopamine neurons develops in a mid-stage of the disease
Clinical symptoms reflecting this nondopaminergic degeneration, such as constipation, anosmia, rapid eye movement (REM) behavior sleep disorder, can precede the onset of the classic motor features of PD
Drug treatment of motor symptoms
Cell-based therapies
transplantation of fetal nigral dopamine cells
transplantation of dopamine neurons derived from stem cells
gene therapies
trophic factors
Surgical therapies
deep brain stimulation
Deep brain stimulation
Electrode placed into the target area and connected to a stimulator inserted SC over the chest wall
Primarily targets the STN or the GPi
Electrical stimulation disrupts the abnormal signal associated with PD motor complications
Provides dramatic results, reducing “off” time and dyskinesias, but does not improve or prevent features that fail to respond to levodopa such as freezing, dementia
Primarily indicated for patients who suffer disability resulting from severe tremor, or levodopa-induced motor complications that cannot be satisfactorily managed with drug therapy
Does not prevent the development of nondopaminergic features
Psychiatric symptoms of PD
Depression
major depression in 5–20% of PD patients
strong association between frequency of depression and severity of PD
high rates of depression and depression treatment at PD onset
likely related to dysfunction in subcortical nuclei and the prefrontal cortex, limbic circuits
alterations in brainstem monoamine systems
Psychoses
visual hallucinations common; behavioural / cognitive changes
high rate in untreated PD patients; some due to PD medications
strong association between the frequency of depression and severity of PD
may represent the intrusion of rapid eye movement sleep behaviour into wakefulness; often associated with sleep / wake disturbance
Impulse control disorders (ICD)
Include compulsive gambling, shopping, sexual and eating behaviours
underreported
ICD rates are not elevated in untreated patients; also occur on other disorders treated with dopamine agonists
Thus, likely related to PD medications
Naga said this is a very important slide for us
Basal Ganglia Pathways
The cortex is the starting point for both pathways
Direct Pathway
Direct Pathway → EXCITATION - Activates cortical activity - overall motor activity in the body will be ↑d
Activation of the direct pathway facilitates movement by allowing positive feedback through the thalamocortical pathway
transiently inhibitory neurons in the caudate and putamen project to tonically active inhibitory neurons in the internal segment of the globus pallidus, which project in turn to the VA/VL complex of the thalamus
There are transiently excitatory inputs to the caudate and putamen from the cortex and substantia nigra
There is transiently excitatory input from the thalamus back to the cortex
Indirect Pathway
Indirect pathway – INHIBITION → Inhibits cortical activity (suppresses inappropriate movement)
Activation of the indirect pathway inhibits movement by suppressing the VLN of thalamus
The indirect pathway (shaded) - Modulates the effects of the direct pathway
Transiently active inhibitory neurons from the caudate and putamen project to tonically active inhibitory neurons of the external segment of the globus pallidus
The influence of nigral dopaminergic input to neurons in the indirect pathway is inhibitory
The globus pallidus (external segment) neurons project to the subthalamic nucleus, which also receives a strong excitatory input from the cortex
The subthalamic nucleus in turn projects to the globus pallidus (internal segment), where its transiently excitatory drive acts to oppose the disinhibitory action of the direct pathway
Actual movements will reflect a balance between the two pathways, plus the input of the other levels of control
Basal ganglia inputs and outputs
Much of the information the basal ganglia receives comes from the cerebral cortex and travels to the caudate or putamen (the main input nuclie of the basal ganglia)
Inputs
Almost all areas of the cerebral cortex project topographically onto the striatum
Motor cortical regions → corpus striatum
Substantia nigra pars compacta → corpus striatum
The striatum then communicates with the thalamus and then back to the cortex via two different pathways
Outputs
Globus pillidus and the substantia nigra are the main output nuclie
They send projections out from the basal ganglia to the crerbral cortex, mostly by way of the thalamus, as well as brain stem nuclei
Main:
Corpus striatum → globus pallidus internal → VA/VL complex → cortex
Other:
Corpus striatum → globus pallidus external → subthalamic nucleus → globus pallidus internal → VA/VL complex → cortex
Components of the basal ganglia
Da agonists
Anticholinergics (Benztropine)
MAOb-inhibitor (selegiline) COMT-inhibitor (entacapone)
Carbidopa & Benserazide
Lovadopa
Breakdown via COMT & MAO
Uptake via DAT
Dopamine (hydrophilic)
L-Dopa (lipophilic) can passthrough the BBB
Tyrosine
Higher concentration of ACh
Lewy bodies Destruction of the substantia nigra
Inhibits movement
frontal cortex
VA/VL of thalamus
GPi
Subthalamus
GPe
Caudate and Patamen : Striatum
substantia nigra
Indirect pathway
KEY green arrow = Glutamate Red Arrow = GABA Green box = on red box = off
Initiates movement
direct pathway
frontal cortex
VA/VL of thalamus
GPi
Cerebral cortex
Caudate and Patamen : Striatum
Substantia nigra
Alzheimer’s
Pathology of AD
All pathologic changes in AD are most prominent in the hippocampus, entorhinal cortex, association cortex, and basal forebrain
Early symptoms of memory loss and disturbance of higher cortical functions
Preservation of primary sensory and motor function until later in the course of the disease
Other structural changes include
Degeneration of basal forebrain cholinergic neurons with loss of acetylcholine
Misfolded and aggregated proteins trigger immune responses
Activation of glial cells release cytokines leading to neuroinflammation and oxidative stress
Decreased oxygen and glucose transport; molecular changes in vascular smooth muscle and in the blood-brain barrier; and mitochondrial defects
Why is there memory loss in alziehmers?
Neuritic plauques and neurofibrillary tangles are more concentrated in the cortex and hippocapus
Thus affacting the encoding and consolidation of memories to a greater extent
There are also structual changes in the brain
enlargement of the ventricles
atrophy of cortex
atrophy of hippocampus
These contribute the diminished functioning of the cortex and hippocampus and thus cause impairment in memory function.
Anticholinergics are contraindicated
Main regions of brain for memory
• Episodic (what happened to you) and sementic (general facts/info)- hippocampus, neocortex and amygdala
• Implicit- (eg motor memories)- basal ganglia and cerebellum
• Working memory- (holds info temporarily) prefrontal cortex
• Long-term – cerebral cortex (note we still do not fully understand this process!)
ACh
All parts of the forebrain and cortex, midbrain, brainstem
Major nuclei in the nucleus basalis
Functional roles include memory, arousal, movement
Most CNS effects are mediated via mAChRs
Treatments
Name the 2 classes of drugs for Alzheimer's and explain why used?
Anticholinesterases
: Examples: Donepezil, Rivastigmine, and Galantamine.
inhibit AChE, which breaks down ACh, (essential for memory and learning). By preventing its breakdown, cholinesterase inhibitors ↑ ACh levels, temporarily improving or stabilizing symptoms related to memory, attention, and cognitive function in mild to moderate stages of Alzheimer's.
NMDA Receptor Antagonists: Example: Memantine.
Blocks NMDA receptors, which are activated by glutamate, a neurotransmitter involved in learning and memory. Excess glutamate activity can lead to neuronal damage, so NMDA antagonists help protect brain cells from overstimulation. Memantine is typically used in moderate to severe Alzheimer's to improve cognition, behavior, and functional ability.
Changes in the brain in AD
The loss of neurons results in brain atrophy
Decreases in brain weight and volume
The sulci widen and the gyri thin (especially in the frontal and temporal lobes)
The ventricles enlarge to fill the space
Loss of synapses, acetylcholine, and other neurotransmitters contributes to the decline of memory and attention
Neuritic plaques and neurofibrillary tangles are more concentrated in the cerebral cortex and hippocampus
Loss of other cognitive functions associated with AD
Major Histopathologic Changes in Alzheimer Disease. Beta-amyloid protein deposits (plaques) in the neutrophil (long arrows) and neurofibrillary tangles (short arrows)
Comparison of Normal and Alzheimer Brain. The brain decreases in volume and weight, the sulci widen, and the gyri thin, especially in the temporal and frontal lobes. The ventricles enlarge to fill the space
The atrophy of the temoral lobe contributes to loss of episodic mempry specifically
Two microscopic features are characteristic of AD
Extracellular neuritic plaques
Containing a core of abnormally folded amyloid beta and tau proteins, intraneuronal neurofibrillary tangles
In the cortex and in the walls of meningeal and cerebral blood vessels (amyloid angiopathy and disturbance in blood flow)
Amyloid material surrounded by axons and dendrites, reactive astrocytes, and microglia
Amyloid Beta Peptide (Aβ)
The major protein in neuritic plaques is amyloid β-peptide (Aβ)
Is proteolytically derived from a membrane protein, the amyloid precursor protein (APP)
The APP mutations result in either ↑d production of Aβ and Aβ42
Aβ42 self-aggregates and promotes plaque formation
Aβ42 is toxic to neurons and stimulates production of cytokines from microglial cells
Aβ42 also triggers the release of glutamate from glial cells and may injure neurons through excitotoxicity
Thus Aβ causes the neurodegeneration
Neurofibrillary tangles
paired helical filaments composed of a hyperphosphorylated form of the microtubule protein tau
Neuritic plaques and neurofibrillary tangles are more concentrated in the cortex and hippocampus
HENCE MEMORY LOSS
The tau protein
A microtubule-binding protein
Detaches and forms an insoluble filament called a neurofibrillary tangle
Contributes to neuronal death
Tau is a microtubule-associated protein that aids in microtubule assembly
Normally tau binds to and stabilizes microtubules
Supporting axonal transport of organelles, and neurotransmitters throughout neuron
In AD, tau becomes hyperphosphorylated and aggregates to form paired helical filament tau
Hyperphosphorylation decreases affinity for microtubules
Paired helical filament tau is a major component of neurofibrillary tangles within the neuronal cytoplasm
The accumulation of this altered protein is toxic to neurons
Protective factors
Lifelong activity, the presence of ApoE2 and antioxidant substances, omega-3 fatty acids, estrogen replacement at the time of surgical menopause, low-calorie diet
Risk factors
The greatest risk factors are age and family history
Diabetes, midlife hypertension, hyperlipidemia, midlife obesity, smoking, depression, cognitive inactivity or low educational attainment, estrogen deficit in menopause, physical inactivity, head trauma, elevated serum homocysteine and cholesterol levels, oxidative stress, and neuroinflammation
Three forms
Nonhereditary sporadic or late-onset AD (70% to 90%)
ApoE4 allell on chromosome 19
Early-onset familial AD (FAD)
Linked to three genes with mutations on chromosome 21 (abnormal APP, abnormal presenilin 1, and abnormal presenilin 2 )
Early-onset AD (very rare)
Alzheimer’s Disease
Alzheimer’s disease (AD) is a neurodegenerative disorder of uncertain cause and pathogenesis that primarily affects older adults and is the most common cause of dementia
Clinical Features
Slowly progressive disorder that runs a course of 5–10 years
Typically begins with impairment of learning and recent memory
Anomia, aphasia, and acalculia
Spatial disorientation causes patients to become lost easily
A frontal lobe gait disorder may appear
Short, shuffling steps, flexed posture, difficulty turning, and a tendency to fall backward
In later stages, social graces are lost
Psychiatric symptoms such as paranoia, hallucinations, and delusions may appear
The neuronal degeneration progresses
Series of abnormalities in the brain that selectively affect neurons in specific regions
In the neocortex, the entorhinal area, hippocampus, amygdala, nucleus basalis, anterior thalamus, locus coeruleus and raphe complex
There is a severe loss of cholinergic neurosis in the affected areas
Terminally ill patients are bedridden, mute, and incontinent
Dementia
An acquired decline in intellectual function resulting in loss of social independence
Symptoms progress over months to years
Alertness is preserved until the very late stages of disease
Causes for Dementia
Alzheimer’s disease (>50% of cases), multiple cerebral infarcts, dementia with Lewy bodies, alcoholism, Parkinson disease
Hypothyroidism, vitamin B12 deficiency, neurosyphilis, brain tumor, hydrocephalus, and chronic subdural hematoma
Neuronal death
Brain atrophy ventricles enlarge to fill the space The sulci widen and the gyri thin (especially in the frontal and temporal lobes)
Basal forebrain and brainstem nuclei
Neurotransmitter deficits (loss of Ach)
crerbral cortex and hippocampus
Inability to encode and consolidate memories Inability to transfer working memory to long term memory
Alzheimer's
Aβ aggregation
Oligomers
extracellular Neuritic plaques
Inflammation, mitochondrial damage & oxidative stress
release of glutamate
excitotoxicity
Pathogenisis
mutated tau protein
becomes hyperphosphorylated and aggregates
Form paired helical filament tau
intracellular neurofibrillary tangles
Genes
Presenilin 1 & 2 Amyloid Precursor Protein (APP) mutations on chromosome 21
β-secretase
increased (Aβ40) formation
increased (Aβ42) formation
clearance (inhibited)
ApoE4 on chromosome 19
Inhibits clearance of Aβ
Brown Sequard
hemisection of the spinal cord
changes below the level of the lesion?
ipsilateral (greater motor loss)
loss of motor control (UMN lesion) (corticospinal tract)
loss of fine touch, pressure, conscious proprioception (dorsal column pathway)
2. contralateral (greater sensory loss)
- loss of pain and temperature (spinothalamic tract)
changes at the level of the lesion?
loss of all sensation
Main Topic
Main Topic
Brown-Séquard syndrome results from hemisection of the spinal cord, leading to a characteristic pattern of sensory loss due to the distinct pathways affected.
Ipsilateral Fine Touch and Vibration Loss:
Pathways for fine touch and proprioception travel through the dorsal columns.
Ascend ipsilaterally. A lesion on one side of the spinal cord will disrupt these pathways before they cross over at the medulla.
Loss of fine touch and vibration sensation on the same side as the lesion.
Contralateral Pain and Temperature Loss:
Pathways for pain and temperature, spinothalamic tract, ascend contralaterally.
Fibers cross over to the opposite side shortly after entering the spinal cord.
Lesion on one side of the spinal cord will cause loss of pain and temperature sensation on the opposite side of the body.
Ipsilateral extensive motor loss
Pathway Disruption:
Anatomical organization of these sensory pathways means that damage to one side of the spinal cord selectively impacts these pathways.
The dorsal columns (fine touch and vibration) are affected on the same side as the lesion,
while the spinothalamic tract (pain and temperature) is affected on the opposite side. This unique presentation is the hallmark of Brown-Séquard syndrome.