Neuroscience Exam 1: Gross Anatomy a. major structures of the nervous system 1. Precentral sulcus 2. Precentral gyrus 3. Central sulcus = sulcus of Rolando 4. Post central gyrus 5. Post central sulcus 6. Heschl’s gyrus = transverse temporal gyri 7. Sagittal fissure = longitudinal fissure 8. Lateral fissure = Sylvian fissure b. primary function of the gross structures 1. Cerebral cortex i. Frontal lobe – motor, social, judgment, reasoning ii. Parietal lobe - sensory iii. Temporal lobe- memory, auditory iv. Occipital lobe – visual 2. Ventricles – buoyancy for brain, circulate neurotransmitters 3. Cerebellum – coord. of mvmt and postural control, motor planning, and rapid shifting of attention 4. Brainstem – origin of most upper motor neurons (excluding corticospinals), axons transmitting somatosensory info, nuclei for CN III – X and XII, and the reticular formation 5. Spinal cord – transmission, processing, and modification of info originating from brain, peripheral nerves, or other spinal cord segments Structure and Function of a Neuron a. major parts of a typical neuron 1. Dendrites – receive information from other cells 2. Axon – carries output information to presynaptic terminal (length varies) 3. Presynaptic terminals – transmit information to other cells (release neurotransmitters) 4. Soma – cell body (where neurotransmitters are produced) b. how the resting membrane potential of a neuron is maintained 1. No net flow of ions across the membrane 2. Must be capable of producing change in ion flow (be excitable) so membrane maintains an unequal distribution of ions across the membrane 3. Typically -70mV 4. Maintained by i. Na+/K+ pump – pumps out 3 Na+ ions for every 2 K+ ions pumped in ii. Negatively charged ions stay inside – too large to diffuse out iii. Passive diffusion of ions through leak channels in the cell membrane c. how an action potential is generated and propagated 1. Generation i. A 15-mV depolarization (change from -70mV to -55mV) produces action potential A. Voltage-gated Na+ channels open and Na+ flows rapidly into cell (due to Na+ concentration gradient as well as attraction to negative charge inside cell) B. Voltage-gated Na+ channels close C. Voltage-gated K+ channels open and K+ leaves the cell D. K+ repelled by positive charge in cell and by K+ concentration gradient E. Hyperpolarizes neuron temporarily 1. Absolute refractory period – no amount of stimulus will provoke another action potential 2. Relative refractory period – a stronger-than-usual stimulus will produce another action potential F. Promotes forward propagation of action potential ii. (Resting membrane potential is restored by leak channels and action of Na+/K+ pump.) 2. Propagation i. An action potential causes depolarization to adjacent area that is in a resting state ii. Due to hyperpolarization and the refractory period it creates, propagation proceeds in one direction – that is down the inactive regions of a membrane iii. Faster propagation A. Larger diameter axon 1. Larger “pipe” allows greater current flow B. Myelination 1. Like insulation for “pipe” – prevents current leak 2. Nodes of Ranvier – breaks in myelin, with high amt. of Na+ and K+ channels, act as stores of charge 3. Saltatory conduction – depolarization from node to node along a myelinated axon d. how synaptic transmission occurs 1. Action potential reaches the presynaptic terminal 2. Voltage-gated Ca+ channels open and Ca+ enters the presynaptic terminal 3. Elevated levels of Ca+ promote the movement of vesicles toward release sites on the cell membrane 4. The synaptic vesicles bind with the membrane, then release neurotransmitter into the synaptic cleft 5. Neurotransmitter binds to receptors on the postsynaptic membrane 6. The membrane receptor changes shape of an ion channel, allowing positively charged ions to enter the postsynaptic cell, or indirectly opens an ion channel through a G-protein, or activates a cascade of intracellular events through a second messenger. e. the major neurotransmitters 1. Acetycholine – prevalent in PNS i. Fast-acting on muscle membranes ii. Slow-acting with heart rate and other autonomic functions 2. Amino acids i. Glutamate – excitatory, fast-acting in CNS, involved w/learning and development ii. Glycine and Gamma aminobutyric acid (GABA) – maj. inhibitory in CNS, esp w/interneurons in SC 3. Amines i. Dopamine – motor activity, cognition, behavior; assoc. w/feelings of pleasure and reward ii. Serotonin – affect mood and perception of pain 4. Peptides i. Substance P – stimulates nerve endings at site of injury and w/in SC to intensify pain signals ii. Endorphins – inhibit neurons in CNS involved in pain perception 5. Nitric Oxide – involved w/persistent changes in postsynaptic response to repeated stimuli and in cell death of neurons Neural Development a. the formation of the brain and nervous system that occurs in utero 1. Preembryonic (conception – 2 wks) 2. Embryonic (2 – 8 wks) i. Neural plate neural groove neural tube 1. Neural tube forms (days 18-26) A. Mantle layer (inner, gray) B. Marginal layer (outer, white) 2. Brain formation begins (day 28+) ii. Neural crest PNS Forebrain Telencephalon Diencephalon Midbrain Mesencephalon Hindbrain Metencephalon Thalamus, hypothalamus, 3rd ventricle, cerebral hemisphere (including BG) Midbrain, Cerebral Aqueduct Cerebellum, pons, 4th ventricle, medulla Myelencephalon 3. Fetal (8 wks – birth) i. Cellular development 1. Cell proliferation, migration, growth (2nd trimester) 2. Synaptic formation (3rd trimester) 3. Myelination (late 3rd trimester – young adulthood) b. typical neural development that occurs in infants and toddlers 1. Infancy i. Proliferation ii. Regression 1. Neuronal death (makes brain more efficient) 2. Axon retraction iii. Experience-expectant maturation (nature, brain “expect” certain experiences – e.g., walking) iv. Experience-dependent maturation (nurture, experience refine brain growth and structure – e.g., a musician’s fine-motor control of the hands) 1. Sensory stimulation builds neuronal connections A. Vision – fetus eyes don’t open until 26th wk; vision undeveloped at birth, can only focus 8-12 in. away; see b&w; can track object across room by 1-2 mos.; big improvement in depth perception by 3-6 mos. B. Hearing – fetus can hear by 24th wk, can recognize parents’ voices; well-developed at birth C. Taste – some flavors thought to be transmitted through amniotic fluid and breast milk; better variety in early diet might make baby more tolerant of variety as infant and toddler D. Smell – babies are drawn to smell of breast milk, even as newborns E. Touch – skin-to-skin contact improves physiological function and development; infant massage positively impacts growth 2. Social-emotional development: if baby’s needs are met, it has better social-emotional development A. Attachment – if baby receives a lot of attention, it has greater attachment, and less anxiety B. Security– not possible to spoil baby its 1st 3-4 mos.; if needs are met, baby can focus on learning C. Stress – if baby is stressed, higher levels of cortisol, and decreased growth D. Sleep deprivation – newborns need sleep, 16-20 hrs/day 3. Development of movement A. Eye-head control – 1st 3 mos. B. Manual skills – reach and grasp 3-6 mos; feed themselves 9-12 mos. C. Locomotion – crawl by 9 mos.; walk by 1 yr. c. developmental disorders that occur due to malformation of the nervous system 1. Cerebral palsy (Box 5-3, pp. 101 of txt) – movement and postural disorder caused by permanent, nonprogressive damage of a developing brain; damage usually occurs postnatally; classified according to motor dysfunction – spastic, athetoid (involuntary slow, writhing, purposeless mvmt), ataxic, mixed – or according to area of body affected – hemiplegia, quadriplegia, diplegia (paralysis affecting symmetrical parts of the body – face, arms, legs). 2. Myelodysplasia/Spina bifida (Box 5-2, pp. 98) – neural tube defect resulting in developing vertebrae not closing around an incomplete neural tube, resulting in bony defect at distal end of tube; symptoms vary, based on severity of neural tissue protrusion, from asymptomatic to paralysis of lower limbs 3. Developmental coordination disorder (pp. 100) – children with normal intellect, without TBI, CP, or other neurologic problems, who lack coordination to perform age-appropriate motor tasks; slow movement is single, reliable characteristic The Spinal Cord and Peripheral Nervous System a. structures of the gray and white matter in cross sections of the spinal cord, Dorsal horn: sensory; contains Dorsal column: sensory tracts endings of sensory neurons, interneurons, and cell bodies of tract cells Lateral horn: only at T1-L2 spinal segments; cell bodies of preganglionic sympathetic neurons Lateral column: sensory and motor Ventral horn: motor; cell bodies of lower motor neurons (LMN) tracts Anterior column: motor tracts Dorsal column Lundy-Ekman Fig 12-6 Anterolateral Pathway White matter of spinal cord: Blue – sensory tracts; Red – motor; Purple – propriospinal fibers. Gray Matter Arranged in Layers Rexed’s Laminae: 10 histologic regions of spinal gray matter Substantia gelatinosa (lamina II): processes pain info Nucleus proprius (laminae III & IV): processes conscious proprioception and discriminative touch Nucleus dorsalis (AKA Clarke’s column; in lamina VII): relays unconscious proprioceptive info to cerebellum Fig 12-7. Gray matter of lower thoracic spinal cord b. major surface markings of the spinal cord Nolte, Fig 10-7A c. the structures of the spinal nerves, from the rootlets (both dorsal and ventral) to the periphery • Dorsal rootlets enter cord at posterolateral sulcus and form dorsal root • Ventral rootlets leaves anterolateral sulcus and form ventral root • Ventral root and dorsal root join to form spinal nerve Lundy-Ekman Fig 1-7 d. the functional difference between damage to a CNS vs PNS neuron 1. Lesion of sensory or motor fiber in spinal region results in myotomal and/or dermatomal distribution 2. Lesion of sensory or motor fiber in periphery results in peripheral nerve distribution. Signs include: paresis or paralysis, sensory loss, abnormal sensations, muscle atrophy, reduced or absent DTR e. A behavioral example demonstrating the gate control theory of pain Hitting your finger with a hammer and then applying pressure to stimulate the pressure receptors to inhibit the pain transmission. The limbic system releases corticosteriods and the periaqueductal gray releases endorphins. Synaptic remodeling can occur at the spinal cord or cortical level if pain stimulus continues for long enough. And the local chemical releases at the skin can make the skin hypersensitive and more likely to be stimulated by less than typical levels of painful stimulus or by a stimulus that would not normally elicit a painful reponse. TENS uses the gate control theory of pain to inhibit pain perception. f. major characteristics of the pathways/tracts of the spinal cord and brain Tract Origin Termination Function Dorsal column/medial lemniscus Peripheral receptors; 1storder neuron synapses in medulla Dorsal horn of spinal cord Primary sensory area cerebral cortex Primary sensory area cerebral cortex Midbrain Reticular formation Amygdyla, basal ganglia, many areas of cortex cerebellum Convey info about discriminative touch and conscious proprioception Convey discriminative info about pain and temp Spinothalamic Spinomesencephalic Spinoreticular Dorsal horn of spinal cord Spinolimbic Spinocerebellar Lateral corticospinal Medial corticospinal Tectospinal High-fidelity paths orig. in peripheral receptors; 1st-order neurons synapse in nucleus dorsalis or medulla Internal feedback tracts originate in dorsal horn Supplementary motor, premotor, and primary motor cerebral cortex Supplementary motor, premotor, and primary motor cerebral cortex Superior colliculus of midbrain Ventral horn of spinal cord (contralateral) Ventral horn of spinal cord (ipsilateral) Ventral horn of spinal cord (contralateral) Nonlocalized perception of pain; arousal, reflexive, motivational, and analgesic responses to nociception Conveys unconscious proprioceptive info Conveys info about activity in descending activating pathways and spinal interneurons Fractionation of movement, particularly of hand movements Control of neck, shoulder, and trunk muscles Reflexive movement of head toward sounds or visual moving objects Rubrospinal Red nucleus of midbrain Medial reticulospinal Pontine reticular formation Lateral reticulospinal Medullary reticular formation Medial vestibulospinal Vestibular nuclei in medulla and pons Lateral vestibulospinal Vestibular nuclei in medulla and pons Ceruleospinal Locus ceruleus in brainstem Raphespinal Raphe nucleus in brainstem Ventral horn of spinal cord (contralateral) Ventral horn of spinal cord (ipsilateral) Ventral horn of spinal cord (ipsilateral) Ventral horn of spinal cord (contralateral) Ventral horn of spinal cord (ipsilateral) Spinal interneurons and motor neurons Spinal interneurons and motor neurons Facilitates contralateral upper limb flexors Facilitates postural muscles and limb extensors Facilitates flexor muscle motor neurons, inhibits extensor motor neurons Adjusts activity in neck and upper back muscles Ispsilaterally facilitates lower motor neurons to extensors; inhibits lower motor neurons to flexors Enhances the activity of interneurons and motor neurons in spinal cord Same as ceruleospinal g. upper motor neuron lesions and lower motor neuron lesions Upper vs. Lower Motor Neuron Lesions UMN Clinical Signs Paresis Spasticity Hypertonia Hyperreflexia Diseases Stroke SCI Parkinson’s TBI MS LMN Clinical Signs Loss of reflexes Atrophy Flaccid Paralysis Fibrillations/fasciculations Diseases Polio Peripheral Nerve Injury Guillian Barre Syndrome Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) = Both UMN and LMN The Brain Stem and Cranial Nerves a. major subunits of the brain stem 1. Horizontal divisions (superior to inferior) i. Midbrain A. CN nuclei III, IV ii. Pons A. Corticopontine tracts synapse B. Some corticobulbar tracts synapse a. CN V – in upper pons b. CN VII – in mid pons C. CN nuclei V, VI, VII D. Middle cerebellar peduncle iii. Medulla A. External anatomy a. Anterior surface i. Pyramids (inferior) – corticospinal tracts cross R<>L ii. Olives – relay info to cerebellum iii. Cranial nerves IX, X, XI, and XII – all exiting b. Posterior surface i. Inferior cerebellar peduncle – connection bet. medulla & cerebellum ii. Central canal widens to be 4th ventricle B. Internal anatomy a. Upper Medulla i. Nuclei for CN VII, VIII, IX, X, XII ii. Corticobulbar tracts to 1. IX, X (bilat.) 2. XII (sometimes contralateral) b. Inferior medulla i. Corticospinal tracts cross (pyramidal decussation) ii. Dorsal column/medial lemniscus cross iii. CN V synapse C. Functions: a. Contributes to control of eye and head movements b. Coordinates swallowing c. *Important*: Helps regulate cardiovascular, respiratory and visceral activity 2. Longitudinal sections i. Basilar section - anterior A. Descending axons from cerebral cortex B. Motor nuclei ii. Tegmentum – posterior A. Reticular formation: adjust general activity level of nervous system B. Sensory nuclei and ascending sensory tracts C. Cranial nerve nuclei D. Medial longitudinal fasciculus: tract that coord. eye & head mvmt iii. Tectum – additional posterior section of Midbrain A. Pretectal area B. Superior and inferior colliculi C. Reflexive control of eye & head mvmt b. the placement of the major nuclei of the brain stem Cranial Nerve Nuclei: Midbrain Pons Mid/Upper Pons Pons Inferior Pons Medulla Upper Medulla Lemniscus Medulla Inferior medulla Central canal Lemniscus c. type of information processed by each tract and by each nucleus of the brain stem Vertical Tracts Location Modifications in brainstem Information processed Trigeminal lemniscus Fasciculus gracilis Midbrain Inferior medulla Crosses to medial lemniscus Fasciculus cuneatus Inferior medulla Crosses to medial lemniscus Spinal tract of trigeminal nerve Posterior spinocerebellar Medulla, pons Synapses w/nucleus ipsislaterally Inferior medulla Touch, pain, temp from face Lower limb – discriminative touch and conscious proprioception Upper limb sensory discriminative touch and conscious proprioception Touch, pain, temp from face Anterior spinocerebellar Inferior medulla, mid/upper pons Conveys unconscious proprioceptive info Tectospinal Inferior medulla, upper midbrain Medial lemniscus Passes thru brainstem Spinothalamic Not modified; passes through brainstem without alteration Axons synapse in nucleus gracilis or cuneatus;2nd-order neurons cross midline to form medial lemniscus Reflexive mvmt of head toward stimuli Discriminative touch and conscious proprioception Convey discriminative info about pain and temp Convey info about discriminative touch and conscious proprioception Sensory (Ascending) Tracts Dorsal column Conveys unconscious tactile and proprioceptive info from lower ½ of body Motor (Descending) Tracts Corticopontine Corticospinal Pons, midbrain Not modified; passes through brainstem without alteration Corticobulbar Axons synapse with cranial nerve nuclei in brainstem Axons synapse within reticular formation Orig. in red nucleus (midbrain), crosses, then descends to synapse w/LMN Passes thru brainstem Corticoreticular Rubrospinal Medial Longitudinal Fasciculus Nuclei Superior colliculis Mesencephalic nucleus of trigeminal nerve Location in brainstem Upper midbrain Upper midbrain Motor output to V, VII, XII (Lateral) Fractionation of movement, particularly of hand movements (Medial) Control of neck, shoulder, and trunk muscles Motor signals from cerebral cortex to cranial nerve nuclei Upper limb flexors tract that coord eye & head mvmt Information processed Unconscious visual input Proprioception of the face Oculomotor nerve parasympathetic nucleus Upper midbrain Oculomotor nucleus Upper midbrain Red nucleus Upper midbrain Substantia nigra Upper midbrain Inferior colliculus Lower midbrain Mesencephalic nucleus Locus ceruleus Lower midbrain Lower midbrain Nucleus of trochlear nerve Pedunculopontine Lower midbrain Lower midbrain Vestibular nuclei Main sensory nucleus of trigeminal Motor nucleus of trigeminal Abducens nucleus Cochlear nucleus Vestibular nucleus Facial nucleus Pontine nuclei Solitary nucleus Vestibular nuclei Accessory cuneate nucleus (visceral motor) Spinal nucleus of trigeminal nerve Mid/upper pons Mid/upper pons Mid/upper pons Inferior pons Inferior pons Inferior pons Inferior pons Inferior pons Upper medulla Upper medulla Upper medulla Nucleus ambiguus Hypoglossal nucleus Inferior olivary nucleus Upper medulla Upper medulla Upper medulla Raphe nuclei Upper medulla Nucleus gracilis Inferior medulla Nucleus cuneatus Inferior medulla Spinal nucleus of trigeminal nerve Inferior medulla Upper medulla Parasympathetic control of pupillary sphincter and ciliary muscle Efferent somatic fibers to extraocular muscles Info from cerebellum, spinal cord, and reticular formation Output to motor thalamus and pedunculopontine nuclei Auditory input Proprioception of the face Physiological responses to stress and panic; releases norepinephrine; regulates attention Motor efferent Reticular and vestibular; source of acetylcholine Vestibular afferent Sensory afferent Somatic efferent Somatic efferent Auditory efferent Vestibular afferent Somatic efferent Somatic efferent Visceral afferent Vestibular afferent Proprioceptive afferent Touch, pain, temp afferent from ipsilateral face Motor efferent of CN X and IX Motor efferent CN XII Motor efferent and proprioceptive afferent Modulate activity throughout CNS; major source of serotonin; inhibition of pain transmission Discriminative touch and conscious proprioception Discriminative touch and conscious proprioception Touch, pain, temp afferent from ipsilateral face d. the neurological principle and behavioral signs of alternating hemiplegia 1. Lesion to one side of brainstem i. At CN III, VI, or XII (not all three) ii. Produces flaccid paralysis on same side of face as lesion 2. Damage to nearby corticospinal tract i. UMN – spastic paralysis of arm/leg on opposite side of body 3. Seldom seen as pure syndrome in clinic Alternating Hemiplegia cn III - LMN = reduced tone - ptosis of left eyelid - left eye lateral at rest -Unable move eye up, down, medially Rubrospinal pathway Corticospinal pathway - UMN = increased tone - spasticity of right extremities Alternating Hemiplegia cnVI - LMN = reduced tone - left eye to midline at rest -Unable to abduct eye Corticospinal pathway - UMN = increased tone - spasticity of right extremities Alternating Hemiplegia cn XII - LMN = reduced tone - difficulty swallowing - slurred speech - tongue deviates to left Corticospinal pathway - UMN = increased tone - spasticity of right extremities Number Name S, M Function or B Connection How test to Brain I Olfactory S Smell Inferior frontal lobe Have patient identify substances II Optic S Vision Diencephalon Check vision Pupillary reflex (sensory portion) III Oculomotor M Moves eye up, down, medially; raises upper eyelid; constricts pupil; adjusts lens shape Midbrain Have track finger Check eyelids open equally Pupillary reflex (motor portion) IV Troclear M Moves eye medially and down Midbrain Have track finger V Trigeminal B Facial sensation, chewing, sensation from TMJ Pons Sensation of face Corneal reflex (sensory portion) Masseter reflex VI Abducens M Abducts eye Between pons and medulla Have track finger VII Facial B Facial expression, closes eye, tears, salivation, taste Between pons and medulla Facial movements Corneal reflex (motor portion) VIII Vestibulocochlear S Sensation of head position relative to gravity and head movement; hearing Between pons and medulla Vesibular function Auditory function IX Glossopharyngeal B Swallowing, salivation, taste Medulla Gag reflex (sensory portion) X Vagus B Regulates viscera, swallowing, speech, taste Medulla Have patient say “ah” (soft palate should rise) Gag reflex (motor portion) XI Accessory M Elevates shoulders, turns head Spinal cord and medulla MMT sternocleidomastoid and upper trap XII Hypoglossal M Moves tongue Medulla Have patient stick out tongue Lundy-Ekman Tables 13.1, 13. 2 and 13.4 Autonomic Nervous System, Hypothalamus and Limbic System a. the functions of sympathetic and parasympathetic nervous system 1. Sympathetic – “flight or fight” i. Cell bodies of preganglionic neurons located in lateral horn T1-L2; thoracolumbar outflow ii. Primary function: maintain optimal blood supply to organs iii. Regulate body temp and metabolic rate; regulate activity of viscera 2. Parasympathetic - “rest and digest” i. Preganglionic cell bodies in brainstem (CN III, VII, IX, X) and sacral spinal cord (S2 – S4); craniosacral outflow ii. Primary function: energy conservation and storage iii. Decreases cardiac activity, facilitates digestion, and regulates activity of viscera b. ANS receptors – 1. Mechanoreceptors – pressure and stretch 2. Chemoreceptors – chemical concentrations 3. Nociceptors – stretch and ischemia 4. Thermoreceptors – small changes in temp c. ANS Afferent pathways 1. Dorsal roots into spinal cord 2. CN VII, IX, and X into brainstem d. Hypothalamus 1. Overseer of homeostasis and ANS 2. All ANS afferents relayed to hypothalamus; receives direct sensory afferent from retina and olfactory 3. Information shared with limbic system 4. Output to medulla and pons to regulate ANS e. Limbic System - primary functions and major structures 1. Emotion a. Amygdala b. Areas in hypothalamus c. Septal area d. Anterior nuclei of thalamus e. Anterior limbic cortex f. Limbic association area 2. Memory a. Hippocampus b. Medial thalamic nuclei c. Posterior limbic cortex d. Basal forebrain 3. Influences motor and autonomic output via emotion 4. Major source of input is from hypothalamus, if there is emotional context of some sort. 5. Influences ANS behavior via hypothalamus if there is an emotional context of output. 6. Behavioral signs associated with limbic system dysfunction - inappropriate display of emotion, inability to control and regulate mood, inability to create and store memories with emotional context.