METHODICAL INSTRUCTIONS
FOR INDIVIDUAL WORK OF STUDENTS IN PREPARATION
FOR PRACTICAL CLASSES
Subject
NEUROLOGY
Topic.
Anatomico-physiological data, pathology and methods of the
vegetative nervous system examination
IV
Year
Faculty
Medical
1. Topicality: The topic is important because of prevalence of the pathology of vegetative
nervous system, importance of welltimed diagnostics on early stages of vegetative nervous
system affection, and because of vegetative dysfunction is often a sign of separate nosologic
form.
2. Specific purposes:
1. To learn
а) to reveal abnormalities of vegetative functions in a patient and to diagnose the level of lesion.
b) to examine a pupil photoharmose , salivation and epiphora
to estimate the function of pelvic organs, trophism of articular system
to diagnose segmental abnormalities of the vegetative nervous system – sympathalgia,
angiotrophoneurosis, ganglionitis, migraine, truncus.
To reveal the affection of oversegmental vegetative control
d) To classify revealed abnormalities
е) To interpret the degree of difficulty
і) To draw schemes, diagrams of affection localization
f) To analyze the case history
g) To make up a treatment regimen
3. Basic knowledge, skills and competences which are necessary for topic studying
(interdisciplinary integration – trasmaterial integration)
1
Subject
Anatomy
2
General physiology (neurophysiology)
3
Physiopathology
Histology
To know
Anatomy
of
oversegmental
and
segmental
nervous
system
To know the function
of the oversegmental
nervous
system
(sympathetic
and
parasympathetic)
To
know
pathophysiological
mechanisms
in
abnormality of the
nervous
system
function
To
know
the
To be able
To know statements
of given subjects
To know statements
of given subjects
To know statements
of given subjects
To know statements
4
5
6
7
morpholological
changes
in
abnormalities
of
vegetative
nervous
system
Diseases of nervous system – clinical Clinic of the vegetative
picture, diagnostics
nervous
system
affections
Biochemistry
To know biochemical
indicators in evaluation
of vegetative nervous
system function
Pharmacology
To
estimate
pharmacological tests
Radiology
To know the signs of
arthropathies
of given subjects
To know statements
of given subjects
To know statements
of given subjects
To know statements
of given subjects
To know statements
of given subjects
4. Assignments for individual work during preparation for the classes
а) The list of the basic terms, characteristics which students must learn during the
preparation for the classes:
№
Term
1.
Oversegmental formations of Structures which are localized mainly in hypothalamic
the vegetative nervous system section and responsible for general regulation of vegetative
supply
Definition
2.
Segmental formations of the Structures which are localized in vegetative formation of
vegetative nervous system
cranial nerves, brainstem, segments of spinal cord,
ganglions and which are responsible for regulation of
vegetative supply on the segmental level
б) The list of theoretical questions:
1. Oversegmental formations of the vegetative nervous system
2. Segmental formation of the vegetative nervous system
с) Practical tasks made at the class :
1. Methods of examination of the vegetative nervous system
Topic contents:
Oversegmental formations of the vegetative nervous system – hypothalamus, limbic system
(cingulate sulcus, hippocamp), reticular formation, amygdaloid nucleus. Segmental formation of
the vegetative nervous system –
Sympathetic section (thoraco-lumbar) - neurons of lateral horns C8-L2, ganglions, prevertebral
nodes and plexes,
Parasymthetic – vegetative nuclei of craniocerebral nerves – trunkal level,
Sacral - neurons of lateral horns S3-S5, ganglions, plexes.
Abnormalities of sympathetic section functions–
Neurons of lateral horns – trophic abnormalities of skin, nails, osteomalacia Paravertibral
ganglions – acute pain, (face, body, extremities), sympathalgia.
Prevertebral nodes and plexes – pain onset in the stomach, spastic colon, dyskinesia of bileducts, solar plexitis etc.
Abnormalities of parasympathetic section functions–
Vegetative nuclei of craniocerebral nerves, sacral centers S2-S5.
N.oculomotorius – exophthalmos, mydriasis, dilation of eye fissurae in affection of the nuclei of
parasymthetic centers N.oculomotorius
n.n.glossofaryngeus,
n.intermedius abnormalities of taste, epiphora, salivation, depression of functions of cardiovascular system and respiration.
n.vagus – depression of cardiac function and respiration in case of exclusion of n.vagus
function.
In the affection of the sacral centers –
Atonic urinary bladder, actual enuresis, encopresis. In exclusion of central regulation there is a
spastic urinary bladder, ischuria paradoxa, a reflex urinary bladder, imperative feeling of
urination.
Affection of the head and neck section of the sympathetic nervous system
Central part – (Jacobson's spinal center - lateral horns – from С8 to Т2 segments)
To differentiate – white connective branches, approaching to truncus simpaticus, and grey
connective branches deviating from it.
Nodes of boundary sympathetic trunk–
Upper – passes the branches to the first – the fifth (1-5) spinal nerves, to the nodes of the tenth
(10) pair of craniocerebral nerves, to thyroid gland, branches which form plexes around the
carotid, around the external carotid, from the node to salivary glands, superior cervical cardiac
nerve
Medium - branches, which form medium cervical nerve
Branches to the forth –the sixth (4-6) cerebral nerves and subclavian loop
Lower – branches to the sixth- the eighth (6-8) cervical cerebral nerves, spine nerve, plexes of
spine artery, branches to plexes of clavicular artery, lower cardiac nerve and branches to the
organs of cardiac cavity.
Symptoms –
Prolapse of the function – ptosis, miosis, enophthalmos, anhydrosis and hypermimia of skin of
face, neck, hands, thorax, sympathalgia.
Irritations – exophthalmos, mydriasis, hyperhidrosis, angiospasm, temperature reducing of the
skin of face, neck, hands, thorax, sympathalgia.
Main section of the parasympathetic nervous system –
Nuclei 3 pair (Yakubovych’s, Perlea’s), 9 pair (n.salvatorius), 10 pair (n.dorsalis n.vagi)
Fibrae preganglionares –
3p. –short radices of the 3-d pair g.ciliare, 13 p. – n.petrosus superficialis major, chorda timpani,
and tongue nerve.
9p. - – n.petrosus superficialis minor, 10p. – Fibrae preganglionares n.vagi
Nodes - g.ciliare, g.pterygopalatynum, g.sublingualis submaxillaris, g.oticum, eztramural,
intermural nodes of the organs of neck, thorax and stomach (n.vagi)
Fibrae postganglionares - short ciliary g.ciliare, n.lacrimalis, nn.sublingualis, submaxillaris,
n.auriculotemporalis, Fibrae postganglionares n.vagi.
Innervated organ – m.sphincter pupille, m.ciliaris , lachrymal gland, aural gland, organs of
neck, thorax and stomach.
Function – narrowing of a pupil, accommodation, tear secretion, salivation, depression of
cardiac function, narrowing of the bronchial tubes, stimulating of digestion, peristalsis, urination.
Methods of examination
Questioning, external examination - to pay attention to the state of coverlet, hypermimia or
paleness, hyperhidrosis, pupil width, pupil symmetry, uniformity of eye fissurae, state of hair
and nails, presence of bedsore, ulcers.
Vegetative reflexes – local dermographism, reflexed dermographism, pilomotor reflexes,
Ashner’s pericardiac reflex, Prevel’s orthostatic reflex, Danielpolu clinostatic reflex, Ortner's
sign.
ECG, radiography, Doppler cardiometry, Minor’s method, thermography etc. рентгенографія,
доплерографія, метод Мінора, термографія, інше.
Material for self-control :
А. Tasks for self-control (tables, schemes, pictures, diagram):
Organ, system, function
Sympathetic innervation
Eye
Exophthalmos, dilation of a
pupil and eye fissurae
Glands of nose membrane, Narrows the vessels, decreases
lachrymal glands, admaxillary thick secretion
glands, submandibular gland
Coronary vessels
Dilation
Vessels of skin
Narrowing
Bronchial tubes
Dilation of bronchial tubes,
decreasing of secretion
Intestines
Depresses
peristalsis,
increases sphincter tone
Gall-bladder
Depresses motor activity
Kidney
Urinary bladder
Genitals
Blood
Basal metabolism
Pancreatic hormone
Tone of skeletal muscles
Physical and mental activity
Parasympathetic
Enophthalmos and narrowing
of a pupil and eye fissurae
Increasing of watery secretion
Narrowing
Dilation
Narrowing, increasing of
secretion
Increases peristalsis, depresses
sphincters tone
Increases
motor
activity,
depresses sphincters tone
Decreases diuresis
Increases diuresis
Depresses
activity
of Increases
activity
of
musculature
of
urinary musculature
of
urinary
bladder, increases sphincters bladder, decreases sphincters
tone.
tone.
Ejaculation
Erection
Prevents hemorrhages
Increases flow
Increases
Decreases
Discharges
Decreasing of discharges
Increases
Decreases
Increases
Decreases
Б. Tasks for self-control:
Vegetative nervous system
1. Tick the function which is not performed by vegetative nervous system:
1.Trophic
2. Adaptation of living function (blood circulation, digestion, excretion)
3. Innervation of inner organs
4. Supply of sense innervation
5. Homeostasis
2. There are clinical methods of examination of vegetative nervous system.Odd one out:
1. Examination of vegetative reactivity
2. Queckenstedt's test
3. Determination of vegetative Kerdo index
4. Orthostatic sign
5. Examination of regional tone
3. Tick the structure which concerns with oversegmental section of vegetative nervous
system:
1.
Sympathetic trunk
2.
Hypothalamus
3.
Parasympathetic nuclei of cranial nerves
4.
Lateral horns of the spinal cord
5.
Intramural ganglions
4. There are basic functions of oversegmental section of vegetative nervous system.
Odd one out:
1.
Homeostasis
2.
Supplying with sexual conduct
3.
Supplying with food conduct
4.
Supplying with volitional movements
5.
Integrating function
5. Tick segmental level formations which concerns with sympathetic section of
vegetative nervous system:
1.
nuclei of Х (the tenth) pair of cerebral nerves
2.
neurons of lateral horns С8-L2
3.
pellucid septum
4.
nuclei of ІІІ (the third) pair of cerebral nerves
5.
reticular formation of brainstem
6. Tick formations which do not concern with parasympathetic section of vegetative
nervous system:
1.
Dorsal nucleus of X (the tenth) of cerebral nerves
2.
Yakubovych nucleus
3.
neurons of lateral horns of spinal cord ( С8-L2)
4.
5.
sacral centers of urination and defication
upper and lower salivatory nuclei
7. Tick the formations of craniobulbar section of parasympathetic nervous system:
1.Yakubovych nucleus ядро
2. caudate nucleus
3. Perlia nucleus
4. Deiters' nucleus
5. Goll's nucleus and Burdach's nucleus
8. There are symptoms of the affection of peripheral plexes of vegetative nervous
system. Odd one out:
1. Pains (sympathalgia)
2. vasomotor disorders
3. peripheral paresis
4. trophical abnormalities
5. perspiration abnormalities
9. Tick the symptoms which are not peculiar to affection of stellate ganglion:
1. acute pains on one side of a face, a neck and a hand вазомоторні розлади
2. vegetotropic abnormalities
4. urination disorders
5. cardiac rhythm disorders
10. Tick one symptom which is not peculiar to sympatheticadrenal attack:
1. skin paleness
2. bradycardia
3. tachycardia
4. increasing of the blood pressure
5. sense of fear
11. Tick the symptom which is not peculiar to vagoinsular attack:
1. redness
2. bradycardia
3. tachycardia
4. decreasing of the blood pressure
5. alimentary tract abnormality
Materials as an illustration –
tables - “Anatomy of vegetative nervous system”,
Computer test program “Test”.
Information sources
1. Shcrobot S.I., Hara I.I. Neurology in lecture (Selected lectures) . Ternopil, TSMU,
«Ukrmedknyha», 2008. 319 p.
2. Reinhard Rohkamm. Color Atlas of Neurology © 2004 Thieme. 440 p.
3. Crash course Neurology by Anish Bahra and Katia Cikurel. Copyright 2006, Elsevier,
Inc. 244 p.
4. Adams and Victors. Principles of neurology. © 2005 McGraw-Hill . Medical Publishing
Division.
5. Mayo Clinic Internal Medicine Review 2006-2007. Chapter 18. Editor-in-Chief Thomas
M. Habermann, MD