2009 The McGraw-Hill Companies, Inc.

All rights reserved

29-1
The Nervous System
PowerPoint presentation to accompany:

Medical Assisting
Third Edition

Booth, Whicker, Wyman, Pugh, Thompson
2009 The McGraw-Hill Companies, Inc. All rights reserved
29-2
Learning Outcomes
29.1 Explain the difference between the central
nervous system and the peripheral nervous
system.
29.2 Describe the functions of the nervous system.
29.3 Describe the structure of a neuron.
29.4 Describe the function of a nerve impulse and how
a nerve impulse is created.

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29-3
Learning Outcomes (cont.)
29.5 Describe the structure and function of a synapse.
29.6 Describe the function of the blood-brain barrier.
29.7 Describe the structure and functions of meninges.
29.8 Describe the structure and functions of the spinal
cord.

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29-4
Learning Outcomes (cont.)
29.9 Describe the location and function of
cerebrospinal fluid.
29.10 Define reflex and list the parts of a reflex arc.
29.11 List the major divisions of the brain and give the
general functions of each.
29.12 Explain the functions of the cranial and spinal
nerves.
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29-5
Learning Outcomes (cont.)
29.13 Describe the differences between the somatic
nervous system and autonomic nervous system.
29.14 Explain the two divisions of the autonomic
nervous system.
29.15 Describe the causes, signs and symptoms, and
treatments of various diseases and disorders of
the nervous system.
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29-6
Introduction
Highly complex system
of two parts
Central nervous
system (CNS)

Peripheral nervous
system (PNS)
Controls all other organ
systems and is
important for
maintaining balance
within those systems
Disorders are numerous and often
difficult to diagnose and treat
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29-7
General Functions of the NS
CNS
Brain
Spinal cord
PNS
Peripheral nerves
Two sections
Somatic nervous system
(SNS)
Skeletal or voluntary
muscles
Autonomic nervous system
(ANS)
Automatic functions

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29-8
General Functions (cont.)
Three types of neurons
Afferent or sensory nerves
Sensory information from environment or inside body
to CNS for interpretation
Efferent or motor nerves
Impulses from CNS to PNS to allow for movement or
action
Interneruons
Interpretive neurons between afferent and efferent
nerves in the CNS
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29-9
Apply Your Knowledge
Match the following:
___ Somatic nervous system A. Motor nerves
___ Autonomic nervous system B. Governs skeletal or voluntary muscles
___ Afferent nerves C. Governs respiratory and GI systems
___ Efferent nerves D. Go-betweens or interpreters
___ Interneurons E. Sensory nerves

C
A
E
D
B
ANSWER:
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29-10
Neuron Structure
Functional cells of NS

Transmit electrochemical
messages called nerve
impulses to
Other neurons
Effectors (muscles or
glands)


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Neuron Structure (cont.)
Neurons lose their ability to divide
If destroyed, not replaced
Neuralgia
Support cells for neurons that can divide
Astrocytes anchor blood vessels to nerves
Microglia act as phagocytes
Oligodendrocytes assist with production of
myelin sheath
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29-12
Neuron Structure (cont.)
Neurons have cell
body processes called
nerve fibers that
extend from the cell
body.
Dendrites short
Receive nerve impulses
for the neuron

Axons long
Send nerve impulses
away from the cell body
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29-13
Neuron Structure (cont.)
White matter axons with
myelin sheath
Schwann cells neurological cells
Wrap around some axons
Cell membranes contain myelin
Myelin insulates axons and
enables axons to send nerve
impulses more quickly

Gray matter axons without
myelin sheath
Schwann
cells
Axon
Dendrites
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29-14
Apply Your Knowledge
True or False:
___ Effectors are neurons.
___ Neurons can reproduce.
___ Astrocytes anchor blood vessels to nerve cells.
___ Microglia act as phagocytes.
___ Oligodendrocytes are reproductive cells.
___ Repolarization is the return to the resting state.
F
T
T
F
T
F
ANSWER:
They are the muscles or glands.
Neurons cannot reproduce.
They take part in
myelin production.
GOOD JOB!
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29-15
Nerve Impulse
Membrane potential
Neuron cell membrane at rest is in a polarized state
Inside of cell membrane is negative
Outside of cell membrane is positive due to more Na
+
and K
+

As Na
+
and K
+
move into the cell, the membrane becomes
depolarized
Inside becomes more positive
Action potential (nerve impulse) is created
Repolarization occurs when K
+
and later Na
+
move to the
outside of the cell membrane
Return of the cell to polarized (resting) state
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29-16
Nerve Impulse (cont.)
Impulse travels down axon to synaptic knob
Vesicles or small sacs in synaptic knob
Produce chemicals called neurotransmitters
Neurotransmitters are released by synaptic knob
Allow impulse transmission to postsynaptic structures
Dendrites
Cell bodies
Axons of other neurons
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Nerve Impulse (cont.)
Functions of neurotransmitters
Cause muscles to contract or relax

Cause glands to secrete products

Activate or inhibit neurons
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29-18
Apply Your Knowledge
What is the function of neurotransmitters?
ANSWER: Neurotransmitters cause muscles to
contract or relax, cause glands to secret products,
activate neurons to send nerve impulses, or inhibit
neurons from sending them.
Right!
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29-19
Central Nervous System
Includes the spinal cord and brain
Blood-brain barrier
Protects layers of the membranes of the CNS
Formed by tight capillaries
Prevents unwanted substances from entering the CNS
tissues
Inflammation can make more permeable
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CNS (cont.)
Meninges protect brain and spinal cord
Dura mater
Tough outer layer
Arachnoid mater
Middle layer (web-like)
Pia mater
Innermost and most
delicate
Directly on top of brain
and spinal cord
Holds blood vessels on the
surface of these structures
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CNS (cont.)
Epidural space
Above dura mater

Subdural space
Below dura mater

Subarachnoid space
Between arachnoid mater and pia mater
Contains cerebrospinal fluid (CSF)
Cushions CNS
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CNS: Spinal Cord
Slender structure continuous with the
brain

Descends into the vertebral canal and
ends around the level of the first or
second lumbar vertebra

31 spinal segments:
8 cervical segments
12 thoracic segments
5 lumbar segments
5 sacral segments
1 coccygeal segment
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CNS: Spinal Cord (cont.)
Cervical enlargement
Motor neurons that control
muscles of the arms
Lumbar enlargement
Motor neurons that control
muscles of the legs
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Gray matter
Inner tissue with darker color

Contains neuron cell bodies and their dendrites

Divisions are called horns

Central canal runs down the entire length of the
spinal cord through the center of the gray
matter
Spinal
Cord/Nerve
CNS: Spinal Cord (cont.)
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White matter
Outer tissue
Contains myelinated axons
Divisions are called columns (funiculi)
Columns contain groups of axons called nerve
tracts

Spinal
Cord/Nerve
Spinal
Cord/Nerve
CNS: Spinal Cord (cont.)
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One function of the spinal cord is to carry sensory
information to and from the brain

Ascending tracts
Carry sensory information up to the brain

Descending tracts
Carry motor information down from the brain to muscles
and glands


CNS: Spinal Cord (cont.)
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29-28
Reflexes
Another function of the spinal cord is to participate in
reflexes
Reflex a predictable, automatic response to stimuli
Receptor
Sensory Neurons
Effectors Motor Neurons
Interneurons
CNS: Spinal Cord (cont.)
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29-29
CNS: Brain
Four sections
Cerebrum
Diencephalons
Brain stem
Cerebellum

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CNS: Brain Cerebrum
Largest section
Two cerebral hemispheres
Connected by a thick bundle of nerve fibers
called the corpus callosum
Longitudinal fissure between hemispheres
Sulci grooves on surface
Gyri or convolutions bumps of brain matter
between sulci
Brain
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29-31
Lobes
Frontal
Motor areas for voluntary
body movements
Parietal
Somatosensory interprets
sensations
Temporal
Auditory interprets sounds
Occipital
Interprets what a person sees
Frontal
Parietal
Occipital
Temporal
CNS: Brain Cerebrum (cont.)
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29-32
Cortex
Outer layer gray
matter
Contains about 75%
of all neurons
Inner layer white matter
Functions
Interpret sensory information
Initiate body movements
Stores memories and creates emotions

Ventricles
Interconnected
cavities within the
brain

Filled with CSF

CNS: Brain Cerebrum (cont.)
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29-33
Between the cerebral hemispheres superior to
the brain stem
Thalamus
Relay station for sensory information going to the
cerebral cortex for interpretation
Hypothalamus
Maintains homeostasis by regulating vital
activities Brain
CNS: Brain Diencephalon
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29-34
Connects the cerebrum to
the spinal cord
Midbrain
Just beneath
diencephalon
Controls both visual
and auditory reflexes
Pons
Rounded bulge on
underside of brain stem
Between midbrain and
medulla oblongata
Regulates respiration
Medulla oblongata
Inferior portion of brain
stem
Directly connected to spinal
cord
Controls many vital
activities, such as heart rate,
blood pressure, and
breathing


Brain
CNS: Brain Brain Stem
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29-35
Location
Inferior to the occipital lobes of the cerebrum
Posterior to the pons and medulla oblongata
Coordinates
Complex skeletal muscle contractions that are
needed for body movements
Fine movements
Brain
CNS: Brain Cerebellum
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29-37
Preventing Brain and Spinal Cord
Injuries
Wear appropriate
protective gear for
sports

Avoid diving into
unknown waters

Always wear seat belts

Follow safety rules on
playgrounds
Children should be in
car seats appropriate
for age and weight

Know how to get help
quickly in emergencies

Follow traffic rules and
signs while walking,
biking, or driving
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29-38
Apply Your Knowledge
Match the following:
___ Meninges A. Carry motor information from brain
___ Ascending tracts B. Stores memories and creates emotions
___ Descending tracts C. Grooves on the surface of the cerebrum
___ Cerebral cortex D. Carry sensory information to the brain
___ Hypothalamus E. Predictable, automatic response to stimuli
___ Sulci F. Maintains homeostasis
___ Cerebellum G. Coordinates skeletal muscle contractions
___ Reflexes H. Protects the brain and spinal cord
B
F
C
G
E
D
A
H
SUPER!
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29-39
Peripheral Nervous System
Nerves that branch
off the CNS

Peripheral nerves
Two types:
Cranial nerves
Spinal nerves
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PNS: Cranial Nerves
I. Olfactory nerves
Carry smell information to the brain for interpretation

II. Optic nerves
Carry visual information to the brain for interpretation

III. Oculomotor nerves
Found within the muscles that move the eyeball, eyelid,
and iris

IV. Trochlear nerves
Act in the muscles that move the eyeball.
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V. Trigeminal nerves
Carry sensory information from the surface of the
eye, the scalp, facial skin, the lining of the gums,
and the palate to the brain for interpretation
Also found within the muscles needed for
chewing
VI. Abducens nerves
Act in the muscles that move the eyeball
PNS: Cranial Nerves (cont.)
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VII. Facial nerves
Found in the muscles of facial expression as
well as in the salivary and tear glands
Also carry sensory information from the
tongue
VIII. Vestibulocochlear nerves
Carry hearing and equilibrium information
from the inner ear to the brain for
interpretation
PNS: Cranial Nerves (cont.)
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IX. Glossopharyngeal nerves
Carry sensory information from the throat and
tongue to the brain for interpretation
Also act in the muscles of the throat
X. Vagus nerves
Carry sensory information from the thoracic and
abdominal organs to the brain for interpretation
Also found within the muscles in the throat,
stomach, intestines, and heart
PNS: Cranial Nerves (cont.)
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XI. Accessory nerves
Found within the muscles of the throat, neck,
back, and voice box

XII. Hypoglossal nerves
Found within the muscles of the tongue
PNS: Cranial Nerves (cont.)
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Peripheral nerves originating from the spinal
cord

31 pairs of spinal nerves
8 pairs of cervical nerves (C1 through C8)
12 pairs of thoracic nerves (T1 through T12)
5 pairs of lumbar nerves (L1 through L5)
5 pairs of sacral nerves (S1 through S5)
1 pair of coccygeal nerves (C0)
Spinal
Nerves
PNS: Spinal Nerves
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Dermatome
Skin segment innervated by spinal nerve
C1 is not associated with a dermatome

Ventral root
Axons of motor neurons only

Dorsal root
Axons of sensory neurons only
Dorsal root ganglion
Contains cell bodies of sensory neurons
PNS: Spinal Nerves (cont.)
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Main portions of spinal nerves fuse to form
nerve plexuses
Cervical supply skin and muscles of neck
Phrenic nerve originates from this plexus
Controls diaphragm
Brachial control muscles in the arms
Lumbosacral lower abdomen, external genitalia,
buttocks, thighs, legs, and feet
Sciatic nerve originates from this plexus
Controls muscles of legs
Spinal
Nerves
PNS: Spinal Nerves (cont.)
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PNS: Somatic Nervous System
Nerves that connect the CNS to skin and skeletal
muscle
Voluntary nervous system
Controls skeletal muscles, which are under voluntary
control
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29-50
PNS: Autonomic Nervous System
Nerves that connect the CNS to organs and other
structures
Involuntary nervous system
Motor neurons located in ganglia
Neuron cell bodies outside the CNS
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29-51
Sympathetic division
Fight or flight Prepares body for stressful or
emergency situations
Neurons release neurotransmitter norepinephrine
Increases heart and breathing rates
Slows down muscles of the stomach and intestines
Dilates pupils
Constricts blood vessels increases blood pressure

PNS: Autonomic Nervous System (cont.)
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Parasympathetic division
Prepares body for rest and digesting
Controls most of the bodys organs
Releases acetylcholine
Slows heart and breathing rates
Constricts pupils
Activates muscles of stomach and intestine
No communication with blood vessels

Sympathetic and parasympathetic divisions
are antagonistic
PNS: Autonomic Nervous System (cont.)
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29-53
Apply Your Knowledge
What is the difference between the sympathetic and
parasympathetic nervous systems?
ANSWER: The sympathetic nervous system prepares the
body for stress. It releases norepinephrine, causing an
increase in heart and respiratory rate, slows down the GI
system, and dilates pupils. The sympathetic system also
controls constriction of blood vessels.
The parasympathetic system prepares the body for resting
and digesting. It releases acetylcholine, which slows heart
and respiratory rate, constricts pupils and stimulates the GI
system. It has no effect on most blood vessels.
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29-54
Neurologic Testing
Typical neurologic examination
State of consciousness
Reflex activity
Speech patterns
Motor patterns
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29-55
Neurologic Testing: Diagnostic Procedures
Lumbar puncture

Magnetic resonance
imaging (MRI)

Positron emission
tomography (PET) scan

Cerebral angiography
Computerized
tomography (CT) scan

Electroencephalogram
(EEG)

X-ray
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29-56
Neurologic Testing Cranial Nerve Tests
Olfactory nerves (Cranial nerve I)
Have patient smell various substances
Cranial nerves III, IV, and VI
Have patient track movement of finger
Cranial nerve V
Have patient clench teeth, feel jaw muscles

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29-57
Cranial nerve VII
Check patients facial expression

Cranial nerve XII
Have patient extend his tongue and move it from
side to side
Neurologic Testing Cranial Nerve Tests (cont.)
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29-58
Neurologic Testing: Reflex Testing
Areflexia
Absence of a reflex

Hyporeflexia
Decreased reflex

Hyperreflexia
Stronger-than-normal reflex
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29-59
Biceps reflex
Absence indicates spinal cord damage in the
cervical region

Knee reflex
Absence may indicate damage to lumbar or
femoral nerves

Abdominal reflexes
Used to evaluate damage to thoracic spinal nerves
Neurologic Testing: Reflex Testing
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29-60
Apply Your Knowledge
Match the following:

___ State of consciousness A. Determines the health of
peripheral nerves
___ Reflex activity B. Loss of balance, abnormal
posture
___ Speech patterns C. Stupor, delirium, vegetative
___ Motor patterns D. Loss of ability to form words
A
D
B
C
ANSWER:
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29-61
Common Diseases and Disorders
Disease/Disorder Description
Alzheimers
disease
Progressive, degenerative disease of
the brain
Amyotrophic
lateral sclerosis
(ALS)
Lou Gehrigs disease
Degeneration of neurons in the spinal
cord and brain
Bells palsy Weak or paralyzed facial muscles
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29-62
Common Diseases and Disorders (cont.)
Disease/Disorder Description
Brain tumors and
cancers
Abnormal growths
Can be primary or secondary tumors
Most common gliomas
Epilepsy and
seizures
Occurs as a result of bursts of
electrical signals that disrupt normal
brain functioning
Guillain-Barr
Syndrome
Bodys immune system attacks the
PNS
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29-63
Disease/Disorder Description
Headaches
Tension
Migraines
Cluster

Episodic or chronic
With aura/without aura
Form of migraines; occurs in groups
Meningitis Inflammation of meninges
Multiple
sclerosis (MS)
Chronic disease of CNS
Myelin is destroyed
Common Diseases and Disorders (cont.)
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29-64
Disease/Disorder Description
Neuralgias Disorders causing nerve pain
Parkinsons
disease
Progressive and degenerative motor
system disorder
Sciatica Damage to sciatic nerve
Stroke Brain cells die because of an
inadequate blood flow; brain attack
Common Diseases and Disorders (cont.)
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29-65
Apply Your Knowledge


True or false:
___ Alzheimers disease is a progressive degenerative disease of
the brain.
___ Epilepsy is due to degenerative neurons in the spinal cord
and brain.
___ Neuralgias are motor system disorders.

___ Stroke occurs when brain cells die because of inadequate
blood flow.
F
F
T
Due to a burst of electrical signals that disrupt brain function.
They are group of disorders referred to as nerve pain.
T
ANSWER:
Bravo!
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29-66
In Summary
Functions of the nervous system
Detecting and interpreting sensory information
Making decision about that information
Responding to and carrying out motor functions
Neurons are responsible for functions
Divisions
CNS brain and spinal cord
PNS cranial and spinal nerves
Knowledge of this system is essential when assisting the
physician during a neurologic exam
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29-67
End of Chapter

Activity of the nervous
system improves the
capacity for activity, just as
exercising a muscle makes it
stronger.
~ Dr. Ralph Gerard