Nervous system(CNS)

Is the chief controlling & co-ordinating system of the body. It controls the voluntary & involuntary activities of the body & adjust the individual to given surroundings.

Nerves are the protoplasmic extension of the nerve(neuron) form the neural pathways called the nerves.

Impulses are given out to brain & goes out the whole body is called as efferent pathway & impulses going from body to brain are the afferent pathway.

Parts of the nervous system

Central nervous system

Peripheral nervous system

brain Spinal cord 12 cranial nerve 31 spinal nerveAutonomic nervous

system

sympathetic

parasympathetic

Cranial nerve Function

1.Olfactory Smell

2. Optic Vision

3.Occulomotor Eye mov.

4.Trochlear -----,,-------

5.Trigeminal

Opthalmic

Mandibular

maxillary

Sensation over face , scalp

6. Abducens Eye mov. & face & scalp sensation

7.Facial Face & scalp sensation, taste

8. Vestibulocochlear nerve

Hearing and balance

9. Glossopharyngeal

Tongue & throat sensation

10. Vagus Throat, voice box, larynx, chest abdomen viscera

11. Accessory Neck and back muscle

12. Hypoglossal Tongue movement

There are 3 types of nervous tissue in the N.S

Neuron or excitable cell

Non-excitable cell or neuralgia

Structure of Neuron and pathway

There are 3 types of nervous tissue in the N.S

Neuron or excitable cell

Non-excitable cell or neuraglia

Structure of Neuron and pathway

Neuralgia cells are of three type:Astrocytes:cells are responsible for transporting water & salts between

capillaries & nerve cells

Microglia:small in size & have many branches, responsible for phagocytosis

Oligodendraglial cells have few dendrites and produce myelin sheath

• AbbreviationsAFP: alpha feto proteinALS: amyotropic lateral sclerosisCVE: cerbero vascular episodeEEG: electro encephalogramICP: intracranial pressureLP: lumbar punctureMS: multiple sclerosisRIND:reversible ischemic neurological deficitTENS:transcutaneous electrical nerve through skin stimulationTIA:transient ischemic attack

• Blood brain barrier: a barrier exist at the capillary level between the blood and nerve cell.

Ganglion:any nervous tissue outside the nervous system is called a ganglion

Autonomic nervous system(controls the involuntary activities like sweating, salivation, peristalsis

Sympathetic nervous systemWidespread & diffused activityto combat acute emergencies.Arises from thoracolumbar outflow, as it arises from T1-L2 segments of Spinal cord.There are two types of fibre Medullated & Non-medullatedNeurotansmitter is nor-adrenaline,exception are the cholinergic Sympathetic nerves supplying the sweat & skeletal muscles

Parasympathetic N.SIt combats chronic emergenciesIt is the craniosacral outflow which contains CN 3,7,9,10 & sacral S1, S2 segments.It releases neurotransmitter likeacetylcholine

Brain

Cerebrum(two hemispheres)

Made up of white & grey matter

Spaces within the tissue are the VENTRICLES

which contain CSFBelow it lies the

Thalamus &HypothalamusCovering are

Duramatter, arachnoid & piamatter

CerebellumLocated beneath

the posterior part of

Cerebrum, co-ordinates

Voluntary mov.Maintains balance

Posture &Muscular tone

Brainstem

Midbrain

Pons means bridge.

It contains nerve tract that

Connects Cerebrum &

Cerebellum with Rest of brain

Medulla oblongataLocated at the baseOf brain, it connects

Spinal cord withRest of the brain.

It continues below As spinal cord

Frontal Parietal Occipital Temporal

SymptomsSuffix Meaning Terminology

algesia Sensitivity to pain Analgesia

Algia Pain Neuralgia

Caus/0 Burning Causalgia

Comat/o Deep sleep Comatose

Esthesia Nervous sensation Anesthesia

Kinesia Movement Bradykinesia

Kinesis Movement Hyperkinesis

Lepsy Seizure Epilepsy/narcolepsy

Lex/o Word Dyslexia

Paresis Slight weakness Hemiparesis

Phasia Speech Aphasia

Plegia Paralysis Hemiplegia

Praxia Action Apraxia

Sthenia Strength Neurasthenia

Syncop/o Cut short Syncopal

Tax/o Order ataxia

Investigations • CSF Analysis: Cell & bacterial counts along with cultures of samples of CSF

are done when diseases of the meninges or brain is suspected. • Cerebral Angiography: Contrast medium is injected into an artery and x-ray

are taken of blood system of the brain. • CT Scan: study the bony & nervous tissue• Myelography: Contrast medium is injected into the subarachnoid space

through lumbar puncture and x-rays are taken of the spinal cord. • Echo encephalography: Ultrasonic waves are beamed through the brain

tissue and echoes coming from the brain structure are recorded. • MRI of the brain: to study tumors of brain• Radioactive studies: Brain scan: radioactive chemicals are given

intravenously and travel to the brain. Special scanner machine then record the passage and absorption of the chemicals into the brain tissue.

• Positron Emission Tomography(PET scan): An isotope that give particles called as positrons is injected i.v combined with glucose, the uptake is recorded on a television

• Electroencephalogram(EEG): recording of electrical activities of the brain. It is used to demonstrate seizure, brain tumors.

• Lumbar puncture(spinal): CSF is withdrawn between two lumbar vertera(L3 & 4).A device to measure the pressure i.e Intracranial pressure.

• Stereotactic radiosurgery(gamma knife):radioactive beam is focused on the brain tissue to be irradiated

Diseases • Spina bifida:congenital defect in the spinal column. types are occulta & cystica. There is

protusion of meninges(meningocele) or protusion of the meninges and spinal cord(meningomyelocele). Pt. has hydrocepahalus, paraplegia & lack of control over bladder & rectum, Rx is surgery.

• Hydrocephalus: abnormal collection of CSF in the brain & spinal cord, leading to enlarged head & small face.Rx a catheter is placed from the ventricles of the brain into the peritoneal space, so that the CSF drains out.(ventriculo-peritoneal shunt)

• Alzheimer’s disease: deterioration of mental capacity(dementia). Pt. complains of loss of memory, impairment of judgment anxiety, depression & emotional disturbance

• Amyotropic lateral sclerosis(ALS)(Lou Gehrig’s disease):degeneration of motor neurons in spinal cord & brain. Pt has weakness of skeletal muscles, difficulty in swallowing, talking & dypnoea leading to quadriplegia.

• Epilepsy:sudden excessive discharge of electrical activity within brain, cause is brain tumors, meningitis, vascular disease. Types are the Tonic-Clonic Seizures(Grand mal seizures) and the absence seizures(petit mal seizures).

• Huntington’s chorea; degenerative disorder of cerebrum leading to bizarre, involuntary, dance like movements, Rx is symptomatic

• Multiple Sclerosis(MS): destruction of myelin sheath on neurons, pt has paresthesia, muscle weakness, unsteady gait & paralysis,Rx immunosuppressive

• Myasthenia gravis: neuromuscular disorder characterized by relapsing weakness of skeletal muscle due to antibodies blocking the acetylcholine receptor.immunosupp.

• Palsy: Paralysis(complete loss of motor function) cerebral palsy due to damage to cerebrum, bells palsy due to palsy of facial nerve

• Parkinson’s disease: degeneration of nerves in the brain, occurring in old age leading to tremors, weakness & slowness of movement. it is due to deficiency of dopamine.

• Tourette syndrome: neurological disorder marked by involuntary, spasmodic, twitching movements, rx with haloperidol

• Meningitis: inflammation of meningitis, caused by meningococcal or streptococcal bacterial or viral infection, pt. has headache, photophobia (sensitivity to light) and stiff neck. Rx is antibiotics.

• Shingles; viral disease affecting the peripheral nerve. Blisters & pain spread in a band like pattern over the skin along the distribution of the peripheral nerves. It is caused by HSV, the same virus causing chicken-pox.

• Brain Tumors: abnormal growth of the brain tissue & meninges, arise from the neurons & meninges(meningioma) astrocytes(glioblastoma multiforme).They cause cerebral edema & hydrocephalus.

• Cerebral Concussion: brief loss of consciousness after injury, recovery less than 24 hrs.

• Cerebral contusion:bruising of brain tissue as a result of direct trauma, neurological deficit persist beyond 24 hrs, it is associated with fracture of skull, subdural & epidural hematoma leading to permanent injury or epilepsy.

• CVE: disruption of normal blood supply to the brain, also called as stroke or cerebral infarct. There are three types of stroke 1.Thrombotic: blood clot in the arteries, leading to occlusion of blood supply, before total occlusion occurs a patient may experience symptoms that point to gradual occlusion of the blood vessels.These short episode of neurological dysfunction are called as TIA. 2.Embolic a clot travelling from other area gets into the cerebral supply.3.Haemorrhagic: bursting of the cerebral artery.

• General Anesthetics• desflurane• enflurane• etomidate• FENTANYL• HALOTHANE• ISOFLURANE• KETAMINE• methohexital• methoxyflurane• MIDAZOLAM• MORPHINE• NITROUS OXIDE (N20)• PROPOFOL• SEVOFLURANE• sufentanil• THIOPENTAL

• Local Anesthetics• BENZOCAINE• BUPIVACAINE• cocaine• LIDOCAINE• prilocaine• PROCAINE• ROPIVACAINE• tetracaine

Opioid Analgesics, Agonist-antagonists

Agonists• CODEINE• diphenoxylate• fentanyl• heroin• HYDROCODONE• l-alpha-acetyl-methadol• levomethadyl acetate• loperamide• MEPERIDINE• METHADONE• MORPHINE• OXYCODONE• d-propoxyphene• combinations - opioids plus acetaminophen

and ASA• TRAMADOL Agonist/Antagonists and Antagonists• BUPRENORPHINE• butorphanol• nalbuphine• nalorphine• NALOXONE• NALTREXONE• nalmefene• pentazocine

Antitussives, Expectorants and Mucolytics (0.5)CODEINEDEXTROMETHORPHANHYDROCODONE

Drugs Used in the Treatment of Motor Disorders• AMANTADINE• BACLOFEN• BENZODIAZEPINES• BENZTROPINE• BROMOCRIPTINE• CARBIDOPA• cyclobenzaprine• DANTROLENE• DOPAMINE• ENTACAPONE• haloperidol• L-DOPA• pergolide• PRAMIPREXOLE• ropinerole• SELEGILINE (deprenyl)

trihexyphenidyl

Antiepileptics• acetazolamide• CARBAMAZEPINE• clonazepam• DIAZEPAM• ETHOSUXIMIDE• felbamate• GABAPENTIN• Lamotrigine• LORAZEPAM• PHENOBARBITAL• PHENYTOIN• primidone• TIAGABINE• topiramate• VALPROIC ACID• vigabatrin

Antiepileptics• acetazolamide• CARBAMAZEPINE• clonazepam• DIAZEPAM• ETHOSUXIMIDE• felbamate• GABAPENTIN• Lamotrigine• LORAZEPAM• PHENOBARBITAL• PHENYTOIN• primidone• TIAGABINE• topiramate• VALPROIC ACID• vigabatrin