Essential Clinical Anatomy of the Nervous System

Chapter 1: Introduction to the Nervous System

Abstract

The nervous system is incredibly complex. This chapter will introduce you to the divisions of the nervous system. It will discuss the broad anatomy of the two main divisions of the nervous system – central and peripheral. The brain and spinal cord will be introduced, as well as some general functions. The structural divisions as well as the functional divisions of the nervous system will be detailed. This will cover an introduction of the somatic and autonomic nervous systems, and define the purpose of these from an anatomical and physiological perspective. The 12 pairs of cranial nerves will also be discussed, and how they differ from other nerves in the body, e.g. peripheral nerves. The clinical relevance of examination of the cranial nerves will also be briefly discussed, as well as common pathologies to affect them. This chapter will take you through in a step-by-step format gently introducing you to the key concepts of the nervous system.

Keywords

nervous system

CNS

PNS

spinal cord

brain

1.1. Overview of the nervous system

The nervous system is comprised of two parts: the central nervous system (CNS) consisting of the brain and spinal cord, and the peripheral nervous system (PNS), consisting of peripheral and cranial nerves as well as the motor and sensory nerve endings of those nerves.

1.1.1. Central Nervous System

The cells of the brain and spinal cord are called neurons (or neurones) and are specialized cells which can electrically conduct and communicate with nearby neurons. The purpose of these cells is to allow communication of the surrounding environments to adjacent cells to help regulate the internal environment of the body, and to respond to external stimulations. Supporting glue called neuroglia also holds the neuronal tissue together. Neuroglia provides nutrients to the neurons, maintains electrochemical stability, but also helps to defend the nervous system environment from attack by pathogens.

1.1.1.1. Brain

The brain is a mass of convoluted neural tissue and is referred to as the cerebrum (Latin: brain). The brain is a complex organ consuming approximately 15% of cardiac output, and can only survive a few minutes deprived of oxygen. If it is deprived of oxygen, death will ensue quickly. It is comprised of two cerebral hemispheres – left and right, and together these arise from the embryologic telencephalon. The cerebral hemispheres process information related to a wide variety of functions, and will be dealt with separately in later chapters. Between these two massive cerebral hemispheres lies the diencephalon. This is the thalamus and hypothalamus. The telencephalon and the diencephalon together form the forebrain – the first part of the brain.

The middle part of the brain, midbrain, or mesencephalon, structurally comprises the tectum, tegmentum, cerebral aqueduct, cerebral peduncles and many nuclei and pathways (or fasciculi). It typically deals with alertness, the sleep/wake cycle, hearing, vision, motor function and some homeostatic regulations like temperature control internally.

The last part of the brain is referred to as the hindbrain and is comprised structurally of two individual components – the metencephalon (pons, cerebellum and some cranial nerve nuclei) and the mylencephalon (medulla oblongata). Clinically, it is easier to refer to the brainstem, which really is the last part of the brain and is composed of the midbrain + pons + myelencephalon (medulla oblongata). In older texts, the diencephalon is included, but for our purposes, the above description will suffice.

The brainstem is directly continuous with the spinal cord at the foramen magnum. This site is crucially important as it acts as a conduit for information passing to and from the periphery to the central processing unit of the brain. If there is an increase in pressure within the cranial cavity, due e.g., to a space-occupying lesion (SOC), intracranial hemorrhage or traumatic brain injury, it can result in pressure at the foramen magnum. The only way the brain has to move in this enclosed space is downwards through the foramen magnum. This is called brain herniation, or coning, and results in pressure on the brainstem, and affects the components in that part of the brain, i.e. cardiorespiratory functions. This is a life threatening condition and requires urgent neurosurgical attention.

The brain is comprised, like the spinal cord, of two types of matter – gray and white. The gray matter of the brain is found in the outer aspect of the brain in the cerebral cortex. The gray matter is comprised of neurons, whereas the white matter is composed of supporting glial cells and myelinated axons. The white appearance (especially in tissue which has been fixed in formaldehyde) is due to the lipids of the myelin. The main substance of the brain is white matter but dispersed throughout it are areas of gray matter referred to as the basal ganglia. These subcortical nuclei are designed for a variety of functions including voluntary motor control, emotions, cognition, eye movements and learning. They will be discussed in detail later in the relevant chapters.

1.1.1.2. Spinal Cord

The spinal cord is a long cylinder which occupies the upper two-thirds of the vertebral canal. Unlike the brain, the spinal cord gray matter is located within the main substance of it, and is surrounded by the white matter. It is the opposite way round in the brain. On the lateral aspects of the spinal cord, is a pair of spinal roots. Each side is composed of a ventral and dorsal root depending on whether it arises from the anterior (ventral) or posterior (dorsal) aspect of the spinal cord.

In summary, there are 31 pairs of spinal roots with their corresponding dorsal and ventral roots. There are eight cervical, twelve thoracic, five lumbar, five sacral and one coccygeal. Each of these combinations of dorsal and ventral roots joins to form a single spinal nerve, which then divides into a dorsal and ventral ramus. The specific details of the spinal cord will be dealt with later.

1.1.2. Peripheral Nervous System

The peripheral nervous system is the part of the nervous system that is comprised of the cranial, spinal and peripheral nerves, as well as their sensory and motor nerve endings. In other words, it is the part of the nervous system which is comprised of nerves and ganglia which lie out-with the brain and spinal cord (which comprises the CNS). As this part of the nervous system primarily lies out-with the skull and vertebral column, it is prone to damage from trauma and from toxins. Therefore, the PNS is comprised of the 12 pairs of cranial nerves, and the 31 pairs of spinal nerves, i.e. 43 pairs of nerves in total. The nerves of the PNS can be classified as belonging to either afferent (taking information to the CNS) or efferent (away from the CNS). With spinal nerves, they contain both afferent and efferent information, whereas some cranial nerves like the olfactory and optic nerves contain only afferent information (for smell and sight, respectively).

Broadly speaking, there are two main divisions of the PNS – the somatic and the autonomic nervous systems. The somatic nervous system terminates on the skeletal muscle, whereas the autonomic nervous system supplies all structures other than the skeletal muscle, e.g. glands and smooth muscle.

1.1.2.1. Neurons

A neuron is a highly specialized cell which is capable of communicating (rapidly) via electrical signals and has the presence of a synapse – a specialized area to allow the passage of electrical activity. These synapses are in two forms:

(1)Chemical synapse – electrical activity in one neuron passes to the presynaptic terminal. Here, a neurotransmitter is released and passes to the postsynaptic cell (dendrite) to takes its effect via receptors in the postsynaptic density.

(2)Electrical synapse – the pre and postsynaptic cells are connected via gap junctions. These regions are specialized in passing electrical current from one neuron to the next.

A neuron has some key anatomical features which are summarized in the table below (Table 1.1).

Table 1.1

In the central nervous system, several different types of neuron are found. The most common type of neuron found in the central nervous system are called multipolar neurons, due to having many types of dendrites, as well as the single axon. The following provides a summary of the main types of neurons.

•Multipolar neurons. These have at least 2 dendrites which extend from the neuronal soma. Multipolar neurons are also classified as Golgi Type 1 neurons, and Golgi Type 2 neurons. Golgi Type 1 neurons have long axons which originate in the gray matter of the spinal cord. Golgi Type 1 neurons are typically found in the ventral gray horn of the spinal cord. They are also typical of pyramidal neurons of the cerebral cortex or Purkinje neurons of the cerebellum. On the other hand, Golgi Type 2 neurons either do not have an axon at all, or if they do, the axon does not exit from the gray matter of the central nervous system. Golgi Type 2 neurons are found in the granular layer of the cerebellum and hippocampus. These neurons are called granule cells, typically found throughout the cerebral cortex, cerebellum, hippocampus, olfactory bulb and the dorsal cochlear nucleus.

•Bipolar neurons. These neurons are less typical and have an axon and dendrite (or extension of the axon) at opposite sides of the neuronal cell body. These neurons are typically involved in transmission of information related to the special senses. They are found in the retina (transmission of visual information), olfactory epithelium (transmission of information related to smell) and the vestibulocochlear nerve (transmitting information related to sound and balance).

•Unipolar neurons. These are also referred to as pseudounipolar neurons. They have a single axon which extends both centrally and peripherally. The central portion of this neuron extends into the spinal cord and the peripheral portion will extend into the periphery, terminating perhaps in the skin, muscle or joints. Pseudounipolar neurons do not have dendrites and are typically found in the dorsal root ganglia.

•Anaxonic neurons. These are neurons where no obvious axon is identifiable from the dendritic tree and are typically found within the retina and the brain.

•Betz neurons. These neurons are the largest of all neurons and are found within the primary motor cortex (of the frontal lobe). These neurons send their axons through the corticospinal (discussed in Chapter 9) tract to reach the ventral horn cells, which contains the motor neurons.

Another classification that exists for neurons is interneurons. These are neurons that connect two neurons together and can either be motor or sensory, but can also be classified as excitatory or inhibitory (more common in the central nervous system). Interneurons can also be thought of as local circuit neurons. Examples of interneurons are now given