PRIMARY CARE PARAMEDIC [PCP] COURSE
NERVOUS SYSTEM
“The right half of the brain controls the left half of the body. This means that only left handed people are in their right
mind.”
MAJOR FUNCTIONS OF THE NERVOUS SYSTEM
● Sensory Input - sensory or afferent neuron detect internal or external changes (stimuli) and send the message to
the brain or spinal cord; gathers information from both inside and outside the body; transmits information to the
processing areas of the brain and spine
● Integration - interneurons in the brain or spinal cord process and interpret the message from the sensory
neurons, and relay the message back to body parts; processes the information in the brain and spine
● Motor Output - motor or efferent neurons receive the message from interneuron and produce a response at the
effector organ (a muscle or a gland); controls and coordinates all essential functions of the body including all other
body systems allowing the body to maintain homeostasis or its delicate balance; sends information to the
muscles, glands, and organs so they can respond appropriately
The Nervous System and Endocrine System are the chief control centers in maintaining body homeostasis. The Nervous
System uses electrical signals (nerve impulses) which produce immediate (but short-lived) responses; the Endocrine
System uses chemical signals (hormones) that produce slower (but long lasting) responses.
So how do these neurons work if someone taps you on the shoulder?
Receptors in the skin sense touch or other stimuli. Sensory neurons transmit the touch message. Information is sorted
and interpreted in the brain. A response is determined by interneurons. Motor neurons transmit a response message to
the shoulder muscles. The shoulder muscles are activated, causing the head to turn.
DIVISIONS OF THE NERVOUS SYSTEM
1. The human nervous system is divided into two main divisions; the Central Nervous System (CNS) and the
Peripheral Nervous System (PNS).
2. Central Nervous System (CNS) is composed of the brain (located in the cranial cavity) and the spinal cord
(located in the vertebral cavity), which serve as the main control centers for all body activities; coordinates body’s
activities; impulses travel through the neurons in your body to reach the brain.
A. Brain
● Brain stem – medulla, pons, midbrain
● Diencephalon – thalamus & hypothalamus
● Cerebellum
● Cerebrum
B. Spine
● Spinal Cord's 31 Segments:
○ 8 Cervical - C1-C8
○ 12 Thoracic - T1-T12
○ 5 Lumbar - L1-L5
○ 5 Sacral - S1-S5
○ 1 Coccygeal
3. Peripheral Nervous System (PNS) is composed of nerves derived from the brain and spinal cord, which serve
as linkage between the CNS and the body; made up of all the nerves that carry messages to and from the Central
Nervous System; similar to telephone wires that connect all of our houses in a community;
● 12 pairs of Cranial Nerves (attached to undersurface of brain)
● 31 pairs of Spinal Nerves (attached to spinal cord)
Central Nervous System (CNS) and Peripheral Nervous System (PNS) work together to make rapid changes
in your body in response to stimuli.
4. Peripheral Nervous System (PNS) can be subdivided into:
● Sensory / Afferent Nerves - send nerve impulse from the body to Central Nervous System (CNS)
● Motor / Efferent Nerves - send impulse from Central Nervous System (CNS) to effector organs
5. Motor / Efferent Nerves are divided into:
● Somatic Nervous system (SNS) - regulates the voluntary contraction of skeletal muscles; relay
information from sense organs, skeletal muscles to Central Nervous System (CNS); brings responses
back to skeletal muscles for voluntary responses ; you consciously control this pathway by deciding
whether or not to move muscles (except reflexes; automatic response to stimulus)
● Autonomic Nervous System (ANS) - regulates the involuntary control of smooth, cardiac muscles and
glands; relay information from Central Nervous System (CNS) to organs; involuntary (you do not
consciously control these)
6. Autonomic Nervous System (ANS) - involuntary; regulates body's involuntary responses; relays information to
internal organs; can be divided into:
● Sympathetic Nerves - stimulate activities of the effector organs (except digestive organs); controls in
times of stress, emergency response, such as the flight or fight response
● Parasympathetic Nerves - inhibit activities of the effector organs (except digestive organs); in controls
body when body is at rest or with normal functions / everyday conditions
Nerve Tissue - composed of 2 main types of cells:
● Neurons - nerve cells that are specialized to detect and react to stimuli, by generating and conducting nerve
impulses
● Neuroglial Cells - accessory cells for filling spaces and supporting neurons
MICROSCOPIC ANATOMY OF NEURONS
Neurons - the basic unit of structure and function in the nervous system; cells that conduct impulses; made up of
dendrites, cell body and an axon; transmits impulses up to 250 mph;
All neurons have a cell body called soma which contains a nucleus, cytoplasm, organelles, and a modified
endoplasmic reticulum called Nissl body. Although there is DNA in the neuron, somehow DNA replication and mitosis do
not occur, resulting in the neuron's lack of ability to reproduce or regenerate.
Extensions of the soma form nerve such as dendrites which conduct nerve impulses toward the soma, and axon which
conducts nerve impulses away from the soma (to another neuron, or to an effect or organ). Impulses travel from dendrite
to cell body to axon.
● The number of dendrites ranges from 1 (in unipolar and bipolar neurons) to thousands ( in multipolar neurons).
● All neurons only contain 1 axon.
● Longer axons are enclosed by a lipoprotein substance called myelin sheath / fat layer (dense lipid layer which
insulates the axon; makes the axon look gray) produced by a type of neuralgia cell called Schwann cells in the
Peripheral Nervous System
Dendrite - branch-like extensions that receive impulses/stimulus and carry them toward the cell body; receptors on this
dendrite receive the neurotransmitter from many other axons; continues to propagate the nerve impulse to the second
neuron (postsynaptic neuron)
Axon - single fiber extension of the neuron that carries impulses away from the cell body; branches out at the end to send
impulses to many different neurons
The myelin sheath insulates the axon against depolarization, leaving only narrow gaps (node of Ranvier; gaps in the
myelin sheath) forces action potential to occur in between the myelin sheath. This type of nerve impulse propagation
where action potential jumps from one gap to the next is referred to as ‘saltatory conduction’ (which increases the rate
of impulse transmission by 240 folds).
Axons enclosed by myelin sheath are called myelinated axons which make up the white matter in the nervous system;
while axons that have no myelin sheath are called unmyelinated axons which make up the gray matter in the nervous
system.
3 CLASSIFICATION OF NEURONS BASED ON STRUCTURE
● Unipolar neuron - a single nerve fiber is extended from the some, and it divides into a dendrite and an axon
(sensory neurons that conduct reflexes or detect various stimuli)
● Bipolar neuron - a dendrite and an axon extend from the soma independently (sensory neurons involved in
special senses such as vision, olfaction, and hearing)
● Multiple neuron - one axon and many dendrites extend from the soma (interneurons located inside the brain and
spinal cord)
3 CLASSIFICATION OF NEURONS / BASED ON FUNCTION
● Sensory / Afferent Neurons - bring messages to CNS; conducts nerve impulses from inside and outside the
body to the brain and spinal cord; endings of its dendrite may be modified to become nerve receptors; usually
unipolar in structure
● Interneurons - between sensory & motor neurons in the CNS; found within the brain and spinal cord, process
incoming impulses from sensory neurons and pass them on to motor neurons; involved in the processing and
integration of the nervous system; usually multipolar in structure
● Motor / Efferent Neurons - carry messages from CNS; carry impulses away from the brain and spinal cord to the
effector organ (muscles or glands); usually multipolar in structure;
- Accelerator Motor Neurons cause an increase of activity in the effector organ
- Inhibitory Motor Neurons cause a decrease of activity in the effector organ
Synapse - small gap or space between the axon of one neuron and the dendrite of another; neurons are not actually
tough at the synapse; junction between two neurons which uses neurotransmitters to start the impulse in the second
neuron or an effector organ (muscle or gland); ensures one-way transmission of impulses; each synapse consists of:
● Presynaptic neuron - sends an impulse to the synapse
● Axon - nerve fiber extends from the presynaptic neuron, that propagates the impulse to the synapse
● Synaptic knobs - round endings of the axon
Neurotransmitters - chemicals in the junction which allow impulses to be started in the second neuron
ACh / Acetylcholine - neurotransmitter of the parasympathetic nervous system, the part of the autonomic nervous
system (a branch of the peripheral nervous system) that contracts smooth muscles, dilates blood vessels, increases
bodily secretions, and slows heart rate.
Synaptic vesicles - membranous sacs that contain a neurotransmitter (e.g. acetylcholine, norepinephrine, dopamine),
located in the synaptic knobs.
Synaptic cleft - a gap between the two neurons in the synapse
Postsynaptic neuron - the neuron that receives the nerve impulse from the presynaptic neuron, through the synapse
IMPULSES
● A stimulus is a change in the environment with sufficient strength to initiate a response.
● Excitability is the ability of a neuron to respond to the stimulus and convert it into a nerve impulse.
● All or Nothing Rule - stimulus is either strong enough to start and impulse or nothing happens
● Impulses are always the same strength along a given neuron and they are self-propagation; once it starts it
continues to the end of the neuron in only one direction; from dendrite to cell body to axon
● The nerve impulse causes a movement of ions across the cell membrane of the nerve cell.
How is an impulse transmitted?
Stimulus excites sensory neurons. Depolarization (a change in charge due to sodium ions) creates a wave of changing
charges down the axon. Impulse moves across the synapse (tiny space between one neuron’s axon and another’s
dendrites) with the help of neurotransmitters.
CLASSIFICATION OF NEUROGLIA
Neuroglia - supporting cells of the nervous system
● Astrocytes - star-shaped cells found between neurons and blood vessels; they are the most abundant glial cells;
structural support transport of substance between blood vessels and neurons, mop up excess ions (K) and
neurotransmitters
● Microglial cells - small ovoid cells; structural support and phagocytosis (immune protection)
● Ependymal cells - cuboidal or columnar shaped cells; form a porous layer through which substances diffuse
between the interstitial fluid and the cerebrospinal fluid
● Oligodendrocytes - resemble astrocytes but have less processes and are arranged in rows along nerve fibers;
produce myelin sheets within the brain spinal cord
REFLEX ARC
● Receptor - reacts to a stimulus
● Afferent pathway (sensory neuron) - conducts impulses to the CNS
● Interneuron - consists of one or more synapses in the CNS (most are in the spine)
● Efferent Pathway / Motor Neuron - conducts impulses from CNS to effector
● Effector - muscle fibers (as in the hamstring muscle) or glands respond by contracting or secreting a product
Spinal reflexes - initiated and completed at the spinal cord level; occur without the involvement of higher brain centers.
Meninges - three membrane coverings around the brain & spine and help cushion, protect, and nourish the brain and
spinal cord
● dura mater - most outer layer, very tough
● arachnoid mater - middle layer and adheres to the dura mater and has weblike attachments to the innermost
layer, the pia mater
● pia mater - very thin, transparent, but tough, and covers the entire brain, following it into all its crevices (sulci)
and spinal cord
○ cerebrospinal fluid (CSF)- buffers, nourishes, and detoxifies the brain and spinal cord, flows through the
subarachnoid space, between the arachnoid mater and the pia mater
REGIONS OF THE BRAIN
Cerebrum - largest portion of the brain encompasses, about two-thirds of the brain mass; consists of two hemispheres
divided by a fissure - corpus callosum; conscious activity including perception, emotion, thought, and planning; controls
memory, intelligence, muscles, conscious activities, language; wrinkled with countless folds and grooves and covered
with an outer layer of gray matter called the cerebral cortex
● Cerebral cortex - thin layer of the brain often referred to as gray matter because it has cell bodies and synapses
but no myelin; it is gray because nerves in this area lack the insulation or white fatty myelin sheath that makes
most other parts of the brain appear to be white
○ covers the outer portion (1.5mm to 5mm) of the cerebrum and cerebellum
○ consists of folded bulges called gyrus / gyri that create deep furrows or fissures called sulcus / sulci
○ folds in the brain add to its surface area which increases the amount of gray matter and the quantity of
information that can be processed
● Medullary body - white matter of the cerebrum and consists of myelinated axons
○ Commissural fibers - conduct impulses between the hemispheres and form corpus callosum
○ Projection fibers - conduct impulse in and out of the cerebral hemispheres
○ Association fibers - conduct impulses within the hemispheres
● Basal ganglia - masses of gray matter in each hemisphere which are involved in the control of voluntary muscle
movements
4 LOBES OF THE CEREBRUM
● Frontal – motor area involved in movement and in planning & coordinating behavior
● Parietal – sensory processing, attention, and language
● Temporal – auditory perception, speech, and complex visual perceptions
● Occipital – visual center – plays a role in processing visual information
Cerebellum - controls balance, posture and movement coordination and aspects of motor learning; muscle coordination
is developed here as well as the memory of physical skills; If the cerebellum is injured, your movements become jerky;
when you see an amazing athlete perform, you are watching a well-trained cerebellum at work
Brainstem - relays information from spine to upper brain; controls involuntary activities; sometimes called the reptilian
brain, because it resembles the entire brain of a reptile; made up of;
● Medulla oblongata - controls involuntary activities / vital reflexes such as heart rate and breathing
● Pons and Midbrain - act as pathways connecting various parts of the brain with each other
Diencephalon - sense impulses throughout the body; autonomic function, endocrine function, motor function;
Homeostasis, hearing, vision, smell and taste; composed of;
Thalamus - brain’s switchboard; filters and then relays information to various brain regions; to relay motor and sensory
signals to the cerebral cortex, regulates sleep, alertness and wakefulness
Hypothalamus - involved in regulating activities internal organs, monitoring information from the autonomic nervous
system, controlling the pituitary gland and its hormones, and regulating sleep cycles and appetite; regulating activities
such as body temperature, thirst, emotions, sex drive; ‘brain of the brain’
Pituitary Gland - secretes hormones, controls metabolism, growth, sexual maturation, reproduction, blood pressure and
many other vital physical functions.
SPECIAL REGIONS
● Broca’s area – located in the frontal lobe; important in the production of speech
● Wernicke’s area – comprehension of language and the production of meaningful speech
● Limbic System – a group of brain structures (amygdala, hippocampus, septum, basal ganglia, etc) that help
regulate the expression of emotions and emotional memory
THE 12 CRANIAL NERVES AND THEIR FUNCTIONS
I. Olfactory Nerve - Conveys a sense of smell.
II. Optic Nerve - Transmits visual information.
III. Oculomotor Nerve - Controls muscle of the eye and eyelid
IV. Trochlear Nerve - Controls the eyeball
V. Trigeminal Nerve - Face, Nose, Mouth, Forehead top of head and Jaw.
VI. Abducens Nerve - Also controls the eyeball
VII. Facial Nerve - Muscles of the face and scalp
VIII. Vestibulocochlear Nerve - Hearing
IX. Glossopharyngeal Nerve - Controls saliva, swallowing, taste.
X. Vagus Nerve - Longest cranial nerve.;
XI. Accessory Nerve - Permits movement of the head and shoulders
XII. Hypoglossal Nerve - Controls muscle of the tongue.