NEUROANATOMY - 50x ˃ neurons=40% of the brain’s bulk

Types:
(Neurological Nursing) A. astroglia/ astrocytes- supply
nutrients to neurons; help
Anatomic & Physiologic Overview maintain neurons’ electrical
of the Nervous System potential; form part of the
blood- brain barrier
NERVOUS SYSTEM B. Ependymal cells- help produce
∙ 2 major parts: CNS & PNS CSF
∙ FUNCTIONS: - Sensory input; processing & C. Microglia- phagocytic cells that
interpreting; and motor output ingest and digest
∙ Composition: 2 principal types of cells microorganisms and waste
(conducting and supportive cells) products from injured neurons
1. Neuron (Neurone, Nerve cell)– has 3 D. oligodendoglia- supports and
main parts electrically insulate CNS axons
⮚ Dendrites- threadlike structures by forming protective myelin
that conveys incoming sheaths
electrochemical messages toward
the cell body. CENTRAL NERVOUS SYSTEM
⮚ Axon- long projections that - Brain & the spinal cord.
generates impulses away from the - Surrounded by bone-skull and
cell body. vertebrae.
⮚ Cell body- center of neuron; - Fluid and tissue insulate the brain and
nucleus spinal cord.
❖ Synapses- fundamental - During embryonic development, the brain
property of neurons that is first forms as a tube, the anterior end
used to communicate with of which enlarges into three hollow
other cells swellings that form the brain, and the
❖ Myelin- whitish, fatty material posterior of which develops into the
(covers long nerve fibers); has spinal cord.
waxy appearance (protects &
insulates the fibers & increases Brain
the rate of nerve impulses) - Part of CNS contained within the
❖ Schwann cells- myelinates the cranium
axon - mass of soft, spongy pinkish gray nerve
❖ Myelin sheath- a tight coil of tissue.
wrapped membranes created - accounts for approx. 2% of the TBW -
after the Schwann cells Main regions of the brain: CEREBRUM ,
❖ Nodes of Ranvier- gaps or BRAIN STEM, & CEREBELLUM
indentations between myelin
sheath
- Neurons produce chemical A. CEREBRUM
substances known as - Largest & most prominent part
NEUROTRANSMITTERS - Governs higher mental processes -
NEUROTRANSMITTERS Consists of the R&L hemisphere
Action: to potentiate, terminate, or separated by the great longitudinal
modulate a specific action and can fissure
either excite or inhibit the target - Joined at the lower portion of the
cell’s activity fissure by the corpus callosum
How: By communicating messages - Associated structures:
from one neuron to a specific target ❖ GYRI or GYRUS- convolutions
tissue ❖ SULCI or SULCUS- shallow
grooves
2. Supporting cells- Neuroglia or Glial ❖ FISSURES- deeper groves
cells/ non- neuronal cells ❖ Cerebral cortex
- Not able to transmit impulses a. gray matter (muscle
 control, sensory perception, D. CEREBELLUM
memory, emotions, and - posterior to the midbrain & pons, &
speech) below the occipital lobe.
b. white matter - Function: integrates sensory
- Divisions/ Lobes of Cerebral information
Hemispheres Structures Protecting the Brain
1. Frontal- largest lobe 1. Skull- bony structure that protects the brain
- Functions: (1) concentration, from injury
abstract thought, information - Major bones: frontal, temporal, parietal
storage or memory and motor and occipital
function; (2) contains Broca’s area; - Suture Lines: Coronal, Sagittal,
and (3) responsible for an lamboidal, and squamosal
individual’s affect, judgment, 2. Meninges- fibrous connective tissue that
personality and inhibitions covers the brain and spinal cord; provides
2. Parietal- primary sensory cortex protection, support and nourishment to the
- Functions: (1) analyzes sensory brain and spinal cord
information, and relays the Layers:
interpretation of the information to a. Dura matter- outermost; covers the
the thalamus and other areas; (2) brain and the spinal cord; tough,
essential for an individual inelastic, fibrous, and gray
awareness of the body in space - Epidural space- potential space
3. Temporal- contains the auditory between the dura matter and skull
receptive areas, interpretive area that in the cranium, and between
provides integration of somatization, periosteum and dura in the
visual, and auditory areas vertebral column
4. Occipital- the posterior lobe b. Arachnoid- middle membrane; white;
responsible for visual interpretation contains the choriod plexus
- Right vs. Left Hemisphere - has unique fingerlike projections,
arachnoid villi
B. DIENCEPHALON c. Pia mater- innermost membrane; thin,
STRUCTURES: transparent layer that hugs the brain
1. Thalamus- relay station for all sensory closely
impulses, memory, and pain impulses 2.
Hypothalamus- located anterior & 3. Cerebrospinal fluid
inferior to the thalamus. - clear & colorless fluid
- Regulation of visceral activities - Acts as protective cushion
- Center for many drives & emotion - - produced at rate of about 500ml/day -
Regulates the pituitary secretion of laboratory analysis: clear color, normal
hormones specific gravity of 1.007, protein count,
minimal WBC count, no RBC, glucose, &
C. BRAIN STEM some electrolytes
STRUCTURES
1. Midbrain- connects the pons & the Spinal Cord
cerebellum with the cerebral - runs along the dorsal side of the body;
hemispheres. links the brain to the rest of the body. -
- acts as master coordinator for all the Carries sensory information to & motor
messages going in & out of the information from the brain.
brain to the spinal cord. - encased in a series of bony vertebrae
2. Pons- helps regulate breathing, contains that comprise the vertebral column.
the respiratory center. - 45cm/18” long & about the thickness of a
3. Medulla oblongata- most inferior part finger
of the brainstem - Surrounded by meninges
- contain centers that control HR, BP, a. Gray matter- inner core; consists
sneezing, coughing, breathing, mostly of cell bodies and dendrites.
swallowing & vomiting b. White matter- made up of fiber
bundles; ascending and descending
 - Vertebral column consists of 7 cervical, voluntary muscles dilate, peripheral BV
12 thoracic, 5 lumbar vertebrae, constrict, inc. RR
sacrum(fused mass of 5 vertebrae); ✔ PNS; predominant during quiet,
coccyx nonstressful conditions
**Each of these subsystems operates in
the reverse of the other (antagonism).
NEUROLOGIC ASSESSMENT
PERIPHERAL NERVOUS SYSTEM
2 Principal Subdivisions A. Cranial Nerve Assessment
1. Sensory or afferent division- carry
I Identify common odors
information from the outside
world;sensory receptors are located II Snellen Chart and peripheral
in the different parts of the body; i.e. vision checks
somatic sensory fibers, visceral sensory
fibers III Check for pupil constriction
2. Motor or efferent division- transmit
impulses from the brain & spinal IV Check for accommodation
cord to the muscles; i.e. voluntary and convergence as the
nervous system, ANS object is brought near the
eyes;
Interconnections between Central
V Check for strength of lid closure
and Peripheral Nervous System:
Identify location of the
❖ Cranial nerves; carry impulses to and
stimulus; Check ability to feel
from the brain.
light, dull and sharp sensation
- 12 pairs of cranial nerves emerge from
on the face; Check jaw
the lower surface of the brain
strength,

VI Check corneal reflex

❖ Spinal nerves; carry impulses to and
from the spinal cord. VII Check for symmetry of facial
- 31 pairs of spinal nerves arising from expressions and muscle
the spinal cord & passing out strength; Identify sweet, sour
through the vertebrae and salty tastes
- 8 cervical, 12 thoracic, 5 lumbar, 5
sacral & 1 coccygeal VIII Weber and Rinne test for
***these nerves serve as the hearing loss;
communication lines of the body*** Romberg’s test for balance

IX Identify sweet, sour and

SOMATIC NERVOUS SYSTEM
salty tastes;
- Fibers which connects the CNS with the
Check gag and swallowing reflex
structures of the body
X Ask the client to say “Ah” -
AUTONOMIC NERVOUS SYSTEM uvula should rise midline;
- operates without conscious control - Check ability to swallow
regulates the activities of internal
organs XI Have the client shrug
- Maintenance & restoration of internal shoulders against resistance;
homeostasis is largely the Turn the head to one side
responsibility of the ANS against the resistance of the
- regulated by centers in the spinal cord, hand
brain stem & hypothalamus.
2 major divisions: XII Have the client stick out
✔ SNS; predominantly excitatory responses tongue – observe for
(fight or flight response) deviations/tremors; Check for
Effects: bronchioles dilate, hearts contractions the strength of tongue
are stronger & faster, arteries to heart & movement as it presses
 Normal findings: PERRLA (Pupil, Equal,
against tongue blade
Round and Reactive to Light and
Accommodation
- Sizes: Pinpoint (miotic), Dilated
B. Glasgow Coma Scale (mydriatic), Normal size: 2-6mm
Score - Shapes:
o Ovoid – may indicate IICP
o Keyhole: patients with
iridectomy
o Irregular – traumatic orbital
injury
- Reaction to light
o Brisk
o Sluggish (Meningitis,
Subarachnoid Hematoma)
o Non-Reactive
- Comparison of pupils
o Isocuria
o Anisocuria

1. AVPU SCALE – quick and easy

C. Level of Consciousness method Awake
Level 1 ∙ Highest level of consciousness - Alert and oriented to person,
characterized by appropriate responses place and time
to internal and external stimuli - Acting reasonably to stimuli
∙ Conscious, alert, fully-awake - Patient is aware of you
∙ Patient oriented to person, place and time approaching him/her
Level 2 ∙ Listless, lethargic, somnolent and Verbal Stimulation (responds to)
obtunded - Responds to voice
∙ Client can be aroused from sleep but - Unawake but will respond by
when stimulation ceases, tends to fall speaking/moaning, facial
asleep again expressions, limb movement,
eyelid blinking
Level 3 ∙ Stuporous
Pain Stimulation (responds to)
∙ Response can only be evoked from
- Patient will only respond to
a strong and continuous stimuli
painful stimuli such as:
∙ The patient elicits poor response
(i.e., reflex withdrawal) o Suborbital pressure
o Pinching the fleshy part near
Level 4 ∙ Semi-coma - no spontaneous the axilla
movement but patient may o Trapezium squeeze
demonstrate reflex activities like o Shaking the shoulders
coughing, swallowing and vomiting
o Earlobe pinch
∙ Incontinence
o Nail pinch
Level 5 ∙ Coma/Deep Coma – absence of Unresponsive
involuntary responses to any - Unawake, no response to verbal
stimuli ∙ Reflexes are absent and pain stimuli
∙ Pupils may be constricted/dilated and
does not react to light

❖ EXAMINING THE REFLEXES;

✔ Reflexes are involuntary contractions
D. PUPILLARY EXAM – changes can of muscles or muscle groups in
indicate abnormal intracranial pressure response to a stimulus.
(ICP) ✔ Classified as deep tendon, superficial
 or pathologic hammer
✔ Assesses the intactness of the loosely in a relaxed manner,
spinal reflex arc at various spinal making a wrist action. Allow the
cord levels. The limb should be hammer to
relaxed while bounce.
applying a short and snappy blow ✔ Patellar, Achilles, triceps, biceps
with a reflex hammer. Hold the • Reflex responses:
0 no response
1+ diminished, low normal
2+ average, normal
3+ brisker than normal
4+ very brisk, hyperactive

Oculocephalic Reflex or Doll’s Eye

Phenomenon
• Done by holding the person’s
eyelids open and rotating
the head from side to side.
• The reflex is present if the eyes
move in the opposite direction of
the head
movements.

Oculovestibular Reflex or Caloric

ice Water Test

• a test that uses differences in

temperature to diagnose
damage to the ear or
brainstem.
Cold water = FAST phase of
nystagmus to the side Opposite
from the cold water filled ear Warm
water = FAST phase of nystagmus to
the Same side as the warm water
filled ear