1. Neuro – A & P, Assessment, Diagnostics Chapter 41 Spring News News

2. Grey’s Anatomy Quote The brain is the human body's most mysterious organ. It learns. It changes. It adapts. It tells us what we see. What we hear. It lets us feel love. I think it holds our soul. But no matter how much research we do, no one can really say how all that delicate gray matter inside our skull works. And when it's hurt, when the human brain is traumatized, well... that's when it gets even more mysterious.

3. Nervous System What does it do? How does it do it?

4. ANATOMY

5. Neurons Initiate and transmit impulses High metabolic rate Longevity Typically non-mitotic Variety of shapes and sizes Comprised of a cell body, dendrites and axons

7. Sensory vs. Motor Sensory Neurons (afferent) –Transmit information to the CNS Motor Neurons (efferent) –Transmit information away from the CNS

8. Impulse Conduction Reflex Arc –Functional unit that provides the pathways for the nerve impulses –The passage of the impulses is called Reflex act or Reflex –Process of Reflex Arc

10. Neural impulses

11. Anatomy Neuroglial Cells –Four types Capable of mitosis and replacing damaged neurons Aid in neuronal development Do not transmit nerve impulses Protect, nourish and provide support for the neurons

13. Anatomy Action Potentials –Movement of an electrical charge thru an impulse along the axon membrane –Allows for communication with neurons and body cells –Initiated by a stimulus –Propagated by rapidly charged ions thru the cell membrane –Faster in myelinated fibers

14. Anatomy Neurotransmitters Synaptic Transmission –One way communication that link the neurons by a chemical synapse –Either inhibitory or excitatory –Chemical neurotransmitters Acetylcholine Norepinephrine Dopamine Histamine GABA (gamma aminobutyric acid) Serotonin

15. Factors Effecting Neurotransmission Distance Strength of Stimulus –Inhibition –Inadequate transmitter substance –ECF changes pH O 2 Medications

16. PHYSIOLOGY

17. Physiology Central Nervous System (CNS) –Brain –Spinal Cord

18. Brain Parts and Function Bone Meninges Cerebrum Brainstem Circle of Willis

19. Brain

20. Table 41-1 General Functions of the Four Regions of the Brain

21. Figure 41–3 Lobes of the cerebrum and functional areas of the cerebral cortex.

22. Table Functions of Lobes of the Cerebrum and Areas of the Cerebral Cortex

24. CSF Clear and Colorless From blood plasma – 99% water –Contains protein, sodium, chloride, potassium, bicarbonate and glucose 80 – 200 mL total volume –Replaced several times per day Cushion for the brain and spinal column Provides nourishment and removes waste

26. Circulation and the BBB Circulation 750 mL of blood per minute Uses 20% of the total O 2 –Needed for the metabolism of glucose – sole source of energy. BBB Allows lipids, glucose, some amino acids, water, CO 2 and O 2 Other substances are prevented from crossing

27. Figure 41–5 Major arteries serving the brain and the Circle of Willis.

28. Spinal Cord Center for conducting messages to and from the brain and a reflex center 33 vertebrae –7 cervical –12 thoracic –5 lumbar –5 sacral –4 fused which form the coccyx

29. Function Ascending tracts- start in spinal cord and end in the brain Spinothalamic Spinocerebellar Descending tracts - start in the brain and end in the spinal cord

31. Physiology Peripheral Nervous System (PNS) –12 pairs of Cranial nerves –31 pairs of Spinal nerves –Autonomic nervous system Sympathetic system Parasympathetic system

33. Cranial Nerve Song

37. Dermatones Area of skin that is innervated by cutaneous branches of a single spinal nerve Provide anatomic landmarks to locate neurologic lesions

39. Autonomic Nervous System Regulates involuntary activity (cardiovascular, respiratory, metabolic, body temps etc) Sympathetic (SNS) Parasympathetic (PNS)

40. Autonomic Nervous System Area AffectedSympatheticParasympathetic PupilDilatesConstricts BronchiDilatesConstricts HeartIncreases RateDecreases Rate GIInhibits peristalsis Stimulates sphincter Stimulates peristalsis Inhibits sphincter Adrenal GlandsIncreases secretion of EN and NE BladderRelaxes Bladder muscle Constricts sphincter Contracts bladder muscle Relaxes sphincter

41. Neurological Assessment History Family history/genetic risks Personal history Current health problems Social history

42. Mental Assessment Mental status Memory Attention Language/Copying Cognition

43. Cranial Nerve Assessment Done to establish a baseline for future comparison to rule out deterioration

44. Sensory Function Assessment Completed on patients with problems affecting spinal cord or spinal nerves: trauma, intervertebral disk disease, infections Evaluate: pain, temperature touch

46. Figure 41–12 Testing two-point discrimination.

47. Assessment of Motor Function Muscle strength Cerebral/brainstem integrity Pronator Drift

48. Assessment of Cerebellar Function Coordination Gait and equilibrium

49. Figure 41–13 Heel-to-shin test.

50. Assessment of Reflex Activity Deep tendon reflexes Cutaneous (Superfical) reflexes Abnormal findings

59. Box 41-1 Abbreviated Neurologic Assessment (Neuro Check)

60. Table 41-5 Glasgow Coma Scale

61. Diagnostic Assessment Laboratory –CSF Lumbar Puncture

63. Diagnostic Assessment Radiographic –Cerebral Angiography –CT –PET –SPECT –Cerebral Blood Flow Evaluation –Brain Scan

64. Diagnostic Assessment Other –MRI –EEG –EMG –Transcranial Doppler