Download nerve

Autonomic nervous systém
1) smooth muscles of internal organs,
vessels and skin
2) glands
3) heart
Parasympathetic
Sympathetic
Enteric system
Eye
Salivatory glands
Superior cervical g.
Lungs
III
VII, IX
X
N. vagus
Stellate ganglion
Heart
Celiac
ganglion
Liver
Stomach
Pankreas
SMG
Inferior
mesenteric
ganglion
Symphatetic trunc
Adrenal
glands
Intestine
Rectum
Urinary
bladder
Genitals
Nn. erigentes
Target organ
Sympathetic nerv. syst. (NA)
Heart
Heart rate and contractility,
Arteries
Constriction ( blood pressure)
Bronchi
Dilatation
Parasympathetic n.s. (Ach)
heart rate
Dilatation (
blood press.)
Constriction
Stomach, intestine
peristaltic activity
peristaltic activity
Intestinal glands
secretion
secretion
Urinary bladder
Pupils
Releasing of the detrusor
Contraction of sphincter
Constriction of vessels
Ejaculation
Secretion of vestibular glands
Dilatation (mydriasis)
Sweat glands
Small amount of sticky secretion
Lot of dilute secretion
Salivatory glands
Small amount of sticky secretion
Lot of dilute secretion
Genitals
Contraction of the detrusor
Releasing of the sphincter
Dilatation of vessels
Erection
Narrowing (miosis)
Temperature
Increased
Decreased
Methabolism
Increased
Decreased
Cervikothoracolumbal systém (C8-L3) X Craniosacral system (III, VII, IX, X, S2-S4)
To the target organ with vessels X with nerves
Autonomic ganglia are far from the target organ X close to the target organ
Mediator in the target organ noradrenaline x acetylcholine
Varikosities on the axons of the postganglionicic fibres
Acetylcholine
Nikotine receptor
Noradrenaline
α + ß receptors
SYMP
Acetylcholin
Muscarine receptor
Para
Preganglial neuron
Postganglial neuron
Sympathetic nervous system
• Paravertebral ganglia – sympathetic trunc
• Prevertebral ganglia – in front of aorta abd.
Paravertebral
ganglia
Paravertebral ganglion
Prevertebral ganglion
GCB
WCB
Interganglionar branch
Cervical ganglia
Cervical gangia
Stellate ganglion
Ansa subclavia
Horner´s syndrome
Injury of the cervical sympathetic systém
• - miosis (narrow pupil)
• - ptosis (drooping of the upper eyelid)
• - enophthalmus (backward displacement
of the eyeball)
If the conjunctiva is exposed to ipratropium (an
anticholinergic agent) by means of metered-dose
inhalers or nebulizers, mydriasis as well as acute
glaucoma may occur.
The BiPAP (bilevel positive-airway-pressure) face mask
was found to fit imperfectly and leak slightly to the
right. The anisocoria resolved within 24 hours after
the patient stopped receiving ipratropium
Thoracic ganglia
Greater splanchnic nerve
Th6-9
Lesser splanchnic nerve
Th9-11
Nervus splanchnicus imus
Th12
Lumbar ganglia
Abdominal aortic
plexus
Schema of the
abdominal aortic
plexus, superior
and inferior
hypogastric
plexus
Superior
and inferior
hypogastric
plexus
Spinal ganglion
Paravertebral
sympathetic
ganglion
Prevertebral
Pasympathetic ganglion
Parasympathetic
ganglion
+ ENTERIC SYSTEM
Enteric system
• Ganglia and plexuses in the wall of the gut from the
cardia to the sphincter ani externus
• Myenteric plexus of Auerbach
• Submucous plexus of Meissner
• 1) enteric neurons in the wall of the gut
• 2) efferent centripetal fibres – dendrites of cells in the
spinal ganglion and ganglion inferius n. vagi and axons
of enteric neurons running to the prevertebral ganglia
• 3) afferent centrifugal fibres – from n.vagus,
• prevertebral ganglia and pelvic ganglia
• 4)enteric glia
Myenteric plexus of Auerbach
ENTERIC SYSTEM
A) intestine – intestine
B) duodenum – gall bladder
C)stomach - pancreas
ESs = submucosous plexus (of Meissner)
ESm= myenteric plexus (of Auerbach)
Ganglia
Trigeminal ganglion (Gasseri)
Geniculate ganglion (VII.)
Sup. and inf. ganglion of the IX.
Sensory ganglia
axon
Sup. and inf. ganglion of the X
dendrit
Parasympathetic ganglia
Sensory root
Sympathetic root
Parasympathetic root
Efferent braches
Afferents
Parasympathetic ganglia
•
•
•
•
Ciliary ganglion
Pterygopalatine ganglion
Submandibular ganglion
Otic ganglion
Ciliary ganglion
Nasociliary n.
Internal carotid pl.
E.W.-r.inf.
n.III.
short.ciliary nerves (cornea)
m.dilator pupillae
mydriasis
m.sphincter pupillae, m. ciliaris
Miosis, akomodation
Pterygopalatine ganglion
Pterygopalatine nn.
Superior posterior nasal branches Inferio
posterior nasal branches
Deep petrosal n.
Orbital branches
Greater petrosal n.
Greater palatine nerve
Lesser palatine nerves
VII. –ncl. salivatorius sup
Glands of the nasal cavity and palate
Communicating branch to the lacrimal n.
Lacrimal gland
Submandibular ganglion
Lingual n.
Glandular branches for
Facial artery pl.
Submandibular and
sublingual gland
chorda tympani
Branches in the lingual
nerve to the
VII. Superior salivatory
nucleus
Glands in the distal 2/3
of the tongue
Otic ganglion
Mandibular n.
Communcating branch to the
Auriculotemporal n.
Middle meningeal
artery pl.
Parotid gland
Lesser petrosal n.
Communicating branch to the
buccal nerve
IX. Inferior salivatory
nucleus
Buccal glands
Motor fibres for tensor veli palatini and tensor tympani VII
pterygoideus medialis V
Cranial nerves
Nuclei of cranial
nerves
Cranial nerves,
base of the brain
Base of the skull
Cranial nerves - II., III., IV., V., VI.
Cavernous sinus and cranial nerves
III.
IV.
VI.
V/1
V/2
Orbit and cranial nerves
IV.
1-n.lacrimalis
2-n.frontalis
n. nasociliaris
III.
II
Common annular tendon
Muscles of the eyeball - schema of
the function and inervation
Levator muscle of the upper eyelid
Superior rectus
Inferior oblique
Lateral
rectus
VI
III
Medial
rectus
Superior oblique
IV
IV
Inferior rectus
Paralysis of nerves III., IV., VI.
• III. – ptosis of the lid, divergent strabismus, diplopia
•
mydriasis – dilated pupil, loss of light reaction
• IV. – rare, diplopia on looking downward (difficulty in
descending stairs), slight convergent strabismus
• VI. – convergent strabismus, diplopia
Alternating hemiplegia
media
superior
Trigeminal nerve
Nuclei of the
trigeminal
nerve
Branches of the trigeminal nerve
Skin supplied by the trigeminal
nerve
Ophthalmic nerve
Maxillary nerve
Mandibular nerve
N.VII
1. ncl. salivatorius
sup.
2. chorda tympani
(VII) do n.
lingualis(V3)
3. ggl.
submandibulare
4. rr.(V3)
5. ggl.
submandibularis,
sublingualis
N. IX
1. ncl saliv. inf
2.n. tympanicus (IX)
do n.petrosusu minor
(IX)
3. ggl. oticum
4. n.
auriculotemporalis
(V3)
5.gl. parotis
Mandibular nerve
Mandibular nerve
Facial nerve
Facial nerve
Facial nerve
N facialis SM ncl. motorius
mimic muscles, p.b.of
digastricus , SH, platysma,
stapedius
N. intermedius VM ncl.
salivatorius sup.
Lacrimal gland, nasal and
palatine and lingual glands,
Submandibular and
sublingual glands
SS skin of pinna přes ggl.
geniculi do Vs
VS anterior 2/3 of the tongue
- ggl. geniculi - ncl. tractus
solitarii IX (ncl. gustatorius)
Facial nerve
Paralysis of the facial nerve
Paralysis of the facial nerve
A – Bells palsy – peripheral facial paralysis) Chilling of the face, middle ear
infections, tumors, fractures, meningitis, hemorrhage.
Localization of the lesion
1)
2)
3)
4)
5)
6)
7)
In pons: colliculus facialis lesioned only motor fibres - ipslateral paralysis of
mimic muscles
At the emergence of the pons (meningitis) involved of other nerves (VIII. a V.)
Internal auditory meatus Involved VIII. nerve nerv – paralysis of VII, deafness,
vertigo
In facial canal involving the geniculate ganglion (herpes zoster) pain,
decreased secretion of tears, hyperacusis, loss of taste in the anterior two thirds
of tongue, reduced salivation, paralysis of mimic muscles
In facial canal involving the stapedius – hyperacusis, loss of taste in the
anterior two thirds of tongue, reduced salivation, paralysis of mimic muscles
In facial canal involving the chorda tympani–loss of taste in the anterior two
thirds of tongue, reduced salivation, paralysis of mimic muscles
Outside the stylomastoid foramen ipsilateral paralysis of mimic muscles
Central paralysis of the facial nerve – lesion of
cortico-nuclear connections
Stroke
Contralateral paralysis of mimic muscles with hemiparesis of
limbs
Taste and salivation are not affected
Temporal and zygomatic branches of the facial nerve are spared
Cortical motor centers for mimic muscles around the eye are
bilateral
Central and Peripheral Facial
Weakness
Central
Peripheral
Hemispasm
Voluntary Central Facial Weakness That Is
Greater Than Mimetic (Involuntary) Central
Facial Weakness
Axial computed tomography of the brain revealed a left hemispheric infarct
involving cortical and subcortical structures (Panel C). Because voluntary
central facial weakness is greater than mimetic central facial weakness, the
cerebral cortex is functionally more damaged than are subcortical structures.
Mimetic (Involuntary) Central Facial
Weakness That Is Greater Than Voluntary
Central Facial Weakness
MRI revealed a deep-seated right hemispheric infarct
Nervus vestibulocochlearis
• Pars vestibularis
N. utriculoampullaris
N. saccularis
N. ampullaris posterior
•
Pars cochlearis
VII
A
P
Fundus meati acustici interni
Lesion: deafness, vertigo, instability, nystagmus
Nervus vestibulocochlearis
Glossopharyngeal, Vagus and Accessory Nerves
IX, X, IX
Ncl ambiguus – SM IX a X – muscles of the soft palate,
pharynx, larynx and esophagus
1-IX
2–X
3 - XII
4 – r.cranialis XI
5 - C1
6 – r.spinalis XI
Ncl. dorsalis n. vagi – VM –parasympaticus IX, X
Upper part – ncl. salivatorius inf.-.parotide gland
Ncl. solitarius VS – IX, X, and VII
Upper part – ncl. gustatorius
Ncl. spinalis n.V. – SS from the pinna and external
auditory meatus, posterior 1/3 of the tongue, tonsilla
palatina and the soft palate
Nervus glossopharyngeus
SM –muscles of the soft palate and pharynx
VM – parotid gland (Jacobsons anastomosis),
cavum tympani
SS +VS- pharynx, tonsills, posterior 1/3 of the tongue,
auditory tube
cavum tympani
Taste – posterior 1/3 of the tongue
Lesions:
Dysphagia
Loss of the gag reflex
Loss of the taste in posterior 1/3 of the tongue
Loss of the sensation of posterior1/3 of the tongue,
pharynx and tonsills
Deviation of the uvula to the well side
Tachycardia (in some lesions)
Neuralgie n. IX. !
Nervus vagus
SM – muscles of the pharynx, laryngx (ncl. ambiguus)
VM – parasympaticus fot the gut, respiratory systém, heart and big vessels.(ncl.
dorsalis n.X)
SS –external acoustic meatus, part of the pinna (ncl.Vs)
VS – from organs (ncl. solitarius)
Taste - from the area around the epiglottis (ncl. gustatorius)
LESIONS
Aphony – loss of voice, dysphony
Dysphagia
Paralysis of the soft palate - rhinolalie
Tachykardia
Loss of the okulokardial reflex
Irritation:
Laryngospasmus, esophagospasmus, pylorospasmus, bradykardia, zástava,
nausea, vomitus, singultus, cough, dyspnoe
Nervus vagus
branches
N. laryngeus reccurens
N. vagus sin.
r. cardiacus
thoracicus dx.
n. laryngeus reccurens sin.
r. cardiacus thoracicus sin.
rr. bronchiales
truncus vagalis ant.
truncus vagalis post.
r. hepaticus
rr. coeliaci
rr. renales
rr. gastrici ant.
rr. gastrici post.
striated muscles
parasympathetic
Sensory ( mainly visceral sensory
fibres)
Nervus accessorius
X.
X.
ramus. externus XI.
XI.
rr.craniales
M.sternocleidomastiodeus (SCM)
C1
M. trapezius (TR)
C2
C3
XI.
C4
C5
Ramus internus XI.
Muscles of the soft palate and
larynx
rr.spinales
C6
LESIONS:
R. internus : paralysis of the soft palate and
dysphony
R. externus: Difficulty in rotating head to the
uneffected side or raising chin (SCM), squareness of
shoulders (TR)
IRRITATION or
CENTRAL
PARALYSIS:
Torticollis spastica
Nervus hypoglossus
Intraglossal and
extraglossal muscles
Lesion:
On protrusion the tongue deviates to
the side of lesion (peripherial
paralysis) or to the side opposite to
lesion (central, supranuclear paralysis)
Test
1 N.lingualis
2 N.glossopharyngeus
3 N.hypoglossus
4 N.laryngeus superior
5 N.laryngeus reccurens
Sources
•
•
•
•
•
•
•
Borovanský, Anatomie 2
Petrovický, Anatomie 3
Petrovický, unpublished schemas
Martin, Neuroanatomy
Netter, Atlas of Anatomy
Kahle,Frotscher, Color Atlas of Human Anatomy, Vol.3
Chusid, Correlative Neuroanatomy and Functional
neurology
• http://Content.nejm.org.-NEJM—Bells Palsy
• http://Image –chalenge.nejm.org-NEJM:Image Challenge
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