1. Carlos Darcy Alves Bersot TSA.SBA
MD RESPONSÁVEL PELO CET H.F.LAGOA
Médico Anestesiologista do Hospital Federal da Lagoa-SUS
Médico Anestesiologista do Hospital Pedro Ernesto-UERJ

3. Nervous System
Nervous System stimulus and reaction
stimulus and reaction
animal
organism
Nervous system
stimulus reaction
sensory Inter- Motor
receptor effector
neuron neuron neuron

4. Nervous System
Nervous System
• Central Nervous System
brain, spinal cord: nervous tissue
meninges, choroid plexus: connective tissue
• Peripheral Nervous System
nerve, ganglion, nerve plexus:

5. Nervous Tissue
Nervous Tissue
Cellular Elements
Ÿ Neuron (Nerve Cell)
Ÿ Neuroglial Cells
central neurglia
astrocyte, oligodendrocyte, microglia and
ependymal cell
peripheral neuroglia
Schwann cell in nerve and ganglion
satellite (capsular) cell in ganglion

6. Neuron
Neuron
Neuronal Morphology
Neuronal Cell Body (Soma)
Ÿ Nucleus
Neuronal Processes
Ÿ Axon
Ÿ Dendrites
Diversity of Neuronal Size and Morphology

8. Diversity of
Neuronal
Morphology

9. Neuron
Neuron
Neuronal Function
Communication
Receptor - Neuron - Effector
- Excitability (Irritability)
- Conductivity
through membrane in intraneuronal conduction
via synapse in interneuronal conduction
neurotransmitters

10. SYNAPSE
SYNAPSE
Ÿ Presynaptic Portion: Synaptic Button
- synaptic vesicle
- mitochondria
- presynaptic membrane: tubulin
Ÿ Synaptic Cleft
- 20-30 nm
Ÿ Postsynaptic Portion
- postsynaptic membrane: actin, fodrin, spectrin
- mitochondria

11. SYNAPSE
SYNAPSE

13. Myelin
Myelin
Myelin Sheath - MYELIN
Schwann sheath
• formed by wrapped plasma membrane of
Oligodendrocyte in CNS
Schwann Cell in PNS
• Node of Ranvier - Saltatory Conduction
- conduction velocity

14. Myelin
Structure of fast nerve conduction

15. Multiple Slerosis – disease of the myelin
oligodendrocyte Jacqueline Du Pre

16. ORGANIZAÇÃO DO SN
ORGANIZAÇÃO DO SN
Central Nervous System
Gray Matter
Nucleus and Cortex
White Matter
Tracts
Peripheral Nervous System
Nerve (Peripheral Nerve)
Ganglion

17. SISTEMA NERVOSO PERIFÉRICO
SISTEMA NERVOSO PERIFÉRICO
 Nerve Fiber
Myelinated Nerve Fiber
Axon, Myelin sheath, Schwann cell
Unmyelinated Nerve Fiber
Axon, Schwann cell
 Connective Tissue Sheath
Endoneurium
Perineurium – blood vessels
Epineurium

18. Receptor
Endings

19. TERMINAÇÕES EFERENTES
Somatic Efferent Endings
Neuromuscular Junction
(Myoneural Junction, Motor End
Plate)
Autonomic Efferent
Endings
Endings on smooth muscle
and blood vessels

20. Neuromuscular
Junction
(Myoneural Junction,
Motor End Plate)
M
NMJ
N

21. Myasthenia Gravis
Defects in NM
Transmission
• muscle weakness
• autoimmune disease
with autoantibodies
against Ach receptor
• treated with
AchT inhibitors,
thymectomy, and
corticosteroids
before treatment after treatment

22. Autonomic Efferent Endings

25. Brain Regions
1. Cerebrum
2. Diencephalon
3. Brainstem
4. Cerebellum
Cerebellum

26. Cerebrum
• O cérebro humano
contém cerca de 100
bilhões de neurônios,
ligados por mais de
10,000 conexões
sinápticas .
• Corpo caloso
• Massa Cinzenta e
Branca.
• Giros e Sulcos

27. • Deeper grooves called fissures separate large regions of the brain.
– The median longitudinal fissure separates the cerebral hemispheres.
– The transverse fissure separates the cerebral hemispheres from the
cerebellum below.
• Deep sulci divide each hemisphere into 5 lobes:
– Frontal, Parietal, Temporal, Occipital, and Insula

28. • The central sulcus separates the frontal lobe from the parietal
lobe.
– Bordering the central sulcus are 2 important gyri, the precentral
gyrus and the postcentral gyrus.
• The occipital lobe is separated from the parietal lobe by the
parieto-occipital sulcus.
• The lateral sulcus outlines the temporal lobe.
– The insula is buried deep within the lateral sulcus.

29. Where’s the
insula?

31. Cerebral
Cortex
• 3 types of functional areas:
1. Motor  Control voluntary
motor functions
2. Sensory  Allow for conscious
recognition of stimuli
3. Association  Integration

32. Cortical Motor Areas
1. Primary Motor
Cortex
2. Premotor Cortex
3. Broca’s Area

33. Primary motor
Premotor cortex cortex
Frontal Eye
Field
Broca’s Area

34. Primary (Somatic) Motor Cortex
• Located in the precentral
gyrus of each cerebral
hemisphere.
• Contains large neurons
(pyramidal cells) which
project to SC neurons
which eventually
synapse on skeletal
muscles
– Allowing for voluntary
motor control.
– These pathways are known
as the corticospinal tracts
or pyramidal tracts.

35. Panfiled?

36. • Located just anterior
Premotor Cortex
to the primary motor
cortex.
• Involved in learned
or patterned skills.
• Involved in planning
movements.
• How would damage
to the primary motor
cortex differ from
damage to the
premotor cortex?

37. Broca’s Area
• Typically found in only
one hemisphere (often
the left), anterior to the
inferior portion of the
premotor cortex.
• Directs muscles of
tongue, and throat that
are used in speech
production.
• Involved in planning
speech production and
possibly planning other
activities.

38. Sensory Areas
• Found in the parietal, occipital, and
temporal lobes.
1. Primary somatosensory cortex
2. Somatosensory association cortex
3. Visual areas
4. Auditory areas
5. Olfactory cortex
6. Gustatory cortex
7. Vestibular cortex

40. Primary Somatosensory Cortex
• Found in the postcentral
gyrus.
• Neurons in this cortical area
receive info from sensory
neurons in the skin and from
proprioceptors which monitor
joint position.
• Contralateral input.

42. Somatosensory Association
Cortex
• Found posterior to the
primary somatosensory
cortex
• Synthesizes multiple
sensory inputs to create
a complete
comprehension of the
object being felt.
– How would damage to
this area differ from
damage to the primary
somatosensory cortex?

43. Primary Visual Cortex
• Found in the
posterior and medial
occipital lobe.
• Largest of the
sensory cortices.
– What does this
suggest?
• Contralateral input.

44. Association
Areas
• Allows for analysis of
sensory input.
• Multiple inputs and
outputs. Why?
1. Prefrontal cortex
2. Language areas
3. General interpretation
area
4. Visceral association
area

45. Prefrontal
Cortex
• Anterior frontal lobes
• Involved in analysis,
cognition, thinking,
personality, conscience,
& much more.
• What would a
frontal lobotomy
result in?
• Look at its
evolution

46. Phineas Gage’s lesion reconstructed
(H. Damasio and R. Frank, 1992)

47. • Large area for Language Areas
language
understanding and
production
surrounding the
lateral sulcus in the
left (language-
dominant)
hemisphere
• Includes: NEGLIGENCIA
– Wernicke’s area 
understanding
oral/written words
– Broca’s area 
speech production

48. Basal Nuclei
• Set of nuclei deep within the
white matter.
• Includes the:
– Caudate Nucleus
– Lentiform Nucleus
• Globus pallidus
• Putamen
• Components of the extrapyramidal system which provides
subconscious control of skeletal muscle tone and
coordinates learned movement patterns and other somatic
motor activities.
• Doesn’t initiate movements but once movement is
underway, they assist in the pattern and rhythm (especially
for trunk and proximal limb muscles

49. Basal Ganglia
Basal Ganglia Components
Components
ff

50. Parkinson’s PD
Disease
Disease of mesostriatal
dopaminergic system
Muhammad Ali in Alanta Olympic normal

51. SYDENHAM’S CHOREA
SYDENHAM’S CHOREA
Clinical Feature
- Complication of
Rheumatic Fever
- Fine, disorganized , and
random movements of
extremities, face and
tongue
- Accompanied by
Muscular Hypotonia
-
Principal Pathologic Lesion: Corpus Striatum

52. HUNTINGTON’S CHOREA
Clinical Feature
- Predominantly autosomal dominantly
inherited chronic fatal disease
(Gene: chromosome 4)
Principal Pathologic Lesion:
Corpus Striatum (esp. caudate nucleus)
and Cerebral Cortex

53. Diencephalon
• Forms the
central core of
the forebrain
• 3 paired
structures:
1. Thalamus
2. Hypothalamu
s
3. Epithalamus

54. Thalamus
• 80% of the
diencephalon
• Sensory retransmission
station where sensory
signals can be edited,
sorted, and routed.
• Also has profound input
on motor (via the basal
ganglia and cerebellum)
and cognitive function.

55. Hypothalamus
• Functions:
– Autonomic regulatory center
• Influences HR, BP, resp. rate,
GI motility, pupillary diameter.
• Can you hold your
breath until you die?
– Emotional response
• Involved in fear, loathing, pleasure
• Drive center: sex, hunger
– Regulation of body temperature
– Regulation of food intake
• Contains a satiety center
– Regulation of water balance and thirst
– Regulation of sleep/wake cycles
– Hormonal control
• Releases hormones that influence hormonal
secretion from the anterior pituitary gland.
• Releases oxytocin and vasopressin

56. Epithalamus
• Above the thalamus
• Contains the pineal
gland which releases
melatonin (involved in
sleep/wake cycle and
mood).

57. Cerebellum
• Lies inferior to the cerebrum and
occupies the posterior cranial fossa.
• 2nd largest region of the brain.
• 10% of the brain by volume, but it
contains 50% of its neurons
• Has 2 primary functions:
1. Adjusting the postural muscles of the body
• Coordinates rapid, automatic adjustments, that maintain balance
and equilibrium
2. Programming and fine-tuning movements controlled at
the subconscious and conscious levels
• Refines learned movement patterns by regulating activity of both
the pyramidal and extrapyarmidal motor pathways of the cerebral
cortex

58. Cerebellum
• The cerebellum can
be permanently
damaged by trauma
or stroke or
temporarily affected
by drugs such as
alcohol.
• These alterations
can produce ataxia
– a disturbance in
balance.

59. a b c
Cerebellar
Ataxia
ROMBERG
d

61. Pons
• The bulging center part of the brain
stem
• Mostly composed of fiber tracts
• Includes nuclei involved in the control of
breathing

62. Medulla Oblongata
• The lowest part of the brain stem
• Merges into the spinal cord
• Includes important fiber tracts
• Contains important control centers
• Heart rate control
• Blood pressure regulation
• Breathing
• Vomiting

63. Spinal segment
C8, T12, L5, S5, Cx1
Anterior (Ventral) Root
Posterior (Dorsal) Root
Dorsal Root (Spinal) Ganglion

64. Spinal Cord
Spinal Cord Meninges
Meninges
Periosteum of Vertebra
Periosteum of Vertebra
--Epidural Space ----------------- epidural anesthesia
Epidural Space ----------------- epidural anesthesia
Dura Mater Spinalis
Dura Mater Spinalis
Arachnoid Membrane
Arachnoid Membrane
--Subarachnoid Space -------- Lumbar Puncture
Subarachnoid Space -------- Lumbar Puncture
Spinal Anesthesia
Spinal Anesthesia
Pia Mater Spinalis
Pia Mater Spinalis

65. Spinal Cord
Spinal Cord Vascular Supply
Vascular Supply
Arterial Supply
Arterial Supply
--Spinal Arteries
Spinal Arteries
Anterior (1) & Posterior (2) Spinal Artery
Anterior (1) & Posterior (2) Spinal Artery
from Vertebral artery
from Vertebral artery
--Radicular Arteries ----- Segmental arteries
Radicular Arteries ----- Segmental arteries
from Vertebral, Ascending Cervical, Intercostal and
from Vertebral, Ascending Cervical, Intercostal and
Lumbar Artery
Lumbar Artery

66. 5. Adamkiwicz artery
anterior spinal artery segmental arteries

67. Spinal Cord
Spinal Cord Ascending Tracts
Ascending Tracts
Spinothalamic Tract
Spinothalamic Tract
Modality: Pain & Temperature Sensation, Light Touch
Modality: Pain & Temperature Sensation, Light Touch
Receptor: Free Nerve Ending
Receptor: Free Nerve Ending
Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)
Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)
Posterior Root
Posterior Root
2nd Neuron: Dorsal Horn (Lamina I, IV, V)
2nd Neuron: Dorsal Horn (Lamina I, IV, V)
Spinothalamic Tract --(Spinal Lemniscus)
Spinothalamic Tract (Spinal Lemniscus)
3rd Neuron: Thalamus (VPL)
3rd Neuron: Thalamus (VPL)
Internal Capsule ----- Corona Radiata
Internal Capsule ----- Corona Radiata
Termination: Primary Somesthetic Area (S I) &
Termination: Primary Somesthetic Area (S I) &
Diffuse Widespread Cortical Region
Diffuse Widespread Cortical Region

68. spinothalamic
tract
decussation
anterior white
commissure
posterior root
Spinothalamic Tract
Spinothalamic Tract
- contralateral loss of pain and temperature
sensation below the level of lesion

69. Spinal Cord
Spinal Cord Ascending Tracts
Ascending Tracts
Spinocerebellar Tract
Spinocerebellar Tract
Modality: Unconscious Proprioception
Modality: Unconscious Proprioception
Receptor: Golgi tendon organ, muscular fuse
Receptor: Golgi tendon organ, muscular fuse
Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)
Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)
Posterior Root ,,
Posterior Root
2nd Neuron: 1. Clarke’s column
2nd Neuron: 1. Clarke’s column
Posterior Spinocerebellar Tract
Posterior Spinocerebellar Tract
2. Accessory Cuneate Nucleus
2. Accessory Cuneate Nucleus
Cuneocerebellar Tract
Cuneocerebellar Tract
3. Posterior Horn
3. Posterior Horn
Anterior Spinocerebellar rrTract
Anterior Spinocerebellar Tract
Termination: Cerebellar Cortex
Termination: Cerebellar Cortex
FUNCTION?
FUNCTION?

70. Spinal Cord
Spinal Cord Descending Tracts
Descending Tracts
Corticospinal Tract
Corticospinal Tract
Origin: Cerebral Cortex
Origin: Cerebral Cortex
Brodmann Area 4 (Primary Motor Area, M I)
Brodmann Area 4 (Primary Motor Area, M I)
Brodmann Area 6 (Premotor Area, PM ))
Brodmann Area 6 (Premotor Area, PM
Brodmann Area 3,1,2 (Primary Somesthetic Area, S I)
Brodmann Area 3,1,2 (Primary Somesthetic Area, S I)
Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)
Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)
Corona Radiata
Corona Radiata
lnternal Capsule, Posterior Limb
lnternal Capsule, Posterior Limb
Longitudinal Pontine Fiber
Longitudinal Pontine Fiber
Pyramid --pyramidal decussation
Pyramid pyramidal decussation
Corticospinal Tract --Lateral and Anterior
Corticospinal Tract Lateral and Anterior
Termination: Spinal Gray (Rexed IV-IX)
Termination: Spinal Gray (Rexed IV-IX)

71. Corona Radiata
lnternal Capsule,
Longitudinal Pontine
Pyramid CR
Pyramidal Decussation
Corticospinal Tract
IC
- Lateral and Anterior
LPF
Corticospinal Tract
Corticospinal Tract
Pyr
PD LCST
- ipsilateral UMN syndrome ACST
at the level of lesion

72. Spinal Cord
Spinal Cord
Syndrome
Syndrome
Amyotrophic
Amyotrophic
Lateral Sclerosis
Lateral Sclerosis
(ALS)
(ALS)
Lou Gherig’s
Lou Gherig’s
Disease
Disease Stephen Haking (1946- )
British Physicist, A Brif History of Time