The autonomic nervous system. Anatomy. Functions. The symptoms of lesion

The autonomic The autonomic nervous system. nervous system.

Anatomy. Functions. Anatomy. Functions. The symptoms of The symptoms of

lesionlesion

Autonomic nervous systemAutonomic nervous system

iis a part of nervous system s a part of nervous system which regulate the activity which regulate the activity

of internal organs and of internal organs and metabolism metabolism

Autonomic nervous systemAutonomic nervous system

iis a part of nervous system s a part of nervous system thatthat regulates the activity of regulates the activity of

internal organs, glands, blood internal organs, glands, blood and lymphatic vessels, and lymphatic vessels,

smooth and striated muscles smooth and striated muscles and organs of sensation and organs of sensation

Connection between the Autonomic Connection between the Autonomic and Somatic nervous systemand Somatic nervous system

The morphological and functional The morphological and functional unit of both system is a neuronunit of both system is a neuron

The main functional unit is a reflex The main functional unit is a reflex archarch

The autonomic nervous fibers go The autonomic nervous fibers go within cranial nerves and spinal within cranial nerves and spinal nervesnerves

Autonomic nervous system:Autonomic nervous system:

CentralCentral (all the autonomic (all the autonomic structures of the brain and spinal structures of the brain and spinal cord)cord)

PeripheralPeripheral (all the others (all the others peripheral structures) peripheral structures)

Central autonomic nervous Central autonomic nervous systemsystem::

Above – segmental levelAbove – segmental level the limbic systemthe limbic system reticular formationreticular formation hypothalamus hypothalamus

Central autonomic nervous Central autonomic nervous systemsystem::

Segmental levelSegmental level nuclei of brain stemnuclei of brain stem autonomic lateral horns of spinal cord (C8-autonomic lateral horns of spinal cord (C8-

L3)L3) cilium-spinal center C8-Th1cilium-spinal center C8-Th1 sympathetic center of urination L1-L2sympathetic center of urination L1-L2 parasympathetic center of urination S3-S5parasympathetic center of urination S3-S5

According to the structure and According to the structure and functional peculiarities segmental functional peculiarities segmental level is divided into:level is divided into:

sympathetic sympathetic parasympathetic parasympathetic

Peripheral autonomic nervous Peripheral autonomic nervous systemsystem : :

The nodus of Ashof – TowarThe nodus of Ashof – Towar The plexus of Meisner and The plexus of Meisner and

AuerbachAuerbach Sympathetic nodusesSympathetic noduses Solar and hypogastrical plexuses Solar and hypogastrical plexuses White and gray fibers White and gray fibers

Functions of autonomic nervous Functions of autonomic nervous systemsystem

ErgotropicErgotropic (homeokinesis) (homeokinesis) – – adjustment to the changes of adjustment to the changes of environment and providing the needs environment and providing the needs of the organism of the organism

TrophotropicTrophotropic (homeostasis) (homeostasis) – it – it supports the constant internal reactions supports the constant internal reactions and provides anabolic processesand provides anabolic processes

The limbic systemThe limbic system

Bulbus olphactorius, tractus olphactorius, Bulbus olphactorius, tractus olphactorius, trigonum olphactorii, substantia perforata anteriortrigonum olphactorii, substantia perforata anterior

Septum pellucidumSeptum pellucidum Gyrus cinguliGyrus cinguli Gyrus hypocampalisGyrus hypocampalis Orbital part of frontal lobeOrbital part of frontal lobe Corpus amygdaloideumCorpus amygdaloideum The pole of temporal lobes The pole of temporal lobes

Functions:Functions:

Emotional reactionsEmotional reactions The reception of afferent impulses from internal The reception of afferent impulses from internal

organsorgans It is a memory substratum; it preserves information It is a memory substratum; it preserves information

about previous genetically inherited experienceabout previous genetically inherited experience It provides motivation to thirstiness, hunger, sexual It provides motivation to thirstiness, hunger, sexual

desiredesire It regulates the state of sleepiness and livelinessIt regulates the state of sleepiness and liveliness It indirectly regulates the function of internal It indirectly regulates the function of internal

organsorgans

The symptoms of lesionThe symptoms of lesion

Emotional disturbances (euphoria and Emotional disturbances (euphoria and depression)depression)

Changes of eating (anorexia or bulimia)Changes of eating (anorexia or bulimia) Sleeping disorders (insomnia, lethargy)Sleeping disorders (insomnia, lethargy) Sexual disturbances (hypersexuality and Sexual disturbances (hypersexuality and

hyposexuality)hyposexuality) Memory disorders (especially on current events)Memory disorders (especially on current events) The irritation of some structures leads to The irritation of some structures leads to

aggressionaggression

Reticular formationReticular formation

It is a tonus motor of the brain, which works It is a tonus motor of the brain, which works constantly in the brain stem. It consists of great constantly in the brain stem. It consists of great number of cells, the axons of which are going in number of cells, the axons of which are going in different directions and create a reticule. different directions and create a reticule.

In spite of the other cells of nervous system the In spite of the other cells of nervous system the cells of reticular formation accept pain, light, cells of reticular formation accept pain, light, temperature and humeral impulses and send them temperature and humeral impulses and send them to the brain cortex. to the brain cortex.

FunctionsFunctions of reticular formationof reticular formation

To support the brain cortex tonus, its state of liveliness To support the brain cortex tonus, its state of liveliness which is necessary for the normal activity. The reticular which is necessary for the normal activity. The reticular formation energizes the brain.formation energizes the brain.

It supports the certain level of activity of autonomic centres It supports the certain level of activity of autonomic centres (the activity is very similar to that of sympathetic nervous (the activity is very similar to that of sympathetic nervous system. There is also the same mediator – system. There is also the same mediator – noradrenalinum)noradrenalinum)

FunctionFunction The control of sleepiness and livelinessThe control of sleepiness and liveliness To accept the information from the environmentTo accept the information from the environment To keep in tonus all the forms of behaviour, those have To keep in tonus all the forms of behaviour, those have

long – lasting characterlong – lasting character

The symptoms of lesionThe symptoms of lesion

The low activity of RF – the patient is The low activity of RF – the patient is unconsciousunconscious

Decreased activity of RF – sleepinessDecreased activity of RF – sleepiness The lower parts of RF have general and The lower parts of RF have general and

long – lasting influence on consciousness long – lasting influence on consciousness and behavior, the upper ones have short – and behavior, the upper ones have short – lasting and specific influencelasting and specific influence

HypothalamusHypothalamus

Anterior – it is associated with Anterior – it is associated with parasympathetic functionparasympathetic function

Middle – endocrine – trophy Middle – endocrine – trophy Posterior – has mainly sympathetic Posterior – has mainly sympathetic

influenceinfluence

The peculiarities of activity:The peculiarities of activity:

Motor cortex receives 440 capillaries per 1 mm3, Motor cortex receives 440 capillaries per 1 mm3, visual cortex – 900 / mm3, hypothalamic region – visual cortex – 900 / mm3, hypothalamic region – from 1650 to 2600 / mm3.from 1650 to 2600 / mm3.

Almost all the arterial brain systems give their Almost all the arterial brain systems give their branches to hypothalamic region. That makes branches to hypothalamic region. That makes impossible disturbances of its activity.impossible disturbances of its activity.

There is no space of glia between the vessels and There is no space of glia between the vessels and gangliocytes. That provides quick reaction to the gangliocytes. That provides quick reaction to the changes of internal surroundings. changes of internal surroundings.

Hypothalamus is closely Hypothalamus is closely connected with:connected with:

CortexCortex ThalamusThalamus Extrapyramidal nervous systemExtrapyramidal nervous system Nuclei of brain stem and spinal cordNuclei of brain stem and spinal cord Reticular formation Reticular formation Hypophysis Hypophysis

The function of hypothalamusThe function of hypothalamus

Regulation of heart – vascular activityRegulation of heart – vascular activity Regulation of lipid, water, mineral metabolismRegulation of lipid, water, mineral metabolism ThermoregulationThermoregulation Regulation of vessels’ and tissue membranes Regulation of vessels’ and tissue membranes

penetrance penetrance Regulation of endocrine glands’ functionRegulation of endocrine glands’ function Constant internal surroundings supportConstant internal surroundings support AdaptationAdaptation BiorhythmBiorhythm Emotional behaviourEmotional behaviour

Hypothalamus rules the internal Hypothalamus rules the internal world by means of three ways:world by means of three ways:

–Through the nervous impulsesThrough the nervous impulses

–HumoralHumoral

–HormonalHormonal

7 tropic7 tropic hormoneshormones

CorticoliberinumCorticoliberinum TirioliberinumTirioliberinum LuliberinumLuliberinum FoliliberinumFoliliberinum SomatoliberinumSomatoliberinum ProlactoliberinumProlactoliberinum MelanocytoliberinumMelanocytoliberinum

3 inhibiting hormones3 inhibiting hormones::

ProlactostatinumProlactostatinumMelanocytostatinumMelanocytostatinumSomatostatinumSomatostatinum

Hypothalamic syndromesHypothalamic syndromes

Autonomic – vascular – visceralAutonomic – vascular – visceral Neuro – endocrine – metabolicNeuro – endocrine – metabolic Neuro – trophicNeuro – trophic Neuro – muscularNeuro – muscular Thermoregulation disturbancesThermoregulation disturbances Sleeping disorders Sleeping disorders PseudoneurasteniaPseudoneurastenia

Autonomic – vascular – visceral Autonomic – vascular – visceral syndromesyndrome

– – is associated with crisis of paroxysmal is associated with crisis of paroxysmal character.character.

–Sympathetic – adrenalSympathetic – adrenal

–Vago – insularVago – insular

–MixedMixed

The disturbance of vegetative functions:The disturbance of vegetative functions:The paroxysmal signsThe paroxysmal signs

Sympathy-adrenal attacksSympathy-adrenal attacks: : Vagoinsular attacksVagoinsular attacks:: skin is pail a) hyperemiaskin is pail a) hyperemia xerostomia b) hyperhidrosisxerostomia b) hyperhidrosis dryness of hair and skin c) oily skin and hairdryness of hair and skin c) oily skin and hair tachycardia d) bradycardiatachycardia d) bradycardia high blood pressure e) low blood pressurehigh blood pressure e) low blood pressure midriasis and widing of f) miosismidriasis and widing of f) miosis eye-slit g) angina pectoriseye-slit g) angina pectoris exophthalmia h) salivationexophthalmia h) salivation tremor i) breathlessnesstremor i) breathlessness gooseflesh j) abdominal spastic pain gooseflesh j) abdominal spastic pain frequent and abundant urination k) diarrheafrequent and abundant urination k) diarrhea

The disturbance of vegetative functions:The disturbance of vegetative functions:

The lesion signs:The lesion signs:Sympathy-adrenalSympathy-adrenal: : VagoinsularVagoinsular:: periarthritis incontinence of urine and periarthritis incontinence of urine and

fecesfeces epicondilitis ischuria /retention of urineepicondilitis ischuria /retention of urine miositis eye accommodation paralysismiositis eye accommodation paralysis hyperkeratosis midriasishyperkeratosis midriasis fissures of skin breathfissures of skin breath arthropatias dyspneaarthropatias dyspnea trophic ulcer apneatrophic ulcer apnea alopecia cardiac arrhythmiaalopecia cardiac arrhythmia hyperpigmentation asystoliahyperpigmentation asystolia Horner’s sign collapseHorner’s sign collapse(ptosis, miosis, enophthalmia)(ptosis, miosis, enophthalmia)

Neuro – endocrine – metabolic Neuro – endocrine – metabolic syndromesyndrome

– – is associated with increasing or decreasing is associated with increasing or decreasing of hypophysis function:of hypophysis function:

Itsenko – KushingItsenko – Kushing AcromegalyAcromegaly Early climaxEarly climax ImpotenceImpotence Non sugar diabetesNon sugar diabetes TyreotoxicosisTyreotoxicosis

Neuro – trophic syndromeNeuro – trophic syndrome

is associated with trophic disturbances:is associated with trophic disturbances: DrynessDryness NeurodermitisNeurodermitis UlcersUlcers Bed soresBed sores Acute perforates of stomach andAcute perforates of stomach and

esophagusesophagus

Neuro – muscular syndromeNeuro – muscular syndrome

– – hypothalamus provides chemical hypothalamus provides chemical and biochemical activity of and biochemical activity of extrapyramidal nervous system and extrapyramidal nervous system and cerebellum.cerebellum.

MyastheniaMyasthenia MyotoniaMyotonia Paroxysmal myoplegiaParoxysmal myoplegia

Thermoregulation disturbancesThermoregulation disturbances

Hyperthermia Hyperthermia (the temperature is 37,1 – 37,5)(the temperature is 37,1 – 37,5) Hypothermia (the temperature is 35)Hypothermia (the temperature is 35)

Temperature asymmetry under the armsTemperature asymmetry under the arms Temperature asymmetry in the mouth Temperature asymmetry in the mouth

and in rectumand in rectum Sometimes this symptom has Sometimes this symptom has

paroxysmal character and is associated paroxysmal character and is associated with tremblingwith trembling

Sleeping disordersSleeping disorders

InsomniaInsomnia Lethargy (a special form – narcolepsy) – Lethargy (a special form – narcolepsy) –

sudden attack of sleepiness that can sudden attack of sleepiness that can happen in any place and position of the happen in any place and position of the patient. Sometimes they are associated with patient. Sometimes they are associated with catalepsy (the loss of muscle tonus)catalepsy (the loss of muscle tonus)

Sleeping inversion Sleeping inversion

PseudoneurasteniaPseudoneurastenia

Parasympathetic nervous systemParasympathetic nervous system

Mesencephalic levelMesencephalic level (nuclei of Perlea and (nuclei of Perlea and Yakubovich), the fibers are going within the III CN Yakubovich), the fibers are going within the III CN and provide innervating of m. Sphincter pupillae, and provide innervating of m. Sphincter pupillae, m. Ciliarism. Ciliaris

Bulbar Bulbar (n.salivatorius superor et inferior, n. (n.salivatorius superor et inferior, n. dorsalis nervi Vagi) within VII, IX, X CN’s innervate dorsalis nervi Vagi) within VII, IX, X CN’s innervate parotid, sublingual, submandibular glands and parotid, sublingual, submandibular glands and internal organs (except the pelvic organs)internal organs (except the pelvic organs)

Sacral partSacral part – the cells of lateral horn S3 – S5 – – the cells of lateral horn S3 – S5 – innervating of pelvic organsinnervating of pelvic organs

Symptoms of lesion on Symptoms of lesion on mesencephalic levelmesencephalic level

– Spasm or paralysis of Spasm or paralysis of accommodationaccommodation

– MydriasisMydriasis– Direct or indirect symptom of Direct or indirect symptom of

Argil – Robertson Argil – Robertson There is the arch of pupil reflex on There is the arch of pupil reflex on

mesencephalic levelmesencephalic level

The symptoms of lesion of bulbar The symptoms of lesion of bulbar level:level:

Salivation or kserostomySalivation or kserostomy Tears or kserophthalmyTears or kserophthalmy Dyspnoe, Biot, Chein – Stocks types of Dyspnoe, Biot, Chein – Stocks types of

breathingbreathing Tachycardia, arythmia, asystoly Tachycardia, arythmia, asystoly Arterial hypertensionArterial hypertension

Symptoms of lesion Symptoms of lesion of sacral part:of sacral part:

Segments of the spinal cord – S3 – S5Segments of the spinal cord – S3 – S5 Retention of urineRetention of urine Truly urine incontinenceTruly urine incontinence Ishuria paradoxa Ishuria paradoxa

Sympathetic nervous systemSympathetic nervous system

Consists of the cells of lateral horn of spinal cord Consists of the cells of lateral horn of spinal cord from C8 to L2 from C8 to L2

The axons within the anterior roots leave the The axons within the anterior roots leave the spinal cord spinal cord

Some of them are finished in sympathetic trunk (it Some of them are finished in sympathetic trunk (it consists of 20 – 23 noduses) – 3 cervical, 10 – 12 consists of 20 – 23 noduses) – 3 cervical, 10 – 12 thoracic, 3 – 4 lumbar, 4 pelvic. thoracic, 3 – 4 lumbar, 4 pelvic.

The rest fibers are going to the prevertebral The rest fibers are going to the prevertebral noduses or plexusesnoduses or plexuses

CommonCommon features: features: There are 2 neurons. The second neuron is located in There are 2 neurons. The second neuron is located in

ganglionganglion Preganglionar fibers are myelin –associated. Preganglionar fibers are myelin –associated. Postganglionar fibers are without myelinPostganglionar fibers are without myelin. .

DifferentialDifferential features: features: Mediator Mediator Sympathetic nervous system – adrenalin, noradrenalinSympathetic nervous system – adrenalin, noradrenalinParasympathetic nervous system – acetylcholineParasympathetic nervous system – acetylcholine The length of fibersThe length of fibersSympathetic nervous system – short pre- and long Sympathetic nervous system – short pre- and long

postganglionar fiberspostganglionar fibersParasympathetic nervous system – long pre – and short Parasympathetic nervous system – long pre – and short

postganglionar fiberspostganglionar fibers

Symptoms of lesionSymptoms of lesion

Lateral horns of spinal cordLateral horns of spinal cord::Autonomic – vascular (pale, cyanosis)Autonomic – vascular (pale, cyanosis)Trophic (edema, arthropaty)Trophic (edema, arthropaty)Secreting (dryness of the skin, hyperhydrosis)Secreting (dryness of the skin, hyperhydrosis) C8 – Th3 – head and neckC8 – Th3 – head and neck Th4 – Th7 – shoulders and armsTh4 – Th7 – shoulders and arms Th8 – Th9 – bodyTh8 – Th9 – body Th10 – L3 – pelvis and legsTh10 – L3 – pelvis and legs


Upper cervical sympathetic nodes:Upper cervical sympathetic nodes:

–CausalgiaCausalgia

–Paresthesia, hypesthesiaParesthesia, hypesthesia

–Vasomotor, secreting, trophic Vasomotor, secreting, trophic disorders in head and neck regiondisorders in head and neck region

–Horner syndromeHorner syndrome


Nodus stellatum:Nodus stellatum: CausalgiaCausalgia Paresthesia, hypesthesiaParesthesia, hypesthesia Vasomotor, secreting, trophic Vasomotor, secreting, trophic

disorders in head and neck regiondisorders in head and neck region


Upper thoracic noduses:Upper thoracic noduses:Cardialgia Cardialgia TachycardiaTachycardiaBreathing disorders plus all Breathing disorders plus all

the above named symptoms the above named symptoms


Lower thoracic and lumbar noduses:Lower thoracic and lumbar noduses: Visceral and autonomic disorders of the organs of Visceral and autonomic disorders of the organs of

abdominal cavity.abdominal cavity.Solar plexus:Solar plexus:

Dull pain in the abdomenDull pain in the abdomen Increased aorta pulsationIncreased aorta pulsation Instable APInstable AP Instable stool Instable stool Poli – oligouriaPoli – oligouria GlucosuriaGlucosuria


Posterior neck sympathetic nodus:Posterior neck sympathetic nodus:

Neck pain like “casque putting Neck pain like “casque putting off”off”

PhotopsiaPhotopsia Vestibular syndromeVestibular syndrome

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The autonomic nervous system. Anatomy. Functions. The symptoms of lesion