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

Autonomic nervous system is a part of nervous system which regulate the activity of internal organs and metabolism

Autonomic nervous system is a part of nervous system that regulates the activity of internal organs, glands, blood and lymphatic vessels, smooth and striated muscles and organs of sensation

Connection between the Autonomic and Somatic nervous system The morphological and functional unit of both system is a neuron The morphological and functional unit of both system is a neuron The main functional unit is a reflex arch The main functional unit is a reflex arch The autonomic nervous fibers go within cranial nerves and spinal nerves The autonomic nervous fibers go within cranial nerves and spinal nerves

Autonomic nervous system: Central (all the autonomic structures of the brain and spinal cord) Central (all the autonomic structures of the brain and spinal cord) Peripheral (all the others peripheral structures) Peripheral (all the others peripheral structures)

Central autonomic nervous system: Above – segmental level the limbic system the limbic system reticular formation reticular formation hypothalamus hypothalamus

Central autonomic nervous system: Segmental level nuclei of brain stem nuclei of brain stem autonomic lateral horns of spinal cord (C8- L3) autonomic lateral horns of spinal cord (C8- L3) cilium-spinal center C8-Th1 cilium-spinal center C8-Th1 sympathetic center of urination L1-L2 sympathetic center of urination L1-L2 parasympathetic center of urination S3-S5 parasympathetic center of urination S3-S5

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

Peripheral autonomic nervous system : The nodus of Ashof – Towar The nodus of Ashof – Towar The plexus of Meisner and Auerbach The plexus of Meisner and Auerbach Sympathetic noduses Sympathetic noduses Solar and hypogastrical plexuses Solar and hypogastrical plexuses White and gray fibers White and gray fibers

Functions of autonomic nervous system Ergotropic (homeokinesis) – adjustment to the changes of environment and providing the needs of the organism Ergotropic (homeokinesis) – adjustment to the changes of environment and providing the needs of the organism Trophotropic (homeostasis) – it supports the constant internal reactions and provides anabolic processes Trophotropic (homeostasis) – it supports the constant internal reactions and provides anabolic processes

The limbic system Bulbus olphactorius, tractus olphactorius, trigonum olphactorii, substantia perforata anterior Bulbus olphactorius, tractus olphactorius, trigonum olphactorii, substantia perforata anterior Septum pellucidum Septum pellucidum Gyrus cinguli Gyrus cinguli Gyrus hypocampalis Gyrus hypocampalis Orbital part of frontal lobe Orbital part of frontal lobe Corpus amygdaloideum Corpus amygdaloideum The pole of temporal lobes The pole of temporal lobes

Functions: Emotional reactions Emotional reactions The reception of afferent impulses from internal organs The reception of afferent impulses from internal organs It is a memory substratum; it preserves information about previous genetically inherited experience It is a memory substratum; it preserves information about previous genetically inherited experience It provides motivation to thirstiness, hunger, sexual desire It provides motivation to thirstiness, hunger, sexual desire It regulates the state of sleepiness and liveliness It regulates the state of sleepiness and liveliness It indirectly regulates the function of internal organs It indirectly regulates the function of internal organs

The symptoms of lesion Emotional disturbances (euphoria and depression) Emotional disturbances (euphoria and 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 hyposexuality) Sexual disturbances (hypersexuality and hyposexuality) Memory disorders (especially on current events) Memory disorders (especially on current events) The irritation of some structures leads to aggression The irritation of some structures leads to aggression

Reticular formation It is a tonus motor of the brain, which works constantly in the brain stem. It consists of great number of cells, the axons of which are going in different directions and create a reticule. It is a tonus motor of the brain, which works constantly in the brain stem. It consists of great number of cells, the axons of which are going in different directions and create a reticule. In spite of the other cells of nervous system the cells of reticular formation accept pain, light, temperature and humeral impulses and send them to the brain cortex. In spite of the other cells of nervous system the cells of reticular formation accept pain, light, temperature and humeral impulses and send them to the brain cortex.

Functions of reticular formation To support the brain cortex tonus, its state of liveliness which is necessary for the normal activity. The reticular formation energizes the brain. To support the brain cortex tonus, its state of liveliness which is necessary for the normal activity. The reticular formation energizes the brain. It supports the certain level of activity of autonomic centres (the activity is very similar to that of sympathetic nervous system. There is also the same mediator – noradrenalinum) It supports the certain level of activity of autonomic centres (the activity is very similar to that of sympathetic nervous system. There is also the same mediator – noradrenalinum)Function The control of sleepiness and liveliness The control of sleepiness and liveliness To accept the information from the environment To accept the information from the environment To keep in tonus all the forms of behaviour, those have long – lasting character To keep in tonus all the forms of behaviour, those have long – lasting character

The symptoms of lesion The low activity of RF – the patient is unconscious The low activity of RF – the patient is unconscious Decreased activity of RF – sleepiness Decreased activity of RF – sleepiness The lower parts of RF have general and long – lasting influence on consciousness and behavior, the upper ones have short – lasting and specific influence The lower parts of RF have general and long – lasting influence on consciousness and behavior, the upper ones have short – lasting and specific influence

Hypothalamus Anterior – it is associated with parasympathetic function Anterior – it is associated with parasympathetic function Middle – endocrine – trophy Middle – endocrine – trophy Posterior – has mainly sympathetic influence Posterior – has mainly sympathetic influence

The peculiarities of activity: Motor cortex receives 440 capillaries per 1 mm3, visual cortex – 900 / mm3, hypothalamic region – from 1650 to 2600 / mm3. Motor cortex receives 440 capillaries per 1 mm3, visual cortex – 900 / mm3, hypothalamic region – from 1650 to 2600 / mm3. Almost all the arterial brain systems give their branches to hypothalamic region. That makes impossible disturbances of its activity. Almost all the arterial brain systems give their branches to hypothalamic region. That makes impossible disturbances of its activity. There is no space of glia between the vessels and gangliocytes. That provides quick reaction to the changes of internal surroundings. There is no space of glia between the vessels and gangliocytes. That provides quick reaction to the changes of internal surroundings.

Hypothalamus is closely connected with: Cortex Cortex Thalamus Thalamus Extrapyramidal nervous system Extrapyramidal nervous system Nuclei of brain stem and spinal cord Nuclei of brain stem and spinal cord Reticular formation Reticular formation Hypophysis Hypophysis

The function of hypothalamus Regulation of heart – vascular activity Regulation of heart – vascular activity Regulation of lipid, water, mineral metabolism Regulation of lipid, water, mineral metabolism Thermoregulation Thermoregulation Regulation of vessels and tissue membranes penetrance Regulation of vessels and tissue membranes penetrance Regulation of endocrine glands function Regulation of endocrine glands function Constant internal surroundings support Constant internal surroundings support Adaptation Adaptation Biorhythm Biorhythm Emotional behaviour Emotional behaviour

Hypothalamus rules the internal world by means of three ways: –Through the nervous impulses –Humoral –Hormonal

7 tropic hormones Corticoliberinum Corticoliberinum Tirioliberinum Tirioliberinum Luliberinum Luliberinum Foliliberinum Foliliberinum Somatoliberinum Somatoliberinum Prolactoliberinum Prolactoliberinum Melanocytoliberinum Melanocytoliberinum

3 inhibiting hormones: Prolactostatinum Prolactostatinum Melanocytostatinum Melanocytostatinum Somatostatinum Somatostatinum

Hypothalamic syndromes Autonomic – vascular – visceral Autonomic – vascular – visceral Neuro – endocrine – metabolic Neuro – endocrine – metabolic Neuro – trophic Neuro – trophic Neuro – muscular Neuro – muscular Thermoregulation disturbances Thermoregulation disturbances Sleeping disorders Sleeping disorders Pseudoneurastenia Pseudoneurastenia

Autonomic – vascular – visceral syndrome – is associated with crisis of paroxysmal character. –Sympathetic – adrenal –Vago – insular –Mixed

The disturbance of vegetative functions: The paroxysmal signs Sympathy-adrenal attacks: Vagoinsular attacks: skin is pail a) hyperemia skin is pail a) hyperemia xerostomia b) hyperhidrosis xerostomia b) hyperhidrosis dryness of hair and skin c) oily skin and hair dryness of hair and skin c) oily skin and hair tachycardia d) bradycardia tachycardia d) bradycardia high blood pressure e) low blood pressure high blood pressure e) low blood pressure midriasis and widing of f) miosis midriasis and widing of f) miosis eye-slit g) angina pectoris eye-slit g) angina pectoris exophthalmia h) salivation exophthalmia h) salivation tremor i) breathlessness tremor i) breathlessness gooseflesh j) abdominal spastic pain gooseflesh j) abdominal spastic pain frequent and abundant urination k) diarrhea frequent and abundant urination k) diarrhea

The disturbance of vegetative functions: The lesion signs: Sympathy-adrenal: Vagoinsular: periarthritis incontinence of urine and feces periarthritis incontinence of urine and feces epicondilitis ischuria /retention of urine epicondilitis ischuria /retention of urine miositis eye accommodation paralysis miositis eye accommodation paralysis hyperkeratosis midriasis hyperkeratosis midriasis fissures of skin breath fissures of skin breath arthropatias dyspnea arthropatias dyspnea trophic ulcer apnea trophic ulcer apnea alopecia cardiac arrhythmia alopecia cardiac arrhythmia hyperpigmentation asystolia hyperpigmentation asystolia Horners sign collapse Horners sign collapse (ptosis, miosis, enophthalmia)

Neuro – endocrine – metabolic syndrome – is associated with increasing or decreasing of hypophysis function: Itsenko – Kushing Itsenko – Kushing Acromegaly Acromegaly Early climax Early climax Impotence Impotence Non sugar diabetes Non sugar diabetes Tyreotoxicosis Tyreotoxicosis

Neuro – trophic syndrome is associated with trophic disturbances: Dryness Dryness Neurodermitis Neurodermitis Ulcers Ulcers Bed sores Bed sores Acute perforates of stomach and esophagus Acute perforates of stomach and esophagus

Neuro – muscular syndrome – hypothalamus provides chemical and biochemical activity of extrapyramidal nervous system and cerebellum. Myasthenia Myasthenia Myotonia Myotonia Paroxysmal myoplegia Paroxysmal myoplegia

Thermoregulation disturbances Hyperthermia (the temperature is 37,1 – 37,5) Hyperthermia (the temperature is 37,1 – 37,5) Hypothermia (the temperature is 35) Hypothermia (the temperature is 35) Temperature asymmetry under the arms Temperature asymmetry under the arms Temperature asymmetry in the mouth and in rectum Temperature asymmetry in the mouth and in rectum Sometimes this symptom has paroxysmal character and is associated with trembling Sometimes this symptom has paroxysmal character and is associated with trembling

Sleeping disorders Insomnia Insomnia Lethargy (a special form – narcolepsy) – sudden attack of sleepiness that can happen in any place and position of the patient. Sometimes they are associated with catalepsy (the loss of muscle tonus) Lethargy (a special form – narcolepsy) – sudden attack of sleepiness that can happen in any place and position of the patient. Sometimes they are associated with catalepsy (the loss of muscle tonus) Sleeping inversion Sleeping inversionPseudoneurastenia

Parasympathetic nervous system Mesencephalic level (nuclei of Perlea and Yakubovich), the fibers are going within the III CN and provide innervating of m. Sphincter pupillae, m. Ciliaris Mesencephalic level (nuclei of Perlea and Yakubovich), the fibers are going within the III CN and provide innervating of m. Sphincter pupillae, m. Ciliaris Bulbar (n.salivatorius superor et inferior, n. dorsalis nervi Vagi) within VII, IX, X CNs innervate parotid, sublingual, submandibular glands and internal organs (except the pelvic organs) Bulbar (n.salivatorius superor et inferior, n. dorsalis nervi Vagi) within VII, IX, X CNs innervate parotid, sublingual, submandibular glands and internal organs (except the pelvic organs) Sacral part – the cells of lateral horn S3 – S5 – innervating of pelvic organs Sacral part – the cells of lateral horn S3 – S5 – innervating of pelvic organs

Symptoms of lesion on mesencephalic level – Spasm or paralysis of accommodation – Mydriasis – Direct or indirect symptom of Argil – Robertson There is the arch of pupil reflex on mesencephalic level

The symptoms of lesion of bulbar level: Salivation or kserostomy Salivation or kserostomy Tears or kserophthalmy Tears or kserophthalmy Dyspnoe, Biot, Chein – Stocks types of breathing Dyspnoe, Biot, Chein – Stocks types of breathing Tachycardia, arythmia, asystoly Tachycardia, arythmia, asystoly Arterial hypertension Arterial hypertension

Symptoms of lesion of sacral part: Segments of the spinal cord – S3 – S5 Retention of urine Retention of urine Truly urine incontinence Truly urine incontinence Ishuria paradoxa Ishuria paradoxa

Sympathetic nervous system Consists of the cells of lateral horn of spinal cord from C8 to L2 Consists of the cells of lateral horn of spinal cord from C8 to L2 The axons within the anterior roots leave the spinal cord The axons within the anterior roots leave the spinal cord Some of them are finished in sympathetic trunk (it consists of 20 – 23 noduses) – 3 cervical, 10 – 12 thoracic, 3 – 4 lumbar, 4 pelvic. Some of them are finished in sympathetic trunk (it consists of 20 – 23 noduses) – 3 cervical, 10 – 12 thoracic, 3 – 4 lumbar, 4 pelvic. The rest fibers are going to the prevertebral noduses or plexuses The rest fibers are going to the prevertebral noduses or plexuses

Common features: There are 2 neurons. The second neuron is located in ganglion There are 2 neurons. The second neuron is located in ganglion Preganglionar fibers are myelin –associated. Preganglionar fibers are myelin –associated. Postganglionar fibers are without myelin. Postganglionar fibers are without myelin. Differential features: Mediator Mediator Sympathetic nervous system – adrenalin, noradrenalin Parasympathetic nervous system – acetylcholine The length of fibers The length of fibers Sympathetic nervous system – short pre- and long postganglionar fibers Parasympathetic nervous system – long pre – and short postganglionar fibers

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

Symptoms of lesion Upper cervical sympathetic nodes: –Causalgia –Paresthesia, hypesthesia –Vasomotor, secreting, trophic disorders in head and neck region –Horner syndrome

Symptoms of lesion Nodus stellatum: Causalgia Causalgia Paresthesia, hypesthesia Paresthesia, hypesthesia Vasomotor, secreting, trophic disorders in head and neck region Vasomotor, secreting, trophic disorders in head and neck region

Symptoms of lesion Upper thoracic noduses: Cardialgia Cardialgia Tachycardia Tachycardia Breathing disorders plus all the above named symptoms Breathing disorders plus all the above named symptoms

Symptoms of lesion Lower thoracic and lumbar noduses: Visceral and autonomic disorders of the organs of abdominal cavity. Visceral and autonomic disorders of the organs of abdominal cavity. Solar plexus: Dull pain in the abdomen Dull pain in the abdomen Increased aorta pulsation Increased aorta pulsation Instable AP Instable AP Instable stool Instable stool Poli – oligouria Poli – oligouria Glucosuria Glucosuria

Symptoms of lesion Posterior neck sympathetic nodus: Neck pain like casque putting off Neck pain like casque putting off Photopsia Photopsia Vestibular syndrome Vestibular syndrome