NURS 5315 PATHO Module 7 N5315 Advanced Pathophysiology Neurologic System Core Knowledge Objectives with Advanced Organizers

Examine the anatomy and physiology of the Central Nervous System. 1. Discuss the anatomy and physiology of the brain and brain stem. a. Explain the function of the twelve cranial nerves I – Olfactory (Smell) Function: Sensory, carries impulses for sense and smell Sign of Dysfunction: Loss or disturbance in the sense of smell. II – Optic (Sight) Function: Sensory, carries impulses for vision Sign of Dysfunction: decreased visual acuity and contrast sensitivity, impaired color vision, and an afferent pupillary defect. (blindness) III – Oculomotor Function: Contains motor fibers to interior oblique and to superior, inferior, ad medial rectus extraocular muscles that direct eye ball; levator muscles of eyelid; smooth muscles of iris and ciliary body; and proprioception (sensory) to brain from extraocular muscles Sign of Dysfunction: Drooping of the eyelid, eyeball moves outward, dilation of the pupil, double vision. IV – Trochlear Function: Propioceptor and motor fibers for superior oblique muscle of eye (extraocular muscles) Sign of Dysfunction: Rotation of eyeball upward and outward, double vision V Trigeminal (facial muscles including chewing, facial sensation) This is the largest cranial nerve Function: Both motor and sensory for face; conducts sensory impulses from mouth, nose, surface of eye, and dura mater; also contains motor fibers that stimulate chewing muscles Sign of Dysfunction: Sensory root – Pain or loss of sensation in the face, forehead, temple and eyes. Motor root – affecting the jaw, trouble chewing VI Abducens (moves eyeballs) Function: Moves the eyeballs outwards by sending nerve impulses to the lateral rectus muscles Sign of Dysfunction: Deviation of the eyes outward; double vision NURS 5315 PATHO Module 7 N5315 Advanced Pathophysiology Neurologic System Core Knowledge Objectives with Advanced Organizers 2 VII Facial (taste, tears, saliva and facial expressions) Function: Mixed: 1. Supplies motor fibers to muscles of facial expression and to the lacrimal and salivary glands. 2. Carries sensory fibers from taste buds of anterior part of tongue Sign of Dysfunction: Paralysis of all the muscles in one side of the face, inability to wrinkle the forehead, close the eye, whistle, deviation of the mouth. Bell’s Palsy VIII Vestibulocochlear (acoustic) auditory Function: Purely sensory; vestibular branch transmits impulses for sense of equilibrium, cochlear branch transmits impulses for sense of hearing Sign of Dysfunction: Deafness or ringing in the ears, dizziness, nausea and vomiting IX Glossopharyngeal (swallowing, saliva, taste) Function: Mixed: 1. Motor fibers serve pharynx and salivary glands. 2. Sensory fibers carry impulses from, pharynx, posterior tongue, and pressure receptor of carotid artery (blood pressure) Sign of Dysfunction: Disturbance of taste; Difficulty in swallowing X Vagus (control of PNS: smooth muscles of GI tract) Function: Sensory and motor impulses for pharynx; a large part of this nerve is parasympathetic motor fibers, which supply smooth muscles of abdominal organs Sign of Dysfunction: Hoarseness and difficulty swallowing and talking. This nerve also regulates the heart, blood vessels and digestion resulting in irregular heartbeat and lowered blood pressure. It regulates the stomach telling it to move food through the digestive system, thus damage can result in decreased digestion and thus nausea, bloating and vomiting. XI Spinal accessory (moving of head and shoulders, swallowing) Function: Provides sensory and motor fibers for sternocleidomastoid and trapezius muscles (movement of head and shoulders) and muscles of soft palate, pharynx, and larynx (swallowing) Sign of Dysfunction: Dropping of the shoulder; inability to rotate the head away from affected area. XII Hypoglossal (tongue muscles, speech and swallowing) Function: Carries motor fibers to muscles of tongue and sensory impulses from tongue to brain. Sign of Dysfunction: Paralysis of one side of the tongue; deviation of tongue toward paralyzed side; thick speech. 3 b. Explain the function of the cerebrum, cerebellum, parietal lobe, frontal lobe, occipital lobe, temporal lobe, brain stem, reticular formation reticular activating system, and limbic system. Cerebrum Location: forebrain Largest part of the bain. Derived from the telencephalon, characterized by numerous convolutions called gyri. Comprised of two hemispheres Contain- cerebral cortex, basal ganglia, epithalamus, thalamus, hypothalamus, subthalamus. Prefrontal lobe- goal-oriented behavior/concentration, short-term memory, elaboration of thought and inhibition on the limbic areas of the CNS. Prefrontal (Brodmann 6) programming motor movements. Basal ganglia system- extrapyramidal system- efferent pathways outside the pyramids of the medulla. Frontal eye fields (lower portion of Brodmann 8) controlling eye movement in the middle frontal gyrus. Function: Divided into numerous smaller areas which are each dedicated to specific areas of function. These areas include frontal lobe, parietal lobe, temporal lobe and occipital lobe Basal ganglia- fine tuning of motor movement. Cerebral cortex has contralateral control of the body. Sign of Injury/Lesion/Disorder: Dependent on location, see below Parkinson’s, Huntington disease- basal ganglia Cerebral cortex has contralateral (opposite side) control of the body. Frontal Location: Anterior portion of the brain encompassing from the frontal part of the skull to the central sulcus of the brain Function: Include prefrontal which is responsible for goal oriented behavior, short term memory, elaboration of thought and inhibition of limbic system. Includes the premotor area which is involved in movements, includes the neurons contributing to the extrapyramidal system or basal ganglia. Frontal lobe also includes primary motor area which forms a somatic organization referred to as a homunculus (little man). Also includes Broca’s area, responsible for speech Sign of Injury/Lesion/Disorder: Damage to the frontal will manifest itself significant to the area of the injury. For example, damage to the Broca area from CVA will cause difficulty in forming words