Summary McTimoney College of Chiropractic - Neuroscience
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Course
McTimoney - Neuroscience
Institution
University Of Ulster
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Neuroscience (NS) - Written Exam
Table of contents
1 – Introduction to Neuroscience 4
1.1 Relation to chiropractic 4
1.2 NS in a nutshell 4
1.3 Other communication systems 5
2 – Meninges & Cerebrospinal Fluid 6
2.1 The brain 6
2.2 Meninges 6
2.2.1 Dura mater 7
2.2.2 Arachnoid Mater 7
2.2.3 Pia mater 7
2.2.4 Intracranial haemorrhage 8
2.2.5 Spinal cord 8
2.2.6 Clinical connection 9
2.3 Cerebrospinal fluid (CSF) 9
2.3.1 CSF production 9
2.3.2 Clinical connection 10
3 – Cerebral Cortex 11
3.1 Anatomical divisions 11
3.2 Cerebral cortex 12
3.2.1 Cerebral hemispheres 12
3.2.2 Cytoarchitecture 12
3.2.3 Clinical connection 13
3.2.4 Lobes 13
3.2.5 Gender differences 14
4 – Diencephalon & Limbic System 15
4.1 Thalamus 15
4.1.1 Nuclei 16
4.1.2 Clinical connection 16
4.2 Hypothalamus & pituitary glands 16
4.2.1 Hypophyseal portal system 17
4.3 Pineal gland 18
4.4 Limbic system 18
4.4.1 Amygdala 18
4.4.2 Cingulate cortex 19
4.4.3 Hippocampus 19
5 – Brainstem 20
5.1 Midbrain (Mesencephalon) 21
5.2 Pons 21
5.3 Medulla oblongata 21
5.4 Reticular formation 21
5.4.1 Clinical connection 22
6 – Cellular Neuroscience 23
6.1 Glial cells 23
6.1.1 Astrocytes 23
6.1.2 Ependymal cells 23
6.1.3 Microglia 24
Page 1 of 80
, 6.1.4 Oligodendrocytes & Schwann cells 24
6.2 Blood-brain barrier (BBB) 24
6.3 Neurons 25
6.3.1 Structure specialisations/adaptations 26
6.3.2 Neuron signalling 26
6.3.3 Neuron types 27
7 – Electrophysiology 28
7.1 Recording electrical activity 28
7.2 Resting membrane potential 28
7.2.1 Maintenance 29
7.3 Action potential (AP) / Impulse / Electrical Signal 29
7.3.1 AP propagation 30
7.3.2 AP properties 30
7.3.3 Clinical connection 31
8 – Neurotransmission 32
8.1 Neurotransmission 32
8.2 Neurotransmitters (NT) 32
8.2.1 NT receptors 33
8.3 Postsynaptic processes 33
8.3.1 Summation 34
8.4 Plasticity 35
8.5 Neuromuscular Junction (NMJ) 35
12 – Sensory inputs to spinal cord 36
12.1 Basic spinal neuroanatomy 36
12.1.1 Transverse structures 37
12.1.2 Review questions 38
12.2 Peripheral nerves 38
12.3 Sensory inputs 40
12.4 Proprioception & Kinaesthesia 40
12.4.1 Muscle spindles 40
12.4.2 Golgi tendon organs 42
12.4.3 Clinical connection 42
13 – Ascending somatosensory tracts 43
13.1 Dorsal Column Medial Lemniscus (DCML) 43
13.1.1 Lower body drawing example 45
13.1.2 Upper body drawing example 46
13.1.3 DCML Testing & Lesions 47
13.2 Lateral Spinothalamic Tract (LST) 47
13.2.1 Drawing example 49
13.2.2 LST Testing & Lesions 49
13.3 DCML vs. SLT 50
13.4 Primary somatosensory cortex (S1) 50
13.4.1 Posterior Parietal Cortex (PPC) 51
13.5 Spinocerebellar Tract (SCT) 51
14 – Pain Physiology 52
14.1 Pain 52
14.2 Pain receptors 52
14.2.1 Nociceptors 52
14.2.2 Sensory receptors 53
14.3 Pain theories 53
14.4 Clinical pain subtypes 55
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, 14.5 Pain modulation & facilitation 55
14.6 Visceral pain 56
15 – Motor control: spinal cord outputs 57
15.1 Voluntary movements 57
15.2 Hierarchical motor system organisation 57
15.2.1 Motor neurons 58
15.2.2 Motor unit 58
15.3 Reflexes & involuntary movement 59
15.3.1 Spinal reflexes 59
15.3.2 Reflex problems 60
15.3.3 Functional application of reflexes 61
15.4 Muscle tone 61
16 – Motor control: descending tracts 62
16.1 Motor cortical areas 62
16.1.1 Clinical connection 62
16.2 Descending motor tracts 63
16.2.1 Lateral Corticospinal Tract (LCST) 63
16.2.2 Motor neuron lesions 65
20 – Blood supply of CNS 66
20.1 Blood supply systems 66
20.2 Posterior circulation 68
20.2.1 Vertebrobasilar insufficiency (VBI) 68
20.2.2 PICA occlusion 68
20.2.3 AICA occlusion 68
20.2.4 Lesion to other posterior circulation arteries 69
20.3 Anterior circulation 69
20.3.1 Anterior cerebral artery (ACA) 70
20.3.2 Middle cerebral artery (MCA) 70
20.4 Circle of Willis 71
20.5 Spinal cord blood supply system 71
20.6 Venous outflow 72
20.7 Clinical connections & red flags 72
20.8 Stroke risk factors 73
21 – Functional anatomy of the brain & neurological impairment 74
21.1 Dysfunction of lobes 74
21.2 Disorders of memory 75
21.3 Language deficits 76
21.3.1 Dysphasia 76
21.3.2 Dysarthria 76
22 – Nerve injury 77
22.1 Nervous system injury 77
22.2 Nerve injury grading scales 77
22.3 Nerve repair 79
22.3.1 Axotomy 79
22.3.2 PNS regeneration 79
22.3.3 CNS regeneration 80
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,1 – Introduction to Neuroscience
The nervous system (NS) enables the following (with examples without that function):
● Perception of environment
o Prosopagnosia (face blindness)
o Post-stroke neglect (1 side blindness with stroke in 1 side of parietal lobe)
● Involuntary function
o Ondine's curse (sleep-associated hypoventilation)
● Voluntary function
o Parkinson’s (shaking & balance/coordination problems)
o Huntington’s (movement & cognitive problems)
● Alert & responsive interactions
o Alzheimer’s (memory & thinking problems)
o Schizophrenia (psychosis episodes – what is real?)
● Emotional response to world
o Autism (social interaction & communication problems + repetitive behaviour)
o Depression (mood problems)
o PTSD (trauma)
● Makes you who you are
1.1 Relation to chiropractic
Neuroscience is relevant to chiropractic:
● Safety & risk assessment ➔ multiple causes for pain symptoms possible
● Diagnosis & management ➔ Treat/co-manage/refer? Urgent or not? What treatment, what
area to work on?
● Prognosis ➔ How many treatments? Effective? Progression?
Known effects of chiropractic on NS:
● Direct nerve impact
● Pain gating ➔ reduction of pain perception through reducing brain’s attention to
nociception by stimulation soft tough & proprioception
● Golgi tendon activation ➔ muscle relaxation & reduced pain through stimulation of stretch
receptors
Possible effects of chiropractic on NS (from limited studies):
● Increased proprioception in muscles relating to adjusted spinal segment
● Increased strength in muscle relating to adjusted spinal segment
● Positively alter CNS pain perception
● Parasympathetic effects (reduced BP)
1.2 NS in a nutshell
Divisions:
● CNS = brain & spinal cord ➔ nuclei = neuron cell body clusters
● PNS = 12 cranial & 31 spinal nerve pairs ➔ ganglia = neuron cell body clusters
o Sensory afferent = receptor detects stimuli (external/internal/nociceptive)
o Motor efferent = brain contracts muscle (skeletal/cardiac/smooth) or glands
▪ Autonomic glands to viscera
⮚ Sympathetic = fight or flight
⮚ Parasympathetic = rest and digest
▪ Somatic skeletal muscle
Page 4 of 80
,Info in NS flows bi-directionally:
● Input (senses) to brain ➔ bottom-up system = afferent
● Output (cerebral cortex) from brain to effector ➔ top-down system = efferent
Behaviour is a response to stimuli ➔ 3 divisions control & coordinate: sensory, motor, integration
(cognitive):
Neurons are organised into local circuits to form modules that perform specific tasks. Local circuits
perform calculations from received info and send results to other circuits via projection neurons ➔
leads to excitation or inhibition. Multiple circuits form a cytoarchitecture (= structural network) in
distinct brain regions to achieve a purpose. Brain regions are distinguished by neuron density &
interconnection patterns and connect with each other to form a functional region.
Functional CNS system:
● Project in orderly sequence ➔ same determined route = topography
● Hierarchical organisation
● Are connected:
o Association fibres = interconnect areas of cortex within 1 hemisphere
▪ Arcuate fasciculus connects major language centres (thought & action)
o Commissural fibres = interconnects areas of cortex to same area in opposite cortex
▪ Corpus callosum connects parietal & frontal lobes together for
communication
Integrative function within CNS is neither sensory nor motor ➔ cognitive function (recognition,
learning, behaviour selection) = give meaning to sensory input.
1.3 Other communication systems
Endocrine & immune systems work together with NS to maintain homeostasis.
Nervous communication Hormonal communication
Transmission Along nerve fibres Bloodstream
Signal Electrical + chemical Chemical
Speed Fast (<130m/s) Slow (s/min)
Effect Localised Widespread
Duration Usually short (ms) Usually sustained (min/wks)
The NS also works together with the enteric NS within the gut.
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, 2 – Meninges & Cerebrospinal Fluid
⇨ Anatomical features of the meninges of brain & spinal cord
⇨ Meninges functions
⇨ Functions & flow of CSF
⇨ Draw & discuss ventricles
2.1 The brain
Everything above foramen magnum = brain.
Everything between foramen magnum & 1st/2nd Lx = spinal cord.
All body activities are designed to protect or facilitate the brain:
● Facilitate ➔ 2% of total body weight (largest organ) & 16-20% of blood supply
● Protect ➔ rigid bony case that forms around brain = skull
o 2 bone layers with air cells inside (less weight)
o Round shape for object deflection
● Brain death = clinical death = when the brain stem is no longer able to activate the
respiratory & cardiovascular centres
Frontal brain & head view:
Galea aponeurotica = a tough layer of dense fibrous tissue that covers upper part of cranium to
connect muscles.
2.2 Meninges
● Dura mater = tough layer for support
● Arachnoid mater = spider/network layer with subarachnoid space for CSF & blood flow
● Pia mater = delicate layer that covers CNS
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