Crash Course Nervous System PDF
Preview Crash Course Nervous System
Nervous System First and second edition authors: Daniel Lasserson Carolyn Gabriel Basil Sharrack Charlie Briar Third edition authors: Mark Hughes Thomas Miller 4 th Edition CRASH COURSE SERIES EDITOR Dan Horton-Szar BSc(Hons), MBBS(Hons), MRCGP, NorthgateMedicalPractice, Canterbury, Kent, UK FACULTY ADVISOR Colin Smith MD FRCPath, Department of pathology, University of Edinburgh, Edinburgh, UK Nervous System Jenny Ross BA(Hons) Medical Student, University of Edinburgh, Edinburgh, UK Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012 CommissioningEditor:JeremyBowes DevelopmentEditor:EwanHalley ProjectManager:AndrewRiley Designer/DesignDirection:StewartLarking IllustrationManager:JenniferRose IconIllustrations:GeoParker ©2012ElsevierLtd.Allrightsreserved. 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Firstedition1998 Secondedition2003 Thirdedition2007 FourthEdition2012 ISBN9780723436249 BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressCataloginginPublicationData AcatalogrecordforthisbookisavailablefromtheLibraryofCongress Notices Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperience broadenourunderstanding,changesinresearchmethods,professionalpractices,ormedicaltreatment maybecomenecessary. Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluating andusinganyinformation,methods,compounds,orexperimentsdescribedherein.Inusingsuch informationormethodstheyshouldbemindfuloftheirownsafetyandthesafetyofothers,including partiesforwhomtheyhaveaprofessionalresponsibility. Withrespecttoanydrugorpharmaceuticalproductsidentified,readersareadvisedtocheckthemost currentinformationprovided(i)onproceduresfeaturedor(ii)bythemanufacturerofeachproductto beadministered,toverifytherecommendeddoseorformula,themethodanddurationof administration,andcontraindications.Itistheresponsibilityofpractitioners,relyingontheirown experienceandknowledgeoftheirpatients,tomakediagnoses,todeterminedosagesandthebest treatmentforeachindividualpatient,andtotakeallappropriatesafetyprecautions. Tothefullestextentofthelaw,neitherthePublishernortheauthors,contributors,oreditors,assume anyliabilityforanyinjuryand/ordamagetopersonsorpropertyasamatterofproductsliability,negligence orotherwise,orfromanyuseoroperationofanymethods,products,instructions,orideascontainedin thematerialherein. The Publisher's policy is to use paper manufactured from sustainable forests PrintedinChina Series editor foreword TheCrashCourseseriesfirstpublishedin1997andnow,15yearson,wearestill goingstrong.Medicineneverstandsstill,andtheworkofkeepingthisseries relevantfortoday’sstudentsisanongoingprocess.Thesefourtheditionsbuildon thesuccessoftheprevioustitlesandincorporatenewandrevisedmaterial,tokeep theseriesup-to-datewithcurrentguidelinesforbestpractice,andrecent developmentsinmedicalresearchandpharmacology. Wealwayslistentofeedbackfromourreaders,throughfocusgroupsandstudent reviewsoftheCrashCoursetitles.Forthefourtheditionswehavecompletelyre- writtenourself-assessmentmaterialtokeepupwithtoday’s‘single-bestanswer’ and‘extendedmatchingquestion’formats.Theartworkandlayoutofthetitleshas alsobeenlargelyre-workedtomakeiteasierontheeyeduringlongsessionsof revision. Despitefullyrevisingthebookswitheachedition,weholdfasttotheprincipleson whichwefirstdevelopedtheseries.CrashCoursewillalwaysbringyouallthe informationyouneedtoreviseincompact,manageablevolumesthatintegrate basicmedicalscienceandclinicalpractice.Thebooksstillmaintainthebalance betweenclarityandconciseness,andprovidesufficientdepthforthoseaimingat distinction.Theauthorsaremedicalstudentsandjuniordoctorswhohaverecent experienceoftheexamsyouarenowfacing,andtheaccuracyofthematerialis checkedbyateamoffacultyadvisorsfromacrosstheUK. Iwishyouallthebestforyourfuturecareers! DrDanHorton-Szar v Prefaces Author Thenervoussystemisoneofourbody’smostfascinatingorgansystems.However, thevastliteratureandseeminglycomplexconceptssurroundingthesubjectcanbe anintimidatingprospectformedicalstudents.Thistextbookhasbeenwritten specificallywithmedicalstudentsinmindandaimstopresentthenervoussystemin awaythatisaccessibleandrelevanttoundergraduates.Notonlyistheinformation morethanenoughtopassyourundergraduateexams,moreimportantlyitwill provideastrongfoundationinthebasicneurosciencesthatwillproveinvaluablein yourstudyoftheclinicalneurosciences. Iwishyouthebestofluckwithyourexams! Jenny Ross Faculty advisor Sincemyundergraduatemedicaltrainingtwodecadesago,thecurriculumhas changedgreatly.Onthenegativesideformalcoursescoveringneuroanatomy, neurophysiologyandneuropharmacologyhavedisappeared.Onthepositiveside theyhavebeenreplacedbymoreintegratedcourseswithgreateremphasison clinicalrelevance.Thisbookisalignedwiththeethosofintegration.Inonesingle volumethereaderisprovidedwithaclinicallyrelevantintroductionto neuroanatomy,neurophysiology,neuropathologyandneuropharmacology.In additionthereisasectioncoveringneuropsychology,animportantanddeveloping areaofclinicalneuroscience.Akeyelementinthesuccessofthebookisthesection aroundclinicalexaminationofthenervoussystem,buildingonthebasic neurosciencediscussedintheprecedingchapters. Havethepreviouseditionsbeensuccessful?Thelevelofsalesandthefeedback fromstudentswouldsuggestthebookisfillinganimportantslotinthecrowded marketplaceofclinicalneurosciencetextbooks.Animportantpartofthesuccessof the“CrashCourse”booksisthattheyarewrittenbystudentsforstudents,andthat witheveryneweditioncomesanewauthorwiththeabilitytocriticallyevaluatethe previousedition.ThethirdeditionwaswrittenbyTomMillerandMarkHughes, andbothhavenowgraduatedandaredevelopingsuccessfulcareersinclinical neuroscience.ThefourtheditionhasbeenrevisedbyJennyRoss,aseniormedical student.Thelayoutofthebookhasbeenmodifiedandtheselfassessmentsection expanded.However,Jennyhasretainedtheethosofthepreviouseditionandhas mademyjobasfacultyadvisorofthiseditionstraightforward.Iamdelightedwith theendresult. vi Prefaces Clinicalneuroscienceremainsanexcitingandrewardingcareerchoice.Studyofthe nervoussystemcaninitiallybedauntingbutforthosewhotakealittletimeto familiarizethemselveswiththebasicprinciplestherewardscanbegreat.Clinical neurosciencesimpactonallaspectsofmedicalcareandpatientswithneurological problemsarecommonanddeserveatleastabasicstandardofcarefromalldoctors theyencounter.Ihopethisbookwillencouragestudentstoachieveafundamental understandingofthenervoussystemandthat,forasmallnumber,willbethefirst steptowardsamoredetailedknowledgeandthebeginningsofalongandfulfilling careerinvestigatingandtreatingdisordersofthenervoussystem. Colin Smith vii Acknowledgements FIGURE CREDITS Fig. 1.1 with permission from AR Crossman and D Neary. Neuroanatomy, 3e. Churchill Livingstone, Elsevier Ltd,2005 Figs 4.2, 4.10, 4.12 and 6.21 adapted with permission from AR Crossman and D Neary. Neuroanatomy, 4e. ChurchillLivingstone,ElsevierLtd,2010 Fig.8.1adaptedwithpermissionfromCPage,MCurtis,MSutteretal.IntegratedPharmacology.Mosby,Elsevier Ltd1997 Figs 9.1 and 9.3 adapted with permission from A Stevens and J Lowe. Human Histology, 2e. Mosby, Elsevier Ltd1997 Fig.12.1adaptedwithpermissionfromRBarker,SBaresi,MNeal.NeuroscienceataGlance,2e.Wiley-Blackwell Publishers,2003 Fig.14.3adaptedwithpermissionfromKLindsay,NeurologyandNeurosurgery,5e.ChurchillLivingstone,Elsevier Ltd,2011 Figs 17.4, 17.8, 17.19, 17.23 and 17.24 adapted with permission from O Epstein, D Perkin, D de Bono, et al. ClinicalExamination,3e.Mosby,ElsevierLtd,1997 Figs 17.51, 17.52, 17.59 reproduced with permission from J Weir and P Abrahams. Imaging Atlas of Human Anatomy,2e.Mosby,ElsevierLtd,1997 viii Contents Serieseditorforeword . . . . . . . . . . . . . . . v 5. Somatosensationandtheperceptionof pain. . . . . . . . . . . . . . . . . . . 63 Prefaces . . . . . . . . . . . . . . . . . . . . . . vi Acknowledgements. . . . . . . . . . . . . . . . viii Sensation . . . . . . . . . . . . . . . . 63 Receptors . . . . . . . . . . . . . . . . 63 1. Introductionandoverviewofthenervous Higherpathwaysofsomatosensationand system . . . . . . . . . . . . . . . . . . 1 thesensorycortex . . . . . . . . . . . 64 Introduction. . . . . . . . . . . . . . . . 1 Theregulationofpain . . . . . . . . . . 66 Coveringsofthecentralnervoussystem. . . 1 Analgesia . . . . . . . . . . . . . . . . 67 Theskull . . . . . . . . . . . . . . . . . 2 Chronicpain. . . . . . . . . . . . . . . 71 Meninges . . . . . . . . . . . . . . . . . 3 Psychologicalaspectsofpain . . . . . . . 71 Thecerebralhemispheresandcerebral 6. Motorcontrol . . . . . . . . . . . . . . 73 cortex . . . . . . . . . . . . . . . . . . 4 Movementcontrol. . . . . . . . . . . . 73 Corticaldamage . . . . . . . . . . . . . . 8 Responsesofmotorunitsindamageand Thebloodsupplytothecentralnervous disease. . . . . . . . . . . . . . . . . 75 system. . . . . . . . . . . . . . . . . . 9 Pathologyofmotorunits. . . . . . . . . 80 Cerebrovasculardisease . . . . . . . . . 11 Motorprogrammesandvoluntary Theventricularsystemandcerebrospinal movement . . . . . . . . . . . . . . . 83 fluid . . . . . . . . . . . . . . . . . . 14 Hierarchyofmovementcontrol. . . . . . 84 Supportivecells . . . . . . . . . . . . . 17 Thebasalgangliaandthalamus. . . . . . 85 Theblood–brainbarrier. . . . . . . . . . 18 Thecerebellum . . . . . . . . . . . . . 88 Metabolicrequirementsofthecentral Controloflocomotion . . . . . . . . . . 90 nervoussystem. . . . . . . . . . . . . 19 Clinicalaspectsofthemotorcontrol 2. Thedevelopmentofthenervoussystem system. . . . . . . . . . . . . . . . . 91 anddisordersofdevelopment . . . . . . 21 Thevestibularsystem,postureand Thedevelopmentofthenervoussystem. . 21 locomotion. . . . . . . . . . . . . . . 93 Malformations,developmentaldiseaseand 7. Theautonomicnervoussystem. . . . . . 99 perinatalinjury . . . . . . . . . . . . . 27 Introduction. . . . . . . . . . . . . . . 99 3. Cellularphysiologyofthenervoussystem Structureandfunctionofthesympathetic andintroductiontopharmacology . . . . 31 nervoussystem. . . . . . . . . . . . .100 Neuronalstructureandfunction. . . . . . 31 Structureandfunctionofthe parasympatheticnervoussystem. . . . .102 Neuronalexcitationandinhibition. . . . . 33 Theentericnervoussystem. . . . . . . .104 Synaptictransmission. . . . . . . . . . . 37 Disordersoftheautonomicnervous Introductiontopharmacologyofthenervous system. . . . . . . . . . . . . . . . .104 system. . . . . . . . . . . . . . . . . 44 8. Vision. . . . . . . . . . . . . . . . . .107 4. Thespinalcordandperipheralnerves. . . 47 Theeye . . . . . . . . . . . . . . . . .107 Thespinalcord . . . . . . . . . . . . . 47 Centralvisualpathwaysandthevisual Thespinaltracts . . . . . . . . . . . . . 47 cortex . . . . . . . . . . . . . . . . .114 ix
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