Crash Course Nervous System

285 Pages·2012·11.272 MB·English

by  Jenny Ross, Daniel Horton-Szar, Colin Smith

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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ThisbookandtheindividualcontributionscontainedinitareprotectedundercopyrightbythePublisher
(otherthanasmaybenotedherein).
Firstedition1998
Secondedition2003
Thirdedition2007
FourthEdition2012
ISBN9780723436249
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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
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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