NURS201 PHYSIOPATHOLOGY

2023-2024 ACADEMIC YEAR, FALL TERM

ASST. PROF. DR. UFUK KAYA

NERVOUS SYSTEM AND RELATED
PROBLEMS
 INTRODUCTION

• The nervous system is a very complex system that works together

with the endocrine system to communicate between different body
parts.

• It controls all organs and plays an important role in maintaining the

functions of systems in a balanced manner.

• The nervous system is responsible for the control of all voluntary and
non-voluntary actions and plays a fundamental role in the
coordination of body organs to maintain homeostasis.
GENERAL FUNCTIONS OF THE
NERVOUS SYSTEM
GENERAL FUNCTIONS OF THE NERVOUS SYSTEM-01

1. Perceiving and interpreting sensory information

2. Making decisions about received sensory information
3. Performing motor function according to the decision made
 GENERAL FUNCTIONS OF THE NERVOUS SYSTEM-02

• Sensory receptors located at the end of peripheral nerves collect

information from the body's internal and external environment. For
example, when you feel pain, sensory receptors collect information.

• All sensory information is collected in the peripheral nervous system and

sent to the central nervous system for interpretation. The individual truly
perceives sensory information when sensory information reaches a part of
the brain called the cerebral cortex.
 GENERAL FUNCTIONS OF THE NERVOUS SYSTEM-03
• The decision-making function occurs in the brain and spinal cord. These
organs receive sensory information and make decisions regarding the
information. For example, if you are experiencing pain, your brain decides
that you need to move away from painful stimuli.

• If the decision is made, the nervous system carries out motor functions.
Motor function is the stimulation of muscles or glands. For example, if your
brain interprets that you touched something hot, it decides that you should
move away from the painful stimulus. Motor function is the stimulation of
skeletal muscles that allows you to move your fingers away from painful
stimuli.
STRUCTURE OF NEURONS
 STRUCTURE OF NEURONS-01

• All kinds of behavior are carried out by the activity of nerve cells called neurons.

• Neurons are the functional cells of the nervous system.

• It transmits electrochemical messages, called nerve impulses, to other neurons and

effectors (muscles or glands).

• The most important feature of neurons is that they have lost their ability to divide.
Therefore, if neurons are lost due to a disease, they do not regenerate.

• Neurons consist of structures called cell body, dendrites and axons.

 STRUCTURE OF NEURONS-02

• Cell Body: It is responsible for the production of proteins and energy

necessary for neurons to perform their functions.

• The structures that expand in the cell body are nerve fibers.

• There are two nerve fibers: axon and dendrites.

 STRUCTURE OF NEURONS-03
• Dendrites: Its function is to receive information from neurons.

• Axons: Its function is to carry information and synthesized substances from

the cell body to other neurons or effective organs.

• Myelin Sheath: It is the structure that surrounds the axons in layers. It

accelerates the transmission of stimuli in the nerve.
 STRUCTURE OF NEURONS-04
• There are 10-50 times as many Glial (support) cells as neurons in the
nervous system. Glial cells (neuroglia) form the support and connective
tissue of the nervous system. The glial cells of peripheral nerves are
Schwann cells.

• Schwann cells surround the axon.

• Glial cells in the central nervous system are oligodendrocytes, astrocytes,

microglia and ependymal cells.
 STRUCTURE OF NEURONS-05
• Neurons are classified according to their functions as sensory neurons and
interneurons or motor neurons.

• Sensory (afferent) neurons carry sensory information from the periphery to

the central nervous system.
 STRUCTURE OF NEURONS-06
• Interneurons are found only in the central nervous system and are
responsible for connecting other neurons together. They are also involved
in the decision-making function of the nervous system. They direct
information directly to motor neurons.

• Motor neurons (efferent) carry information from the central nervous

system to effector organs in the peripheral nervous system. They are
responsible for stimulating the contraction of muscles or the secretion
production of glands.
NEURAL CONDUCTION AND SYNAPSE
 NEURAL CONDUCTION AND SYNAPSE-01

• Neuron cell membranes have cell membrane potential. These membranes

are polarized. Just like a battery, one end is negative and the other end is
positive.

• In most cells in the body, the outer membrane of the cells is positively
charged due to the presence of more positively charged ions, and the
inside of the cell membrane is negatively charged.
 NEURAL CONDUCTION AND SYNAPSE-02

• Potassium and Sodium ions are both positively charged.

• When a neuron is at rest or when there is no stimulation, the outside of

the membrane is positively charged and the inside is negatively charged.
Because total Potassium and Sodium ions are more outside the
membrane.

• As the resting period of the neuron increases, it remains in a polarized

state.
 NEURAL CONDUCTION AND SYNAPSE-03
• A neuron responds to stimuli such as temperature or pressure by changing the
polarization amount of the membrane. For example, it may respond to a stimulus by
making the outer face of the membrane less positive. When this happens, the neuron
depolarizes.

• Some Sodium ions pass into the cell membrane to make the outer surface of the
membrane less positive.

• A nerve impulse (action potential) occurs when the membrane of an axon is sufficiently
depolarized. A nerve impulse is the flow of electricity across the axon membrane.

• Eventually, the axon membrane becomes polarized, with ions outside the cell becoming
positively charged again. Returning to original polarity is called repolarization.
STRUCTURE OF THE NERVOUS
SYSTEM
STRUCTURE OF THE NERVOUS SYSTEM-01
 CENTRAL NERVOUS SYSTEM-01
• Brain (Encephalon): It is the control system of the body and is divided into 4 basic
parts within the skull: cerebrum, cerebellum, diencephalon and brainstem.

Cerebrum: It is located in the uppermost region of the skull. It is divided into right
and left hemispheres. The outermost layer of the cerebral hemispheres is known as the
cortex.
 CENTRAL NERVOUS SYSTEM-02
Cerebrum: The cerebral cortex consists of neuron cell bodies and dendrites and is
gray in color. The part called white matter consists of axons and appears lighter in color.

The cerebrum is divided into 4 lobes: frontal, parietal, temporal and occipital
lobes, each with a special function.
 CENTRAL NERVOUS SYSTEM-03
Lobes and Functions of the Cerebral Hemispheres
Lob Function
Frontal Lobe Conscious thought, abstract
thinking, memory, judgment,
initiation of motor activity
Parietal Lobe Sensory function, touch, vibration
Temporal Lobe Receiving auditory information,
memory, learning and emotional
behavior
Occipital Lobe Visual images, noticing,
interpreting, storing memories
 CENTRAL NERVOUS SYSTEM-04
Cerebrum: The part most involved in voluntary movements is called the motor
cortex. The motor cortex controls voluntary activities and is the final decision-making
center regarding movement.

• The right part of our body is reflected in the left brain hemisphere, and the left part is
reflected in the brain hemisphere.

• Cerebrospinal fluid protects and nourishes the brain.

 CENTRAL NERVOUS SYSTEM-05

Cerebellum: It is the second largest part of the human brain. It plays a role in
balance, posture, fine movements and coordination.

• Damage to one hemisphere of the cerebellum causes lack of coordination, unsteady

gait (ataxia), and tremor on the same body side as the lesion, without accompanying
loss of strength or sensation.

• Problems such as unbalanced walking, lack of coordination in both arms, intention

tremor, nystagmus and slowing of speech occur due to widespread damage to the
cerebellar hemispheres.
 CENTRAL NERVOUS SYSTEM-06
Diencephalon: Located between the brainstem and cerebrum.

• The diencephalon consists of the thalamus, hypothalamus, epithalamus and

subthalamus.

• The thalamus receives sensory information from the periphery and transmits it to the
cerebral cortex. It also transmits the information from the cortex to the spinal cord
and other parts of the brain.

• The thalamus also plays an important role in the recognition of pain and the limbic
system, which controls instinctual and emotional impulses such as hunger, fear, sexual
drive and short-term memory.
 CENTRAL NERVOUS SYSTEM-07

Diencephalon: The epithalamus is made of gray matter. Here is the pineal gland,
which secretes the hormone melatonin.

• The subthalamus regulates motor activity.

• The hypothalamus is the main connection point between the endocrine and nervous
systems, which has many roles in ensuring homeostasis, and is also the body's
thermostat. It also controls the pituitary gland. It plays a role in regulating emotions,
hunger and thirst.
 CENTRAL NERVOUS SYSTEM-08
Brainstem: Connects the spinal cord and other parts of the brain and carries out
sensory, motor and reflex functions.

• The brainstem consists of structures such as mesencephalon, pons, medulla oblangata,

and reticular formation.

• The midbrain or mesencephalon is the center of hearing and visual reflexes. It plays a
role in controlling the brain's alertness.

• There are reflex centers in the Medulla Oblongata that control blood vessel diameter,
heart rate, breathing, coughing, swallowing, nausea and sneezing.

• The reticular formation is important in consciousness, wakefulness and the sleep-wake

cycle.
 CENTRAL NERVOUS SYSTEM-09

• Spinal Cord: It is the communication pathway between the brain and

other parts of the body that are not supported by cranial nerves.

• It consists of 31 pairs of spinal nerves, including 8 cervical, 12 thoracic, 5

lumbar, 5 sacral and 1 coccygeal, depending on their location in the
vertebral column.

• Nerves leaving the cervical region innervate the upper extremities, and
nerves leaving the lumbosacral region innervate the lower extremities.
 CENTRAL NERVOUS SYSTEM-10
• Meninges: These are the membranes that protect the brain and spinal
cord and consist of three layers from outside to inside: dura mater (thick
layer), arachnoid mater (like a spider web) and pia mater (thin layer).

• The space between the dura mater and the skull bones is called the
epidural space. The space between the dura mater and the arachnoid is
called the subdural space.

• The space between the arachnoid and pia mater is called the
subarachnoid space. Cerebrospinal fluid circulates in the subarachnoid
space.
CEREBRAL METABOLISM
 CEREBRAL METABOLISM-01
• Energy Source:
• The brain's energy source is only glucose, and since the brain does not have the ability
to store energy, it requires a constant supply of ATP to maintain the necessary ion
balance in the cells.

• If there is sufficient oxygen supply in the brain, glucose is broken down by aerobic
metabolism and 36 ATP is obtained in this way.

• In cases where oxygen is insufficient, 2 ATP and lactate are released from glucose
broken down by anaerobic metabolism.

• The resulting lactic acid accumulates both inside and outside the cell, creating an acid
environment. In an acidic environment, mitochondria's ability to remove calcium is
insufficient and the amount of calcium increases, resulting in a toxic effect.
 CEREBRAL METABOLISM-02

• Cerebral Blood Flow: The brain uses approximately 15% of the blood circulating in the
body (750 ml per minute).

• Autoregulation: Brain arterioles have the ability to keep cerebral blood flow constant
by vasoconstriction when systemic blood pressure increases and vasodilatation when
it decreases within certain mean arterial pressure limits.

• Autoregulation changes occur depending on the degree of ischemia.

• As age progresses, autoregulation becomes less effective and therefore symptoms of

cerebral ischemia are more common in older people.
 CEREBRAL METABOLISM-03

• Autoregulation:
• PaCO2: An increase in arterial PaCO2 is a possible stimulus for increased cerebral blood
flow. Due to this increase, cerebral arterial vasodilation occurs. The decrease in
arterial PaCO2 causes cerebral blood flow to decrease.

• PaO2: PaO2 affects cerebral blood flow in the opposite direction of PaCO2. If lateral
PaO2 increases, cerebral blood flow decreases; if PaO2 decreases, cerebral blood flow
increases.

• pH: A decrease in pH increases cerebral blood flow.

PERIPHERAL NERVOUS SYSTEM
PERIPHERAL NERVOUS SYSTEM-01
 PERIPHERAL NERVOUS SYSTEM-02

• The peripheral nervous system consists of cranial and spinal nerves.

• There are 12 cranial nerves in total.

• Spinal nerves are 31 pairs.

PERIPHERAL NERVOUS SYSTEM-03
PERIPHERAL NERVOUS SYSTEM-04
 PERIPHERAL NERVOUS SYSTEM-05
Somatic Nervous System:
• It has a fundamental role in the contraction of skeletal muscles and
regulation of voluntary activities.
 PERIPHERAL NERVOUS SYSTEM-06
Autonomic Nervous System:
• It plays a fundamental role in maintaining homeostasis by regulating the body's
automatic and involuntary functions.

• Its structure is unique and is divided into two parts: the sympathetic part and the
parasympathetic part.

• The sympathetic department controls many internal organs when stressful

situations occur.

• The parasympathetic department uses acetylcholine to control all internal

responses associated with a state of relaxation and therefore has an opposing effect
on the body to the sympathetic nervous system.
NERVOUS SYSTEM DISEASES
 INCREASED INTRACRANIAL PRESSURE

• It is the pressure within the skull caused by 3 intracranial components such as brain
tissue, cerebrospinal fluid and blood.

• Space-occupying lesions such as bleeding in the brain tissue due to head injury, brain
tumor, infection, and brain abscess also cause an increase in intracranial pressure.

• Increased intracranial pressure is defined as sustained pressure above 15 mmHg

measured from the lateral ventricles (normal value 5-10 mmHg).

• If increased intracranial pressure is not treated, perfusion is impaired and herniation

or shifts in the brain tissue develop.
 STROKE-01
• It develops as a result of impaired blood flow due to vascular occlusion or
hemorrhage from a ruptured vessel.

• Interruption of blood supply to the brain tissue will result in ischemia, or if ischemia
is prolonged, death of brain cells will occur.

• With stroke, cerebral hypoxia and neuronal cell death develop in patients, resulting
in damage to the brain tissue.

• With the formation of acidosis as a result of hypoxia, ion channels are activated and
ultimately contribute to brain damage.

• 24-72 hours after stroke, neuronal cell death reaches its highest level and brain
damage occurs.
 STROKE-02
• It is seen in two types: ischemic and hemorrhagic.

• Ischemic Stroke: It accounts for 85% of all strokes. If a brain artery is

blocked by a blood clot, blood flow in brain cells is impaired.
Arteriosclerosis, which occurs in the artery wall due to high levels of
cholesterol, is the most important cause of this type of stroke.

• Hemorrhagic Stroke: It develops as a result of rupture of a blood vessel.

This type of stroke occurs when hypertension cannot be controlled in the
long term. The condition that causes death in this type of stroke is
increased intracranial pressure.
 PARKINSON

• It usually affects older individuals and progresses over time.

• This disorder is caused by the loss of cells that produce dopamine, which is involved
in the control of muscles.

• Its symptoms are seen directly as a result of the decrease in dopamine.

• Dopamine level is also closely linked to the level of other chemicals in the brain, such
as acetylcholine.
 ALZHEIMER-01
• The incidence rate in people over the age of 85 is 47%.

• This disease is a progressive swelling that causes brain cell death. This loss mainly
occurs in cerebral damage and causes atrophy in the brain.

• Deficiency of acetylcholine, which plays a role in memory and learning, causes

forgetfulness and impairment of systematic functions in individuals with Alzheimer's
disease.

• There is a gradual decrease in mental competence, systematic state, thinking,

judgment ability, spatial perception and language skills, planning and execution of
known tasks, personality and sensory status.
 ALZHEIMER-02

• Although its content is still unknown, the disease causes changes in the brain
structure, especially in plaques and spindles.

• The disease causes changes in acetylcholine formation, neural electrical outage,

brain memory and flexibility in all technological functions.

• As a result, the patient manifests itself with memory loss, decreased reasoning
ability, disorientation, confusion, personality changes leading to mood changes, and
sometimes violent outbursts.
 MULTIPLE SCLEROSIS-01

• MS is an autoimmune disease that affects the central nervous system, resulting in

damage to the myelin sheath and causing localized areas of inflammation called
plaques.

• The exact cause is unknown and this condition cannot be treated.

• There are 4 types. 1) relapse remiting (the most common type), 2) primary
progressive, 3) secondary progressive, 4) progressive-relapsing.
 MULTIPLE SCLEROSIS-02

• MS primarily causes deterioration in the myelin sheath surrounding axons,

preventing the normal conduction of nerve impulses.

• MS symptoms are observed because myelin sheath and axon destruction causes
temporary or permanent interruption in nerve conduction.

• Astrocytes alter axon functions and the resulting lesions and scar tissue forms,
causing permanent disability.
THANK
YOU!