functional division of the peripheral nervous system that innervates smooth muscle, cardiac muscle, and glands

includes both sensory and motor fibers

includes sympathetic and parasympathetic nervous system

hypothalamus

dorsal longitudinal fasciculus

indirectly

two neuron chain

ANS: 2 neuron chain

Neuron 1:

Neuron 2:

1) preganglionic neuron, has it's cell body in the CNS (brain stem or spinal cord) the axon terminates on the cell body of neuron 2

2)postganglionic neuron, has it's cell body outside of the CNS, the axon terminates on the target organ

Sympathetic System

Preganglionic neurons are located _____ - also referred to as the ______.

thoracic and upper 2 lumbar segments

intermediolateral cell column

SNS:

preganglionic axons exit the spinal cord in ______; they travel from the spinal nerves to the ____ via the _____.

thoracic and lumbar nerves

sympathetic chain

white rami communicantes

SNS:

Some preganglionic axons synapes in ____ and others pass through to reach ______.

sympathetic chain

postganglionic cells in other ganglia

SNS:

Axons from sympathetic chain exit the ganglia and rejoin the _____ via the ____.

spinal nerves

grey rami communicantes

sympathetic chain

prevertebral ganglia (celiac, superior mesenteric, inferior mesenteric)

adrenal medulla

short

long

acetylcholine

norepinephrine

HR increase

BP increase

dilation of coronary arteries

dilation of bronchioles

dilation of pupils

Peristalsis decrease

shunting of blood away from gut toward skeletal m.

Parasympathetic Nervous System:

preganglionic neurons are located -

cranial nerve nuclei III, VII, IX, X (most parasympathetic control is from this)

sacral segments 2-4 (control of lower bowel, bladder, and genetalia)

PNS:

postganglionic neurons are located in ____ that are _____

ganglia

within or very close to the target organs

PNS:
Preganglionic fibers are generally _____

Neurotransmitters are:

long

acetylcholine for preganglionic and postganglionic

decreased cardiac output

decreased blood pressure

increased peristalsis

contraction of the bladder

pupillary constriction

- more discrete than ANS (does not have an overall parasymp. affect, can be more localized)

with spinal cord injury above T6 (SC level)

Autonomic Dysreflexia-

Mechanism:

visceral stimuli along sympathetic afferents (pain, pressure, ect.)

exaggerated response to afferent input at spinal level due to absence of hypothalamic control of ANS

leads to increased sympathetic efferent output

severe headache

dramatic increase in BP
pallor below lesion, flushing above

profuse diaphoresis

blurred vision

regional pain disorder, disproportionate to any precipitating event

pain

autonomic abnormalities

motor symptoms

trophic (skin, hair, and nail) changes

formerly known as Reflex Sympathetic Dystrophy

patients develop the syndrom following an initial painful event that may or may not have been traumatic (sprain, strain, etc)

formerly causalgia

precipitating event includes injury to a major peripheral nerve

Diagnosis of CRPS-

Criteria

• preceding noxious even (with our without obvious nerve lesion)
• spontaneous pain, not limited to a single nerve teretorry and disproportionate to the event
• edema, skin blood flow or sudomotor abnormalities, motor symptoms, trophic changes
• exclusion of other diagnoses

burning pain (most common)

pain is beyond area of initial injury

increased pain when limb is dependent

may involve entire limb sometimes contralateral limb

disproportionately increased pain response to mildly noxious stimulus

weakness (typically from disuse)

impaired fine motor skills

Tremor in about 1/2 patients

EMG and NCV are normal

abnormal nail growth

increased or decreased hair growth

contractures

skin atrophy  (later)

CRPS:

Appears to have some ___ component. Some patients have sympathetically maintained pain (SMP) that can be aleviated by ____. There is a possibility that the cortex is reorganized in response to ____.

SNS

Sympathetic block

altered sensory inputs

desensitize the extremity

increase ROM

increase pain free function

restore strength

trauma

vascular disease

tumor

disease

other (infection, metabolic, etc.)

males

those between agess 16 and 45

C4-C6

T11-L1

vertebrae have more mobility in these areas

A- complete (no motor or sensory in S4/S5)

B- sensory, but no motor below lesion

C- incomplete, mmt <3

D- incomplete mmt >3

E- normal

loss of pain/temp (anterolateral system)

loss of voluntary motor activity (primarily corticospinal)

incontenance is common

typically proprioceptioin and discriminative touch are preserved (posterior columns)

motor and sensory loss primarily in UE (due to somatotopic organization)

not necessarily bilateral

people with congenitally narrow spinal canals

elderly with narrowing of the spinal canal secondary to osteoarthrits

loss of voluntary motor control, proprioception and discriminative touch ipsilaterally below the lesion

loss of pain and temperature sensation contralaterally below the lesion

flaccid paralysis of lower limb muscles, bowel, and bladder

sensory loss usually in sacral segments

no hypertonia or hyperreflexia

*lower motor neuron lesion

neurologic involvement without vertebral column disruption

caused by brief displacement, stretching of the spinal cord past it's tolerance

typically in young children

Tumor compressing the spinal cord:

Patient presents with _____. Tumor is usually ____.

pain along a dermatome pattern or back pain

epidural

destruction of motor pathways in the lateral funiculus and anterior horn cells of the spinal cord

*no sensory involvement

males

over 50

rare, progressive disorder

development of syrinx (fluid filled cavity) in the cervical region of the spinal cord

compresses pathways in the area

autosomal recessive disease

white matter of the spinal cord slowly demylinates

begins with spinocerebellar tracts