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Clinical Neuroscience > Autonomic Nervous System > Flashcards

Autonomic Nervous System Flashcards

1
Q

Autonomic Nervous System (ANS)

Regulation of Function ~

A

paired endocrine (slow / long-lasting) and ANS (rapid / short-acting)

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2
Q

Autonomic Nervous System

Sensory System ~

A

GVA from only the core, NOT the periphery

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3
Q

ANS Sensory System Receptors:

A

nocireceptors (pain), mechanoreceptors (fullness), other specialized receptors

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4
Q

ANS Sensory System Cell Bodies:

A

pseudounipolar neurons in DRG of T1-L2 (SNS) + S2-S4 (PaNS) and CN IX / X nuclei

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5
Q

Autonomic Nervous System

Motor System ~

A

rapid single/multi-synaptic effector motor system with sensory input @ spinal cord, brainstem and cerebral hemisphere

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6
Q

ANS Motor System Efferent (GVE):

A

2-neuron system; contrast w/somatic (GSE) 1-neuron

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7
Q

ANS Motor System Target:

A

smooth muscle (BP / peristalsis), cardiac muscle (HR, Force) and glands (secretion)

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8
Q

ANS Motor System Core + Periphery:

A

parasympathetics only core; SNS both core & periphery

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9
Q

Input to ANS =

A

Hypothalamus

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10
Q

ANS 1° Neuron has cell body in

A

hypothalamus —> axon via descending pathways to:

a) PaNS: CN III, VII, IX and X nuclei in brainstem/medulla + S2-S4 lateral horn
b) SNS: intermediolateral horn of T1-L2

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11
Q

Sympathetic (Thoracolumbar T1-L2)

1° Neuron (descending pathway) —>

A

2° Neuron (Interomedolateral Horn) —> Ventral Root —> White Rami —> Sym Chain

  • Synapse: at same level —> gray rami —> peripheral nerve
  • Rise/Drop: at different level —> gray rami —> peripheral nerve at different level
  • Leaves w/Out Synapse: synapses in prevertebral ganglion (splanchnic); pelvic + abdominal viscera
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12
Q

Sympathetic (Thoracolumbar T1-L2)

Preganglionic —> Postganglionic

A

Preganglionic —> AcH —> Postganglionic —> NorEpi
- Exception: sweat glands + erector pili muscle receive AcH
- Note: adrenal medulla chromaffin cells get direct
preganglionic with AcH

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13
Q

Parasympathetic (Craniosacral)

CN III:

A

Edinger-Westphal (Midbrain) —> Ciliary Ganglion

—> Constrict Pupil

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14
Q

Parasympathetic (Craniosacral)

CN VII:

A

Superior Salivatory (↑Medulla) —> PP/SMD —> Lacrimal/Salivary

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15
Q

Parasympathetic (Craniosacral)

CN IX:

A

Inferior Salivatory (↑Medulla) —> Otic —> Parotid Gland

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16
Q

Parasympathetic (Craniosacral)

CN X:

A

Nucleus Ambiguus/Dorsal Motor Nuc of Vagus (mid-Medulla) —> Visceral —> bronchioconstriction, ↓HR, dilate abdominal arteries

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17
Q

Parasympathetic (Craniosacral)

S2-S4:

A

Lateral Horn S2-S4 —> syn peripheral —> desc colon/pelvic viscera

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18
Q

Parasympathetic (Craniosacral)

Preganglionic —> Postganglionic

A

Preganglionic —> AcH —> postganglionic —> AcH

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19
Q

Enteric System Organization:

A

receives SNS (tertiary neuron w/NorEpi) and PaNS (AcH) + intrinsic enteric nervous system = Myenteric / Submucosal Plexi

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20
Q

Myenteric (Auerbach) Plexus =

A

between circular and longitudinal muscle layer; regulates smooth muscle / motility

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21
Q

Submucosal (Meissner) Plexus =

A

between muscularis mucosa and circular smooth muscle; regulates glandular secretions

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22
Q

Enteric System can operate independently of

A

ANS; final common pathway is via enteric neurons with AcH as nueroTx

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23
Q

Parasympathetics
Eye
Targets/Response

A

Pupil = Constricts
radial muscle = contracts
ciliary muscle = contracts
near vision

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24
Q

Sympathetics
Eye
Targets/Response

A

Pupil = Dilates
radial muscle = relaxes
ciliary muscle = relaxes
far vision

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25
Q

Parasympathetics
Gland
Targets/Response

A 
Lacrimal = ↑ 
Salivary = watery
Parotid =  watery
Sweat =  n/a
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26
Q

Sympathetics
Gland
Targets/Response

A 
Lacrimal = n/a 
Salivary = thick
Parotid =  thick
Sweat =  ↑
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27
Q

Parasympathetics
Heart
Targets/Response

A

Muscle = ↓ force
Coronary Arteries = dilate
SA/AV Nodes = ↓ rate/conduction

28
Q

Sympathetics

Heart

A

Muscle = ↑ force
Coronary Arteries = constrict (ɑ) / dilate (β)
SA/AV Nodes = ↑ rate/conduction

29
Q

Parasympathetics
Arterioles
Targets/Response

A 
Skin = Dilate
Skeletal = Dilate
Pulmonary = Dilate
Abdominal = Dilate
Renal = Dilate
30
Q

Sympathetics
Arterioles
Targets/Response

A 
Skin = constrict (ɑ) / dilate (β)
Skeletal = constrict (ɑ) / dilate (β) 
Pulmonary = constrict (ɑ) / dilate (β)
Abdominal = constrict (ɑ) / dilate (β) 
Renal = constrict (ɑ) / dilate (β)
31
Q

Parasympathetics

Lung

A

Bronchial Muscle = Contracts (constricting bronchi)

32
Q

Sympathetics

Lung

A

Bronchial Muscle = Dilates bronchi

33
Q

Parasympathetics
GI
Targets/Response

A

Wall Muscle = ↑ Peristalsis
Sphincter Muscle = opens
Secretions = ↑

34
Q

Sympathetics
GI
Targets/Response

A

Wall Muscle = ↓ Peristalsis
Sphincter Muscle = close
Secretions = ↓

35
Q

Parasympathetics
Pancreas
Targets/Response

A

Endocrine Pancreas = ↑ Insulin-glucagon

36
Q

Sympathetics
Pancreas
Targets/Response

A

Endocrine Pancreas = ↑ glucagon; ↓insulin

(both SNS/PaNS ↑glucagon)

37
Q

Parasympathetics
Liver
Targets/Response

A

Hepatocytes = n/a

38
Q

Sympathetics
Liver
Targets/Response

A

Hepatocytes = ↑ glycogenolysis

39
Q

Parasympathetics
Adrenal
Targets/Response

A

Chromaffin Cells = n/a

40
Q

Sympathetics
Adrenal
Targets/Response

A

Chromaffin Cells = ↑ epinephrine

41
Q

Parasympathetics
Ureter/Bladder
Targets/Response

A

Wall muscle = ↑ contraction

Sphincter = relaxes

42
Q

Sympathetics
Ureter/Bladder
Targets/Response

A

Wall muscle = relaxes

Sphincter = ↑ contraction

43
Q

Parasympathetics
Reproductive
Targets/Response

A

Erectile Tissue = “point” = erection (relaxes vessels)

44
Q

Sympathetics
Reproductive
Targets/Response

A

Erectile Tissue = “shoot” = ejaculation

45
Q

Signs of ANS Damage

A
  • Syncope (fainting), Near Syncope (light headedness), orthostasis (syncopic episodes when rising) ~ CN X
  • Constipation (↓PaNS), Diarrhea (↑PaNS), Urinary Incontinence/Retention ~ CN X / SNS
  • Skin flushing, pallor, Raynaud’s ~ SNS (ɑ / β receptors)
46
Q

Horner’s Syndrome

A

Sympathetic lesion anywhere from hypothalamus to ciliary nerves

47
Q

Horner’s Syndrome

Two Types of Lesions:

A
  • Patient with C8-T1 spinal cord lesion —> Central Horner’s Syndrome
  • Patient with C8-T1 nerve root lesion —> Peripheral Horner’s Syndrome
    ∴Anything before first synapse in interomediolateral horn = Central
48
Q

Horner’s Syndrome Sympathetic Course

A
  1. 1° Neuron originate in hypothalamus –> spinal cord to T1/T2 —> Synapse
  2. 2° Neuron (interomediolateral horn) –> exit T1/T2 –> sup cervical gangl
  3. Tertiary Neuron (sup cer gan) –> carotid plexus
    - -> long/short ciliary nn
  4. Target: tarsal muscle (eyelid) + dilator
49
Q

Horner’s Syndrome Presentation

A
  1. Meiosis: small pupil
  2. Ptosis: drooping eyelid
  3. Anhidrosis: inability to sweat
    - Complete Loss on 1 Side = Central Lesion (hypo, brainstem, spinal cord)
    - Head/Neck Only = Peripheral Lesion (T1/T2, Chain, Carotid Plexus)
50
Q

Cardiovascular Function Via

A

CN IX and X

51
Q

Cardiovascular Function Baroreceptors:

A

sense pressure; found in aortic arch & carotid sinus

52
Q

Cardiovascular Function Chemoreceptors:

A

sense O2/CO2 content; found in carotid body

53
Q

Cardiovascular Course CN IX and X:

A

all afferent (GVA) via CN IX and X

  1. ΔBP / CaO2 —> GVA —> Nucleus of Solitary Tract
  2. Interneurons communicate to Nucleus Ambiguus / Dorsal Motor Nucleus
    - Consequence is GVE via CN X to ↓HR / BP
  3. Interneurons communicate to Rostral Ventroalteral Medulla —> preganglionic sympath in lateral horn
    - Consequence is GVE via 2° –> tertiary sympathetics to ↑HR / BP
54
Q

ANS Disease

Neurodegnerative

A
  1. Multisystemic Atrophy

2. Idiopathic Parkinson’s Disease

55
Q

ANS Disease

Acute Neuropathies

A
  1. Guillan Barre (Acute Inflammatory Demyelination)
  2. Acute Autonomic Neuropathy
  3. Paraneoplastic (Eaton-Lambert)
56
Q

ANS Disease

Chronic Neuropathies

A
  1. Diabetes
  2. Amyloidosis
  3. EtOH
  4. Chemotherapy (MT Damagers)
  5. HIV
  6. Infectious: lyme disease / syphilis
  7. Hereditary Sensory Neuropathy ~ Riley-Day
57
Q

Pre-Synaptic ~

A

Δ synthesis, storage or release of neuroTx

58
Q

Pre-Synaptic ↓ Synthesis —>

A

↓AcH or NorEpi

59
Q

Pre-Synaptic Metabolic Transformation of Precursor —>

A

replace NorEpi with methyl-NorEpi (~clonidine ~ ɑ2 agonist) —> ↓SNS outflow

60
Q

Pre-Synaptic Block Reuptake —>

A

accumulation of NorEpi + ↓choline recycling (but recall AcH would still be degraded)

61
Q

Pre-Synaptic Block Transport / Storage Vesicle —>

A

↓AcH storage + destroy NorEpi via mitochondrial MAO

62
Q

Pre-Synaptic Promote Exocytosis of neuroTx from Storage —>

A

↑AcH or NorEpi activity

63
Q

Pre-Synaptic Prevent Exocytosis of neuroTx —>

A

↓AcH or NorEpi activity

64
Q

Post-Synaptic ~

A

Δ binding or physiologic effect

65
Q

Post-Synaptic Mimic neuroTx ~

A

effect determined by location of receptors

66
Q

Post-Synaptic Block Post-Synaptic Receptor ~

A

effect determined by location

67
Q

Post-Synaptic inhibition of Enzymatic Breakdown ~

A

↑AcH, little effect on NorEpi (adjunctive agents in Parkinson’s)

Clinical Neuroscience (14 decks)

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